Showing posts with label OEF. Show all posts
Showing posts with label OEF. Show all posts

Sunday, May 22, 2016

VETERANS AFFAIRS IN NEED OF MAJOR OVERHAUL


WHAT’S UP, DOC?

A short essay outlining how the Veterans Administration
might reorganize its Medical system


We have heard the problems. Now, let’s get a viable solution. The United States Congress seems unable to figure this out, perhaps because so few of them have served in the Armed Forces. Those few who have served are in positions where they will never have to personally encounter the Department of Veterans Affairs medical system.
It is certain nice to have Congress appropriate funds to run the system. The fix involves a restructuring of the medical system from the bottom to the top. If you change the basic structure, you will change the culture. It is the culture, which stems from the structure, which has pushed the VA Medical System over the cliff. Why must Veterans put up with a medical system that hasn’t evolved since its inception under Herbert Hoover: July 21, 1930

The second consolidation of federal Veterans programs took place July 21, 1930, when President Herbert Hoover signed Executive Order #5398 and elevated the Veterans Bureau to a federal administration—creating the Veterans Administration—to "consolidate and coordinate Government activities affecting war veterans”. At that time, the National Homes and Pension Bureau also joined the VA. [1]

Note Bene: Check out the number of “Executive Orders” enacted by President Hoover!


Surprisingly, the fix is relatively simple, as all the necessary parts already exist within. I understand that Congress loves to create new stuff and put their signatures on it. But, there is no reason to re-invent the wheel. The structure of a typical VA Medical Center looks like, if you will, a large farm field with a row of grain elevators: aka Silos. The field represents the whole Medical Center. Each Silo represents a specific department within that larger farm field. Call the farm field the “system”. Let’s take a look at the relationship between the Silos.                  

VA Medical Center’s Silo Structure



Field of Dreams
This may not look like it is relevant to this argument on the surface, but, remember, this a bottom up scenario.

If you are a nurse, you work for the Director of Nursing [the Nursing Silo]. In your department you may have a specific Supervisor. Where you are placed in the Hospital depends on where your Supervisor and Director want you to go. Supervisors and Department Directors seem to allocate Human Resources without regard to any Nursing Specialty you may possess, so you chance ending up in a position for which you have little, or no, skill. Once in your allocated position, the Medical or Mental Health Department Directors and Supervisors have no effective say in what your role is in that specific Department. Any changes to your routine be initiated by your physical workplace Supervisor; must travel up the chain to that Department’s Director, then laterally to the Nursing Department Director, and then down that chain to your Nursing Department Supervisor. The final decision on any change, whatever that may be, goes back through the same channels it took to get to your Nursing Supervisor. This means that the person you work with on a daily basis is part of an entirely separate Silo and has no say over your duties, hours, or responsibilities in your actual workplace. This, then, translates into the inability of the Director of any specific medical or mental health Department to format and control the normal workday of the people who work in his/her department.



This type of Personnel insulation/isolation is detrimental to anyone trying to run any VA Medical Center program effectively. The history of how this became the norm is not important, any more. What is important is that a solution be found before the entire Department of Veterans Affairs is purposely allowed to implode and become “privatized”.
One technique of solving industrial, commercial, or institutional problems that I am familiar with is the application of the “Six Sigma”/”Kaisen” theory of looking at one scenario. You draw on all your human resources to implement the most lean, streamlined, efficient way to deliver your product.

You the work out any bugs, and, when you are satisfied you have problem solved, you simply duplicate the new structure as many times as you need to. In this case, you take one VA Medical Center and work your magic on just that unit. Once you have it running correctly and efficiently, you simply go Medical Center by Medical Center and duplicate the first restructuring in each of the remaining Medical Centers.

I want to include one excerpt from:
Eric Whitney, Montana Public Radio and Michael Tomsic, WFAE
“Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors” [2]
Congress and the VA came up with a fix: Veterans Choice, a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

This winter, when Montana Sen. Jon Tester sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.
But he says he's mired in bureaucracy. "The VA can't do it in seven months, eight months? Something's wrong," he says. "Three hours on the phone," trying to make an appointment. "Not waiting," he says, "talking for three hours trying to get this thing set up for my new hearing aids”.

........Meanwhile, though, Veterans continue to wait. "If I knew half of what I knew now back then when I was just a kid, I would've never went in the military," says Bobby Wilson. "I see how they treat their veterans when they come home."
This is part of collaboration with NPR's Back at Base project, local member stations, and Kaiser Health News.

