Vets and Agent Orange

Bill's first day on board

2010-02-16T09:41:00.000-08:00

Bill Fariello was a little bit insane.

He was a nice enough guy so long as you didn't cross him. But it was important to avoid crossing him. He was a little guy, about 5'5", but muscular with a quick reaction time.

He established himself quickly when he first arrived on the ship. He'd spent a couple of years driving a forklift at a Navy warehouse in Pearl Harbor before arriving on board so he was far from new to the Navy even though this was his first sea duty.

His first day on board he was working on deck on the 01 level when a signalman walked by. The signalman was a tall guy, well over 6 feet tall, and he towered over Bill. Bill was blocking his way to a ladder up to the signal deck and when the signalman told Bill to move he did so while calling Bill a "little shit". Without uttering a word Bill punched him. He did a quick little crouch and sprung up into the air so that his 5'5" frame came up off the deck and he could deliver a straight on punch flat into the signalman's face.

The signalman actually went down from that one punch and Bill just walked off.

His reputation was permanently established.

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This story, and others like it, can be found in Navy War Stories.

Free Lunch

2009-11-10T14:25:00.000-08:00

Veterans get a free lunch at Applebee's on Veteran's Day, Mov. 11.

Computerized health records

2009-10-27T13:56:00.000-07:00

The Wall Street Journal seems to like the way the VA does things.

As health-care providers gear up for a digital overhaul, they could learn important lessons from an early innovator in the field—veterans hospitals.

The government is spending nearly $20 billion in stimulus funding to help hospitals and doctors switch to digitized records, and Medicare will start penalizing those who don't use them in a meaningful way by 2015. The goal is to boost the quality of care and slash costs by keeping better track of patients.

But the Department of Veterans Affairs made that digital switch years ago—with striking results. Independent studies show that the VA system does better on many measures, especially preventive services and chronic care, than the private sector and Medicare. VA officials say its technology has helped cut down hospitalizations and helped patients live longer.

Even though the sprawling health-care industry faces lots of challenges as it goes digital, advocates say that the VA's experience shows the technology, combined with quality measurements, can work on a large scale.

The records system, which also delivers an easy way to track physician performance, has been a boon to patients, says Ashish Jha, associate professor of health policy at the Harvard School of Public Health and a staff physician at the VA hospital in Boston. Over the years, he says, "quality goes up, but cost stays flat, compared to the rest of the country."

Healthy and Efficient

The VA's system allows doctors and nurses at more than 1,400 facilities to share a patient's history, which means they can avoid ordering repeat MRIs or other unnecessary tests. But the system isn't just a warehouse to store patient data. More important, it has safeguards to improve care quality. The system warns providers, for example, if a patient's blood pressure goes beyond a targeted level, or if he or she is due for a flu shot or cancer screening.

It also helps the VA monitor patient care at home, especially for people with complex, chronic illnesses, such as diabetes and heart failure. The VA gives those patients special gadgets free of charge to measure weight, heart rates, blood pressure and other conditions, and the daily results are automatically transmitted into the VA's medical-record system, says cardiologist Ross Fletcher, chief of staff at the VA medical center in Washington. If the numbers exceed target levels, a nurse is notified.

Dr. Fletcher recently pulled up the record of a 59-year-old man from Maryland for a demonstration. The record listed his health problems, such as hypertension and diabetes, and data for his weight and blood pressure since he first became a patient at the VA. The doctor could also open digital images of the patient's past X-rays, lab results and other materials, and zoom in for details.

A reminder also popped up, warning Dr. Fletcher that the patient's blood-sugar control level was above 8%, according to a home-measurement device and a test at the clinic. The reminder will stay there for all providers in the system to see until the patient brings it below 8%. He also has other services due, such as a flu vaccine. Before the appointment, he'll get a reminder call—and if he misses the visit, he'll get a call to reschedule it.

Also on the screen: a list of the patient's medications, including insulin, the pain medication Oxycodone and heart-failure drug Furosemide. Dr. Fletcher can reorder a drug through the system and have the request show up at the pharmacy; the patient can also order refills through an online portal. And if the doctor orders a new medication that interferes with something the patient is already taking, a warning pops up.

Higher Quality

The VA says the system has brought dramatic improvements. Consider the VA's in-home monitoring program, which has about 40,000 patients enrolled. The VA says the program has reduced hospital admissions by 25% and length of hospital stay by 20%. The system's automated reminders have also boosted performance in many areas. For example, the percent of patients receiving a flu vaccine rose to 83% last year from 27% in 1995, says Fernando Rivera, the Washington VA hospital's medical director. Colon-cancer screenings increased to 84% from 34% during the same period.

What's more, the VA says it has reduced medication errors significantly since it introduced a scanning system in 1999. It requires nurses to scan tags for patients and medications to ensure that they are giving the right medication to the right patient at the right dose and time.

Patients notice the difference. When Dwayne Thompson went for a physical last month at the veterans hospital in Baltimore, he didn't have to fill out any paperwork. He checked in for the appointment using his last name and part of his Social Security number, and waited less than 20 minutes before he was called for a blood sample, a visit with a social worker and an ankle X-ray—which was immediately fed into the hospital's electronic health records.

"The process was effortless," says Mr. Thompson, a 42-year-old Persian Gulf veteran in Baltimore. "They seemed to have everything in order."

The situation at the VA stands in stark contrast to the rest of the nation's health-care system. Only 1.5% of U.S. hospitals nationwide have a comprehensive digital-record system, let alone share information among different providers, according to a recent study co-authored by Dr. Jha in the New England Journal of Medicine.

To be sure, the VA's health-care system isn't a perfect roadmap for the industry—since the agency is in a unique position. The VA, through the Veterans Health Administration, employs the doctors, nurses and other health workers, which makes it easier to mandate performance standards. The VA also has an incentive to keep patients healthier because it takes care of veterans for life and sicker patients eat up the VA's budget faster. (Indeed, some veterans have trouble getting into the system partly because of the VA's budget limitations.) Elsewhere, most doctors and hospitals work independently, making it harder to monitor patient care. And those providers are rewarded for simply providing more care, not high-quality care.

