Kristina Derro
Veteran Advocate

The wars in Iraqa and Afghanistan have dragged on for over a decade now. Since 2001, the U.S. has sent more than 2.2 million troops to battle, more than 6,600 were killed, and 50,000 were injured. This is a dismal reality of war.

However, the strides that have been made in medicine as a result of the war are astounding. The signature wounds of both conflicts, post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), have led the Department of Defense to apportion hundreds of millions of dollars for research studies and treatment.

In the past six years, the Department of Defense has invested a minimum of $2.7 billion in understanding psychological and neurological injuries. $700 million has been apportioned for TBI research which has included an effort to develop a portable diagnostic tool for TBIs. Additional funding has gone towards researching combat wounds that failed to heal, partly attributable to unique bacteria present in Afghanistan.

The VA has its own set of priorities when it comes to researching. The VA is currently faced with rehabilitating veterans who have suffered complex wounds and are considered “polytrauma”, those who have sustained injuries to more than one organ system, or have severe brain injuries, or are amputees, or were severely burned. VA has worked on improving how it coordinates care to this group of veterans. It’s also worked on developing hearing and vision implants as well as robotic prosthetic devices. It even has pioneered its own TBI program which explores different treatment modalities like personalized medicine and nerve regeneration.

There are challenges in coordinating massive research programs and implementing them for our troops and veterans. A January 2012 report by the Government Accountability Office found that the Department of Defense’s mental health and TBI research needed better quality control mechanisms to report financial data. However, despite these limitations, some of the world’s best researchers and massive amounts of money are being utilized in an attempt to assist our nation’s troops and veterans.

Jim Fausone
Veteran Advocate

We receive about 300 emails a month asking for help. We try to sort out those VA disability claims where we can really help. The first two rules are you have to have a current disability and then explain how it is service connected. If you just feel entitled or need money or the government owes you for serving, it is not a claim that should be filed or re-filed. If you do not have a legitimate claim, you are part of the 900,000 claims backlog and only clog the system.

Today I received an email stating, “I am at the point that I must procure legal representation for my claim. I am on my third appeal. Have been diagnosed with PTSD and have knee problems as well”. The veteran was last denied in 2010.

If you wait until your third appeal, or second, to get help, then you are your own worst enemy. Either you don’t have a legitimate claim (an attorney or VSO should tell you that) or you don’t speak VA’s language and you need professional help.

Stop banging your head against the wall. Please get help earlier in the process.

Jim Fausone
Veteran Disability Attorney

One of the saddest situations we help with involves military sexual trauma (MST).  The rape of men and women in the military is a black stain on the Defense Department.  The VA disability process only makes this stain more stubborn.

We have developed an approach that looks at markers that show the MST even when it has not been reported.  The fact is that 70-80% of MST is not reported.  We often approach the VA process to prove the mental aspect of the MST, such depression, PTSD, etc.  We point out the fall off of performance ratings, discipline issues, AWOL, drug use, alcoholism or dark letters home.

This unique problem is now getting Congressional attention. The Ruth Moore Act aims to reduce the standard of proof for victims of military sexual assault so that they can more easily obtain benefits, similar to how the Veterans Administration two and a half years ago relaxed the burden of proof for combat veterans with post-traumatic stress disorder.  The Ruth Moore Act, if it passes, would make it so that victims need only a diagnosis of a mental health condition and a link between the assault and that condition to receive benefits.  This is a step in the right direction. Let’s hope Veteran Service Organizations support this bill and Congress acts on this bill.

http://www.stripes.com/news/us/maine-woman-inspires-federal-bill-to-help-military-sexual-assault-victims-get-va-benefits-1.207371

Jim Fausone
Veteran Disability Lawyer

President Obama and the Department of Veterans Affairs (VA) pledged in 2010 to work together to end homelessness among veterans within five years.

A report which was released to Congress in December 2012 by the United States Interagency Council on Homelessness (USICH) found that the number of homeless vets has, indeed, dropped.

According to the report, a 2011 assessment was done by the Department of Housing and Urban Development that found 67,495 veterans were homeless in January 2011 during a one-day count. That number was a 12 percent decrease from the same sort of one-day count a year ago, in January 2010. The USICH report points to an increase of funds for homeless assistance programs and an unusual level of cooperation and collaboration between multiple federal agencies as essential reasons for the lower numbers of homeless vets.

“Any decline in the number of homeless vets is a reason to applaud,” said veterans lawyer James Fausone. “Here’s hoping the joint efforts continue to help homeless vets and the numbers continue to decrease.”

Studies indicate that higher concentrations of homeless vets are found inCalifornia,New York,FloridaandTexas, in the urban areas of those states. Numbers for how many homeless vets reside in rural areas are harder to come by, as fewer services are available in rural areas and those homeless vets may less visible for any census undertaking.

The 2010 Annual Homeless Assessment Report found that homeless vets who are  Native American make up a large demographic; while Native Americans make up just 0.7 percent of the total number of U.S. veterans, they account for 2.5 percent of the veterans who are homeless.