Many Veterans, me included, have friends and acquaintances who could sit down at a table for a week and hash out the details of a solution to this mess. Almost to a person, they have said, “All the Government has to do is ask.” Believe me! If I can identify the problem and start the ball rolling toward a solution, then far better minds than mine would have no problem, whatsoever, in completing the task of restructuring the Department of Veterans Affairs in very short order.
Some may ask why Veterans are trying to hold on to the VA Medical system. The answer is both simple and complex. The simple part is that most Veterans feel more at ease dealing with their medical and mental health conditions when they are in the company of other Veterans. The complex part is Veterans don’t feel the “private sector” (civilians) necessarily understand what they’ve been through and the types of conditions involved. The “privatization” of the VA system will discourage any Veteran from seeking medical, or mental health, treatment. Consider what is already happening; the break-up of families, substance abuse, the venting of anger and frustration, and suicide. Is this what we really want for those men and women, who volunteer to defend this Country?

And, what will be the inevitable larger, big-picture problem? Young men and women will see how Veterans disrespected, mistreated, and lied to. The resultant plummeting of Armed Forces recruitment and enlistment will leave this Country without a means of defending itself, let alone others.

further suggested reading:

1)  More Than Medicine (Why the VA matters), by Joseph J. Frank - The       American Legion Magazine, June                                                                 2016 http://www.legion.org/magazine/232777/more-medicine







Are These Men and Women Really Less Than Honorable?

From: The American Legion Magazine, June 2016
Booted after battle

By Ken Olsen



Max Fernandez was arrested for a bar fight the first weekend after he came home from Iraq. The Marine Corps machine gunner didn’t think twice about the altercation. 
“Coming back, my mindset was so aggressive,” he says. “I thought it was funny.” 
No one pressed charges and Fernandez’s commanders ignored the incident, he says. He and his buddies continued partying and fighting until Fernandez was booted out of the military, without getting treatment for an IED blast that damaged his vision and hearing – or the nightmares that followed him home from combat.

Today Fernandez is living in a homeless shelter in Los Angeles, undergoing treatment for addiction, pursuing a VA claim for PTSD and TBI, and trying to rebuild his life under the shadow of a bad discharge. It’s the story of thousands of former service members who don’t get help when their combat injuries fuel misconduct. Instead, they are discarded with involuntary discharges that prevent them from receiving military retirement, medical care, disability and GI Bill benefits – all in the interest of speed and cost savings.

“According to current DoD and service branch regulations, it’s permissible to separate service members who have committed misconduct, even if they are suffering from a mental disorder that makes them unfit to serve,” says Thomas Moore, manager of the Lawyers Serving Warriors project at the National Veterans Legal Services Program. “I believe this is a big problem.”

There’s a cultural issue at work, too, says Kathleen Gilberd, executive director of the Military Law Task Force. Sick or injured troops are considered troublemakers simply because they are not fit to deploy. “That means getting rid of them, usually without medical benefits, for misconduct or other designated mental and physical conditions,” she says. 

LIFE SENTENCE 
Being dismissed from the military leaves an indelible stain on a veteran’s pride – and his or her future. 
“An other-than-honorable discharge usually means something went awry with you in the service”, says Waldo Tapia, an attorney who recently left the Inner City Law Center on Skid Row in Los Angeles and is representing Fernandez. “It’s a difficult stigma to overcome, particularly if it’s tied to PTSD.” 
Civilian jobs are often unavailable once a prospective employer sees a problem discharge on a veteran’s DD-214. 

“If you get caught using drugs at a warehouse job, you might get fired,” Tapia says. “If you get caught using marijuana in the military, the other-than-honorable discharge follows you forever.”

Many of these veterans end up homeless. Many have no access to health care even though VA has the discretion to provide medical benefits on a case-by-case basis. Veterans who are kicked out of the military for misconduct related to PTSD, TBI and other invisible wounds are also excluded from receiving help from many nonprofits, says Kristina Kaufmann, executive director of the Code of Support Foundation. 
In other words, the people who most need help often are the least likely to receive it. 

