How the VA Hooked Veterans on Opioids

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In yet another example of well-researched reporting, the Washington Post details how the Department of Veterans Affairs (“the VA”) hooked Veterans on opioids and other powerful prescription drugs and then failed to provide these Veterans adequate treatment facilities.

The U.S. Department of Veterans Affairs acknowledges its role in creating a large population of opioid-addicted veterans by overprescribing painkillers for injuries and post-traumatic stress disorder. After the agency tightened prescribing practices in 2013, many veterans bought pain pills sold illicitly on the streets. When those became too expensive, they sought heroin and fentanyl, a potent synthetic narcotic.

The VA is now struggling to undo the damage. Hampered by budgetary and bureaucratic obstacles, it has failed to build a rehabilitation program robust enough to meet the overwhelming demand for treatment from the tens of thousands of veterans with opioid addiction, say analysts who have studied the issue. That has left many veterans to fend for themselves, tapping whatever resources they can find to battle a chronic, complex—and frequently fatal—condition.

While the number of toxic opioids prescribed by the VA began to decline after 2013, the damage had been done to many Veterans returning from our wars in Iraq and Afghanistan.  SFTT has long argued against the use of these addictive drugs, but the VA has been slow to respond to the evident abuse and potentially lethal consequences for Veterans suffering from PTSD.

Drug Abuse

While the much needed reform within the VA has received widespread bi-partisan Congressional support, labor leaders like David Cox have blocked any meaningful reform.  Clearly, the self-serving interests of VA employees appears to take preference over the needs of our Veterans.

The Commission on Care report on overhauling the VA was released on June 30th, 2016.  Sadly, political parties lined up on either side of the report to misrepresent the meaningful reforms sought by “disinterested” consultants seeking to improve treatment for Veterans.  It is difficult to speculate what – if any – of these reforms will be implemented by the new administration, but it appears that the labored search for a new VA Secretary suggests that it is a rather difficult position for the Trump administration to fill.

President Barack Obama

As the Obama administration gives way to a new one, President Obama would do well to heed the advice of John Rowan, President of the Vietnam Veterans of America, “to pardon all post 9/11 Veterans who received less-than-honorable discharges without the due process of a court-martial.”

Mr. Rowan argues that

The “misconduct” the military frequently cites to justify less-than-honorable discharges is often related to PTSD, traumatic brain injury or other service-related illnesses and injuries. Yet the military itself is culpable, having for years under diagnosed those problems. After service, things often get worse, since “bad paper” discharges can result in the denial of veterans benefits. Without proper care, and with the stigma of a less-than-honorable discharge, these veterans are often more likely to become substance abusers, homeless or incarcerated — or to die by suicide.

While some may be absolved by this sweeping policy, it could be a step forward to call attention to the plight suffered by many Veterans suffering from PTSD and TBI that have been ill-served by the medical community in treating this debilitating injury.

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Archi’s Acres: Promoting Veteran Wellness through Sustainable Agriculture

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Archi’s Acres has long been at the forefront of sustainable agricultural programs that promote Veteran wellness.  Stand For The Troops is proud to support their endeavors which allows Veterans to gain a valuable and self-sustaining education in farming.

Karen and Colin Archipley of Archi's Acres

Karen and Colin Archipley of Archi’s Acres

Found below are excerpts from a letter from Karen Archipley which explains Archi’s Acres programs in more detail:

“My name is Karen Archipley and I am a Co-Founder of Archi’s Acres, B Corp and Archi’s Institute for Sustainable Agriculture – and our accredited venture with Cal Poly Pomona (a college member of the California university system).

 “As a military family, when my husband Colin Archipley returned from his third tour in Iraq, our farm became his career and next place of service.    When he came to his End of Service, so many of the men he served with were re-enlisting due to not being able to find gainful employment.  Our farm model had proved out already in 2007 to almost equal Colin’s income just with a small greenhouse growing basil (which is what we are known for).    We had our first Veteran on the farm in July 2007; to date we have now trained over 450 students.

“When they graduate it marks day one of our extended relationship as we not only train them, we help identify employment and other business opportunities.  Additionally, they can review what they learned studying with us whenever they need to. We also have quite a few homeless veterans come through our program and for many we have been able to then connect them with farms where they now manage orchards, groves etc and have their own quarters on those farms.

