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

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ptsd002As this story tells us, it is a dilemma faced by VA doctors caught between their legal confidentiality obligations to their patients and the obligation to tell deploying military units that their patients may be harmful to themselves or their unit if sent back into combat.


The barriers to this are the fear that if they know that a VA doctor is going to report them to their units, more troops will not show up for treatment thus leading to more suicides. However, looking at this in a humane way, the basic humanitarian question needs to be asked. Which is more immoral failure to maintain confidentiality with a patient who is a potential harm to himself or others or waiting for something to go terribly wrong once that trooper deploys his or her second, third, fourth or more time to a war zone?


Robert L. Hanafin
Major, U.S. Air Force-Retired
Veterans Advocacy Editor
VT News Network &
Our Troops News Ladder

     

Veterans’ PTSD Places VA Doctors in Dilemma – To Deploy or Not To Deploy

2009491260_400                                         Iraq War Veteran Tim Juneman went to a Department of Veterans Affairs psychiatrist in January 2008 to talk about his recurrent thoughts of suicide.

     PHOTO RELEASED BY THE JUNEMAN FAMILY

The 25-year-old Washington State University student was had survived a year of tough fighting that left him with a twin diagnosis of post-traumatic stress disorder (PTSD) and traumatic brain injury. His biggest worry, according to notes taken by the VA psychiatrist, was a looming call back to active duty by the Washington National Guard. The order would have sent the specialist back to Iraq.

[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.

[Simply put then get a Veteran to sign a release, it’s called proactive medical treatment. Fine the Vet doesn’t want to sign a release or let his unit commander know for whatever reason. That must and should be the Veteran’s call not the VA’s.  However, to say that Veterans might be floundering in civilian life and looking forward to a return to combat, is like saying Veterans in the Individual Ready Reserve (IRR) return to combat because they can’t hack it outside the military. Bullshit. Now, of course sense of duty or obligation to those they left behind makes a little more common sense. Point: Obviously our young Veterans face a more deadly dilemma that either the VA or DOD excuses for not talking to eachother. VT, Ed. ]

VA officials say they must comply with privacy rules and are not required to share a veteran’s health status with the Defense Department, according to a statement released by the VA in response to a Seattle Times inquiry. But VA rules do allow disclosure under certain limited circumstances. These exceptions include "to assure the proper execution of a military mission," according to a VA privacy statement. But VA officials define such exceptions narrowly, and the patient information typically is released only if the military requests it.
Jacqueline Hergert, Juneman’s mother, says the VA should have contacted the National Guard about her son’s plight.

"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.

"He was coping the best he could, but I think this overwhelmed him," Hergert said. She said she was unaware of her son’s suicidal thoughts. But Juneman apparently was forthright with the psychiatrist. Juneman was having strong thoughts of suicide, which included a plan to hang himself, [which he eventually did] the psychiatrist wrote in notes from a Jan. 5, 2008, appointment obtained by Juneman’s family. Juneman said he learned of his deployment a couple of months ago and believed that was the trigger for the worsening of his depression, the psychiatrist wrote. Hergert said copies of the notes were found in her son’s apartment. She wondered if he intended to show them to his commanding officers. She doesn’t know if he ever considered signing the form to allow his medical records released to the Guard. Hergert said that would have been a difficult decision for her son who, despite his problems, felt a profound duty to serve.

At his National Guard unit in Spokane, no one had seemed aware of the depths of Juneman’s despair. "It breaks our heart to lose somebody the way we lost that soldier," said 1st Lt. Keith Kosik, a spokesman for the National Guard. "Had we had any indication that he was struggling with those kinds of things, we would have done everything we could have to get him help."

[It’s reasonable that no one had been aware of the depths of Juneman’s despair, but it is also reasonable for that unit to be more sensitive to the fact that other troops in their units, like Juneman are human beings first and Soldiers second. They are not machines. VT. Ed.]

Stars and Stripes
Written by Hal Bernton
Tuesday, 28 July 2009 09:43


[Going to the original source of the story, the Seattle Times, we noted that this story got about 44 comments within a very short timeframe. We also noted that where the story was listed in the newspaper may have been just as significant as the story itself. The Seattle Times listed it under Health as in Healthcare which had been in the media’s eye recently. It was not listed under Veterans, the Military, or even the Iraq or Afghanistan War, but under Healthcare something all Americans can relate to regardless where we passionately sit for or against government run healthcare. Not to say that we agree or disagree with the comments made. Anyway, the comments and reactions to the story are just as telling as the story. VT. Ed.]


Robert L. Hanafin

Veterans Advocacy Editor

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Readers are more than welcome to use the articles I've posted on Veterans Today, I've had to take a break from VT as Veterans Issues and Peace Activism Editor and staff writer due to personal medical reasons in our military family that take away too much time needed to properly express future stories or respond to readers in a timely manner. My association with VT since its founding in 2004 has been a very rewarding experience for me. Retired from both the Air Force and Civil Service. Went in the regular Army at 17 during Vietnam (1968), stayed in the Army Reserve to complete my eight year commitment in 1976. Served in Air Defense Artillery, and a Mechanized Infantry Division (4MID) at Fort Carson, Co. Used the GI Bill to go to college, worked full time at the VA, and non-scholarship Air Force 2-Year ROTC program for prior service military. Commissioned in the Air Force in 1977. Served as a Military Intelligence Officer from 1977 to 1994. Upon retirement I entered retail drugstore management training with Safeway Drugs Stores in California. Retail Sales Management was not my cup of tea, so I applied my former U.S. Civil Service status with the VA to get my foot in the door at the Justice Department, and later Department of the Navy retiring with disability from the Civil Service in 2000. I've been with Veterans Today since the site originated. I'm now on the Editorial Board. I was also on the Editorial Board of Our Troops News Ladder another progressive leaning Veterans and Military Family news clearing house. I remain married for over 45 years. I am both a Vietnam Era and Gulf War Veteran. I served on Okinawa and Fort Carson, Colorado during Vietnam and in the Office of the Air Force Inspector General at Norton AFB, CA during Desert Storm. I retired from the Air Force in 1994 having worked on the Air Staff and Defense Intelligence Agency at the Pentagon.