Tallying War's Increasing Costs and Strains

A selection of some of the latest OEF/OIF-reported stats. First up, from yesterday's New York Times editorial board:

Repeated, long deployments have put unsustainable stress on troops and pose significant risk to the all-volunteer military. Some 1.6 million troops have served in Iraq and Afghanistan since 2001; many of them have deployed to the war zone for three or four tours. Fifteen-month combat tours, followed by only 12 months of home leave, put incredible stress on families and make it hard to train for the next mission.

President Bush and the Congress favor expanding the number of ground forces. The Army has already had to reduce its standards to meet recruitment quotas. In 2007, only 79 percent of recruits had high school diplomas, down from 92 percent in 2003. The Army is also granting an increasing number of so-called “moral” waivers — given to recruits with criminal histories ranging from marijuana use to felony convictions.

Retaining the best and most experienced war fighters is getting harder. The Army has only 83 percent of the majors that it needs. It has offered bonuses of up to $35,000 to keep captains from leaving, promoted junior officers at an unprecedented rate and allowed senior officers to serve beyond mandatory retirement dates.

Nearly one-fifth of the troops — some 300,000 men and women — have returned from Iraq and Afghanistan reporting post-traumatic stress disorders; only half have sought mental health treatment, in part because many feel it will derail careers, according to a study by the RAND think tank [full pdf : summary pdf]. That leaves countless service members susceptible to depression and suicide. ...

The National Guard, whose primary task is to protect the homeland and respond to disasters, has only about 61 percent of its equipment because the rest is overseas. The Pentagon’s acquisition process is so flawed that dozens of the most costly weapons program are billions of dollars over budget and years behind schedule, according to a recent study by Congress’s Government Accountability Office.

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Stop-loss figures from USA Today:

[Defense Secretary Robert] Gates, in an interview Friday, said he's concerned about the Army's stop-loss policy, which can keep a soldier in the service if his or her unit deploys within 90 days of the end of the soldier's commitment. The Army maintains that it uses stop-loss to ensure the integrity of units headed to war. About half of the soldiers affected are mid-level non-commissioned officers.

"I've been very worried about stop-loss ever since I got here and found out what it was," Gates said. "I sent the Army a memo a year ago this spring asking for their plan to reduce stop-loss. Unfortunately, my decision to go to 15-month tours just made it impossible for them to achieve that."

President Bush's decision to send an additional 30,000 troops to Iraq prompted Gates to order combat tours to be extended from 12 to 15 months. The number of soldiers affected by stop-loss, rose from 8,540 in May 2007 to 12,235 in March. The last of the additional soldiers sent to Iraq will return home this summer. That should allow the number of troops affected by the policy to decline beginning in September, Gates said. ...

USA TODAY reported last week that more than 43,000 U.S. troops since 2003 were sent into combat even though they had been listed as medically unfit in the weeks before their scheduled deployment to Iraq or Afghanistan.

Recruitment waiver stats from CNN:

Pentagon statistics show the Army granted 511 felony waivers in 2007, just over twice the 249 it granted the year before. The Army aims to recruit more than 80,000 new soldiers a year. The Marines -- which recruits fewer new service members each year than the Army -- also reported a rise in waivers for felonies, with 350 granted in 2007, compared with 208 in 2006. ... He said the Army never issues waivers for some types of offenses, including sexual violence, alcoholism and drug trafficking.

But the Pentagon statistics showed the Army allowed 106 convicted burglars to enlist in 2007, up from 36 the year before. It also granted waivers to 43 recruits convicted of aggravated assault that year, up from 33 a year before; and to 130 people convicted of possession of drugs other than marijuana, a rise from 71 in 2006. It also allowed two people convicted of making terrorist or bomb threats to enlist in 2007, up from one the year before.

The Marines did not immediately respond to request for comment. The Navy reported a slight decline in felony waivers, from 48 in 2006 to 42 in 2007. The Air Force said it granted no felony waivers in either year.

TBI and mental health numbers from The New Republic:

An astounding 60 percent of troops entering Walter Reed Army Medical Center suffer from brain trauma as their primary or secondary malady, typically the result of an improvised explosive device. The physics look something like this: A roadside bomb sets off a blast wave that travels at a speed of 1,600 feet-per-second toward a soldier's vehicle. On impact, the blast rattles the soldier's brain against his or her skull--often leaving no visible scratches, but prompting closed-head traumas that can be hard to diagnose: torn cerebral tissue, internal bleeding, and relentless swelling of the brain's inner cavities. ...

[The RAND study] highlighted a less widely-covered trend: Some 320,000 troops returning from both wars are plagued by traumatic brain injuries--again, with only half seeking treatment.

Army Suicide stats from CNN:

Every day, five U.S. soldiers try to kill themselves. Before the Iraq war began, that figure was less than one suicide attempt a day. The dramatic increase is revealed in new U.S. Army figures, which show 2,100 soldiers tried to commit suicide in 2007. ...

According to Army statistics, the incidence of U.S. Army soldiers attempting suicide or inflicting injuries on themselves has skyrocketed in the nearly five years since the start of the Iraq war. Last year's 2,100 attempted suicides -- an average of more than 5 per day -- compares with about 350 suicide attempts in 2002, the year before the war in Iraq began, according to the Army. ...

The Army lists 89 soldier deaths in 2007 as suicides and is investigating 32 more as possible suicides. Suicide rates already were up in 2006 with 102 deaths, compared with 87 in 2005. ... Traditionally, the suicide rate among military members has been lower than age- and gender-matched civilians. But in recent years the rate has crept up from 12 per 100,000 among the military to 17.5 per 100,000 in 2006, she said. That's still less than the civilian figure of about 20 per 100,000, she said.

The "typical" soldier who commits suicide is a member of an infantry unit who uses a firearm to carry out the act, according to the Army.

Surge stats from the New York Times:

Seven active-duty Army brigades have been scheduled to deploy to Iraq later this year, the Defense Department announced yesterday, a plan that would allow U.S. commanders to keep troop levels at about 140,000 through the end of the Bush administration and into the next president's term.

The deployments will be part of the regular rotation of troops into Iraq and will come on the heels of the "surge" of troops, which is expected to end this summer. The increase of troops in Iraq -- which topped out at about 170,000 -- is expected to go down to 140,000 by the end of July. U.S. officials plan to keep 15 combat brigades in Iraq through the end of the year, though ongoing assessments could allow commanders to change those numbers.

The brigades that will deploy come from the 25th Infantry Division in Hawaii and Alaska, the 4th Infantry Division in Colorado, the 1st Infantry Division in Kansas, the 82nd Airborne Division in North Carolina, the 173rd Infantry Brigade in Germany and the 1st Cavalry Division in Texas. All have prior experience in Iraq, some with multiple tours. About 25,000 troops will take part in the deployment, which will be limited to 12 months under current Pentagon policy.