Still, there are signs that private providers are taking lessons from the VA. In fact, some hospitals are adapting the VA's record system, VistA, for commercial use. (Some applications of the software, which was developed by the government, are available free.)

A Vast Setup

The VA turned to electronic records out of necessity. It serves 7.84 million patients through 153 hospitals, 765 outpatient clinics and 230 veterans centers and other facilities, and many patients are seen at different facilities. The Washington VA hospital alone used to have between 4,000 and 5,000 folders, not including imaging files, and sometimes they got lost during file transfers, Mr. Rivera says. Now the storage room is used as office space.

The VA started developing the VistA system in the 1970s, and began sharing lab results and medication information in the 1980s, says Dr. Fletcher, who was involved in the development process. The system got a major upgrade in the mid-1990s, when it became easy to use for doctors and nurses, and added clinical reminders and other quality measures.

One of the next big steps for the system is allowing doctors to see information about patient care received outside of the VA, since most VA patients also use other health-care providers.

Already, the VA and the Defense Department are sharing information on 3.4 million patients treated both at the VA and military facilities, says Chuck Campbell, chief information officer for the Military Health System. In addition, he says, the department has collected information on 4.8 million patients from its various electronic systems since 2002 and forwarded it to the VA once they were discharged.

In January, the two systems and a private managed-care company, Kaiser Permanente in San Diego, plan to test a pilot on how to share information on patients seen by the three systems. If successful, it will be expanded to other insurers.

Mr. Campbell sees the test run as a harbinger of things to come. Once everyone uses the same standard for digital records, he says, "you can share information easily across the nation."

Flashbacks

2009-09-22T03:16:00.000-07:00

I had a run in with a VA cop over the weekend and felt very threatened. I haven't written anything about it yet, but I'm working on it.

Tonite I couldn't sleep and kept thinking about something that happened 40 years ago. I can't get it out of my mind, I'm trembling and feeling extreme anxiety about some appointments I have at the VA today. I guess I'm afraid I'm going to run into that cop. I don't really know. I guess this is what PTSD is about.

Leaving the hospital

2009-09-21T09:41:00.000-07:00

Last Thursday afternoon I checked in the hospital for monitoring while my blood pressure and diuretic medications were being “adjusted”. I have heart and kidney problems and diabetes. The hospital staff took my BP, weight, etc when I checked in. My BP was very high, in the over 180 range. Earlier in the day it had consistently been in the 200 range (the DIA readings weren’t so bad, more like 80).
During the next 5 hours I received no treatment. None. No medications, no monitoring of any kind. Nothing. My nurse told me that nothing was scheduled for me. I’d been fed supper earlier (after complaining to the nursing staff of hunger) but it included milk and salty foods – things I knew I should not be eating.
I thought it was important to do something about the blood pressure so I went home simply because at least that way I’d be able to take some blood pressure medications and would be able to monitor my blood pressure. I thought that was medically important and I got no positive response at all from the staff when I brought it up.

VA management style

2008-11-17T13:05:00.000-08:00

I was cleaning out a pile of old papers on my desk and ran across an old article from Computer World that I'd ripped out a while back (July 2007) intending to someday do a blog post about it.

So that someday finally came.

The article was about a GAO news release on "Inadequate Controls over IT Equipment at Selected VA Locations".

In July 2004, GAO reported that the six Department of Veterans Affairs (VA) medical centers it audited lacked a reliable property control database and had problems with implementation of VA inventory policies and procedures. Fewer than half the items GAO selected for testing could be located. Most of the missing items were information technology (IT ) equipment. Given recent thefts of laptops and data breaches, the requesters were concerned about the adequacy of physical inventory controls over VA IT equipment. GAO was asked to determine (1) the risk of theft, loss, or misappropriation of IT equipment at selected locations; (2) whether selected locations have adequate procedures in place to assure accountability and physical security of IT equipment in the excess property disposal process; and (3) what actions VA management has taken to address identified IT inventory control weaknesses. GAO statistically tested inventory controls at four case study locations.

And it's not just equipment that gets lost.

A weak overall control environment for VA IT equipment at the four locations GAO audited poses a significant security vulnerability to the nation's veterans with regard to sensitive data maintained on this equipment. GAO's Standards for Internal Control in the Federal Government requires agencies to establish physical controls to safeguard vulnerable assets, such as IT equipment, which might be vulnerable to risk of loss, and federal records management law requires federal agencies to record essential transactions. However, GAO found that current VA property management policy does not provide guidance for creating records of inventory transactions as changes occur. GAO also found that policies requiring annual inventories of sensitive items, such as IT equipment; adequate physical security; and immediate reporting of lost and missing items have not been enforced. GAO's statistical tests of physical inventory controls at four VA locations identified a total of 123 missing IT equipment items, including 53 computers that could have stored sensitive data. The lack of user-level accountability and inaccurate records on status, location, and item descriptions make it difficult to determine the extent to which actual theft, loss, or misappropriation may have occurred without detection. GAO also found that the four VA locations reported over 2,400 missing IT equipment items, valued at about $6.4 million, identified during physical inventories performed during fiscal years 2005 and 2006. Missing items were often not reported for several months and, in some cases, several years. It is very difficult to investigate these losses because information on specific events and circumstances at the time of the losses is not known. GAO's limited tests of computer hard drives in the excess property disposal process found hard drives at two of the four case study locations that contained personal information, including veterans' names and Social Security numbers. GAO's tests did not find any remaining data after sanitization procedures were performed. However, weaknesses in physical security at IT storage locations and delays in completing the data sanitization process heighten the risk of data breach. Although VA management has taken some actions to improve controls over IT equipment, including strengthening policies and procedures, improving the overall control environment for sensitive IT equipment will require a renewed focus, oversight, and continued commitment throughout the organization.

The entire report runs 53 pages and you can find it here.

