1 June, 2018 09:17

WSJ: Injured in Training or Injured in Combat? It Makes a Big Difference in Vets’ Access to Care

Many veterans who say they experienced traumatic brain injury while firing shoulder rockets in training are finding themselves in a medical Catch-22

By Ben Kesling

Parker Dial was a 21-year-old Marine on his way to Iraq in 2007 when his unit stopped in Kuwait for final training before going into combat. That training included a variety of shoulder-fired rockets, and Mr. Dial shot five in one day.

He said he didn’t feel the effects of the first few rockets. Then he shot a shoulder-launched, multipurpose assault weapon, or SMAW, two times in quick succession.

“The first shot sucked out my ear protection,” Mr. Dial recalled. “I followed up with a second shot and was completely concussed, and had some blood coming out of my ears.”

Mr. Dial, a paramedic who now lives in California, said his injury led to lasting migraines and other symptoms associated with traumatic brain injury. But because the Marines, like the rest of the military, don’t record when or how many rockets are fired in training, he said it has been difficult to get the VA to recognize the injury.

Inadequate record-keeping, gaps in policy and limited research have left military veterans like Mr. Dial, who file claims for brain injuries related to the use of weapons in training, struggling to get treatment from the military or benefits from the Department of Veterans Affairs.

Traumatic brain injury, or TBI, has become one of the signature injuries of the current generation of troops, with some 380,000 personnel affected since the beginning of the wars in Iraq and Afghanistan, according to the Defense Department.

Lawmakers are pushing for new requirements to track and prevent blast exposure. The Army is making changes that will likely help identify these injuries, including for the first time logging when troops shoot shoulder-fired rockets in training. The Marine Corps is considering a similar move. That could eventually drive VA policy changes regarding disability claims, officials said.

Until changes arrive, some veterans say they are stuck in limbo.

The VA often requires conclusive proof, like a doctor’s note, before it will cover training injuries. While troops who suffer brain injuries in combat often have documentation or can more easily tie long-term effects to combat action, that often isn’t the case with injuries that occur in training.

“There’s no proof of it, really,” Mr. Dial said of his injuries. “There’s my statements and pictures of us holding rockets. But that’s just a picture of me holding a rocket.”

Like many who suffer injuries in training, Mr. Dial said he didn’t seek immediate medical attention because of the nonchalant attitude troops take to such injuries, which at the time can seem like just an acceptable hazard of the job.

Marine spokesman Capt. Christopher Harrison declined to comment on Mr. Dial’s case, but said Marines go through a pre-firing safety briefing. That procedure could change in the future, he added.

The VA judges disability claims on a case-by-case basis, said spokesman Curt Cashour, and case managers consider veteran statements, “buddy statements” from people who know how the injury happened, and the possibility that clear documentation doesn’t exist. Case managers are often instructed to look favorably, rather than skeptically, on claims.

Statements, however, don’t often provide the conclusive proof needed for claims. Mr. Cashour said the VA could change its policies if “pertinent information becomes available,” such as new trends among troops or new scientific data.

Paul Scharre, a researcher at the defense think tank Center for a New American Security, is among those who have gathered data and documented trends, hoping to sway the military and VA.

“Anecdotally, the soldiers who have fired these antitank weapons a lot know that they don’t feel well afterwards, but we now have scientific data linking this to cognitive issues,” he said.

Mr. Scharre said the military has been slow in the past to identify and recognize long-term harm from Agent Orange exposure, Gulf War syndrome or exposure to burn pits in Iraq and Afghanistan.

The Army began extensively researching concussions in 2007 and started noticing the potentially harmful effects of troops firing their own weapons in training a few years ago, said Tracie Lattimore, director of the traumatic brain injury program with the Office of the Army Surgeon General. But the issue needs more study before broad policy changes begin, she said.

“I don’t think we are prepared right now to say there is this 100% connection,” Ms. Lattimore said, adding: “There is no denial that these weapons are producing higher levels than ideal of blast overpressure.”