“One story is Paul N. who came through our program last year.  He was very enthusiastic about organic farming to the point that we hired him as our Field Instructor for Lab Hours.  As we got to know him better, we found out that he was living in many of his classmates garages, couch surfing.  We were able to connect him with an 8 acre Apple Orchard looking for someone to take over their management and willing to train him in Apples.  They also offered him a 3 bedroom house on the property that the retiring manager was soon to move out of.   Or a studio apartment next door.  Paul is now a full member on that farm and has been there almost a year.   The 85 year old past manager took him under his wing to teach Apples and now the owner is helping him to purchase the land next door and together they are building a cidery on the property.   He is fully employed with a future.    Paul spends his holidays with us (for the second year) and now has a girlfriend with a child and they are excited to be moving into the 3 bedroom house.   This is just one of many stories.

“The grants that are currently needed ($13,500 for the class) are also compelling stories:  One such is Sarah H, who is still active duty, Sarah came to our program from Florida and had hoped to use her GI BILL, but due to shocking local bureaucracy nitpicking was not able to use it – even though Washington ruled she could.   Usually we would have had to turn her away to wait for another class until we could find a grant, but Sarah’s situation was different, she had found out about class while stationed in Florida.   She worked out with her command that due to her End of Service being in January, they would allow her to move with her two small children and her mother who she was taking care of after a surgery to North Carolina, their family land. Her Battalion deployed right after to Japan where they are still.   When the bureaucratic problem happened with the GI BILL, had we not allowed her to take the class, Sarah would have had 48 hours to be back in Florida with her family or would have been considered AWOL.  She also would have returned to a different command, which can be a challenging situation when there’s no history and where it could have been seen as special treatment for her to be allowed to come to us in the first place.

“Because of my husband’s service, we more than understand and therefore would NEVER allow that to happen.  Instead, we both let her take the class and took the responsibility for her financial debt.   Please know we are a very small farm and when we do not have grants for these students it comes right out of our basil income – which is how we live.

“As you consider donating to Stand For The Troops to assist our students, I wanted to let you know how much that means to us and tell you the story of those students who are so worthy of supporting. Your donation to Stand For The Troops goes 100% to the students via Cal Poly Pomona for tuition.  Stand For The Troops is our absolute Champion in assisting students!

“Please know if you are in a position to help, it means so much for so many.   For 2016 we actually still owe $13,500.   We offer follow up for all our graduates if you would like to follow their stories.  If willing for next year, $30,000 would help 10 students with partial grants, which really makes a difference in their lives.”

During this holiday season, do consider our Veterans and help them build a future in sustainable farming.  If you would like to contribute to their education, please CLICK HERE so SFTT can continue to support these vital programs.

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The VA Semantics of Treating Veterans with PTSD

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While watching the “Talking Heads” address the Russian hacking scandal through the prism of partisan politics, it struck me that much the same language is used by the VA when discussing the treatment of Veterans with PTSD.

PTSD Support Veterans

While I have always thought that the proper use of language should be celebrated rather than used as a divisive instrument, I am very much bothered by the implications of blurring the meaning of words to suit one’s political ends.

Specifically, hacking DNC or private servers is very much different than “intervening” in the election process.  Most, if not all, governments (including our own) hack foreign and often their own domestic communication’s networks.

While one can endlessly debate the ethics of hacking, it has been going on for centuries.  It is simply a derivative of spying.

Using that purloined information to disrupt or interfere in our own or any other election process can most certainly be construed as an aggressive act.

The point here is that the act of “hacking” and “weaponizing the information” from that hack are two very different subjects.    Blurring the meaning and intent of these two very separate activities is cause for alarm. Specifically, it introduces a number of conflicting and non-related elements into the equation that cannot be properly analyzed.  Formulating an “appropriate response” will even be more difficult.

The intent here is not to discussing Russian hacking, but to show how the use of language can be used to create a distorted view of the efficacy of various VA programs to treat Veterans with PTSD and TBI.

Specifically, there is huge difference between the following statements:

The VA is treating Veterans with PTSD;

The VA is treating Veterans for the symptoms of PTSD.

As Maj. Ben Richards eloquently points out, there is no evidence that VA-prescribed therapies have  “healed” or resulted in any significant improvement to Veterans suffering from PTSD and TBI.

 

Clearly, treating the symptoms of PTSD and TBI is quite a bit different than restoring brain function and permanently improving the physical and mental condition of military Veterans suffering from PTSD.

In effect, current VA programs seem to be designed to help Veterans cope with the side-effects of PTSD and TBI (i.e. depression, suicidal thoughts, alienation, etc.) rather than cure the underlying problem.    In many cases, we have seen that lethal combinations of prescription drugs have had the opposite effect.

