Veterans Groups need to put more pressure on Shinseki and Congress to allow VA doctors to communication with deploying milita

[This touches on the issue of troop dwell time which we are currently collecting data on for another story. VT, Ed.]

A VA psychiatrist hospitalized Juneman but never notified the National Guard unit of his patient’s distress over redeployment. Juneman was released that month, and then missed follow-up appointments.

In early March 2008, Juneman hanged himself in his Pullman apartment. His body was discovered some 20 days later, The Spokesman-Review newspaper reported. His death underscores an unsettling new reality for VA health care providers. Unlike in decades past, they now often treat veterans headed back to war. And this can pose an ethical challenge for VA doctors if they think PTSD, traumatic brain injury or other unhealed wounds could put a patient or others at greater risk on the front line.

Confidentiality rules generally prevent them from informing active-duty commanders of a veteran’s medical problems, unless the veteran signs a release.

In some instances, veterans may resist signing a release, even when they have serious cases of PTSD and traumatic injury. These veterans might be floundering in civilian life and look forward to a return to combat, seeing that as a way of putting their lives back on track. Or their sense of duty makes them balk at opting out of service, even if they are reluctant to return to the war.

"In Tim’s case," Hergert said, "he had already been placed under suicide watch, and somebody should have told his unit. Perhaps doing that would have saved my son. What he really needed was for the VA to be an advocate for him."
As a growing number of combat veterans head back to war zones, the gaps in knowledge about the mental health of reservists are a concern to some National Guard leaders.

[Remember our article as one senior Army officer calls for a quick exit from Iraq another calls for more troops for Afghanistan, so minus a significant SURGE in military enlistments or the draft, the ops tempo is not going to get any better for our exploited patrioitic volunteers. That’s why we are going to be pushing more VSOs to get on board for adequate dwell time for our troops so that they can either recoup or get the rehab they need before sending them back into combat. If nothing else, we can buy time for them to complete their eight year commitment before being sent back a third or fourth time gambling with death. VT. Ed.]

"The VA is very protective of this information, as they should be," said Lt. Col. Carol Munsey, deputy state surgeon for the Washington Army National Guard. "But if you’re talking about a person who is not doing well, then the command needs to know about it."

Young men drafted into past wars usually returned to civilian life free of obligations to continue serving in the Reserves or the National Guard.

[Note: Unlike the All Volunteer Force where a youngster signs a basic eight year commitment, during the draft the commitment of conscription was legally limited to only two years. Far too many troops tell us that they rarely think on an eight year commitment when enlisting and the military recruiter doesn’t highlight that fact. VT. Ed.]

But things have changed as an all-volunteer military, whose numbers represent less than 1 percent of the nation’s population has become responsible for fighting two long-running wars.

[Another factor that makes adequate dwell times a necessity not just nice to have. VT. Ed]

Each enlistee typically has an eight-year service obligation. The active-duty portion might involve multiple tours in a war zone, and returning soldiers face more years of possible call-up to Reserve or National Guard units that remain a key part of the military campaigns in Iraq and Afghanistan.

[We must emphasize that in order for our government to not have to demand commitment to it war(s) from the American people Reserve or National Guard units must remain a key part of the military campaigns in Iraq and Afghanistan the alternative would be THE DRAFT. With conscription would come of course an end to the war(s), and an Americans would clearly define America’s lack of commitment to the one percent who do the fighting and dying for the rest of us. VT. Ed.]

That means soldiers’ medical care can be fragmented: VA doctors treat them when they return to civilian life; they’re back to Army doctors if they are called up again.

[Civilian doctors of course have no commitment nor obligation to the Pentagon to ensure troops are sent back into combat no matter what. Military doctors on the other hand are under Pentagon control with one objective in mind – to ensure an adequate fighting force in terms of numbers is able to be fielded, so that the brass does not have to ask for supplementary manning via conscription. VT. Ed.]

Army doctors and commanders [also] generally do not have access to VA medical records that might help them assess whether a veteran should return to front-line duty. Instead, it’s largely up to the veteran to decide what – if anything – should be disclosed to commanders.

At a VA Puget Sound counseling session last year for veterans with PTSD and traumatic brain injury, the topic aroused intense debate, said Mark McPherson, a Washington National Guard veteran from Seattle.

"I had a very strong discussion with one of these guys and told him he wasn’t doing any favors to himself or others by not disclosing," McPherson said. "But he was a sergeant, and he wanted to go. For a lot of these guys, the only part of their identity that seems to make sense anymore is the one that fits into the uniform."
For VA officials, confidentiality is an important part of their outreach effort to help persuade veterans to seek treatment. A 2008 study by the Rand Corp. found that nearly 20 percent of men and women who served in combat reported symptoms of post-traumatic stress disorder. Yet nearly half had not sought treatment, with many fearing that could harm their military careers, according to the study.

VA officials worry that number would rise even higher if confidentiality standards were loosened.

Munsey, the state’s deputy surgeon, says some Washington Guard veterans do volunteer to release VA information about PTSD and other health issues. The state Guard also has all soldiers headed for deployments fill out a health checklist. When issues are disclosed, some soldiers still are able to deploy if doctors conclude they won’t put themselves or others at undue risk.

"It’s all self-reporting," Munsey said. "All the soldiers are required to go through the process. But how do I know they are telling the truth?"

When Tim Juneman first sought help from the VA in early 2008, he was trying to leave the military behind and fashion a new career as a speech pathologist. Serving with the Fort Lewis-based Stryker Brigade had put him into the thick of the Iraq war. His brigade was slammed by more than 1,380 roadside bombs during a year in Mosul, according to a brigade tally.

After four years in the Army, Juneman opted to finish his military commitment by serving in the Washington National Guard. He thought the Guard would grant him at least two years [dwell time] stateside, according to his mother. In 2007, he enrolled at Washington State University. He struggled with headaches, insomnia and other problems, but his studies appeared to be going well. Then, in the fall of 2007, he learned that his National Guard unit would be sent to Iraq the following summer.