HISTORIC PRACTICE 
Involuntary discharges have been a volatile issue since at least the Vietnam War. A 1980 Government Accountability Office (GAO) investigation recommended that service members have the right to a hearing before being tossed out of the military. But the boards that review these cases are usually sympathetic to the wishes of commanders eager to get rid of service members, and the service members are often convinced that they are better off if they waive their right to a hearing, Gilberd says. There is also a persistent myth that other-than-honorable discharges are automatically upgraded if service members stay out of trouble for six months after leaving the military, which may give them an incentive not to pursue a hearing that would help their case. It’s unfair to just blame commanders, who are dealing with the realities of fighting long wars with an all-volunteer force. 

“I get it,” Kaufmann says. “I was a commander’s wife during the surge from ’06 to ’08. I remember the pressure on my husband to have a battalion that is at full strength and ready to deploy.” And similar pressure to get rid of people who aren’t. Involuntary discharges again became an issue during the wars in Iraq and Afghanistan. A litany of negative media prompted Congress to order the military to carefully review the combat experiences of service members before discharging them for misconduct. Yet another 22,000 soldiers have been involuntarily discharged since that 2008 legislation was passed, according to an investigation by National Public Radio. Today the Army Inspector General is conducting its own investigation, again under pressure from Congress.

Involuntary discharges for misconduct are only part of the problem. A significant number of U.S. service members who are discharged for personality disorders or adjustment disorders are also diagnosed with combat-related mental health issues such as PTSD during military medical exams.

“We’ve reviewed cases where service members have been consistently diagnosed with PTSD, yet one diagnosis of personality disorder results in their administrative separation,” Moore says. “Many are then consistently diagnosed with PTSD by VA examiners after discharge from service.”
Service members separated for personality disorders may receive honorable discharges, but they do not have access to key benefits associated with medical retirement. 

“The most valuable retirement benefit is access to the military’s health-care program, TRICARE, which provides medical care for the veteran and the veteran’s dependents,” Moore says.

ATTITUDE PROBLEM 
Service members are reluctant to seek help, even when they know they’ve been injured – particularly when it comes to mental health issues. “There’s a kind of attitude that PTSD is a weakness – that a good soldier, a strong soldier, just works through it,” Gilberd says.

Fernandez is but one example of that attitude. The physician who examined his squad after their armored cargo carrier was hit by an IED near Fallujah in February 2006 recommended they spend a week on light duty as part of their recovery. They refused. “None of the Marines I was with or knew wanted to leave the field,” Fernandez says. “Any injury I had, I had to push out of my mind.”

That attitude is pervasive, Tapia says. “A lot of guys don’t want to report an illness or injury because they worry they will be viewed as holding their unit back.”
As a result, many aren’t diagnosed until they get out of the service, Kaufmann says.
Once back in the United States, Fernandez continued to deny he’d been injured. “I was having nightmares and intrusive thoughts,” he says. “I had the option of seeing people (medical staff), but that would have been frowned upon.”

Instead, Fernandez self-medicated. He and his buddies “drank day and night.” He flunked a random drug test and was stripped of a promotion. But the Marines allowed him to stay after he pleaded his case to a non-judicial punishment board. That is, until he got in yet another fight that left one man in a coma. He went from proud Marine to homeless addict with an other-than-honorable discharge in a matter of months.
“I was bitter,” he says. “Instead of looking at the paperwork – drug abuse – what about the two years that I served? They need to reform the rules and regulations to deal with the epidemic of psychological issues people are coming back with.”

Society shares the blame for the military’s attitude. “I think it’s a complete misunderstanding of PTSD and TBI,” Kaufmann says. “But it’s not just the military. We’re terrible with mental health in this country. We have such a lack of understanding and fear any anything mental health-related.” 

HAZING THE INJURED 
Fernandez might not have fared any better if he had sought help for his injuries. Service members who seek treatment for PTSD and other mental health issues are often harassed to the point of career-ending misconduct, Gilberd says. 
Michael Wells knows this territory firsthand. He says he encountered hostility at Fort Gordon, Ga., when he sought help for PTSD and TBI following his second tour in Iraq in 2008. His acting first sergeant tried to prevent him from getting mental health treatment; he sneaked off to his psychiatric appointments anyway, he adds. The repercussions escalated.