Combat-related Iraq attack figures from AP:

The U.S. military is reinforcing the sides of its topline mine-resistant vehicles to shore up what could be weak points as troops see a spike in armor-piercing roadside bombings across Iraq, The Associated Press has learned.

The surge in attacks is putting the mine-resistant, ambush-protected vehicles (MRAPs) to the test, and so far they are largely passing. Statistics reviewed by the AP show that while bombings involving the deadly penetrating explosives have jumped by about 40 percent in the past three months, deaths in such bombings have dropped by as much as 17 percent.

Officials attribute much of the decline in deaths to the increased use of MRAPs, pronounced "M-raps." To date, about a half-dozen troops have died in incidents that involved the new bomb-resistant vehicles, and several of those deaths occurred in rollovers rather than from explosives penetrating the armor. ...

According to military statistics, in the past three months:

_ EFP incidents in Iraq jumped by nearly 40 percent, while casualties related to those attacks went down by about 17 percent.

_ Overall roadside bomb incidents in Iraq increased about 10 percent, while casualties dropped by more than 40 percent.

_ Roadside bomb incidents in the Baghdad area, including Sadr City, rose by about 20 percent, and casualties went up 30 percent. Fighting spiked recently due to battles with Shiite militia members in Sadr City.

_ In the Baghdad area, EFP incidents increased by about 17 percent, while casualties fell by 43 percent.

Officials said that the bulk of the casualties around Baghdad during April were the result of the armor-piercing explosives.

Attacks in Afghanistan from Globe and Mail:

Data collected by security consultant Sami Kovanen, of Vigilant Strategic Services Afghanistan, show a steady increase in insurgent attacks in the first 14 weeks of 2008, with every week except one recording a higher volume of incidents than the same week in the previous year. Then, in the 15th to 18th weeks [during the annual spring harvest of poppy fields for opium production], the number of attacks dips down in a lull similar to the calm before previous fighting seasons. Over all, however, VSSA had counted 226 insurgent attacks in Kandahar this year, as of May 4, compared with 167 during the same period last year, leading some analysts to predict that this fighting season will bring more violence than the last.

Casualty and media coverage info from the Boston Globe:

The death toll for the US military in Iraq hit 49 in April, making it the deadliest month since September, according to the Associated Press. Around Iraq, at least 1,080 Iraqi civilians and security personnel were killed last month, an average of 36 a day, according to the AP tally. While that's down from March's total of 1,269, or an average of 41 per day, those casualties certainly don't add up to a stable Iraq.

But Iraq isn't getting the prominent play of other news topics. The latest statistics from the Project for Excellence in Journalism back up the conclusion that coverage of the Iraq war is on the decline.

The Washington-based research organization studied roughly 1,300 stories from 48 news outlets during the month of April. The group's analysis found that during that time frame, the top news story was the presidential campaign, which accounted for 33 percent of news coverage. The economy came in second, accounting for 6 percent. The pope's visit accounted for 4 percent of the coverage, and the Texas polygamy case garnered another 4 percent.

Even as violence in Iraq increased, events on the ground in Iraq accounted for only 3 percent of news coverage, and the Iraq policy debate accounted for another 3 percent. In April 2007, the Iraq policy debate was the second biggest story at 8 percent; and events on the ground in Iraq accounted for another 7 percent of the news, according to Mark Jurkowitz, associate director of the Project for Excellence in Journalism.

And finally, the Iraq tally from Michael Hastings for the LA Times:

Iraq often gets treated by pundits, writers and politicians - all those thoughtful cheerleaders turned war critics - as an intellectual exercise. It's not. Hundreds of thousands live personally with its consequences every day. The tens of thousands of Iraqis who've been killed, the families of 4,074 American servicemen and women killed, the more than 900 contractors killed, the more than 29,000 U.S. wounded. The individuals who make up such statistics - and those who loved them - understand what the war actually costs.

Related Posts

• The War List: OEF/OIF Statistics
  
• Iraq War Costs and Casualties Tallied Up

UCTV Health Matters Segment on Combat PTSD

University of California Television has a 20-minute discussion on combat PTSD history, symptoms, and treatment on YouTube. While there's nothing really "new" here, it's a good basic look at the experience of PTSD through the psychological/clinical lens:

More and more we hear about Post-Traumatic Stress Disorder or PTSD, but what does it really mean? Who is affected and how? Jeffrey Matloff, Assistant Clinical Professor of Psychiatry, UCSD, and Clay King, Acting Associate Director VA San Diego Healthcare System, discuss PTSD with special emphasis on how our combat military veterans are affected. Series: Health Matters [6/2006] [Health and Medicine] [Show ID: 11668]

Attempts to Remove PTSD Stigma Gain Steam Under Secretary Gates

From the Billings Gazette:

Defense Secretary Robert Gates recently has been urging troops to seek treatment instead of trying to ignore the problem. "You're tough and you go into the hospital when you receive a physical wound," Gates said on a visit to a Texas Army post. "That doesn't mean you're weak in some way, and so why wouldn't you when you've received a psychological wound? It's the same difference. They're all wounded."

To make it easier for soldiers to seek treatment, Gates has announced a change on the application for a government security clearance that asks: In the last seven years, have you sought mental-health counseling? That question will no longer be asked. National Public Radio reported that studies show that the fear of losing a security clearance is one of the biggest reasons that combat veterans do not seek mental-health care. Under the new policy, applicants who seek mental-health treatment could still obtain clearances if the treatment was for problems stemming from service in a combat zone.

Earlier this month, the American Forces Press Service reported that Gates is willing to consider awarding Purple Heart medals to combat veterans suffering with PTSD.

John E. Fortunato, who runs the Recovery and Resilience Center at Fort Bliss, Texas, told reporters that awarding the Purple Heart to PTSD sufferers would go a long way toward chipping away at prejudices surrounding the disease. Because PTSD affects structures in the brain, it's a physical disorder, "no different from shrapnel," Fortunato said. "This is an injury."

PBS' NewsHour coverage on this issue:



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PBS NewsHour segment, Part 2:



Another related editorial in the Dallas Morning News:

A mental health crisis has been brewing for years in the U.S. military, despite commanders' best efforts to hide it. At long last, Pentagon leaders have begun speaking openly about post-traumatic stress disorder and encouraging troops to seek help.

As recently as last year, according to a Pentagon study, the prevailing mentality at U.S. bases was to deny PTSD's existence and even punish service members who sought help. The attitude was reminiscent of World War II, when Gen. George S. Patton slapped soldiers seeking help for "combat fatigue."

Troops say they fear losing promotions or security clearances if they mention PTSD. Many have suffered in silence, often with such tragic consequences as suicide, homicide or fits of violent rage. Attempted suicides among veterans now run about 1,000 a month, a grim statistic the Veterans Administration tried to keep secret until recently.