The Surgeon General’s office is working with Army field units to require “shot logs,” a system of documenting when, where and how many times troops fire rockets in training. The Defense Department already has limits on the number of rounds troops can fire at any given time.

Capt. Harrison, the Marines spokesman, said the Marines are “in the initial stages” of pursuing a pilot program for blast monitoring. He added that they could institute shot logs as well.

Lawmakers are also pushing for tighter controls. Sens. Elizabeth Warren (D., Mass.) and Joni Ernst (R., Iowa) recently introduced legislation to require the military to track troops’ exposure to blasts in both combat and training and update training guidelines.

Such future changes are little help to veterans like Russell Langshaw, who served in an Army Ranger regiment in the 1990s. While he never saw combat, Mr. Langshaw said he fired a rocket launcher called the Carl Gustaf more than a hundred times over his roughly four years of service.

In the decades that followed, Mr. Langshaw said, he began experiencing memory loss and symptoms of post-traumatic stress. Since he’d never been in combat, it didn’t make sense to him. His first disability claim was for hearing loss, not brain damage.

He’s currently seeing a counselor for his PTSD-type symptoms. The counselor said Mr. Langshaw should appeal his disability claim to account for brain injury. But he has no conclusive record to cite.

“I got my service records for my appeal, and that was one of the things I was going to do is say, ‘Hey I fired all these rounds.’ But there’s no shot log,” he said.

All he has are the memories of his service and the many rounds he fired.

“We were proud of it. We were the big gunners, and it was a lot of fun,” he said. “We had no idea what it was doing to us.”

WaPo: The Health 202: This is going to be the next VA secretary’s first big task

By Paige Winfield Cunningham May 31 at 9:14 AM Email the author

THE PROGNOSIS

A weighty task awaits Robert Wilkie upon his likely installation as Veterans Affairs secretary: Spelling out the precise details of a hefty new law making it easier for military veterans to access private medical care.

Congress passed the VA Mission Act last week to try to ease the burden on military hospitals and clinics, which lack capacity to treat a huge influx of aging Vietnam-era veterans and younger service members returning from the wars in Iraq and Afghanistan. One-third of veterans get government-paid care in private settings under the 2014 Choice Act, but that program has been heavily criticized as being too unwieldy and bureaucratic.

Lawmakers and veterans’ groups hailed the bipartisan Mission Act as a critical change. But it’s important to realize that there’s a lot in the text that is open to interpretation by the VA secretary, who will have to lead the agency in defining who is eligible to visit a privately run facility instead of one of VA’s 1,200 health-care centers.

Two things need to happen first, though. President Trump has to sign the Mission Act into law – veterans’ advocates told me the White House is tentatively eyeing June 7 for the signing — and Wilkie needs to be confirmed by the Senate.

Yesterday, he stepped down as acting secretary (a post he has held on a temporary basis since Trump fired Secretary David Shulkin in March) to await the confirmation process. Former VA chief of staff Peter O’Rourke will serve in his place in the meantime, the White House said.

From Leo Shane III, deputy editor for Military Times:

White House announces Robert Wilkie has stepped down as acting VA Secretary in advance of his formal nomination. Peter O’Rourke becomes acting Sec now. Deputy Sec Thomas Bowman is retiring.

— Leo Shane III (@LeoShane) May 30, 2018

Wilkie is expected to sail through his confirmation process with relative ease, in stark contrast to Trump’s initial, disastrous VA nominee, Ronny Jackson. He has strong backing from veterans’ groups and was confirmed once (unanimously) by the Senate as a Pentagon undersecretary for personnel and readiness.

Yet his confirmation hearing hasn’t been scheduled because the Senate Veterans’ Affairs Committee is awaiting official paperwork from the nominee and the White House. Press secretary Camlin Moore said yesterday the panel will “expeditiously vet and process the nomination once the paperwork has been submitted.”