Teeth Problems

2008-11-08T17:01:00.000-08:00

I have diabetes, The VA considers it a service connected disability caused by exposure to Agent Orange, which is cool. But the diabetes has caused some problems with gum infections which lead to teeth falling out. That's not so good. In fact it's terrible because the OKC VA wouldn't provide dental care unless I was 50% disabled and it was service connected. Diabetes is only considered a 20% disability.

So I started checking into Mexican dentists for dentures and the possibility of payday loans to pay for it.

Then I discovered that the Wichita VA doesn't ration health care as badly as the OKC VA and I transferred all my health care to Wichita. Viola, new teeth, no charge, service connected.

So I'm getting dentures.

Faith Hill

2008-11-04T10:43:00.000-08:00

I needed to call a VA 1-800 information number yesterday. You get a recording of Faith Hill, introducing herself and saying, "blah blay, God bless You and God Bless America".

God?

Exactly whose God is she talking about? Hers? Mine? I don't have a God, so it must be hers. What the hell is the VA doing promoting her God? It's one thing to be listening to the radio and hear Sean Hannity spout off claiming that the United States is a country created by God. It's another hearing the government itself demand a blessing from God.

It makes me want to go get apayday loan so I can retain a lawyer to sue them.

McCain/Palin and vets

2008-09-04T08:55:00.000-07:00

John McCain always struck me as a guy who didn't think vets needed GI Bill educational benefits because all they'd need to do to get into a good college was get their grandaddy to approve their admission and have them given a full scholarship. That's what he did, no reason everybody couldn't do it that way.

Jon Soltz seems to think even less of McCain's choie of running mate than I do about McCain

have to assume with no real history of judgment of her own on war, Palin will back John McCain's dismal judgment on military and veterans matters - endless war in Iraq, inability or unwillingness to get Osama bin Laden and al Qaeda in Afghanistan and Pakistan, opposing education benefits and greater VA funding, continued overextension of our military, and a shoot-first/think-later mentality.

The politics of medical diagnosis

2008-05-19T11:28:00.000-07:00

You would think that the primary criteria for making a medical diagnosis would be medical. But in the case of the VA you'd be wrong. It seems that in America politics trumps medicine.

Do what you're told -- or else

2008-04-28T07:58:00.000-07:00

Simple Justice has a story of a 74 year old woman in Florida who got tired of being pushed around at an airport by nut cases in uniform. She pushed back. Of course, she was arrested as a result. That's what happens when you refuse to do as you're told these days.

I made a similar mistake of telling a VA cop "No" at the VA hospital in OKC the other day.

The details make for a long story. I went to the emergency room in Cushing, OK because of a difficulty breathing. They couldn't find anything wrong but after them administering oxygen I was feeling much better (a later diagnosis which I concur with is that I was suffering from newly developed allergies).

The hospital in Cushing wanted to admit me overnight for observation (mostly because they couldn't find anything wrong). But the VA was paying the bill (I have a service connected disability) so they had to het approval from the VA in OKC. By this time I was feeling much better and wasn't so sure that staying a day for observation was a good idea. But I went along with it anyway. Then the OKC VA decided I should be transported to OKC for admission to the VA hospital there.

As all this went on I was becoming much less convinced that a day in the hospital for observation wasn't worth the time or effort.

But I continued to go along with it -- allowing myself to be strapped into a gurney and put into an ambulance in a small enclosed space with a steroid using fireman for the hour plus trip over mostly bumpy two-lane highway. That's not an experience I intend to repeat.

It appears that the procedure was fotme to be transferred from ER to ER, then be admitted to the VA hospital from the VA ER. That appears to be the procedure, but it didn't work out that way.

It seems that in the time it took to transport me they'd changed shifts in OKC. The VA doctor on duty who told the Cushing ER to transport me to OKC had left. And the new shift wasn't expecting me. And they had no hospital beds available. And the nurse on duty was actually angry with me about it. Like it's somehow my fault that they're a bunch of incompetent boobs.

I was feeling okay by then and just didn't see much point in hanging around in the hall to be observed by people who couldn't even figure out how to pass medical information along from one shift to another. I thought the best plan was to walk upstairs and see if I could get squeezed into a last minute clinic appointment to see my primary care doctor -- who was somebody whose judgment I trusted.

The ER nurse started telling me I couldn't do that. First I needed to be "situated" by them. I don't know what the hell that meant, but it didn't interest me. Then she told me that she had to remove the IV valve in my arm. I told her that I had received no treatment from her and there was no reason to start now. I'd take care of the IV removal upstairs if I ended up not being admitted into the hospital.

One thing I needed to do before I officially refused treatment was ensure that I could get transportation back to Cushing. The DAV had a van that ran from Cushing to the VA hospital and clinic and I needed to stop by the hospital DAV transportation office to make sure that the van had run that day and find out what time I needed to be ready to go to get a ride back home. If I wasn't going to be able to get a ride back to Cushing until the next day then I was going to be more willing to wait around in the ER hallway to be observed by the clowns.

An ER nurse followed me. I found out later that she was following me so that she could watch me and make sure I didn't use the little IV valve in my arm to inject some unauthorized drugs. Because I'm 59 years old with no history at all of drug problems and you can't be too careful when it comes to fighting the drug war.

Anyway, she was on a cell phone, telling the VA Police where I was at all times while they sent two nut case cops up to get me. One of them was one of these no neck, steroid storage tanks who ended up going completely nuts. He put his face inches from mine (he was a little shorter than me but he jutted up his jaw so our faces were more parallel) and just screamed at me. I don't know any way to describe him other than just insane.

I ended up going down to the little police office next to the ER with them. I was more worried about being assualted by this nut than I was being arrested, although they were threatening to issue me a citation for disturbing the peace, or some such nonsense.

They wanted me to do two things. 1. Return to the ER and have a nurse remove the EV valvle and 2). Sign a form saying I was leaving against medical advice.

I explained to them that I wasn't leaving the hospital, I was just going to another department in the hospital to seek medical advice and I had no reason to sign some form that said otherwise.