The semantics of VA administrators stating that they are “treating PTSD” rather than “coping with the symptoms of PTSD” is not a trivial distinction.  In fact, there seems to be little evidence that the VA has provided Veterans with a clear path to restore some level of normalcy in their everyday life.

Clearly, with VA consultants like Dr. David Cifu suggesting unorthodox practices to deal with “concussive events” that no one in the medical profession seems to support, it is not surprising that the Veteran treatment outcomes have been so poor.

While there is clearly a need to help Veterans cope with the myriad of frightening symptoms that emanate from PTSD and TBI, we urgently need benchmarks to help provide Veterans with a path to recovery.

As long as a disproportionate amount of money is spent by the VA on drugs and ineffective therapy programs to deal with the behavioral symptoms of PTSD and TBI, then Veterans will be shortchanged by the organization responsible for their care.

With new leadership on the horizon at the VA, SFTT remains hopeful that Veteran trust in the VA will be restored and that the organization will be purged of the toxic leadership of Dr. David Cifu and others who defend the status quo.  Our Veterans and those in the military are not well served by these corrosive and divisive administrators.

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Preventing Concussions: Can Help be on the Horizon?

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Concussions and preventing concussions continues to be a hot topic in the media, particularly when parents decide whether to allow their kids to play contact sports.

Treating PTSD and TBI also receives its share of attention, but most of the media coverage seems to be focused on coping with the symptoms of brain injury rather than offer any meaningful long-term solution for Veterans with these conditions.

Far less attention is devoted to preventing concussions in the first place.  Perhaps, we should be moving forward on all fronts simultaneously.

military drugs

Just this week the FDA just approved a series to trials to evaluate ecstasy to help people cope with PTSD.

After successful preliminary trials, the FDA is moving forward with a large scale study for using Ecstasy as a prescription drug to treat post-traumatic stress disorder.

The study approved on Tuesday would be the final measure necessary before the agency could legalize the drug, according to the New York Times. If the results are favorable, the drug also known as MDMA would be available to patients as early as 2021.

While some may view this new FDA initiative with relief, I am not encouraged by yet another new drug that treats the symptoms of PTSD rather than drugs that permanently reverse brain damage itself.   As we have seen with opioids, treating symptoms opens up a pandora’s box of other medical and neurological problems, particularly when these medications are combined with other prescription drugs.

Granted, reversing brain injury is new uncharted territory, but many Veterans seem to have lost hope that permanently improving  brain “wellness”  is considered to be a high priority for either the VA or the FDA.

If this is the case – and I hope it is not – then studies focused on reducing the incidence of concussion certainly take on far more importance.  Found below is a recent Ted Talk  by David Camarillo focused on developing new protective gear to reduce concussions:

Mr. Camarillo takes issue with both the CDC and NFL models of what happens when a concussive-event occurs. Swedish scanning imagery points to something far different occurring within the brain than what is argued by conventional sources.

Could it be that existing helmet designs for the military and the NFL are based on flawed models and questionable scientific research?

I don’t know the answer to that question, but I continue to be disturbed by the conflicting messages sent out by the VA, the FDA, the CDD and the NFL.  Surely, “I don’t know,” is a far more honest answer than continued claims by those in authority that “we are making progress” in helping Veterans with PTSD or protecting NFL players.

If the flawed product were an automobile which caused a fatality, a recall notice would be issued.  How is it possible that the NFL continues to operate with impunity when the evidence strongly suggests that repeated concussions causes chronic traumatic encephalopathy (or ”CTE’)

The recent FDA “Ecstasy” trial isn’t particularly reassuring, particularly knowing that the results will not be available until 2021.

Questions that seem more relevant would be these:

– Will Dr. David Cifu continue to dictate VA protocols in treating concussive events?

– When will military helmet sensor data be released to the scientific community to help provide our brave military personnel with better helmets?

– Can the VA provide any clinical evidence that it has successfully treated and “cured” PTSD and/or TBI?

– Are more drugs the answer to treat PTSD?

I can’t answer these questions, but tens of thousands of brave men and women with PTSD and TBI deserve an answer.

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Veterans with PTSD: Why a Dog May be Your Best Friend

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Veterans with PTSD:  Relief may be around the corner.  Practically, every day one sees Veterans with PTSD coming out from under the dark clouds of depression with the support of a canine companion.

Service Dogs and Veterans

I certainly am not qualified to speculate on the benefits that a service dog provides Veterans suffering from PTSD or other mental impairments, but there does appear to be genuine love and understanding between a Veteran and his or her companion dog.