Sen. Jon Tester, top Democrat on the Veterans Affairs Committee, appears quite open to supporting Wilkie:

.@SenatorTester on Wilkie’s nomination. Trump blasted Tester after he spoke publicly last month about allegations made against Ronny Jackson, his former pick for VA secretary pic.twitter.com/PbJt1GqQoZ

— Nikki Wentling (@nikkiwentling) May 18, 2018

Assuming all these pieces fall into place, Wilkie will officially take the reins at VA sometime this summer. And once he does, one of his first big tasks will be to collect input from advocates and propose eligibility rules for when veterans may seek outside private care.

“We recognize that rulemaking is a critical component in this,” said Louis Celli, the American Legion’s executive director of government and veterans affairs. He added that the group wants to make sure the rules comply “with the spirit of what was discussed.”

The Mission Act overhauls the Choice program in several key ways, including doing away with a fixed requirement that a veteran must have waited for at least 30 days for an appointment or lived at least 40 miles away from a VA facility to go outside the system. The legislation doesn’t set a new standard, but instead lays out some general principles for the agency to consider as it proposes a more nuanced set of guidelines.

“There were so many problems with that standard,” Celli said. “So Congress is trying to give the VA intelligent flexibility to allow them to make smarter decisions.”

For example, the new law says VA should take into account whether the veteran lives far from a VA hospital, if the wait for an appointment is too long and if the care at the closest VA hospital is “deficient” compared with other private and VA medical offices. The veteran could appeal if the request was rejected. It would also require the agency to allow a veteran to see a private doctor if they agree with their VA physician that it’s in their best interest.

The Congressional Budget Office has estimated that an additional 640,000 veterans each year would go outside the VA system under the new law. That could get costly — the CBO has projected the Mission Act would cost $46.5 billion over a five-year period — so veterans groups say they’re also concerned with making sure all VA resources are being fully spent before veterans are sent to outside care.

Besides the eligibility revisions, the Mission Act also consolidates the agency’s multiple private-care programs, opens the door to contracting with an outside company to streamline billing and expands VA’s popular caregiver program by extending stipends and other benefits to veterans of all eras, not just families of injured post-9/11 veterans.

The agency also would be required to review all its underused hospitals, leading to possible closures — a provision conservatives especially liked. A telehealth program would expand and VA would get new tools to recruit medical professionals to address thousands of troubling vacancies.

Military Times: White House finalizes plan to stem suicides among recently separated troops

By: Leo Shane III  13 hours ago

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WASHINGTON — White House officials on Thursday finalized their promised interagency plan for suicide prevention among veterans and military members, pledging an expansion of outreach and peer support services across a range of government departments.

The move includes bolstering the Defense Department’s Military One Source program to include access to mental health resources and other support services for a year after troops leave the service. It also sets a goal of a 20 percent reduction in suicides among troops and veterans by 2025, in keeping with broader administration targets for the nation’s mental health.

The new plan is the culmination of four months of work following President Donald Trump’s executive order in January promising more counseling and mental health care for recently separated servicemembers, who face a significantly higher risk of suicide than other military groups.

That order called for a new plan from the Departments of Defense, Veterans Affairs and Homeland Security by mid-March. But as the deadline approached, Trump fired VA Secretary David Shulkin via Twitter, throwing the department’s leadership in to disarray.

VA officials did agree to a draft plan before Shulkin’s firing and worked on revisions through March and April. Trump gave his final approval to the outline this week.

Acting VA Secretary Peter O’Rourke called Thursday’s announcement “a critical first step for ensuring that service members transitioning from active duty to veteran status understand that VA, DoD and DHS are committed to easing the stress of transition by providing the best mental health care possible.”

The entirety of the 16-point plan won’t be enacted until summer 2019, although several portions are expected to be rolled out in coming weeks.

They include establishing new open, twice-monthly peer groups at VA Whole Health locations by the end of July, increased use of monitoring tools in veterans health care programs by the end of August, and new protocols put in place this spring to require more check-up calls to recently separated veterans.

Plans for later this year include new mental health screening by defense officials for all transitioning troops and a new public service campaign to raise awareness of military and VA mental health services. Officials are also looking at changes to the Transition Assistance Program and more pre-separation registration for VA health care.

A progress report on the efforts is expected this fall. Officials estimate the changes — which do not have a stated cost — could bring more than 32,000 new veterans into VA health care programs.