But since I was going to get a ticket (and have to appear in a a Federal Court) if I didn't, I agreed to let some ER nurse remove the IV valve. We went into the ER and got the valve pulled out. Then the nurse gave me a form and insisted I sign it. The insane cop had calmed down by then but he also said I had to sign it.

The form said that I was leaving the hospital against medical advice. I pointed out that I was just leaving the ER, not the hospital and suggested we pencil in a change. They told me we could modify the document because it was an "Official Federal Form".

I'm telling you, these people are all crazy. Just flat out insane.

I signed it. It was either that or get arrested. Does that actually release them of liability if they use police threats of arrest to get me to sign something?

I went upstairs. My doctor wasn't in. But I saw his nurse. She suggested that rather than having been having a heart attack that maybe I was developing some severe pollen allergy of some sort. Subsequent experience and diagnosis verified her guess.

That was all a couple of weeks ago. Yesterday I went back to see my doctor. Since it was a late afternoon appointment rather than my usual early morning appointment I drove rather than what I usually do -- take the DAV van.

I was dreading going into the parking lot because they have a guard shack where you have to show ID, etc to a VA cop. You know, post 911 and all that. I just didn't want to have any contact with any of those assholes. But I gritted my teeth and drove in.

He just waved me through. Because I look a lot like Timothy McViegh and I was driving a van, but I'm not Arab.

GI Bill educational benefits

2008-03-21T23:09:00.001-07:00

There are various categories of eligibility for GI bill educational benefits. As a general rule your benefits will expire 10 years after your release from active duty. So, don't put off school too long.

Depression and the military

2008-03-17T23:10:00.000-07:00

Troy at the You Served Blog has some first hand thoughts on depression resulting from service in Afghanistan.

VA Mortgage Refinancing

2008-03-16T02:38:00.000-07:00

The FSBO files gives a few suggestions about ensuring that you get the best rate available when refinancing a VA mortgage.

Those old guys are tough

2008-03-12T16:07:00.000-07:00

A couple of aging Vietnam vets take down a razor-wielding nutcase in a New York courtroom.

State benefits

2008-03-01T10:13:00.000-08:00

In addition to veterans benefits from the VA, each state offers various benefits to veterans. Check out what's available in your state.

For example, in Oklahoma veterans who are 60% or more disabled don't have to pay for hunting or fishing permits.

In Texas the state administers 3 different veteran's land programs.

In Kansas low income veterans can get free prescription drugs.

Mental Health and the Military

2008-02-28T06:07:00.000-08:00

AlterNet has a story titled "Military Doctors Withholding Treatment from Soldiers with Mental Health Problems". There's really nothing new about that, the military has always fallen far short of providing adequate mental health treatment for the troops. What's new is the lack of sufficient manpower in the military today which is causing extreme levels of stress on some units.

Over the past 6 years and and six months, their 2nd Brigade Combat Team (BCT) has been the most deployed brigade in the army. As of this month, the brigade had completed its fourth tour of Iraq. All in all, the soldiers of BCT have spent 40 months in Iraq.

And, not just in Iraq. They've done combat tours in Afghanistan also.

Meanwhile, the soldiers of the 2nd BCT have been given too little time off in between deployments: In one case they had only six months to mentally "re-set"; following an eight-month tour in Afghanistan -- before beginning a 12-month tour in Iraq.

The 12 months turned into 15. They haven't been handling that well.

This level of losses is unusual. "On their most recent deployment," the VFA report notes, "members of the 2nd BCT were more than five times as likely to be killed as others who have been deployed to OEF and OIF and more than four times likely to be wounded." One can only wonder to what degree depression and other mental health problems made them more vulnerable to attack.

They're back in Fort Drum, New York now. In the dead of winter, and many of them are severely depressed.

Soldiers told the VFA that "the leader of the mental health treatment clinic at Fort Drum asked soldiers not to discuss their mental health problems with people outside the base. Attempts to keep matters 'in house' foster an atmosphere of secrecy and shame," the report observed "that is not conducive to proper treatment for combat-related mental health injuries."

That's the way the military likes to handle mental health problems. Ignore it. Sweep it under the rug. Be tough. The military Officer Corp is really very poorly trained in how to actually work with people. The command structure of the military is still based on some 19th century idea of command by bluster and threats.

I served on a ship for a short period with a guy who had chronic sea sickness. It was really bad. He simply couldn't function at sea. Not at all. He came to our ship from some brig time after he'd gone over the hill before a 6 month deployment on his last ship. They busted him to E1 and put him on another ship. The official Navy diagnosis was that he was a slacker.

One day, while we were tied up alongside a pier in San Diego, we were below deck, having coffee in the berthing compartment and he started turning green and getting sick. He claimed we were moving. It turns out we were moving. We didn't know it but the ship had been untied from the pier and pushed out by a tug so that another ship could slip in and tie up pierside (then they tied us up alongside that ship). His body could detect that slight movement. And it was so slight that none of the other 6 or so experienced sailors with us below could feel it.

He wasn't a slacker. He was a hard worker who did his job in port. I only went to sea with him once. On a three day trip to the yards in Bremerton he was completely incapacitated. I got out of the Navy shortly after that so I don't know what happened to him. I'm pretty sure they just kept sending him to the brig until they tired of him then gave him a BCD and let him loose to try to repair his destroyed life as best he could. All because Navy psychiatrists kept diagnosing him as perfectly healthy, as a guy who was faking it to try to get out of a deployment to Vietnam.

That was absurd thinking at best. If the Navy would have dealt with his illness as it should have they'd have simply found a shore duty assignment for him. In 1968, for a bos'n mate, that would have meant some warehouse or dockside line-handling job in-country. Getting out of sea duty wasn't a way to escape danger. But the Navy was just pretty much run by idiots. The military is still run by idiots.

Vietnamese and Agent Orange

2008-02-27T06:55:00.000-08:00

Vietnamese who had been exposed to Agent Orange can't sue for damages.

