This past week, the U.S. Senate passed a resolution submitted by Sen. Kent Conrad [D-ND] marking today, June 27, as National PTSD Awareness Day. Boy, have we come a long way.

It's been three decades since post-traumatic stress disorder was first listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Since then, the study of trauma has taken off, reflected in academic publications such as the Journal of Traumatic Stress.

In February, in fact, JTS devoted an entire issue specifically to combat PTSD as it has affected veterans and military families embroiled in our current wars in the Middle East.

A few stats from the issue's editorial [pdf]:

High-profile events such as the terrorist attacks on 9/11 have contributed to an increased public recognition of trauma as well as greater professional interest. The number of articles on disaster increased substantially from the period in the 5 years before 9/11 to the period 5 years after by 145% in specialty disaster journals and 320% in general medical journals, with the largest increase being 2,340% in the New England Journal of Medicine (Kelen & Sauer, 2008). Other high-profile events -- the wars in Iraq and Afghanistan, the bombings in London and Madrid, Hurricane Katrina, and the tsunami in Southeast Asia -- have undoubtedly had a similar impact.

KFYR-NBC out of Bismarck, N.D., broadcast news of National PTSD Awareness Day in a segment now online. In extended, a few informative videos including a recent PBS interview with Dr. Jonathan Shay, noted VA psychologist, author and 2007 MacArthur Fellow.

I hope today will help to further chip away at the stigmas associated with seeking help for those battling traumatic injuries of all kinds.

Quick looks at the latest news containing statistics of interest to returning veterans, military families and their caregivers.

First up, Kristin M. Hall for AP:

Brig. Gen. Stephen Townsend addressed the 101st Airborne Division with military brusqueness: Suicides at the post had spiked after soldiers started returning home from war, and this was unacceptable.

"It's bad for soldiers, it's bad for families, bad for your units, bad for this division and our Army and our country and it's got to stop now," he insisted. "Suicides on Fort Campbell have to stop now."

It sounded like a typical, military response to a complicated and tragic situation. Authorities believe that 21 soldiers from Fort Campbell killed themselves in 2009, the same year that the Army reported 160 potential suicides, the most since 1980, when it started recording those deaths.

But Townsend's martial response is not the only one. Behind the scenes, there has been a concerted effort at Fort Campbell over the past year to change the hard-charging military mindset to show no weakness, complete the mission.

While most in Washington have been busily paying attention to the Sotomayor hearings this week, the Senate Veterans Affairs' Committee met Tuesday morning to consider the quality of VA care provided to our nation's 1.8 million female veterans.

Some, but certainly not all, of their concerns regarding access to their health benefits reflect the same frustrations felt by their male counterparts. Carrie Wells, McClatchy News:

The Department of Veterans Affairs often fails to provide adequate medical care to female military veterans, five of them told the Senate Veterans Affairs Committee Tuesday.

A Veterans Affairs official agreed.

"At the root is a system that has not been responsive to the needs of women veterans," said Patricia Hayes, the department's national director of women's health care.

The five veterans said women sometimes aren't properly informed upon discharge that health benefits are still available. They described how dealing with government is frustrating and confusing, and that often their unique needs, such as child care and sexual assault counseling, aren't understood by government officials.

"I looked to the VA for help when I most needed it, but never succeeded in completing my enrollment, let alone actually receiving the care I needed," said Genevieve Chase, the founder and executive director of the American Women Veterans organization.

Hayes agreed. "Women don't really know about VA services," she said.

More coverage in extended.

The proceedings, Women Veterans: Bridging the Gap, lasted about two hours and can be viewed in full at the link.

And now, back to reality.

After my glowing post yesterday, nodding to the many Army generals nudging military culture into the 21st century by admitting that anyone can and does get PTSD, it doesn't take long for things to come crashing back down to reality.