Full details on the plan are available on the VA’s web site.

An estimated 20 veterans a day take their own lives. Of those, the majority have little or no contact with VA services.

To contact the Veteran Crisis Line, callers can dial 1-800-273-8255 and select option 1 for a VA staffer. Veterans, troops or their families members can also text 838255 or visit VeteransCrisisLine.net for assistance.

Military Times: Stunning failures found in Global Train and Equip counter-terrorism programs

By: Geoff Ziezulewicz   14 hours ago

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As billions of U.S. taxpayer dollars continue to flow into projects aimed at increasing counter-terrorism capabilities for countries from Jordan to the Philippines and Romania, a new government watchdog report raises questions about how effectively the Pentagon and State Department are overseeing these projects.

The Global Train and Equip program was first authorized as part of the 2006 defense bill.

It has since bankrolled training, weapons and other supplies for local forces via hundreds of projects around the world, according to a Government Accountability Office report released this week.

But the Pentagon continues to struggle with the task of ensuring the right gear is going to these indigenous forces and that such projects are sustainable, according got the GAO.

Of 21 Global Train and Equip projects undertaken in 2016 and 2017, just eight resulted in improved capabilities for the local forces, according to the GAO.

Reasons the projects failed included proposal design shortfalls, equipment suitability and procurement problems, partner nation failings and staffing shortages, the GAO report found.

The Pentagon’s track record in assessing the effectiveness of such projects has been minimal as well, according to the GAO.

Of 262 Global Train and Equip projects undertaken by the Pentagon from 2006 to 2015, just a third of the initiatives were assessed for efficacy, according to the GAO.

Nearly $2 billion was allocated for such projects in fiscal years 2016 and 2017 alone, according to the GAO.

Those projects included nearly $83 million in force structure and counter-terrorism training to Niger, where four U.S. soldiers were killed last year in a battle with Islamist extremists.

Among other efforts, about $132 million was doled out for helicopter and artillery needs in Kenya and $83 million was allocated for Tunisian intelligence, border training and helicopter programs.

The lion’s share of the funds in 2016 and 2017, about $865 million, went to gear and training efforts in Jordan and Lebanon, according to the GAO.

This week’s GAO report follows a 2017 Defense Department Inspector General assessment that also found problems with the Global Train and Equip program.

That IG report found the Pentagon had failed to develop a program strategy with clear objectives and an overarching plan for execution, nor did it allocate enough staff and resources to effectively manage the sprawling effort.

It also found that project proposal guidance “was not sufficiently instructive or enforced,” and that project proposals did not always include enough information regarding costs, risks and benefits.

The IG report also noted that updates provided to Pentagon and State Department leaders, as well as to Congress, had not been “sufficiently informative in explaining the collective impact” of the program.

Pentagon officials are supposed to consider project objectives and the ability of a partner nation to absorb new capacity when deciding to proceed, according to the GAO.

An assessment of the country’s current capability and future sustainment needs are also supposed to be part of the equation, but the GAO report found that only happened in less than 75 percent of the proposals.

DOD officials countered that some projects did not require long-term sustainment.

GAO also notes that the Pentagon has made improvements in ensuring that all four factors are part of these multi-million-dollar projects.

Pentagon officials told the GAO that “an informal quality review process” was enacted to ensure that proposals include all four elements, but the GAO report urges that the DoD put such a review in formal writing to better track the program’s efficacy.

Only 19 percent of proposals included information on whether a partner country could absorb the new tools or training in 2015, but that percentage has risen to more than 80 percent as of 2017, according to the GAO.

Improving that percentage involved the DoD tweaking its proposal template, the report states.

“According to DoD officials, they updated the proposal template to better identify problems with absorptive capacity because of its importance and because it is an area of high congressional interest,” GAO investigators wrote.

Officials told the GAO that assessing whether a country can take on first-world weapons systems or training is a challenge.

“One senior official also noted that pressing national security goals, such as quickly developing the capabilities of strategic partners for ongoing operations, required the U.S. government to assume some risk by supporting a project without fully assessing or documenting a partner nation’s absorptive capacity,” the report states.