GI Bill educational benefits

2008-02-19T07:43:00.000-08:00

The GI bill sure has gotten more complicated than it used to be. Now they have benefits for reservists, now you can transfer your benefits to dependents, all kinds of stuffs that didn't used to be part of the GI Bill.

Let's just look at part of it, GI Bill for Selected Reserve. That's 36 months of educational benefits for reservists who have a 6 year obligation and have completed initial active duty for training (basic).

You may use this education assistance program for degree programs, certificate or correspondence courses, cooperative training, independent study programs, apprenticeship/on-the-job training, and vocational flight training programs. Remedial, refresher and deficiency training are available under certain circumstances.

You have 14 years to use the benefit (more if you are called to Active Duty).

This is really a pretty good deal.

Update:
But not exactly a great deal. The monthly payments for the Reserve version of the GI Bill are only $317 for a fulltime college student. Of course every little bit helps, but it's not much. When I was drawing GI Bill money for college in the early '70's I was getting $256 a month.

Simularities between depression and post-traumatic stress disorder

2008-02-16T02:16:00.000-08:00

PTSD and depression have similar symptoms and, particularly in veterans, often go hand in hand. Common symptoms are

(For PSTD) symptoms include recurrent recollections or dreams about war, flashbacks that cause you to relive various traumas, and avoidance of any reminders of combat. The condition can also result in emotional numbing (diminished responsiveness to the world around you), intense distress when confronted with reminders of battle, and hyperarousal, a feeling of frequently being on edge and on the alert for new threats.

...

Depressed veterans often feel worthless and profoundly sad, but other typical symptoms include poor concentration, lack of interest in social activities, feeling of hopelessness and helplessness, changes in appetite, difficulty sleeping, or oversleeping, unusual irritability, apathy and listlessness, and suicidal thoughts or attempts.

The 6 services in VA non-institutinal long term care for veterans

2008-02-14T20:31:00.000-08:00

The Veterans Administration offers 6 non-institutional services related to long term health care.

1. Adult day health care An outpatient day program, which provides health maintenance and rehabilitative services to frail elderly and functionally impaired veterans.

2. Geriatric evaluation An inpatient or outpatient program where an interdisciplinary health care team performs multidimensional evaluations on a targeted group of elderly patients.

3. Respite care A program with the unique purpose of providing temporary relief for unpaid caregivers from routine care giving tasks, thus supporting caregivers in maintaining the chronically ill veteran in the home.

4. Home-based primary care Primary health care in the home directed to severely disabled, chronically ill patients.

5. Homemaker/home health aide Pays for homemaker and home health aide assistance for veterans.

and
6. skilled home health care. In-home professional services that include: skilled nursing, physical therapy, occupational therapy, speech therapy, social work services, clinical assessment, treatment planning, treatment provision, patient and/or family education, health status monitoring, reassessment, referral, and follow-up.

These services are not offered at every VA region and in many cases there is a waiting list.

Combat Veterans in the US Senate

2008-02-13T19:15:00.000-08:00

At one time you couldn't get elected to the US Senate without some kind of history of military experience. Since we don't have a draft anymore most Americans don't serve and we no longer expect it of our politicians. But the Senate actually has a few vets, although most of them served the the National Guard or Reserve in the days when the National Guard and Reserve were at almost no risk of being called up for combat, it was just a way to dodge the draft.

But we do have 10 Senators with actual combat service. I think that's a good thing

#Daniel K. Akaka (D-HI)
#Thomas Carper (D-DEL)
#Chuck Hagel (R-NE)
#Daniel Inouye (D-HI) (Medal of Honor)
#John Robert Kerry (D-MA)
#Frank Lautenberg (D-NJ)
#John R. McCain (R-AZ)
#Ted Stevens (R-AK)
#John R. Warner (R-VA)
#Jim Webb (D-VA)

PTSD and Ecstasy

2008-02-13T03:21:00.000-08:00

Research is underway to treat PTSD with the outlawed drug Ecstasy.

Although the research is being conducted in South Carolina, and has FDA approval, the researchers are mostly Swiss and Norwegians. Research into medicinal uses of outlawed recreational drugs without a patent owned by a big drug company just isn't popular in the United States.

Maybe the work will bear fruit. But I think it's doubtful that the VA will be giving vets with PTSD ecstasy anytime soon.

Agent Orange

2008-02-11T21:52:00.000-08:00

If you served in-country in Vietnam and have been diagnosed with
Leukemia
Diabetes
Hodgkin’s disease.
Multiple myeloma.
Non-Hodgkin’s lymphoma.
Prostate cancer.
Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea).
Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma).

Then you are eligible for a VA service connected disability payment.

Some shipboard service might count as in-country if you operated in coastal or inland waters. Having anchored in DaNang harbor would be considered operation in inland waters, for example.

You can get help applying for VA benefits from most Veterans Service Organizations.

Some stories

2008-02-11T06:51:00.001-08:00

This page has some stories of VN vets who live in South Dakato. Here's an example

I, as a young seventeen year old, joined the Navy. I was on 3 DIFFERENT carriers with Attack Squadron 36 including the USS Saratoga, USS America, and the USS Enterprise. I was blown overboard and into the nets my first time on the flight deck, but then went on to be the squadron trouble shooter, checking and arming the planes while on the catapults to be launched, working flight quarters to flight quarters. I then was attached to the Army and the CH 47 Chinook, 610th Transportation at Qui Nhon in the central highlands and later Red Beach, ten miles north of DaNang. Of the 4 years, 6 months, and 4 days that I served, I was overseas 4 years and 4 days of it, 2 years of which were in Vietnam.

When I returned home, I disconnected myself from all things and went on with my life...most people in my community never even knew that I had served my country. Then one day in 2002 my son, Michael, died after a valiant battle with soft tissue sarcoma. With my family's encouragement, I went to the VA seeking medical answers, but instead, I was treated crudely and rudely, to say the least. I gave up, but my daughter would not. She persisted until the VA personnel agreed to do the Agent Orange tests. I finally was given the tests, but later was told the results would not be given to me because it served NO PURPOSE either way.