Female veterans are also at a high risk for homeless, the study found. Women vets may return to civilian life that includes additional challenges, such as raising children as single parents, and some suffer from PTSD from military sexual trauma.  The VA has services geared specifically for women vets who are homeless or at risk of becoming homeless, including Supportive Services for Veteran Families Program (SSVF), which awards grants to private nonprofit organizations and consumer cooperatives offering support to low income veterans and veteran families who live in or are transitioning to live in permanent housing.

Jim Fausone
Veterans Disability Lawyer

Legislators in Missouri want a court created specifically for veterans.

Rep. Jay Barnes,R-JeffersonCity, has drafted legislation requesting thatMissouricircuit courts create a place specifically for current and former U.S.military who are struggling with substance abuse or mental illness issues. Barnes stated that the country owes it to the veterans to get them the treatment they need to get their lives back on track. The idea is supported by Rep. Charlie Davis,R-Webb City, who said the vet treatment court would run like a drug courts, where a judge would have the ability sentence a defendant to a rehabilitation facility or to perform some community service, without mandatory prison or jail time. Judges overseeing a veterans court can use the power of the court to force a vet to get treatment; proponents believe that recidivism rates for vets processed through a specialized vet court are lower than for those vets who do not go through a veterans court.

The court would be well-versed in Post-Traumatic Stress Disorder (PTSD) issues as well as Traumatic Brain Injury (TBI) issues, two conditions which can lead to law-breaking behaviors among military vets back in civilian life. According to a study in the Journal of Consulting and Clinical Psychology, vets with PTSD or TBI were far more likely than vets without either condition to be arrested. The bill currently proposed would not only help vets get treatment while taking into count their specific circumstances, the court would also be able to more efficiently deal with the backlog of veterans with court issues.

Objections that were previously raised in the Senate when discussing a veterans court included concerns from some that it would be used for veterans accused of committing violent crimes.

The veteran’s court model includes veteran mentors who assist with the program.  While some systems vary, generally, a collaborative team made up of the judge, probation officers, a public defender, and a Veterans Administration representative get together to review cases to decide which veterans will be admitted to veterans court for a multi-phase, long-term system.

The first veterans court of this type was put into place in Buffalo, New York, in 2008.  As of 2011, there were no reports of recidivism among the vets who completed the Buffalo program. There are now more than 70 veterans courts in theU.S.

http://www.ncsc.org/Topics/Problem-Solving-Courts/Veterans-Court/Resource-Guide.aspx
http://ncsc.contentdm.oclc.org/cdm/ref/collection/spcts/id/233
http://www.economist.com/node/18775315

Kristina Derro
Veterans Disability Lawyer

Heartbreakingly, a new report out from the Department of Defense shows that in 2012 more soldiers took their own lives than died in combat. Through November 2012, 177 active-duty personnel had committed suicide compared with 176 soldiers who were killed in action during the same time frame. Army suicides have increased by at least 54 percent since 2007.

Blame has been placed on the military culture in which soldiers believe they will be deemed weak and denied promotions if they seek mental health aid. There is also the problem that our soldiers today face multiple deployments during their service. However, the Army has referenced the anti-suicide strategy that that it put in place in April 2009 and claims that with the new programs in place it will just be a matter of time until they start making a dent in the issue. The Army stressed that soldiers are assured that seeking mental health counseling will not harm their chances at gaining a security clearance.

In July 2010, the Army released a report that purportedly explained its suicide epidemic. The report referenced loosened recruitment and retention standards due to the furious pace of repeated deployments. The Army claimed this allowed more than 47,000 people to remain in the Army, despite histories of substance abuse and misdemeanor crime. Obviously, this report only angered families who had lost members to suicide because it insinuates that those individuals were in some way “flawed” and prone to suicide, despite the fact that they served honorably. It also completely overlooked the fact that soldiers were subject to multiple deployments.

These findings only highlight the fact that the military culture is still one where mental health treatment is not fully embraced. It is also a sign that further programs need to be put into place in the military to prevent further suicides. Having our active-duty personnel being placed in harm’s way during combat is a necessary evil. Having them end up surviving combat, but dying once they get home due to a lack of a supportive military environment—the same military that sent them to combat—is atrocious.

Kristina Derro
Veterans Disability Lawyer

Massachusetts School of Professional Psychology has started a program that helps train veterans to become therapists who can help other veterans. The “Train Vets to Treat Vets” program has been funded for over two years by the state of Massachusetts with $250,000. The funds help the school reach out and train veterans to become therapists, as well as to allow veteran therapists to travel and visit college campuses around the state to promote mental health professions.

In the past decade, less than a half percent of Americans were serving on active duty in the military. This reduction in the population of active duty military personnel leads to a reduction in the population of veterans. As such, the population of veterans involved in the mental health field is decreasing. This has left many returning veterans feeling isolated while working with non-veteran therapists. Research has obviously shown that veterans feel more comfortable talking to other veterans. If the goal is acclimating recently-discharged veterans back to civilian culture, fellow veterans will need to be utilized. This program will provide veterans with the skills, training, and background to counsel these individuals.