Studies indicate that a quarter to 38 percent of the 1.6 million who have served in Iraq and Afghanistan suffer serious mental health problems, but fewer than half are willing to seek help.

Defense Secretary Robert Gates and Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, launched a campaign last week to change the military's outdated attitude. ... Adm. Mullen told reporters in Washington that "it's way past time" for the military to recognize the war's toll "inside our minds, as well as outside our bodies." But it's unrealistic to "expect a private or a specialist to be willing to seek counseling when his or her captain or colonel or general won't do it."

By ending its own state of denial, the Pentagon is taking a healthy first step toward ending PTSD's stigma and getting troops the treatment they deserve.

More on Gates' visit to Ft. Bliss' Recovery and Resilience Center and the questionnaire change from the American Forces Press Service:

Gates announced the new policy after touring the Restoration and Resilience Center that opened in July to treat combat veterans diagnosed with post-traumatic stress disorder. The center, part of Fort Bliss’ Beaumont Army Medical Center, uses treatments ranging from group and individual therapy to yoga, acupuncture, massage, chiropractic and hot-stone therapy. Its goal, officials at the experimental facility explained, is to help troops recover so they can stay in the Army.

Gates told reporters he had an “extraordinary experience” visiting the new center and seeing work under way to help soldiers deal with combat stress.

“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”

Gates said he’ll take the idea of possibly replicating Fort Bliss’ prototype program to other posts. He also noted other techniques being developed in the combat theater to give troops additional tools to deal with the circumstances they face. “These are clearly worth additional attention as well,” he told reporters. Gates called additional resources and capabilities to treat troops dealing with PTSD just one aspect of a two-part effort.

“The second, and in some ways equally challenging, is to remove the stigma that is associated with PTSD and to encourage soldiers, sailors, Marines and airmen who encounter these problems to seek help,” he said.

But he acknowledged that not every soldier returning from Iraq and Afghanistan is getting the treatment they need. He cited an Army inspector general report’s findings that troops often forgo mental-health care because they’re concerned it could prevent them from getting a security clearance and potentially could damage their careers.

Gates cited “Question 21” on Standard Form 86, the government security-clearance form that specifically asks applicants whether they have ever received treatment for mental-health issues. The question asks if the person has consulted with a mental-health professional or other health-care provider during the past seven years about a mental-health related condition. Respondents who answer “yes” must provide dates of treatment and the provider’s name and address.

“For far too long and for far too many, this question has been an obstacle to care,” the secretary said. The Defense Department has been working with other agencies for eight months to strike a balance that enables troops to get the treatment they need and the intelligence community to get the information it needs, he said.

“It took longer than I would have hoped, but it is done,” Gates said. “Now it is clear to people who answer that question that they can answer ‘no’ if they have sought help to deal with their combat stress in general times.”

New language for “Question 21” asks if the person consulted with a health-care professional during the past seven years regarding an emotional or mental health condition. It specifies, however, that the answer should be “no” if the care was “strictly related to adjustments from service in a military combat environment.”

Gates directed in a policy letter dated April 18 that the revised language be used by anyone completing the SF 86 form. A letter being distributed throughout the military explains the new policy and its rationale.

“Seeking professional care for these mental health issues should not be perceived to jeopardize an individual’s security clearance,” states the memo, co-signed by Undersecretary for Intelligence James R. Clapper Jr. and Undersecretary for Personnel and Readiness David S.C. Chu.

“On the contrary,” they wrote, “failure to seek care actually increases the likelihood that psychological stress could escalate to a more serious mental condition, which could preclude an individual from performing sensitive duties.” The letter urges men and women in uniform who are exhibiting symptoms of PTSD to seek help and makes clear that this is not going to put their security clearances or their careers in jeopardy, he said.

“The most important thing for us now is to get the word out as far as we can to every man and woman in uniform to let them know about the change, to let them know the efforts under way, to remove the stigma and to encourage them to seek help when they are in the theater or when they return from the theater,” Gates said. “So this is a very important issue for us.

“We have no higher priority in the Department of Defense, apart from the war itself, than taking care of our men and women in uniform who have been wounded -- who have both visible and unseen wounds,” he said.

Gates called the new Restoration and Resilience Center an example of new approaches the military is taking to provide that care. “This center here is illustrative of what can be done,” he said. Thirty-six volunteers participating in the program, all diagnosed with PTSD after serving in Iraq or Afghanistan, receive care that combines group and individual therapy sessions with meditation, yoga, acupuncture, massage therapy, chiropractic and hot-stone therapy treatments.

Background on Purple Heart issue from Stars and Stripes:

The veterans group for combat wounded troops whose mission is to preserve the integrity of the Purple Heart has come out against giving the award to troops suffering from post-traumatic stress disorder.

"I don’t think people should get the Purple Heart for almost getting wounded," said Joe Palagyi, of the Military Order of the Purple Heart. PTSD does not merit the Purple Heart, according to an Army regulation that lays out the criteria for the award. Recently, a military psychologist at Fort Bliss, Texas, told reporters during a roundtable that making troops with PTSD eligible for the Purple Heart could help destigmatize the disorder.

"These guys have paid at least a high — as high a price, some of them — as anybody with a traumatic brain injury, as anybody with shrapnel wound, and what it does is it says this is the wound that isn’t worthy, and I say it is," said John E. Fortunato.

When asked about Fortunato’s suggestion later, Defense Secretary Robert Gates called it an "interesting idea," adding the matter is "clearly something that needs to be looked into." But Palagyi, who was awarded the Purple Heart for service in Vietnam, said PTSD does not meet the standards for the award, the forerunner of which was established by Gen. George Washington.

"The Purple Heart was set up for combat wounds, for those who have shed blood, and I believe that although PTSD is a physical disease and is an injury ... [it] does not qualify for the merit of Purple Heart based on that," he said Tuesday.

Injuries that merit the Purple Heart must happen in a combat theater and must be a direct result of enemy action, said Jack Leonard, also of the Military Order of the Purple Heart. The group’s concern about PTSD is that it can be caused by other factors, not necessarily the enemy.

A brief collection of "person on the street" comments on the Purple Heart/PTSD issue from WMAL News:




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• As Combat PTSD Stigma Fades Somewhat, Funding Fight and Political Disillusionment Come Into Focus
  
• Veterans Work to Ease the Stigma of Combat PTSD

Combat PTSD or Adjustment Disorder? Saving Money, Not Lives, Floated at One VAMC

Last year, a firestorm erupted when it was found that 24,000+ OEF/OIF veterans had been booted out of the military with Personality Disorder discharges. PD (once labeled "Section 8") discharges are a quicker and more cost-efficient way of dealing with service members who are exhibiting problematic behavior.

The problem, of course, was that some of the discharged were combat-injured Purple Heart recipients who may have instead been coping with PTSD, a fact that would allow them access to VA health care benefits to treat their condition.