“He tried to take away my security clearance,” Wells says of the first sergeant. “He threatened me with physical harm.” Amber Wells, who met her future husband at Fort Gordon during this ordeal, worried Michael would kill himself. “They wouldn’t let him go to the hospital,” she says. “They would say, ‘Real men don’t get PTSD.’”
The first sergeant also blocked his attempts to apply for medical retirement, Wells says. He reported the harassment to a command sergeant major from another unit and the Army Criminal Investigation Command (CID) without result, he says. Then, finally, he just left Fort Gordon.

“He had actually gone to his psychiatrist – it’s in his records – and said, ‘If you don’t help me, I’m going AWOL,’” Amber says. “His psychiatrist basically laughed at him.’”
Fort Gordon referred questions about Wells’ case to U.S. Army Medical Command, which did not respond. However, the office of Sen. Dean Heller, R-Nev., confirmed that it is working on the case.

DISAPPEARING ACT 
Once he reached the point that he couldn’t look at his uniform, Wells left Fort Gordon and traveled the country until he was certain his unit had dropped him from the rolls. He then turned himself in at Fort Knox, Ky., where he was given an other-than-honorable discharge. He spent the next three years scraping by with Social Security disability and low-income housing while fighting to get help for PTSD, TBI, and neck, back and hip injuries. An Idaho employer fired him when it discovered he had PTSD, on his third day on the job. Other help was off-limits. “There were a lot of outreach programs and veterans services I couldn’t use because I had an other-than-honorable discharge,” Wells says. “We survived on just over $1,000 a month for a couple of years.”  

Amber filed VA disability claims on his behalf and scoured the Internet for help. She connected with Reno, Nev., radio host Boone Cutler and his wife, who raised the money to bring the Wells family and their two children to Reno. There, Michael finally got his first treatment at the local VA, but only after threatening to kill himself.
“It took me getting hospitalized for PTSD, survivor’s guilt and suicidal thoughts,” he says. 

Cutler also connected Michael with Heller, whose staff was instrumental in getting his discharge upgraded to general under honorable conditions because of his PTSD. And VA eventually granted Wells a 90 percent disability rating for PTSD and hip problems. Today, he and his family are living in Texas, where he is undergoing a series of hip
surgeries. Heller’s office is helping him pursue a 100-percent disability rating.
It’s been an arduous and dispiriting journey, Amber says. “Even after you fight for your country, you have to come home and fight for your benefits,” she says. But they believe Michael’s case shows that with persistence and the right advocate, other service members can overcome a bad discharge. 

“It took five years,” he says. “But I want other soldiers to know that it’s possible. No matter what, keep trying.”  
 Ken Olsen is a frequent contributor to The American Legion Magazine [1]
This is a link and a PDF for the form needed to initiate an upgraded discharge:
http://arba.army.pentagon.mil/documents/dd0293.pdf



Friday, April 4, 2014

IAVA Press Release

From my personal email, 4/3/2014



Dear Hutch,
The last 24 hours have been tough ones for many in our community. We want you to know that IAVA is working hard to provide support for our members, friends, and families in and around Fort Hood. At the same time, we are speaking out nationally for you -- our veterans and those who support them. Below is the statement we issued to the press this morning and the message we have been sharing with reporters throughout the day.
IAVA Statement on Fort Hood Events
The military and veteran community is an incredibly tight knit group and our hearts and prayers go out to those affected by the Fort Hood tragedy. IAVA's #1 priority right now is to provide support to our community in Texas and worldwide. We ask all Americans to make it their priority too.
While we still don't know the details about what motivated yesterday's tragic events, it's important we remember that our men and women currently in uniform and the veterans who have returned home from the wars are amongst the finest and most dedicated people in America and the actions of one individual don't diminish or change that fact. In moments like this, there is a tendency by some to paint a broad brush across the entire veterans community and it's important to guard against that mistake. We encourage everyone--especially those in the media and political positions--to be thoughtful and responsible in their reactions and to remember that correlation does not imply causation.
At the same time we recognize that the vast majority of our military and vets are not in crisis, we must all acknowledge that there are indeed problems with the way mental health care and transitional support is managed and available to our service members and veterans. As we did last week in Washington with our Campaign to Combat Suicide during Storm the Hill, IAVA will continue to advocate for urgent and practical solutions to these problems and challenge our leaders to help us solve them in the weeks and months ahead.


-- Team IAVA

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                                                                                                                                                                       This concerns                            all of us.