Michael de Yoanna and Mark Benjamin for Salon:

For more than a year he's been seeking treatment at Fort Carson for a brain injury and post-traumatic stress disorder, the signature injuries of the Iraq war. Sgt. X is also suffering through the Army's confusing disability payment system, handled by something called a medical evaluation board. The process of negotiating the system has been made harder by his war-damaged memory. Sgt. X's wife has to go with him to doctor's appointments so he'll remember what the doctor tells him.

But what Sgt. X wants to tell a reporter about is one doctor's appointment at Fort Carson that his wife did not witness. When she couldn't accompany him to an appointment with psychologist Douglas McNinch last June, Sgt. X tucked a recording device into his pocket and set it on voice-activation so it would capture what the doctor said. Sgt. X had no idea that the little machine in his pocket was about to capture recorded evidence of something wounded soldiers and their advocates have long suspected -- that the military does not want Iraq veterans to be diagnosed with PTSD, a condition that obligates the military to provide expensive, intensive long-term care, including the possibility of lifetime disability payments.

And, as Salon will explore in a second article Thursday, after the Army became aware of the tape, the Senate Armed Services Committee declined to investigate its implications, despite prodding from a senator who is not on the committee. The Army then conducted its own internal investigation -- and cleared itself of any wrongdoing.

Fort Carson, you may recall, was the site of a major scandal in 2006-2007 when first the Colorado Springs Independent (CSIndy) and CBS News reported in July 2006 that some troops were receiving abuse rather than proper treatment for their reintegration issues and/or PTSD after returning from Iraq. In December 2006, NPR broke the story even wider; Senate investigations followed.

Recently in the news:

• The Associated Press | VA hires vets to go find comrades who need help - "Graner is one of 100 former service members hired nationally by the Department of Veterans Affairs as outreach specialists to help get Iraq and Afghanistan veterans into programs aimed at easing their transition back to civilian life. They frequent job fairs, welcome-home events and other places where troops back from the wars might congregate and look for those struggling to adjust. The goal is to persuade them to visit one of 230-plus vet centers nationwide...[for] free services from job hunting assistance to marriage and mental health counseling. Experts applaud the effort to actively search for veterans who may need help, even if some advocates say the program should be much bigger."
  
  
• USA Today | Military puts focus on epidemic of suicides - "In Maj. Thomas Jarrett's stress management class ... American troops are urged ... to strive for 'post-traumatic growth.' During a 90-minute presentation entitled "Warrior Resilience and Thriving," Jarrett, a former corporate coach, offers this and other unconventional tips on how troops can stay mentally healthy once they return home. He quotes Roman Emperor Marcus Aurelius, Paradise Lost author John Milton and German philosopher Friedrich Nietzsche... Walking through the crowd of young GIs in the makeshift classroom, Jarrett urges them to fight their "internal insurgents."
  
  
• News-Leader | Videos explain health care benefits to military families - "Military families throughout TRICARE’s west region now have a new way to learn about their health care benefits through the movies. ... “TRICARE 2 You” video topics, which run an average of three minutes in a prime-time news format, include explanations of TRICARE plan options, how to access specialty care, behavioral health resources, pharmacy options and newborn enrollment, among others. “We wanted to do whatever it takes to help our beneficiaries maximize use of their TRICARE benefit and avoid out-of-pocket costs,” said David J. McIntyre, president and CEO of TriWest Healthcare Alliance. “This is especially useful for service members, particularly those in the National Guard and Reserve who live or work in rural areas without convenient access to military base resources,” he said. Produced by TriWest, in partnership with TRICARE Regional Office-West, the videos are housed in the company’s new TRICARE 2 You Online Library."
  
  
• IAVA | Iraq Veteran Testifies On Capitol Hill - "Veteran Carolyn Schapper testified at a hearing before the House Veterans Subcommittee on Disability & Memorial Affairs about the disparities in PTSD diagnosis for male and female soldiers in combat. During her deployment to Iraq from October 2005 to September 2006, Carolyn participated in over 200 combat patrols as a member of a Military Intelligence unit with the Georgia National Guard."