This week, we've moved from the military's diagnoses of Personality Disorder over PTSD to a Texas VAMC PTSD program coordinator advising that Adjustment Disorder diagnoses should be handed out over that of PTSD. The reason given? Saving money.

From the Washington Post:

"Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Tex. Instead, she recommended that they "consider a diagnosis of Adjustment Disorder." VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD," Perez wrote.

Adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months, said Anthony T. Ng, a psychiatrist and member of Mental Health America, a nonprofit professional association.

Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition, said Alison Aikele, a VA spokeswoman. Those found to have adjustment disorder generally are not offered such payments, though veterans can receive medical treatment for either condition. ...

Veterans Affairs Secretary James B. Peake said in a statement that Perez's e-mail was "inappropriate" and does not reflect VA policy. It has been "repudiated at the highest level of our health care organization," he said. "VA's leadership will strongly remind all medical staff that trust, accuracy and transparency is paramount to maintaining our relationships with our veteran patients," Peake said.

Citizens for Responsibility and Ethics in Washington (CREW) and VoteVets released a copy of the email on Thursday.

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The fallout, from AP:

Two congressional committee chairmen said Friday they plan to investigate whether there were broader motives behind a Veterans Affairs Department employee's e-mailed suggestion to diagnose veterans with mental disorders that have a lower disability payout.

Sen. Daniel K. Akaka, D-Hawaii, chairman of the Senate Veterans Affairs Committee, said he has asked the VA's Inspector General to review diagnosis patterns at the facility. ...Akaka said in a statement that he asked Peake to provide renewed guidelines to all VA offices on the proper treatment of PTSD cases.

Last week, House Veterans Affairs Committee Chairman Bob Filner, D-Calif., called Peake before his committee to answer questions about a different set of e-mails that had surfaced during a trial that seemed to suggest VA officials were hiding the number of veterans who were trying to commit suicide. Filner asked Peake to fire those involved with the e-mails, but Peake said after the hearing that he had no plans to do so.

Filner said Friday in an interview at his office that he will likely ask Peake to appear again to answer more questions. Filner said he wants to know what motivated the Texas employee to send the e-mail about saving the VA money. "Where is she getting it from?" Filner said. "Why is she saying this? Who is giving her the order?"

Although the employee was a team leader, VA spokeswoman Alison Aikele said Friday that the woman was not in management and her e-mail was just a suggestion. "We're not aware of any other instances where this happened," Aikele said.

Senator Barack Obama is also calling for a formal investigation. In addition, CREW has filed a Freedom of Information Act [pdf] request "asking for all records pertaining to any guidance given [the VA] regarding the diagnosis of PTSD."

To help in understanding the difference between Adjustment Disorder and PTSD, some helpful definitions from a 2006 brochure produced by the US Army Center for Health Promotion and Preventive Medicine [pdf]:

An Overview of Deployment-Related Stress
Our bodies and minds are built to deal with and handle stress. Sometimes, though, the amount of stress we face overwhelms our defenses. When this happens, we start to act, feel, and think in ways that are different from what is normal for us – we just don't feel "right," or we feel like we can't do the things we are used to doing.

Whether these problems are mild or serious and whether they last for a short time or a long time depends on the nature of the stress and the strength of our defenses at the time the stress occurs. Keep in mind, though, that the strength of everyone's defenses varies over time based on what else is going on in their lives and their overall health.

For the most part, there are four kinds of deployment-related stress problems that you should know about. These are...

* Combat/Operational Stress Reactions (COSRs)
* Adjustment Disorders
* Acute Stress Disorder (ASD)
* Posttraumatic Stress Disorder (PTSD)

You can think of COSRs as being the mildest and most common form of deployment-related stress problems and PTSD as the most severe. Another way of thinking about this is to say that Soldiers experiencing COSRs are in the Green/Amber Zone, Soldiers with Adjustment Disorders are in the Amber Zone, and Soldiers with ASD or PTSD are in the Red.

Any deployment-related stress problem can be serious, but most are resolved quickly with just a little bit of help. ...

Adjustment Disorders
Adjustment Disorders are much more common than either PTSD or ASD and, on the whole, are usually much less serious. An Adjustment Disorder occurs when an individual is exposed to stress, causing a reaction that results in significant distress or impairment. That reaction can involve depression, anxiety, disturbance of conduct, or any combination of the above.

Principle Types of Adjustment Disorders

* Adjustment Disorder with Depressed Mood
* Adjustment Disorder with Anxiety
* Adjustment Disorder with Mixed Anxiety and Depressed Mood
* Adjustment Disorder with Disturbance of Conduct
* Adjustment Disorder with Mixed Disturbance of Emotions and Conduct

In general, Adjustment Disorders do not last for extended periods of time. Symptoms may start to appear as long as three months following the stressor, but are usually resolved in no more than 6 months.

And finally, a personal account by former Army Sergeant Kristofer Shawn Goldsmith, an Iraq veteran diagnosed with Adjustment Disorder, who testified before Congress earlier this week at a hearing organized by the Congressional Progressive Caucus [view C-Span coverage; read written testimony]. He is a member of Iraq Veterans Against the War, and his story may shed light on the genesis of the severity of psychological injuries and disillusionment that some returning soldiers carry home with them from war:

While deployed in support of Operation Iraqi Freedom III, the morale of Soldiers in 3-15 Infantry was very low. This was aggravated by the unit's Command and the tactics they used to attain reenlistment numbers. In the summer of 2005 the Battalion Command Sergeants Major and the Brigade Command Sergeant Major locked Soldiers who refused to reenlist in a room for hours, demanding that we sign up for a meeting with a career councilor. This included Soldiers who were affected by the Stop-Loss policy, who if not for the deployment they were currently on, would have already separated from Active Duty. Most of the Stop-Lossed Soldiers had already been deployed in OIF-I. I personally refused to consider reenlistment, and instead of being allowed to hydrate and prepare my gear for an upcoming patrol, I was kept in this room for over three hours. This reenlistment tactic put my life, and the lives of those I worked with, in real physical danger.

During this time my Battalion Command Sergeant Major attempted to make each of us who remained in the room believe that none of us could succeed in life outside of the Army. This is common practice in attempting to gain reenlistment numbers for my former unit. Our command would prey on the Soldiers who because of the stress of deployment felt hopeless about their future. These Soldiers who may have been candidates for therapy, were instead used to meet the Army's required unit reenlistment numbers while they were obviously distressed. Another unethical tactic often used by 3-15 to increase reenlistment numbers was to give the option to Soldiers who tested positive for drug use to reenlist in order to make the test results "disappear". This tactic was well known in my Battalion. ...