I was told to start seeing my local doctor as it would cost me for any more calls to the VA. I served my country PROUDLY, in fact, I did things that if asked to do today, I wouldn't even consider. I was paid hazardous duty and combat pay at the same time for pennies per hour for what I was doing for my country in Vietnam.

Now they say because once again I am part of society and worked for a living, they WON'T HELP me. I ask nothing more of them than to support the Agent Orange research and to provide those who are left affected by Agent Orange with the necessary medical information. The truth is there should be another 100,000 names on the wall...of the ones who came home and died as well as the veterans' children who continue to die as a result of the chemicals. South Dakota has stood VERY TALL not once but TWICE now for the Vietnam veterans.

When in GOD's name are the VA and our government going to stand Tall and do what is right to help those who are left with the Agent Orange issue? WHEN ARE THEY GOING TO SERVE THE VETERANS AS HONORABLY AS THE VETERANS SERVED THEN???

I don't think anyone with an ounce of common sense believes we have adequately addressed the Agent Orange issue. We all know there is a serious problem to be resolved, not only for the veterans but for their children as well.

Ship board violence

2008-02-11T06:14:00.000-08:00

Richard DeNoble was a friend of mine. Like me, he was a Seaman (E3) in the deck force of a destroyer (USS Hull) on the VN Naval Gunline. He was a real nice guy. Big, quiet, unassuming. I let him down.

Our Division Officer was ENS Joseph Santarlasci, a real piece of work, a twit. None of us really had any meaningful respect for him.

We went to Vietnam short-handed of Petty Officers in the deck crew. We had one BM2 and one BM3. The BM2 was a lifer, the BM3 a reservist. We had a BM1 until right before we deployed but he had just gotten out of the Navy to accept a Warrant in the Army (driving Army supply barges on rivers). He wasn't replaced until we got a BMC and two more BM2's about 4 months after we got to Vietnam.

This happened when the BM2, his name was Duck, was a senior division petty officer. He was your typical 8th grade educated boatswains mate from the hills of Arkansas. He was from Mountian Home, Arkansas. Just a big, dumb redneck. But Santarlasci depended on him heavily.

One morning at quarters DeNoble muttered something insulting about Santarlasci and a couple of us standing near him laughed. Santarlasci glared at us then whispered something to Duck. Duck ordered DeNoble to go below.

As DeNoble started to climb down the hatch Duck stood behind him and kicked him in the back, knocking him down the hole to the deck below. Duck then climbed down the ladder, following him. We could hear the sounds of a scuffle below.

Santarlasci stood there trying to look all tough. Nobody moved to help DeNoble, and I really thought I should. But there really wasn't anything any of us could have done, at least that's what I'm sure we all were telling ourselves.

In my case, Duck was a lot bigger and meaner than me. Any attempt to help DeNoble would have gotten me hurt. In those kinds of situations at sea in a war zone you can't really dismiss the possibility of just getting killed. And even if a bunch of us helped and most of us didn't get hurt, when it was over the story would have been told by Santarlasci and we'd have ended up in a brig. Nobody would have asked any non-rated sailors accused of mutiny what had happened, that's just not the way the Navy I was in worked.

I felt terrible. I still fell terrible. Helpless. My chest is trembling as I type this, 40 years after it happened. I wanted to help him so badly. But I was afraid.

DeNoble was okay afterwards. He had some kind of rib injury, I don't know if they were fractured or bruised, or what. He wasn't allowed to go to sick bay, he was threatened and there would have been more retaliation if he'd have gone on sick call. For a couple of weeks he had some pretty severe pain whenever he moved his upper body. But it healed itself eventually.

Joseph Santarlasci was a real piece of work. A real loser. A scared little boy with no ethical backbone at all. But we couldn't really touch him. The Navy is very class conscious and on board ship officers are pretty much untouchable, the punishment for retribution against Santarlasci would have been severe, no matter how worthless a human being he actually was.

There was small amount of retribution against Duck. A couple of nights after it happened someone broke into Duck's locker and threw everything he owned over the side. After that Duck posted a guard on his rack every night in two hour shifts. The guard had to wake him up when he was relieved. After a week of that Duck negotiated an early re-enlistment in exchange for a transfer to another ship. I think him having everything he owned thrown over the side in the dead of night scared him as much as I was scared that day. Probably more so because he knew there were 20 men who would like nothing better than to throw him over the side.

I want to apologize to Richard DeNoble for not having helped him that day.

Veterans History Project

2008-02-11T06:03:00.000-08:00

Participate in the Veterans History Project

A participant may be a veteran, an interviewer, or person donating a veteran’s collection

The Project collects first-hand accounts of US veterans who served in World War I, World War II, the Korean War, Vietnam War, Persian Gulf War (1990-1995), or Afghanistan and Iraq conflicts (2001-present). U.S. citizen civilians who actively supported war efforts (such as war industry workers, USO workers, flight instructors, medical volunteers, defense contractors, etc.) are also invited to share their valuable stories.

VA Pension

2008-02-10T07:42:00.001-08:00

You don't have to have a service connected disability to get a VA pension.

You can receive a monthly pension if you are a
wartime veteran with limited income, and you
are permanently and totally disabled or at least
65 years old.
Time Limits: There is no time limit to apply for
Compensation and Pension benefits.

VA Home Loans

2008-02-09T01:48:00.001-08:00

The VA doesn't give loans, they guarentee loans which are given by banks or mortgage companies. The gaurentee by the VA will get the vet a lower interest rate than he'd have otherwise been able to get.

You're eligible for a VA loan if you served during WWII, Korea, or Vietnam for at least 90 days under other than dishonorable conditions.

You're eligible if you served pre-1980 peacetime for at least 181 days.

Post 1980 you're eligible if you served 24 months of continuous active duty or 6 years of active reserves.

In some cases you qualify with shorter terms than any of the above specifications if you were seperated from active duty because of a service connected disability, a hardship, or other reasons.