More PTSD Combat Diigo links.

Earlier today, Congressman Joe Sestak (PA-07) took to the floor of the House of Representatives to talk briefly about 2009's Brain Awareness Week, which began Monday and continues through March 22.

Over the course of the past years, with a notable uptick in tempo over the past few months, we've been witnessing a distressing rise in military suicides. We outside observers haven't been alone in taking note. The military has as well.

The Army, for instance, has been undergoing a month long "stand down" meant to put renewed focus on suicide prevention. They now enter the "chain teaching" phase, which will run through July 15. (In 2007, a 90-day PTSD/TBI education chain teaching program was initiated.) In addition, last week Army Vice Chief of Staff Peter Chiarelli held a blogger's roundtable [audio-mp3], "assuring those on the line that the Army understands the severity of the problem, and is doing everything it can to prevent even a single suicide from happening."

"The culture of the Army is that of a team," said Chiarelli. "And anytime one of our own feels so lost that he or she sees no other option than to take their own life, then we've failed as an organization." And so, the real work begins.

The Army is also introducing a new fitness program, set to launch in May, that will combine physical and mental strength and resiliency training. Army Chief of Staff Gen. George W. Casey Jr. said it is "designed to move mental fitness up to the level we give to physical fitness" and will "give more soldiers coping skills so they can deal with the difficult challenges of combat and come back stronger."

It's good to see the Army (and other military branches) responding as they are. While a small element, kudos to their using blogger's roundtables to engage more intimately and directly with us. [I was invited to take part in one last summer, but was unavailable; I mention it, though, because it does show that they are trying to reach out to more of us in ways that they never had before.]

Many, many Americans care about this issue, and wish to ensure that our military families have the resources they need when they serve, and when they return home, too.

Last Monday, Rep. John Hall [D-NY], the chairman of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs, introduced important legislation that would give vets coping with PTSD easier access to their disability benefits and the treatment they need. Press release:

After visiting with veterans at the U.S. Veterans Hospitals at both Montrose and Castle Point, Congressman Hall announced legislation he has written called the COMBAT PTSD Act: Compensation Owed for Mental Health Based on Activities in Theater. The legislation will remove the onus from any veteran diagnosed with PTSD to have to prove that a specific incident during combat caused his or her PTSD. Hall's COMBAT PTSD Act will make it so that any veteran diagnosed with PTSD who served in combat will automatically have the ability to get treatment and benefits for the service injury of PTSD. ...

The VA's current policy forces veterans to "prove" that a specific stressor during a war triggered their PTSD, even if they have already been diagnosed and been receiving treatment for the condition. Veterans must track down incident reports, buddy statements, present medals, and leap other hurdles to validate to the VA that their PTSD was a result from their war service.

"The current policy violates common sense," stated Hall. "A soldier who does not have PTSD before entering a war, who returns home from war with PTSD, should not have to prove that his PTSD is a result of a specific experience during war. Simply serving in combat can induce PTSD. The wars America is fighting right now have no front or rear lines. Danger can strike in any place, anywhere. It is clear that the current regulations are in need of change."

People are beginning to chime in on the issue.

Just when you think that our beleaguered veterans can relax, that health care improvements are on the way or already there, the latest VA report (yes, another one) confirms we're merely treading water.

While things are all a boil, again, this week, the veterans claims processing backlog (and everything that flows from it) has been a long-simmering problem.

While Illinois Veterans Affairs Director Tammy Duckworth has been tapped by President Obama to be the public face of the federal VA (as assistant secretary of public and intergovernmental affairs), her Senate confirmation hearing has yet to be scheduled. In the meantime, Michael Blecker, a Vietnam vet and executive director of Swords to Plowshares, offers this advice to them both.