The ineffectiveness of 3-15 IN's role during OIF-III led to an immediate pitfall in troop morale. Upon returning home to America in December 2005 and January 2006, there was little for we, the Soldiers, to be proud of. Although we were automatically considered as 'heroes' for having served overseas, all that we really did well in Sadr City was do our best to keep each other alive. The tremendous sacrifice of taking more than one thousand Soldiers from 3-15 IN away from their homes and families to spend eight months in Sadr City and having them accomplish nothing of real value, was forever damaging to those who made the sacrifice.

As with any group who have deployed, some came home with serious mental issues, such as Post Traumatic Stress Disorder and Severe Chronic Depression. As we were preparing to leave Iraq, we were given a mental screening test, which was supposed to identify possible mental ailments. But we were warned by the medical staff issuing the test that "should you come up positive for mental problems, you could be forced to stay in [Iraq] for three to four more months before you can go home." Most lied while completing the test because they wanted to get home as soon as possible. No one was held in Iraq any longer due to this test, but in hindsight, it is clear that verbal warning was used to prevent the inconvenience to the Army of having Soldiers that needed medical attention.

Alcoholism, drug use and violence plagued the unit upon our return home. Relationships stressed from a year long deployment resulting in dozens of divorces, while many men were arrested for Driving Under the Influence or domestic assault. The eight months in Sadr City, the total year long deployment in Baghdad, has not left the psyche of anyone who served in 3-15 IN during OIF-III. Most Soldiers whose contract was up with the Army after the OIF-III Stop-Loss policy expired, left without ever seeking council for Mental Health problems, because they feared it could possibly extend their time in the Army or make getting out more difficult.

For those who still had time to serve in the Army, getting help for alcoholism or mental issues was viewed as one of the most damaging things they could do to their careers. During weekly safety briefings as per the Army's mandate, commanders would almost jokingly say "if you're thinking about killing yourself, don't be afraid to get some help". However, it was in the back of everyones minds that if they were found to be a "broken Soldier" or diagnosed with any mental illness, as with any physical illness, it could prevent them from promotion of favorable action by the unit. Moreover, real instructions were not provided to inform Soldiers of the availability of mental health assistance on Fort Stewart either verbally or in written form by commanders, or by being posted on the information boards in the company areas.

I am one of the Soldiers who was too intimidated to get help when I first realized that I needed it. Suffering from depression and alcoholism in 2006, I came up for promotion to Sergeant (E-5) that May and had to hide my problems to protect my career. With the active duty part of my contract expiring in May 2007, I had every reason to believe I was never going to set foot in Iraq again, and would be going to college in fall of 2007.

With the troop surge of last year, Goldsmith's plans fell through.

The Stop-Loss and Stop-Movement Orders came to my unit soon after the plan for the Surge was announced. Those orders meant that no Soldier, for any reason other than administrative separation, could leave the unit until three months after the unit returned home from its deployment. The Troop Surge meant that my Brigade, 2nd Brigade, 3rd Infantry Division, was going to deploy three months earlier- in may 2007. In reaction the the early deployment, my unit immediately scheduled two months of field training exercises from the end of January 2007 until mid March 2007. Faced with so much isolation from family and loved ones and an impending fifteen to eighteen month deployment, over a dozen Soldiers from 1-30 IN went Absent With-Out Leave (AWOL). Many Soldier affected by Stop-Loss began to stop caring about training and acted out while on duty, while drug tests increasingly had higher levels of positive testing results. I personally found myself extremely frustrated during field exercises and was verbally reprimanded on a few occasions for not having greater control of myself.

On multiple occasions between January and March 2007, I attempted to seek mental counseling but initially had no success in finding help. As recommended by my unit, I asked the Medical Platoon of 1-30 IN and received guidance to find a building close to my company which held the Mental Health team of the Third Infantry Division. I found this building to be abandoned, and received no further instruction on how to find the Mental Health team.

On March 27 2007, I admitted myself to the emergency room at Winn Army Community Hospital on Fort Stewart complaining of what I believed to be a heart attack. After various cardiac screenings, I tested negative for any physical problem and after confiding in the doctor that I had been feeling depressed and under extreme stress, I was finally given accurate instructions on how to find the Mental Health Division at Winn Army Community Hospital. I was told to sign in as an emergency patient as a possible suicide risk at the front desk. After anxiously waiting nearly six hours in a waiting room I was finally seen by a therapist, who diagnosed me with Adjustment Disorder with Disturbance of Emotions and Conduct. Although I showed the obvious symptoms of PTSD, I was not diagnosed with it at this time. Months later, after separating from Active Duty, I was finally diagnosed with PTSD by the Veterans' Affairs Hospital at Northport, New York.

I was then recommended by the therapist to attend group therapy sessions run by Colonel Ana Parodi twice weekly because one-on-one counseling was mostly unavailable due to the Third Infantry Division Mental Health team having been overwhelmed by Soldiers and the families of Soldiers who needed assistance. I attended as many sessions as I could, but found few positive results. Each session held for approximately 90 minutes contained only one Psychologist, Colonel Ana Parodi, and up to two dozen patients. Unlike typical group therapy, the patients attending varied in age, social status, rank in the military, and civilian relation to members of the military. No two patients seemed to have the same problem, so the therapeutic experience was minimal for all attending. I frequently witnessed people leaving in frustration because the sessions seemed more harmful to them than helpful. There were many times when patients were asked to leave due to overcrowding in the room. Most everyone seemed disappointed with the care that we were receiving, however, this was the best treatment available to the Soldiers of Fort Stewart, so we kept coming just hoping for things to get better.

Things did not improve. Goldsmith attempted suicide and was later threatened with an Article 15 violation. His closing words:

In my testimony, I have specifically mentioned just three of the victims of the Troop Surge and the Stop-Loss Policy. Thirty thousand American Soldiers were directly affected by George Bush's Troop Surge. Thousands of those Soldiers were like me, Stop-Lossed, forced to serve on active duty beyond the date they signed on their contract. Most are still currently overseas. Those who are not overseas have either been administratively separated from the Army and lost their benefits as I have, or have been injured and possibly lost a limb or an eye and medically evacuated from combat, or have lost their lives.

Most Soldiers are eligible for upwards of forty thousand dollar, tax-free reenlistment bonuses while overseas; but many are choosing instead not to reenlist, and to simply wait until the Army releases them from their involuntarily extended contracts. This is happening while suicide rates among Veterans are at the highest rate since they began keeping such records in 1980. Last year, about 2,100 soldiers injured themselves or attempted suicide, compared with about 350 in 2002, according to the U.S. Army Medical Command Suicide Prevention Action Plan. Reports from the Veterans Affairs (VA) state that approximately 20% of Veterans are returning from Iraq with symptoms of PTSD and Depression, 70% of which do not seek help through the Army Medical system or VA. Each deployment reportedly makes a Soldier 60% more likely to have contract a mental illness.