Some projects have failed to achieve their goals due to poor designs that fail to reflect the realities of a partner nation, according to the GAO.

Partner nation shortfalls in various projects have included the receiving government not using assistance in the intended way, inability to maintain equipment and difficulties in manning and training receiving units, the GAO found.

“For example, the 2016 assessment report for a 2015 project found that, although the recipient unit was able to plan and execute more complex operations to combat regional threats, such as Boko Haram, in a professional manner, the assessment team received no evidence that the unit had played more than a minor role in counter-Boko Haram operations,” according to the GAO.

The report also notes that a 2013 project was stymied due to the low education levels of the local forces that hindered their ability to operate and maintain modern combat systems.

One 2015 project was hindered because the uniforms and helmet procured for the local forces did not match the body size of those local forces, according to the report.

“Additionally, the assessment noted that consideration was not given to providing body armor with built-in buoyancy for personnel operating in a maritime environment,” according to the GAO. “Further, the assessment noted that bright orange life jackets were provided as tactical equipment, when a subdued color would have been more appropriate.”

A 2012 project was hindered because the Army didn’t have a contract to obtain diesel vehicles from a specified manufacturer and had to rely on vehicles for which there were no dealerships in the host country, the report states.

One 2016 assessment of construction projects found that firms weren’t willing to go to remote locations for the projects, and that the local government sometimes failed to keep up its end of the deal, according to the GAO.

“The assessment found that relying on a partner nation to provide the additional funds frequently results in the construction not being completed,” the report states.

While DoD officials told GAO investigators that pre- and post-project assessments and monitoring of the projects had been inconsistent in past years, the department was working to improve its track record.

Pentagon officials cited insufficient staffing and high turnover among security cooperation officers at U.S. embassies as reasons why oversight had faltered in the past, according to the GAO.

“The officials overseeing project implementation may not have been responsible for project development and are less likely to understand the capabilities of the intended recipient units or the capability gaps that could be addressed by equipment and training,” the GAO report states.

An increase in funding for the Global Train and Equip program left staffers swamped, according to the GAO, with three people generally managing all the projects at a combatant command, according to the GAO.

“Staff were unable to maintain consistent levels of due diligence on issues such as ensuring that proposal packages addressed absorptive capacity and sustainment planning,” the report states. “According to DOD officials, negative effects of this inconsistent due diligence included the arrival of equipment not suitable for operations and overestimation of one partner nation’s absorptive capacity, necessitating unplanned training and resulting in project delays.”

Pentagon officials told the GAO they are taking steps to increase staffing in these areas.

DOD officials concurred with the GAO’s recommendations to ensure all four parts of a project proposal are followed.

The State Department, which partners with the DOD on such projects, did not respond to the GAO’s recommendations, according to the report.

Stripes: VA hospital in NC purchased more than $1M in supplies that it didn’t use

By NIKKI WENTLING | STARS AND STRIPES Published: May 31, 2018

WASHINGTON — The Department of Veterans Affairs hospital in Durham, N.C., spent more than $1.3 million on medical supplies that it didn’t need or use, according to documents released Thursday by the U.S. Office of Special Counsel.

The Durham Veterans Affairs Medical Center purchased $385,000 in computer equipment in 2014, as well as about $1 million in items such as vital signs machines, dental chairs and cabinets that were discovered years later, unused and still in boxes.

“The equipment was stored in an off-site storage facility for several years with no plan in place to put the equipment into use, or to place it at another VA facility with a bona fide need,” reads a VA report to the Special Counsel in 2017.

An anonymous whistleblower at the Durham VA alerted the Special Counsel to the problems in 2017. The Special Counsel is an independent federal agency that investigates whistleblower complaints.

The VA has now addressed the problems, Special Counsel Henry Kerner said. The investigative documents were publicly released Thursday because the office now considers the case closed, 15 months after the Special Counsel brought the problems to the attention of VA leadership.

