Associated Press: By PAUL ELIAS SAN FRANCISCO — A federal appeals court on Monday reversed its demand that the Veterans Affairs Department dramatically overhaul its mental health care system.
A special 11-judge panel of the 9th U.S. Circuit Court of Appeals said that any such changes need to be ordered by Congress or the president.

The 10-1 ruling reversed an earlier decision by a three-judge panel of the same court.

The May 2011 ruling had ordered the VA to ensure that suicidal vets are seen immediately, among other changes. It found the VA’s “unchecked incompetence” in handling the flood of post-traumatic stress disorder and other mental health claims was unconstitutional.

The new decision said courts are powerless to implement the fixes sought by two veterans groups that filed the lawsuit against the VA in 2007. The lawsuits alleged that hundreds of thousands of veterans had to wait an average of four years to fully receive the mental health benefits owed them. Continue reading →

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Time: Battleland
Military Mental Health A Lagging Indicator
By Mark Thompson April 20, 2012 |Even as the pace of war, and the number of Americans waging it, is falling, their need for mental-health care is growing. On Thursday, the Department of Veterans Affairs announced it is boosting its mental-health workforce by 1,600 psychiatrists, psychologists and social workers – a 10% hike, as well as hiring 300 support staff to help them do their jobs.

“History shows that the costs of war will continue to grow for a decade or more after the operational missions in Iraq and Afghanistan have ended,” VA chief Eric Shinseki says. “As more veterans return home, we must ensure that all veterans have access to quality mental health care.” The trouble, of course, will be finding them. The civilian world has a shortage of such help, as does the Army. The VA will be no different.

The wars in Afghanistan and Iraq have triggered wave after wave of vets coming home with mental ills. They include post-traumatic stress and traumatic brain injuries, which often trigger depression, anxiety and other problems.

Much of the additional hiring will be to reduce current waiting times for mental-health care, veterans’ advocates say. Many wait weeks or months for appointments, and additional vets seeking care will only make such delays longer without additional help. Continue reading →

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Could blasts from bombs or grenades have a catastrophic impact similar to those of repeated concussions in sports, and could the rash of suicides among young veterans be a result?

New York Times: By NICHOLAS D. KRISTOF
Published: April 25, 2012

He was a 27-year-old former Marine, struggling to adjust to civilian life after two tours in Iraq. Once an A student, he now found himself unable to remember conversations, dates and routine bits of daily life. He became irritable, snapped at his children and withdrew from his family. He and his wife began divorce proceedings.

This young man took to alcohol, and a drunken car crash cost him his driver’s license. The Department of Veterans Affairs diagnosed him with post-traumatic stress disorder, or P.T.S.D. When his parents hadn’t heard from him in two days, they asked the police to check on him. The officers found his body; he had hanged himself with a belt.

That story is devastatingly common, but the autopsy of this young man’s brain may have been historic. It revealed something startling that may shed light on the epidemic of suicides and other troubles experienced by veterans of wars in Iraq and Afghanistan.

His brain had been physically changed by a disease called chronic traumatic encephalopathy, or C.T.E. That’s a degenerative condition best-known for affecting boxers, football players and other athletes who endure repeated blows to the head. Continue reading →

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Wednesday’s hearing before the Senate Committee on Veterans’ Affairs followed the release of an inspector general’s report Monday that found the VA has greatly overstated how quickly it provides mental-health care for veterans.

By Steve Vogel, The Washington Post
WASHINGTON — The Department of Veterans Affairs’ mental-health-care system suffers from a culture where managers give more importance to meeting meaningless performance goals than helping veterans, according to testimony before a Senate committee Wednesday.

The hearing before the Senate Committee on Veterans’ Affairs followed the release of an inspector general’s report Monday that found the VA has greatly overstated how quickly it provides mental-health care for veterans.

“They need a culture change,” Linda Halliday, the VA’s assistant inspector general for audits and evaluations, told the committee. “They need to hold facility directors accountable for integrity of the data.” Continue reading →

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By Steve Vogel, Washington Post
With the Department of Veterans Affairs facing a growing backlog of more than 900,000 disability claims, advocates for veterans warned Wednesday that pressure by the VA to reduce the numbers will increase the number of mistakes it makes.The number of pending claims before the VA stood at 903,000 this week, up 50,000 from January and an increase of about one-half million from three years ago, numbers driven by veterans returning from Iraq and Afghanistan with complex injuries, and a policy change making it easier for Vietnam veterans to file Agent Orange-related claims.

“The tidal wave of claims coming in on VA is putting unprecedented demand on VA,” Paul Sullivan, representing the National Organization of Veterans’ Advocates, told the House Veterans Affairs Committee at a hearing on the disability claims process.