Some of the best, most qualified, and patriotic Americans of my generation have grown tired of repeat deployments in support of a mission with unclear or impossible objectives, and refuse to fight any longer. Stop-Lossed Soldiers should be seen as not as part of "an all volunteer force" but as silent protesters, who refuse large sums of money and have chosen to just wait out their time rather than continue serving Our Nation. In reality, Stop-Lossed Soldiers, a huge part of the Troop Surge, are simply prisoners of the contracts which bind them into a war they no longer wish to fight.

Harsh words that make many uncomfortable -- or even angry -- to be sure, but they are reflections that we must consider with as much weight as those that more easily fulfill our need of doing right and good by each other. Both views are correct. Both views are valid. Both views are required for us to explore and understand if we are to wrap our head around the events and situations that lead some of our veterans to become disillusioned, to return home with injuries that many of us would prefer not to see.


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• As Combat PTSD Stigma Fades Somewhat, Funding Fight and Political Disillusionment Come Into Focus
  
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"Healing the Hidden Wounds" Symposium to Unite Nashville Military and Private Veterans' Caregivers

Happy Armed Forces Day, everyone.

On Thursday, I buttoned up my semester at NIU.

This weekend, I'm busy preparing for my upcoming "Healing the Hidden Wounds" veteran symposium presentation. Organized by Nashville Public Television, NAMI Tennessee and YMCA/Restore Ministries, the summit aims to raise awareness of existing resources for active duty personnel and veterans from all branches of military service and to begin forging partnerships between the Veterans Administration and community mental health agencies.

Event: "Healing the Hidden Wounds"
Date: May 21, 2008
Time: 8:00 a.m. to 5:00 p.m.
Place: Scarritt-Bennett Center, Foundren Hall, 1008 19th Avenue South, Nashville, TN

Visit the event sign-up page if you'd like to join us.

Most of you, even while my posting here has been on hiatus, have surely seen the avalanche (an incredible understatement) of combat PTSD-related news reported lately. While the news itself can be unnerving, the fact that we are tackling these problems publicly is a relief to me. The increased coverage given and attention paid to these issues -- and the promising number of greater minds and talents that have entered the reporting and advocacy and support fray -- is a welcome change from the relatively quiet 2005 media landscape that greeted my initial questions on our returning troops from Afghanistan and Iraq.

Again, I thank everyone who has been a supporter of my work these past years. It's been a remarkable journey, much more so than I ever could have imagined at the outset. I have appreciated the chance to write on the important issues that concern both our military families and the rest of us as well, especially when it seemed not enough of us were paying attention or speaking up. I'm happy to count myself among those who at least tried to do both to the best of my abilities.

My Nashville keynote address is the last such event slated for my book, Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops. Moving forward, PTSD Combat will be updated only occasionally, not routinely as I've tried to do these past years. While updates to the ePluribus Media PTSD Timeline are planned in July and that part of my OEF/OIF PTSD work will continue, my blogging here will remain sporadic as I expand my reporting focus and writing to other areas as well.

This work, however, will certainly remain the most fulfilling and valuable of all that I have done or attempt to do in the future. Thank you for taking this journey with me, and for doing what you can in your own way to honor the sacrifices and pay your respects to the service of the incredible men and women who wear our nation's uniform.

They deserve no less from us.

More to Come as Time Permits

Apologies for the momentary halt to postings.

I'm currently swamped with classes and other responsibilities, but will return to updates ASAP. Until then, be sure to check out what others are saying on combat PTSD in the feeds in the right-hand column.

Editorial: Veterans funding or permanent tax cuts?

From the Mankato [MN] Free Press editorial board:

The U.S. House of Representatives and the U.S. Senate recently passed budgets that boost funding for veterans’ health care and other veterans’ needs at amounts higher than the Bush Administration’s proposal. The Bush budget boosts total VA funding by about 1.6 percent, or $1.7 billion.

The House bill adds about $600 million to the Bush proposal, which would bolster overall spending to about 2.6 percent. The Senate adds $3 billion, making the overall spending increase about 5 percent.

Many veterans groups have favored the congressional proposals saying the number of veterans entering the VA health system from wars in Iraq and Afghanistan warrants the extra funding. In fact, Congress and the president in the most recent fiscal year boosted VA funding by an “emergency” $3.7 billion appropriation midway through the budget year after seeing tremendous increases in health care costs for veterans returning from Iraq and Afghanistan. That figure is close to the increase being proposed by Bush.

Click on 'Article Link' below tags for more...

In educational interest, article(s) quoted from extensively.

Continuing:

The funding is aimed at not only taking care of the increase in VA patients, but also aimed at reducing, for example, the time it takes for the VA to process a disability claim. In 2007, it took 183 days to process a claim. That figure dropped to 169 days in 2008 and the current budget aims to bring that down to 145 days. That’s still a long time to wait for veterans who may have no other way to earn money when they are disabled.

The Bush budget also cuts medical research by 10 percent for the VA and major construction projects budget is cut by 50 percent. Both are restored to some extent in the House and Senate budgets. ...

The national office of the Veterans of Foreign Wars says the Bush budget is a good start but “demands” Congress up the funding for construction projects and medical research. The research funding would go toward what VFW national president George Lisicki calls the “signature wounds of war.” That research would help the VA better treat traumatic brain injuries, post traumatic stress disorder, prosthetics and improve treatments for burns and blind rehabilitation. ...

The cost of the Bush tax cuts are significant when compared to the VA budget needs. One tenth of the revenue from removing just tax breaks to hedge fund managers would fund the increase in the VA that Congress is proposing.

Related Posts

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Hiring More Vets, Keeping Them in Their Homes, Offering Group Therapy, East Texas Resources

• KTRE-Ch 9/East Texas has published a comprehensive veterans resources guide chock full of phone numbers and information that is a must to check out if you're an area military family.
  
  
• Sen. Chuck Grassley [R-IA] and the White House are tossing letters back-and-forth with one another, the senator aiming to get the president to "establish the goal that 10 percent of all new hires by federal agencies be veterans." Meanwhile, Senate colleagues are attempting to extend foreclosure protection for veterans to nine months following return from overseas deployment.
  
  
• The National Alliance on Mental Illness (NAMI)--Kern County, Calif., chapter offers returning vets, military families local support group services. Phone 661-868-5061 for more information.
  
  
• On the other end of the country, a related feel good story: 11 Tampa Bay-area Vietnam veterans, aka 'Group 11,' have had their PTSD group therapy sessions reinstated after the VA abruptly terminated the program. "We're pleased, and we're shocked," said one member after hearing the news.

Unknown Allies: School Shooting Victims and Combat Veterans

Back in September, I sat down with Diane Strand, a reporter for DeKalb's MidWeek News, to discuss combat PTSD and other issues covered in my book, Moving a Nation to Care.

Those of you who read PTSD Combat regularly know I'm currently a student at Northern Illinois University and shared my experiences the day of the shooting and beyond.