More advice: Veterans for Common Sense unveiled its Four PTSD Priorities for 2009 asking the DoD to: 1) "implement the 1997 Force Health Protection law, PL 105-85, Section 761-771, that requires the military to provide pre- and post-deployment medical exams to all service members; 2) implement a strong anti-stigma program as required by the National Defense Authorization Act for 2009; 3) hire additional mental health professionals to meet the increasing demand for examinations and treatment; and 4) urges VA to work more closely with DoD implementing the Force Health Protection law so VA has sufficient records to provide medical care and process disability claims."

And in state news, legislators in Alaska are gearing up to designate March as Brain Injury Awareness Month. "Sadly, Alaska is number one per capita for TBIs [at about 800 reported cases every year] and it is one of the leading causes of death for young people in our state," said sponsor Sen. Lesil McGuire, R-Anchorage. In related news, the Pentagon reports that current wartime brain injuries are thought to be in the 180,000-360,000 range, or about 20 percent of those who have deployed to Afghanistan and/or Iraq.

A few quick stops:

• Will the upcoming change in VA leadership result in fewer facility closures? Congressman Jerry McNerney [D-CA] hopes so. In a letter to President-elect Barack Obama's VA secretary nominee, Gen. Eric Shinseki, McNerney (who serves on the House Committee on Veterans' Affairs) has asked that Livermore VA medical facilities not only remain opened but be expanded to include a PTSD and major depression treatment center.
  
  
• Great news coming out of the home of the 3rd Infantry Division today as "medical officials at Fort Stewart’s Winn Army Community Hospital will take part in a ground-breaking ceremony for two clinics dedicated to the treatment of post-traumatic stress disorder (PTSD) and traumatic brain injuries."
  
  
• The issue of combat PTSD reaches a national audience today on Dr. Phil. "Beyond the Front Lines" features the stories and far-too-often struggles of some of our returning troops. [UPDATE Dec 20, 2008]: Larry Scott of VA Watchdog has uploaded the full program on YouTube, which I've added in extended below.
  
  
• In Ohio, following years of effort by veterans Tom Shugerts and Paul Nelson, 2009 will usher in the newly-designated Ohio Veterans Memorial Bridge. The pair's idea inspired the bill now expected to be signed into law by by Gov. Ted Strickland.

More news over at Jon Steinman's greatly-recommended daily Veterans for America News Analysis column. Bookmark it!

One of my favorite female OIF vets, Abbie Pickett, shared the following video on her facebook page. (If you're a frequent reader of PTSD Combat and wish to connect with me via my facebook account, you're invited to do so; I frequently post PTSD-related content via that channel when I'm pressed for time -- which is often when my semesters are in full-swing).

The video is for a song called "Talking Post Trauma Blues."

As Congress begins their annual August break, a look at some of their pre-recess veterans-related work:

• The U.S. House of Representatives passed [409-4] the 2009 Military Construction and Veterans Affairs Appropriations bill that would eclipse President Bush's budgetary request by $3.4 billion and gives the green light on construction of a new replacement VA hospital in Louisville, Ky. It still has to pass the Senate -- and the president's veto pen -- before the full $118 billion can be doled out.
  
  
• The House also rushed through another eight veterans' benefits bills, including the unanimous approval of the Disability Claims Modernization Act, which would speed up claims processing for those veterans recovering from disabilities clearly (i.e., serious physical combat wounds) connected to their military service. Senators Charles Schumer [D-NY] and Hillary Clinton [D-NY] have agreed to introduce Rep. John Hall's [D-NY] legislation it in the Senate in the "hopes of improving the delivery of compensation to veterans, their families and survivors."
  
  
• Meanwhile, the Senate passed the Veterans Compensation Cost of Living Adjustment Act, which would provide the nation's 3 million veterans drawing service-connected disability benefits the same cost-of-living increases Social Security recipients receive today. The legislation will have to pass the Senate and be signed into law before it can go into effect on December 1, 2008.
  
  
• The new GI Bill, dubbed "a GI Bill for the 21st century," officially went into effect on Friday, more than doubling the educational benefit each Afghanistan and Iraq veteran earns to $90,000 from $40,000. "The Post-9/11 GI Bill will cover full tuition at the most expensive public college in a veteran's home state, grant up to $1,000 for books and supplies, and provide a monthly living stipend."