“When VA focuses attention on expediting new claims, VA exacerbates the already bad situation by increasing the error rate, leading to even more appeals and even longer delays,” Sullivan added. Speaking at the hearing, Rep. Silvestre Reyes, (D-Tx.) expressed concern that the VA “culture overemphasizes quantity over quality.” Continue reading →

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By Cheryl Pellerin
American Forces Press Service
WASHINGTON, April 18, 2012 – Over the past 20 months, the Army has been working to refine the way it tracks and treats the most common form of battlefield brain injuries — concussion, also called mild traumatic brain injury, or mTBI.
The job isn’t easy, because even in the United States, where civilians experience traumatic brain injuries at the rate of 1.7 million a year, according to the Centers for Disease Control and Prevention, no single diagnostic standard exists for TBI.
In the words of experts at the 2nd Annual Traumatic Brain Injury Conference last month in Washington, treatment of TBI and especially acute, or rapid-onset, TBI is still “a major unmet medical need” worldwide.
“This is why we have our program,” Army Col. (Dr.) Dallas Hack, director of the Army’s Combat Casualty Care Research Program, told American Forces Press Service. Continue reading →

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From Stars and Stripes
By LEO SHANE III
Published: April 10, 2012
WASHINGTON — A coalition of nursing schools and medical organizations will train more than 3 million nurses in coming years on how to recognize and respond to post-traumatic stress disorder, traumatic brain injury and other unseen war wounds in veterans, White House officials announced Tuesday.

The news comes three months after officials from the nation’s leading medical colleges announced they’d work similar lessons on war wounds into their curricula.

But Amy Garcia, chief nursing officer of the American Nurses Association, said the new initiative should have a more immediate impact on veterans care, because officials can introduce the lessons into professional development courses, medical journals and other nursing resources in a matter of weeks, not years. Continue reading →

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Democracy Now!, March 27, 2012: As Staff. Sgt. Robert Bales is charged with murdering 17 Afghans, we speak with reporter Mark Benjamin, who revealed the Pentagon recently launched an emergency review of a controversial anti-malaria drug known to induce psychotic behavior. Mefloquine, also called Lariam, is used to protect soldiers from malaria, but has been known to have side effects including paranoia and hallucinations. It has been implicated in a number of suicides and homicides, including within U.S. military ranks. In 2009, the Army decreed that soldiers who’ve suffered traumatic brain injuries should not be given the drug. But this month, just nine days after Bales’ shooting rampage, the Army issued an emergency decree calling for the review to be expedited. “The military announced that this drug should not be given to people who have brain problems like traumatic brain injuries,” Benjamin says. “What the military has discovered is that out on the battlefield, those rules aren’t being followed, and some soldiers who do have these kinds of problems are getting this drug.” The Pentagon says there’s no connection between its review of mefloquine and the murders, but it’s refused to confirm or deny whether Bales was given the drug. Benjamin reports for the Huffington Post that the Pentagon initially ordered the review of mefloquine in January.

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The U.S. Senate declared March 30th as Welcome Home Vietnam Veterans Day, agreeing unanimously to a resolution introduced by Senator Richard Burr (R-N.C.), Ranking Member of the Senate Committee on Veterans Affairs.

On March 30, 1973, all U.S. troops withdrew from Vietnam under the terms of the Treaty of Paris. This March 30th, the Senate has encouraged Americans across the country to recognize Vietnam veterans for their sacrifice and demonstrate a warm welcome to these soldiers who returned from war to a politically divided country. Continue reading →

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The current VA manual that is used by VA employees is M21-IMR ( the manual rewrite ). This manual contains instructions to follow when VA employees receive claims, develop for evidence, and make disability compensation decisions.

The VA has an obligation to assist with claims, to obtain evidence, and to make reasonable efforts to obtain records, including federal records under the Veteran Claims Assistance Act (VCAA).The VA should make every reasonable effort to request all evidence needed to decide claims and to obtain federal records.
M21-IMR – Part III, Subpart iii, Chapter 1, Section A

To obtain evidence and to verify service information of the author of a “ buddy statement “ a Personnel Information Exchange System (PIES) request should be submitted by use of entry 3101.
M21-IMR – Part II, Subpart iii, Chapter 2, Section E

If the VA denies a claim that is supported by significant favorable evidence, the VA must discuss the value of the evidence and the benefit-of-the-doubt rule. The VA has a heightened obligation to carefully consider the benefit-of-the-doubt rule and corroborative testimony when military records may have been destroyed; and, the VA must explain why the evidence was not credible or could not be ccepted in cases where service connection cannot be awarded based on corroborative testimony.
M21-IMR – Part IV, Subpart ii, 2.A.2.

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