Just this past Wednesday, I posted here on my column that ran in the Northern Star, relfecting on the fact that veterans are a dazed school shooting student's natural ally; they understand the pain and trauma of being in danger and in the vicinity of extreme violence (on an entirely different level than those of us on campus that day, however). Another commonality is an increased risk for post-traumatic stress disorder.

Ms. Strand and I must have been channeling one another. From her Wednesday piece in the MidWeek News:

What does a veteran have in common with a college student? Unfortunately for some, it may be Post Traumatic Stress Disorder. Typically, PTSD affects people who have been victims or have witnessed a death, disaster, injury or other crisis. If the shock has not diminished after a month, the diagnosis may be PTSD. ...

Herb Holderman, who heads the county's Veterans' Assistance office, says he has seen several individuals with PTSD from Vietnam, and recently is seeing more Iraqi War vets. Holderman said he refers individuals to psychologist Peter Coe, in Sycamore, who has had a contract for counseling with the Veterans' Administration for several years.

Professionals who have followed the history of Iraqi vets after they return home, have found cases of depression, suicide and homicide, and they predict widespread cases of PTSD as more Iraqi vets return.

Could victims of the Cole Hall tragedy at NIU be vulnerable to such a disorder? “Absolutely,” said Lynette Spencer, a licensed social worker at DeKalb Clinic. “It can be caused by any exposure to an extreme event---injury or death. It can also happen to witnesses of the event...even first responders and hospital workers.”

Coe said individuals in the room where the shooting took place, Cole Hall, would be most inclined to suffer from PTSD, but any prior traumas they've experienced might increase the possibility. He noted that most students will get past the grieving and loss without complications.

Click on 'Article Link' below tags for more...

In educational interest, article(s) quoted from extensively.

Continuing:

Coe and Spencer agree that repressing what happened is unhealthy and may lead to depression and substance abuse. In fact, Coe said 80-85 percent of Vietnam vets with PTSD turned to alcohol and drug abuse and may still be addicted. A history of broken marriages, arrests and DUIs may have followed.

Later in counseling, the individual will develop coping skills and relaxation techniques, Coe said, to deal with the memories. Their sense of identity and place in the world, often distorted by the experience, can be rebalanced.

At NIU, “those most at risk are those who were in the actual classroom,” Coe said.

Spencer noted NIU's many counseling resources including the Employee Wellness and Assistance Program, the Counseling Center and the Psychology Clinic within the psychology department. She supported the university's effort to have instructors and counselors available to all students on the initial days back on campus.

What if the student doesn't report concerns? “As an instructor, I think you know your students..., at least in the smaller classrooms,” Spencer said

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A&E 'Intervention' Program Features Iraq Veteran with PTSD

A&E's Intervention program recently featured a segment on Brad, a young man coping with his PTSD by self-medicating with alcohol and marijuana after two Iraq tours with the 101st Airborne.

For those unfamiliar with the show, Intervention is a "series in which people confront their darkest demons and seek a route to redemption" by profiling "people whose dependence on drugs and alcohol or other compulsive behavior has brought them to a point of personal crisis and estranged them from their friends and loved ones." Brad's journey is a powerful and important episode.

Part 1


Click on 'Article Link' below tags for the rest of the segment...

Part 2


Part 3


Part 4


Part 5

Army Vice Chief of Staff General Richard Cody: Soldiers, Families 'Stretched and Stressed' to Limit

Yesterday, in morning testimony before the House Veterans Affairs Subcommittee on Health, we heard Colonel Charles W. Hoge, M.D., Director of the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research, say studies show "longer deployments, multiple deployments, greater time away from base camps, and combat intensity all contribute to higher rates of PTSD, depression, and marital problems."

Appearing later the very same afternoon before the Senate Armed Services Committee, Army Vice Chief of Staff General Richard Cody stated [written testimony pdf]:

Today’s Army is out of balance. The current demand for our forces in Iraq and Afghanistan exceeds the sustainable supply and limits our ability to provide ready forces for other contingencies. ...Current operational requirements for forces and insufficient time between deployments require a focus on counterinsurgency training and equipping to the detriment of preparedness for the full range of military missions.

Given the current theater demand for Army forces, we are unable to provide a sustainable tempo of deployments for our Soldiers and Families. Soldiers, Families, support systems, and equipment are stretched and stressed by the demands of lengthy and repeated deployments, with insufficient recovery time. Equipment used repeatedly in harsh environments is wearing out more rapidly than programmed.

Army support systems, designed for the pre-9/11 peacetime Army, are straining under the accumulation of stress from six years at war. Overall, our readiness is being consumed as fast as we build it. If unaddressed, this lack of balance poses a significant risk to the All-Volunteer Force and degrades the Army’s ability to make a timely response to other contingencies.

Click on 'Article Link' below tags for more...

In educational interest, article(s) quoted from extensively.

Ann Scott Tyson for the Washington Post:

Both the Army and Marine Corps are working to increase their ranks by tens of thousands of troops -- to 547,000 active-duty soldiers and 202,000 Marines -- but newly created combat units will not be able to provide relief until about 2011.

U.S. soldiers are currently deploying for 15-month combat tours, with 12 months at home in between. Marines are deploying for seven-month rotations, with seven months at home. Both services seek to give their members at least twice as much time at home as time overseas. "Where we need to be with this force is no more than 12 months on the ground and 24 months back," Cody said.

Rick Maze writing for Navy Times covered a March Senate Armed Services Committee hearing that touched upon the same issues:

The stress on the force from extended deployments could get worse before it gets better, top combatant commanders warned Congress on Tuesday.

No decision has been made on whether the U.S. military will go ahead with plans to cut troop levels in Iraq in July at what was supposed to be the end of the so-called “surge” of combat forces designed to give the Iraqi government time to stabilize, and more troops could be needed in Afghanistan, said Adms. William Fallon, chief of U.S. Central Command, and Eric Olson, chief of U.S. Special Operations Command.

At a Senate Armed Services Committee hearing, Fallon said there should be “little doubt of our desire to bring force levels down” and cited “encouraging trends.” But he said ground commanders also want to be cautious about withdrawing troops “because it is critical to not lose the ground that was so hard-fought this year.” ...

Olson said special operations forces do not expect to stand down if the Iraq and Afghanistan operations wind down. Operating tempo “will remain high even when conventional forces downsize in Iraq and Afghanistan,” he said, adding that his command “anticipates no relief from our deployed commitments even when U.S. force levels in Iraq and Afghanistan are reduced.”

Last month, Stars and Stripes' Vince Little wrote about the changes wrought across the services due to the increased military operations tempo:

The Iraq war has altered the dynamic for military units across the Pacific over the past five years. Along the way, there have been no shortages of stress and sacrifice. It’s carved out new roles for the Air Force and Navy, ushering in a brisk deployment tempo, and intense training sessions built specifically around prepping troops for duty on Iraq’s perilous streets and battlefields. ...