Sunday, January 12, 2014

“Recent al-Qaida push stresses LI Iraq War vets” – NEWSDAY


My friend, Martin Evans, is keeping the flame alive, as he reports on the plight of Long Island’s Veteran population. His most recent article, below, helps to give some insight to the feelings of frustration and anger that our OIF & OEF Veterans are currently experiencing. The old guard, Viet Nam Veterans, had a similar feeling of despair, frustration, anger, and mistrust after the fall of South Viet Nam in 1975. I am honored with the opportunity to walk among some of our newly returned Veterans, and I am equally saddened by what they are going through in their battle to re-enter civilian life. As Mr. Evans has reported before, the suicide rate for our younger Veterans is climbing at alarming speed. It is now true that the primary cause of death for Soldiers and Veterans is suicide, not being in battle. Thank you Martin, for keeping this subject on the radar.
I sincerely hope that the United States of America comes to its senses, and stops making Veterans.

Originally published: January 9, 2014 7:53 PM
Updated: January 9, 2014 9:27 PM
By MARTIN C. EVANS (click)
martin.evans@newsday.com

   Photo credit: Newsday / John Paraskevas | Francis Romanitch,
   a Marine Corps reservist who helped pacify Anbar Province
   when he served in Iraq. (Jan. 9, 2014)

The al-Qaida takeover of parts of Iraq's Anbar province, where about a third of American troops killed in the war perished, has left area Iraq War veterans bitterly wondering what their sacrifice was all about.

"It's disheartening," said Francis Romanitch, 28, a Marine Corps reservist who served in the Anbar city of Ramadi in 2004 as Marines fought door-to-door 25 miles away in Fallujah.It’s like seeing the Japanese flag flying over Iwo Jima 10 years after World War II," said Romanitch, of Babylon.

Last week, al-Qaida-linked forces overran parts of Fallujah and Ramadi, commandeering police and military facilities, and setting up armed checkpoints. The White House has ruled out resending U.S. troops -- who withdrew from Iraq in 2011 -- but is providing the Iraqi government with arms.

Beginning in 2004, Anbar, a Sunni power base for Iraqi dictator Saddam Hussein before his capture, became the scene of some of the bloodiest confrontations during the war.

After insurgents hung the burned bodies of four American contractors from a bridge in Fallujah, U.S. troops that April rooted out opponents during weeks of door-to-door confrontations. But they paid a horrific price, according to historian Richard Lowry, author of the book "New Dawn: The Battles for Fallujah."

"These young Marines -- 19 years old -- went in every building and every room of Fallujah," Lowry told Fox News. "They entered darkened rooms, kicking down doors, never knowing if they would find an Iraqi family hunkered down in fear or an Islamist terrorist waiting to shoot them and kill them. And they did that over and over and over again."

Mental health workers have said witnessing a military collapse can be emotionally traumatic for war veterans regardless of what conflict they fought in.

"It's re-traumatizing, if you will," said Denis Demers, who served as a psychological medic in Vietnam and now counsels veterans at the Suffolk Veterans Service Agency.

In 2004, Michael Posner was stationed in Mosul with a New York National Guard unit when a bomb ripped through a military mess tent, riddling him with shrapnel and killing 14 fellow soldiers. He said watching parts of Iraq slip under insurgent control weighs heavily on him.

"It brings back a lot of memories and flashbacks," said Posner, 43, of Bellport. Feelings of anxiety, depression and anger spawned by his wartime experience for a while pushed  him to abuse alcohol and cost him his marriage.

"I lost a part of my soul over there," he said.

Posner, who since returning from Iraq has helped counsel fellow soldiers suffering from anxiety attacks, said he's recently received phone calls from veterans expressing rage.

"A lot of these guys lost a lot of their buddies and saw a lot of bloodshed," he said. "There was so much work they did, and it's gone to hell."

Scott Molloy, 29, of Kings Park, who served in Afghanistan in 2012, said the feeling of accomplishment he had over there has turned to disillusionment. Molloy has struggled to control feelings of anger and frustration related to post-traumatic stress disorder. He said those feelings have worsened because of the al-Qaeda surge.

"It hits you like a ton of bricks," he said. "You ask yourself, 'Why did I go through all that? Why am I suffering?' "d him to abuse alcohol and cost him his marriage.

Galleries:
(click)Honoring Long Island's veterans 
(click)Military heroes return to Long Island







(click)LI, NYC war casualties
(click)LI troops who died in war