Jim Fausone
Veterans Disability Lawyer

We hear from hundreds of veterans a month about VA disability claims or medical malpractice.  We understand the frustration of a veteran going it alone against the federal government.  When we have filed medical malpractice actions against the VA it seems like pushing water up hill. What gives you hope in these situations are stories like this one where a federal judge had the courage to find the VA’s actions negligent and properly find for a veteran.

On January 16, 2013, Senior U.S. District Judge James M. Munley  awarded $3.7 million to an Iraq War veteran from who sued the U.S. Department of Veterans Affairs after his war-induced post-traumatic stress disorder worsened because the agency prescribed him the wrong medication and treated him over the telephone.    The ruling was in favor of Stanley Laskowski III, 34, and his wife, Marisol, after a civil nonjury trial before the judge at federal court in Scranton.  It took 3 years for the case to be heard for this Marine Sergeant. He was required to testify and relive the stressors that gave him PTSD in Iraq.

In Judge Munley’s 69-page ruling, he agreed that clinicians with the local VA should never have prescribed Sgt. Laskowski new medications or changed his medications over the telephone to treat his PTSD.

Also when Sgt. Laskowski first sought help in April 2007, he was not treated by a physician for several months and instead dealt mainly with “physician extenders” – medical professionals like nurses and physician’s assistants, the judge wrote.

In addition, clinicians did not immediately offer psychotherapy to help him overcome nightmares, paranoia, insomnia and flashbacks spawned by his gruesome wartime experiences, according to court testimony.

The lack of appropriate care worsened his condition, causing him to make the rash choice to break into a pharmacy in Olyphant and steal prescription medications, his attorneys argued.  So this case should give veterans and their attorneys hope that there are reasonable federal judges who will find the VA at fault.  This Pennsylvania veteran had to fight his demons since his discharge in 2007 without appropriate care. Let’s hope this award allows him to get the care he needs and encourages VA to help all those veterans who need its help.

http://thetimes-tribune.com/news/carbondale-veteran-awarded-3-7m-in-ptsd-case-1.1430479

Jim Fausone
Veteran Disability Lawyer

We receive hundreds of emails a month from veterans, many of them claim hearing loss or tinnitus (ringing).  The problem is always connecting the disability to service.  VA traditionally looks only to certain types of jobs or combat status as contributing to hearing loss or tinnitus.

Among veterans, tinnitus and hearing loss are the most common service-connected disabilities, with more than 1.5 million veterans receiving compensation for those problems at the end of 2011. Of about 805,000 veterans who began receiving disability compensation that year, nearly 148,000 were for tinnitus or hearing loss, according to a recent VA report. By comparison, the next most prevalent disability was post-traumatic stress disorder, for which about 42,700 veterans began receiving compensation in 2011.

The VA, which has become the nation’s largest consumer of hearing aids in recent years as policy changes have allowed it to provide devices to nearly every veteran who needs them at little or no cost.  The VA is recognizing that multiple military occupations may result in hearing loss, not just the most obvious.  The advice to veterans is to continue to push for these disabilities even if the VA initial denies the claim.  An excellent article on the problem is in Stars and Stripes.

http://www.stripes.com/news/us/veterans-quietly-manage-ear-pain-1.203470

A revolutionary foam has been developed to help stop internal bleeding.  The developers of the foam, who believe it may save lives on the front lines, have received funds from the U.S. military to continue developing the product.

Researchers have been working on a medical foam which would limit the amount of internal bleeding once injected into the body. The foam is comprised of two separate liquids which, when injected, mix together, expand and harden to become a kind of internal wound dressing.  The technology, still in its infancy, would help save the lives of wounded soldiers far from medical facilities by slowing or staunching blood loss. Currently, there is no way to stop or slow the internal bleeding in the chest and abdomen prior to in-hospital care.

The polyurethane polymer foam mix is expected to control internal hemorrhaging for at least one hour and possibly longer, researchers say. The foam is designed to be easily removed by surgeons as a solid mass. Abdominal injuries are considered especially dangerous, as the best methods for treatment at this time to stop blood loss is with compression pads and tourniquets.

The foam mix was presented to the American Association for the Surgery of Trauma annual meeting in Hawaii earlier this year. The study on the foam use estimated an increase in survival rates for liver injuries from 8 percent to 72 percent and a dramatic reduction in blood loss for more than three hours. The foam may be used in as many as 50 percent of battlefield wounds currently seen, either to control hemorrhaging far from medical care or to manage care when facing multiple injuries, such as head injury and major internal bleeding.

The product has yet to be approved by the Federal Drug Administration. It still needs extensive testing to ensure it is safe and effective, and a plan for staff training on use must be developed, researchers caution. Polyurethane foam is widely used for thermal insulation and inside refrigerators.

A loss of blood has long been a major cause of death in war, but battlefields have also been the place where many medical inventions were developed, due to necessity. Though ligatures had been used by Arabs and the Romans in ancient times, the practice had been dropped. It wasn’t until the 1600s when during the Siege of Turin, someone “reinvented” the us of ligatures to stop bleeding arteries.  Previously, most battlefield wounds were treated with cauterization and boiling oil.

http://www.bbc.co.uk/news/technology-20693705