In recent years, the Army also has turned to the Navy and Air Force for help with security, civil engineering, infrastructure support and other critical roles in the war. In 2007, two Kadena Air Base squadrons, the 31st and the 33rd Rescue Squadrons, provided medical evacuation capabilities to other services in Afghanistan and Iraq. Defense contractors now routinely visit Pacific bases to teach airmen combat skills and convoy-ambush survival tactics.

Four-month rotations remain the standard for most Pacific airmen, but many are away for longer stretches. The wars in Iraq and Afghanistan were the first in which F-16CJ fighter jets were tasked to fly close-air support, providing cover, reconnaissance and munitions to coalition ground forces.

There are almost 1,400 Pacific Fleet sailors serving as individual augmentees in CENTCOM, with hundreds more at sea, the Navy said. The deployments range from six months to a year.

Navy leaders want to strike a better balance between war-on-terror requirements and improving stability for sailors and families at home, said Petty Officer 1st Class Shane Tuck, a Pacific Fleet spokesman. A new detailing process will be used for permanent-change-of-station transfers, rather than a “midtour, short-notice assignment,” he added.

Dale Eisman for the Virginian-Pilot:

The Navy also is feeling the strain, said Adm. Patrick Walsh, the vice chief of naval operations, even though ground forces are doing most of the fighting. The sea service has assigned thousands of sailors to support jobs ashore in the Middle East, using them to fill jobs that normally would be done by soldiers.

Walsh warned that the Navy's ability to maintain ships and aircraft will be imperiled unless lawmakers soon provide billions in extra funding sought by the Army and Marines to continue operations in Iraq. Without that money, Pentagon leaders will tap Navy and other noncombat accounts to pay war bills, he suggested. The Army is seeking an additional $66.5 billion and the Marines $1.8 billion this year for war-related expenses.

The military leaders' testimony at a Senate Armed Services subcommittee hearing fit a pattern of increasingly blunt warnings from the Pentagon about the war's toll on military families and equipment. The Bush administration began reducing the U.S. force in Iraq late last year, but Gen. David Petraeus, the top American commander there, is expected to recommend a pause in the drawdown when he testifies next week before House and Senate committees.

Capt. Wes Ticer writes in Air Force Link:

Airmen from the 379th Air Expeditionary Wing continue to maintain increased operations, both in the air and on the ground, in support of ground forces in Afghanistan and Iraq. ...

The 34th Expeditionary Bomb Squadron is called upon daily to provide close-air support to ground forces through precision bombing and shows of force and presence. The additional flying made for a busy week for aircrews and ground support.
"This was a good test for us to stretch our legs a little and get a taste of surge operations," said Lt. Col. Quinten Miklos, the 34th EBS director of operations. "It's an issue of stamina because what I'm asking people to do is to fly sorties more frequently."

Aircrew members are on a cycle that consists of crew rest, flying and recovering from a mission. A 12-hour sortie typically occupies the aircrew for 18 hours, Colonel Miklos said.

"For the crews, it presents a scheduling challenge because we are limited in the normal flow of sortie generation," Colonel Miklos said. "Our planners have to juggle the schedule to adjust crews to ensure the proper rest and time for planning."

It's obvious that our service members are doing a commendable, remarkable job under the increased tempo demanded of them. It's just unfortunate that we in the civilian sector don't have nearly as much political nerve to do right by them.


Related Posts

• Army Chief Agrees Troops Need More 'Dwell Time' at Home After Deployment
  
• Webb-Hagel 'Dwell Time Amendment' Needs Our Support Today
  
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• Three Months Tacked Onto All Army Combat Deployments
  
• America's 'Ready' Brigade Not So Ready Due to Deployment Stress
  
• Surge -- And Strain
  
• Increased Deployment Tempo Strains Military Family Ties
  
• WaPo: Army Reserves Feel the Pinch of Increased Operation Tempo
  
• War Stress: Not Only for Those in Combat

House Veterans Affairs Subcommittee Hears Testimony on PTSD Treatment and Research

Yesterday, the House Veterans Affairs Subcommittee on Health convened a long-anticipated hearing on Post Traumatic Stress Disorder (PTSD) Treatment and Research: Moving Ahead Toward Recovery. The hearing was the first to be telecast live from the House committee's website and can be viewed online in full today.

From Chairman Michael H. Michaud's opening statement:

Post-traumatic stress disorder is among the most common diagnoses made by the Veterans Health Administration. Of the approximately 300,000 veterans from Operations Enduring and Iraqi Freedom who have accessed VA health care, nearly 20 percent –60,000 veterans- have received a preliminary diagnosis of PTSD. The VA also continues to treat veterans from Vietnam and other conflicts who have PTSD.

With the release of the 2007 IOM report “Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence,” we learned that we still have much work to do in our understanding of how to best treat PTSD. I hope that my colleagues will continue to work with me in supporting VA’s PTSD research programs.

I look forward to hearing testimony today from several organizations that are working to provide comprehensive and cutting edge treatment to those with PTSD. The committee recognizes that this is an important issue and one that will be with us for a long time to come. We are committed to ensuring that all veterans receive the best treatment possible.

Click on 'Article Link' below tags for more...

In educational interest, article(s) quoted from extensively.

Colonel Charles W. Hoge, M.D., Director, Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research:

I would like to briefly discuss the findings of three studies published since my last testimony to this committee in September 2006, which highlight both the successes and challenges in addressing the mental health needs of our service members.

The first is a study reported this past November in the Journal of the American Medical Association (JAMA) involving nearly 90,000 Soldiers who completed both the post-deployment health assessment (PDHA) and the post-deployment health reassessment (PDHRA) after return from deployment to Iraq. Soldiers completed the PDHA immediately upon their return and they completed the PDHRA six months later. The study confirmed that many mental health concerns do not emerge until several months after return from deployment, highlighting the importance of the timing of the PDHRA, particularly for Reserve Component Soldiers.

20% of Active Component and 42% of Reserve Component Soldiers were identified as needing mental health referral or treatment, most often for PTSD symptoms, depression, or interpersonal conflict. About half of Soldiers with PTSD symptoms identified on the PDHA showed improvement by the time of the PDHRA, often without treatment. However, more than twice as many Soldiers who did not have PTSD symptoms initially became symptomatic during this same period.

One counterintuitive finding was that we could not demonstrate any direct relationship between referral or treatment for PTSD as identified on the PDHA and symptom improvement six months later on the PDHRA. The difficulty in demonstrating the effectiveness of the PDHA assessment may reflect, in part, the inherent limitations in screening or the fact that mental health services remain overburdened with the current operational tempo, despite the extensive efforts to bolster services and training.

An encouraging finding was that many Soldiers sought care wi