• The Rural Veterans Access to Care Act, which would launch a three-year pilot program in selected regions (including the home of its sponsor, Kansas Rep. Jerry Moran [R-KS]) giving veterans in remote areas the chance to access health benefits from local non-military providers, was given the green-light by the House Committee on Veterans Affairs. Next stop: a full House vote.
  
  
• The VA is launching a pilot advertising program in Washington, DC., to broadcast the news that "It takes the courage and strength of a warrior to ask for help." The aim of the blitz is to get the word out on their veterans helpline number, 800-273-TALK (8255). Thanks go to Congressman Harry Mitchell [D-AZ], Chairman of the Veterans’ Affairs Subcommittee on Oversight and Investigations, who pushed the VA to become active rather than passive in engaging veterans. View the VA's public service announcement, featuring actor Gary Sinise urging suicidal vets to seek help, below the fold.
  
  
• Meanwhile, following a continuing spate of recent OEF/OIF veteran suicides (including six being cared for by Spokane's VA), Sen. Patty Murray [D-WA] will take to the floor of the Senate this afternoon to call for more from the VA than a mere ad campaign can offer. Time for the speech is not set in stone, but will not be before 5:00 PM ET/ 3:00 PM PT. C-Span 2 is set to carry it live in Washington State, and I believe should cover it nationally as well.
  
  
• One final political note: Presidential candidate Sen. Barack Obama has been in the Middle East over the weekend, meeting with Afghani and Iraqi leaders and U.S. military commanders. He's also been meeting with the troops. Video below from ABC News:

As Memorial Day approaches, both aisles of Congress have done something quite extraordinary: joined forces to deliver on another important reintegration resource -- education benefits -- for returning troops. Robert Pear for the New York Times:

Twenty-five Republican senators broke with President Bush and voted Thursday for a major expansion of veterans’ benefits as part of a bill to finance another year of the wars in Iraq and Afghanistan. The proposal, adopted by a vote of 75 to 22, also provides money for extended unemployment insurance benefits and other domestic programs to which Mr. Bush has objected. ...

While 25 Republicans supported the proposal, 22 opposed it. Forty-eight Democrats and two independents voted for the bipartisan measure, drafted by two Vietnam veterans, Senators Jim Webb, Democrat of Virginia, and Chuck Hagel, Republican of Nebraska. The proposal on veterans’ benefits was approved by a veto-proof majority, with support from conservative Republican senators including Saxby Chambliss of Georgia, James M. Inhofe of Oklahoma and John Thune of South Dakota.

The bill now goes back to the House, where its future course is somewhat uncertain. The House had endorsed a similar expansion of education benefits for veterans, but has also adopted policy measures to speed the withdrawal of American troops from Iraq. The Senate rejected efforts to limit the president’s hand in Iraq.

Senators John W. Warner, Republican of Virginia, and Frank R. Lautenberg, Democrat of New Jersey, said they were in the Senate today because of the help they had received under an earlier G.I. Bill. Mr. Hagel said the new legislation “fulfills the commitment that America made in 1944, and has continued, to honor every generation of veterans since World War II.”

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 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.

• 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.

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.

A few items to share:

• Stars and Stripes today offers an in-depth look at the return home of one Fort Drum, N.Y., soldier following a 17-month deployment to Afghanistan.
  
  
• The House Veterans Affairs Committee goes high tech this Tuesday when the April 1, 2008 Subcommittee on Health “PTSD Treatment and Research: Moving Ahead Toward Recovery” hearing is webcast at 10 a.m. EST.
  
  
• Cumberland County, Tenn., officially welcomes home its Vietnam veterans this weekend proving that it's never too late to thank those who serve in uniform.
  
  
• Military Handbooks' 2008 crop of pdf offerings have arrived -- and they're free for the asking.