Mental Health and the Department of Veterans Afffairs

2008-01-02T06:06:00.000-08:00

Congress recently had hearings about "Mental Health Challenges withing the US Department of Veterans Affairs".

AlterNet has a discussion of the hearings.

As near as I can tell the whole thing was pretty much empty of any meaningful content. Testimony from the Deputy Chief of the VA Office of Mental Health was pretty much nothing but empty platitudes.

My own experiences with the mental health services offered by the VA are a mixed bag, with tendency towards the really bad.

A morning at the VA hospital

2007-11-16T09:01:00.000-08:00

I had some blood work done at the VA hospital in Oklahoma City this morning as a prelude to seeing my primary care doctor. He had ordered some blood work and urine testing before seeing me. Another doctor, a psychiatrist had also ordered some blood test done for other reasons and I'd told him I was having blood tests done on Nov. 16th so he put his on for the same day, even though I'm not seeing him again until January.

I showed up bright and early to the lab. They only took one vial of blood and didn't give me a urine cup as I'd expected. I asked them about that and they assured me that's all they needed.

Okay.

So I went to see my doctor. He said the only lab work they'd done was for the psychiatrist. So he said he could enter a work order for his tests again and they wouldn't need more blood but he wanted a urine test so I could go back up to give them a sample.

I went back upstairs to the lab. I gave them my ID and the work number the doctor had given me and sat down to wait.

When they called me the clerk just handed me a slip of paper, no cup. I asked her what that was for. "Take it into there", she said, pointing into the room they use to draw blood.

"Are you sure"?

"Yes", she said.

"The doctor told me I was just coming up to give a urine sample?"

"No, he ordered a blood test", she said.

"Yes, but you already took blood this morning and he told me you wouldn't need a new blood sample but he wanted a urine test".

"He didn't order that".

"Okay, let me tell you what happened from the git go and maybe you can call him and clarify", I said.

She didn't take her eyes from the computer screen. Never looked at me at all.

Some other woman was standing behind the counter, no my right, talking to a 3rd employee who was in front of the counter on my left. Loudly. I waited patiently (yes, at that point I was being very patient) for them to stop yelling over us so I could talk to the clerk. They didn't stop talking.

Finally I said the the clerk, "I guess that's one reason y'all tend to screw things up".

"What reason?", she said.

I pointed to the two employees carrying out their conversation by yelling over us rather than one of them stepping off to the side so they could speak directly to each other. "Them, not paying attention at all to who they interrupt by talking over others".

Without missing a beat the two jerks moved off to one side.

It turns out, I discovered later, that the one behind the counter was some kind of supervisor.

Myself and the clerk kept going back and forth, I kept trying to explain to her what had happened, she kept ignoring me and staring at the computer screen. I was probably getting loud, since everyone knows that when someone doesn't want to listen to you that they'll always soften up and start paying attention if you just talk louder (that's a joke).

So, the supervisor came out and told me to talk to her. I said, Okay. Then she said, "What is your question"?

Well, I didn't actually have a question at that point. By then It was pretty clear to me what had happened with crossed computer messages and I just was under the mistaken impression that the miscommunication between doctor and lab could be easily cleared up by simply having the doctor and lab talk directly.

No, that's not the way things work.

I had to talk to the doctor again, the supervisor told me. Since I'd just talked to him I didn't see much point in that.

"I'm trying to help you and you're just getting angry," she said.

The concept of an angry Vietnam vet is one I'm familiar with. It means "I'm going to call security".

I was very frustrated probably, maybe even agitated. But I actually wasn't angry. That's not the right word to describe me at all.

The clerk had told me that they needed more blood. Now the supervisor told me that they didn't need more blood and they didn't need urine. Need blood. Don't need blood. That's two different things? Right?

Well, I told her she was clearly not paying attention since they were telling me two different things. She denied that Need blood and Don't need blood are different things.

Of course I was the one getting angry.

So I pissed in a cup and left it with them and went back down to see the doctor. I didn't give them more blood.

I explained it to the receptionist at the clinic who cleared it up.

I went back upstairs to the lab to make sure they had everything they thought they needed. A different clerk (one who'd witnessed the previous exchange but hadn't participated) assured me it was all cleared up now.

Nobody apologized. Why should they? They didn't screw anything up. It was that angry Vietnam vet who caused all the problems.

########.

Pre-existing condition

2007-10-21T10:49:00.000-07:00

From the St. Louis Post-Dispatch

After two combat tours in Iraq on a "quick reaction team" that picked up body parts after suicide bombings, Donald Schmidt began suffering from nightmares and paranoia. Then he had a nervous breakdown.

The military discharged Schmidt last Oct. 31 for problems they said resulted not from post-traumatic stress disorder but rather from a personality disorder that pre-dated his military service.

Schmidt's mother, Patrice Semtner-Myers, says her son was told that if he agreed to leave the Army he'd get full benefits. Earlier this month, however, they got a bill in the mail from a collection agency working for the government, demanding that he repay his re-enlistment bonus, plus interest — $14,597.72.

...

Meds from the VA

2007-10-17T14:30:00.000-07:00

I recently transferred from the VA clinic in Tulsa (which is part of the network of the hospital in Muskogee) to the VA hospital in Oklahoma City. I was very happy with my doctor in Tulsa but had to transfer because of transportation problems. I'm closer to Tulsa than OKC but only slightly and the DAV won't provide transportation to Tulsa but will to OKC. Sometimes, such as for eye exams, I need transportation even when my truck is running.

I finally got in to see my new primary care physician last Thursday. I got refills on a number of pills and got some prescriptions for some new ones. I had a problem sleeping the night before, and the DAV was picking me up at 6:45 am, so I got no sleep the night before. I had a 1 p.m. appointment with the eye doctor (got my eyes dilated) and a 2 p.m. appointment with my primary care phsycian that wasn't finished until 3 p.m.