During the past year, the Special Counsel had to ask the VA on multiple occasions to send more information to fully explain the situation – amounting to months of back-and-forth between the VA and the Special Counsel that Kerner said was “regrettable.”

“Our veterans deserve the very best medical care, but when equipment sits unused in storage, the VA is wasting taxpayer resources,” Kerner said in a prepared statement. “After a whistleblower revealed these purchases, the VA is finally taking steps to ensure that the medical equipment will be used to care for our veterans.”

In addition to the unused equipment, it was discovered last year the hospital stockpiled and used bottled water that expired in 2010, violating VA policy that bottled water be used within one year.

The hospital was ordered to dispose of the expired water and develop a plan to put the unboxed equipment into use in Durham or at another VA hospital. The VA Administrative Investigation Board found no violations of federal law.

The purchase of unneeded supplies was attributed to errors with how employees turned in equipment – problems that have existed for a decade. With thousands of items, employees didn’t properly record when they turned them in.

“Since 2018, there have been significant failures in the turn-in program that can be attributed in many instances to lack of employee/supervisory ownership and accountability,” one VA investigative report reads.

The logistical problems in Durham are analogous to issues discovered last year at the Washington DC VA Medical Center, where roughly $150 million in medical supplies were not inventoried. The VA Inspector General blamed the widespread and long-running issues in DC on a pervasive “culture of complacency.”

The Special Counsel said the VA started training employees in Durham late last year about the equipment turn-in process.

KCEN TV: Women veterans share their trailblazing stories

"It’s about time they realize we’re not just second citizens. All of us try to do our share. And some have done a lot more than their share," said Specialist Eileen Parker, a member of the Women’s Army Corps Veterans’ Association.

Author: Jillian Angeline

Published: 5:28 PM CDT May 30, 2018

Updated: 10:27 PM CDT May 30, 2018

Many women were trailblazers in their time, some overcoming both the gender and racial barrier.

In honor of Women Veterans Day coming up on June 12, we are asking veterans from the Women’s Army Corps Veterans’ Association to share their stories.

Retired Sergeant First Class Acquanetta Pullins was in basic training with some women who had never seen an African-American woman before in the 1970s. It was just one of many challenges she has had to push through in her 20 years in the U.S. Army. She said it was about survival and persevering through.

"Yes, even as far as going through initial training, going through school. In fact, I had one instructor say I don’t know if you’re going to make it, and it was in an environment where it was mostly male. Of course, that was just a challenge for me," Pullins said.

But she said that was more motivation, a motivation born from inspiration from her father, a soldier, who was often the only African-American in his groups at the time. Pullins did not just deal with the gender barrier, like many of her counterparts.

"Going through basic, I go through basic with women, with women who had never seen a black person in their lives," she said.

And Pullins is not alone. Women’s Veterans Day in the state of Texas this year recognizes women’s achievements in the military and their sacrifices for the United States. Women from the Women’s Army Corps Veterans’ Association fought an uphill battle, with naysayers along the way.

"It’s a breath of fresh air, considering what women before me went through to get me here," Retired Sergeant Chrea Jones said.

Pullins looked back on those changing times.

"I wonder if it was a challenge for the men, in the sense of, for the men to realize, the realization that women on the way, women were here and they weren’t going anywhere and that kind of was my attitude in terms of ‘this is my job, this is what I’m going to do,’" Pullins said.

Pullins said her education was very important to her and she stresses the importance of education to her younger generations too.

It’s about time they realize we’re not just second citizens. All of us try to do our share. And some have done a lot more than their share," said Specialist Eileen Parker.

Parker enlisted in the Army in 1959. She and her colleagues are trailblazers.

"What will I do? And what will I not do? Promotions aren’t worth some things because I need to be able to look in the mirror and I need to be able to look at the counterparts. I have a daughter," Retired Sergeant First Class Adrienne Evans-Quickley said.

The Women’s Army Corps veterans are encouraging all women vets to step up, tell friends and neighbors, and discuss their service proudly. The organization encourages women to discuss their service not just on June 12, but also throughout the year.

"June 12 is a long time coming. So, for those that came before me, thank you," Jones said.