I'd been to the OKC VA before for chronic care and knew it would take half hour or an hour to get the pills from the pharmacy, I was operating on no sleep (one of the new pills was a sleeping aid), and 6 other patients were waiting on me for the return trip in the van. So I just told the doctor to have the pills mailed. I had enough of most of my pills to last a few more days and how long could it take. I figured I'd get the new pills in the mail Saturday, Monday at the latest.

Well, it's Wednesday. I ran out of my diabetes meds Monday. No pills in the mail. I called the VA. They told me it usually takes at least 10 days.

Ten days to put a bottle in a sack and drop it in the mail.

My mistake.

PTSD

2007-10-15T09:56:00.001-07:00

Because you never know when one of those crazy vets might go crazy and start shootting people.

Jill Manges guesses that if she’d suffered an epileptic seizure that day in class, she’d still be enrolled at Eastern Illinois University. But Manges, who has post-traumatic stress disorder, instead suffered a flashback during French history that led her to shout and sob uncontrollably.

“I can’t deny the fact that what happened was disruptive,” says Manges, who was sentenced to a year-long suspension by the university judicial board last month for violating two sections of the student conduct code barring the disruption of university functions and the academic environment in particular

Disability

2007-09-24T20:57:00.000-07:00

I ran across this on the internet while looking for something else. Although my name isn't mentioned, it's my disability appeal for Agent Orange exposure and diabetes.

Update:
Interestingly, as short as it is, this post is one of my most often visited posts from Google searches. So I thought I'd update it with a little more detail about agent orange exposure and in-country service in Vietnam.

If you have diabetes and served in country it's a legal presumption that exposure to diabetes caused the diabetes. You don't have to prove the exposure and you don't have to prove the causation.

I was in Vietnam, but technically wasn't in-country. I was on a destroyer mostly on the Navy Gunline in the DMZ. We also did some close in gunfire support from DaNang Harbor and offshore at Hue right after the Tet offensive of 1968. But I never had orders to go to Vietnam, I had orders to report to USS Hull DD945, then the ship went to Vietnam.

If you served in the Brown Water Navy in Vietnam you were in-country. You had individual orders to Vietnam. If you were shipboard at Yankee Station you probably weren't in-country. You were in a war zone, but you were not close to the Vietnamise coastal waters.

That's why you see the language in my appeal about operating close to the shoreline in the DMZ and anchoring inside DaNang harbor. That put me within coastal waters which meant that I was legally presumed to have been exposed to Agent Orange and my diabetes was presumed to have been caused by that exposure.

You have to play the game, and you have to know the rules of the game.

Some of the history of agent orange

2007-08-09T09:43:00.000-07:00

This is a summary of what we know about the effects of agent orange, and have known for a while

Mental Health care for Vets.

2007-08-07T17:43:00.000-07:00

American style mental health care.

President's task force to improve health care delivery for our nation's veterans

2007-07-26T13:46:00.001-07:00

That's the name of the group that just presented this report to the President.

I haven't read it yet, but it's not that long so I'm pretty sure I will. I just wanted to comment on the name of the group.

Just the name of the group is political speak at it's worst. "Health care delivery for our nation's veteterans"

What's wrong with "Veteran's health care" Or "Health care delivery for veterans"?

I'll tell you what's wrong with those shorter titles. They don't serve to evoke emotional feelings of ownership. "Our Nation's Veterans". It's an emotional appeal to unity. The President (or someone on his staff) picked that title at the very git-go. That suggests to me that the whole thing is just a political jerk-off to try to make everybody feel better.

When the title is chosen for it's emotional appeal rather than it's descriptive value then I'm not really going to be expecting much.

Class action lawsuit against the VA

2007-07-25T23:06:00.000-07:00

From the San Francisco Chronicle

Two veterans' rights groups filed suit Monday in San Francisco seeking to force the federal government to make major changes in how it cares for hundreds of thousands of injured veterans of U.S. wars in Iraq, Afghanistan and elsewhere.

Depression and anxiety disorders

2007-07-24T11:07:00.000-07:00

Many vets develop mental problems. The most common is PTSD (Post Traumatic Stress Disorder). That's an ailment that can often be addressed with talk therapy, even group therapy, and various kinds of psychoanalysis.

Psychoanalysis is based on the idea that there is some event, or group of events, in your past that can be pointed to as some sort of cause for your current mental problems. With PTSD that would certainly be the case.

But sometimes that kind of stress can seem to trigger more serious mental disorders. Various irrational fears and feelings are grouped together under the two umbrellas of anxiety disorder (irrational fears) and affective disorders (irrational feelings and depression). When that's the case psychoanalysis probably isn't going to help.

Full blown depression or anxiety is based on a disorder of thought, it doesn't have a "cause" somewhere back in the history of your life. There may be some historical event that seems to have triggered the disorder, and combat stress can certainly be such a trigger. But that event probably didn't really cause anything. The stress just brought the effects of an existing underlying disorder of thought to the surface.

Once the underlying disorder hits the surface you can quickly reach a situation where your brain is essentially re-wired, you begin the make very irrational judgements about life risks and life situations that seem rational to your disordered brain.

You'll almost always need medication to re-wire such a miss-wired brain. And often the medication really won't do the brain re-wiring, it will just free up your brain to be re-wired. Psychoanalysis, looking to the past, won't help.

What probably will help is cognitive therapy. Cognitive therapy helps get the damaged thought processes back to rationality by looking to the short term future, but directly addressing cause and effect -- "If I get on that airplane it might crash, but it probably won't". The disordered brain thinks, "If I get on that airplane it will crash".

Some psychoanalysts do cognitive therapy as part of their bag of tricks. But not many, and even some who claim to do so don't really rely on it. If you suffer from an actual mental disorder rather than PSTD which is traceable to a specific event, then steer away from psychoanalysts who want to talk about your childhood or want to do hypnosis. Those are not serious practitioners of cognitive therapy.

Vets and agent orange

2007-07-17T15:17:00.000-07:00

A blog for collecting experiences of veterns exposed to agent orange. Both experiences of the combat exposure and subsequent experiences dealing with the Veterans Administration. Experiences of both vets and those who know vets or work with vets.