Sadly, the Department of Veterans Affairs (“the VA”) does not provide “service dogs” to Veterans suffering from PTSD.  In fact, the VA only provides limited benefits to those service members with an approved VA disability:

VA will pay for veterinary care and the equipment (e.g. harness and/or backpack) required for optimal use of the dog. Veterinary care includes prescribed medications, office visits for medical procedures, and dental procedures where the dog is sedated (one sedated dental procedure will be covered annually). Vaccinations should be current when the dog is provided to the Veteran through an accredited agency. Subsequent vaccinations will be covered by VA. Prescribed food will be reviewed on a case-by-case basis.

Veterinary care does not include over-the-counter medications, food, treats and non-sedated dental care. Flea and tick medications are considered over-the-counter and are the responsibility of the Veteran along with over-the-counter dental care products (bones, dental treats, etc.). Grooming, boarding and other routine expenses are not covered.

The VA differentiates between a “guide dog” (for Veterans that are blind) and a “service dog” as follows:  to help those with severe to profound hearing loss by alerting the individual to a variety of sounds or someone with a physical impairment that substantially limits mobility  by assisting in the performance of a wide variety of tasks depending on need and training (e.g. opening doors, retrieving, etc.).

Currently, the VA does not provide Service Dogs to Veterans suffering from PTSD because “there is not enough research yet to know if dogs actually help treat PTSD and its symptoms.”  Studies are now underway to evaluate the benefits of service dogs to Veterans suffering from PTSD and TBI, but these results will not be available for several years.

Nevertheless, many Veterans can attest to the healing benefits of having a service dog regardless of the VA’s propensity to study the issue further.  Found below is a video of a Navy Seal who explains the emotional well-being of his service dog.

While the VA continues its research, many privately-funded organization have sprung up across the United States to provide trained service dogs to many Veterans seeking canine support to help them cope with PTSD and TBI. Found below is a list of just a few of these organizations which provide Veterans with canine support that is still under consideration by the VA.

Train a Dog Save a Warrior:  SFTT’s Rescue Coalition Partner providing service dogs to Veterans dealing with the silent wounds of war.

Paws for Veterans:  A privately-funded program which rescues dogs from shelters and then trains both the Veterans and their service dogs.

Vets Adopt Pets:  A list of several programs across the United States to help pair Veterans with “support” pets.

This Able Veteran:   A service dog program designed to help Veterans cope with PTSD and recover their lives.

Canine Angels USA:  Another program which rescues dogs for animal shelters and trains them to work with Veterans suffering from PTSD and TBI.

As the VA continues to “study” the self-evident benefits of a service dog, many well-intentioned private organizations across the United States are already providing much needed training and support for Veterans seeking a canine companion.

In many cases, these organizations are rescuing dogs for animal shelters to help provide these Veterans with a healing companion.

Thanks to the steadfast dedication of many wonderful people, the lives of countless Veterans have been improved.  On behalf of our Veterans, SFTT thanks you for your continued kindness and generosity!

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Veterans Affairs: Hope on the Way for Those Suffering from PTSD and TBI?

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With the expected change in the administration of the Department of Veterans Affairs (“the VA”), hope could well be on its way to provide more effective and timely treatment for the tens of thousands of Veterans suffering from PTSD and TBI.

Regardless of one’s political affiliation, the VA doesn’t seem to have a handle on treating Veterans with serious brain injury.  One hopes that the “new” VA will be more open to alternative therapy provided in the private sector, rather than current dogmatic approaches that have produced few – if any – positive approaches to treating PTSD and TBI. Maj. Ben Richards explains in far more detail below:

I just finished watching an exceptional documentary on PBS by Bob Woodruff entitled Medical Medicine Beyond the Battlefield.   The video, which may be watched below if you can spare 58 minutes – details some incredible medical breakthroughs in helping Veterans recover their lives after they have lost limbs in combat.  Truly miraculous!

Approximately 36 minutes into the video, Mr. Woodruff focuses on how the VA is dealing with brain injury.  Shortly thereafter, he chronicles the issues faced by Elana Duffy, an intelligence Sgt. First Class who suffered traumatic brain injury while serving in Iraq (39 minutes).

It is evident that the VA is not making as much progress in treating neurological disorders as they are on other medical rehabilitation fronts.

While concerted efforts are being made to understand and treat PTSD traumatic brain injury, it appears that “progress” within the VA has been impeded by dogmatic positions maintained by Dr. David Cifu and others. In effect, Veterans suffering from PTSD and TBI are given few treatment alternatives outside the narrowly defined treatment programs so vigorously defended by VA administrators.

SFTT has long held the view – based on feedback from many Veterans – that the VA is not in a position to provide the necessary care and treatment to truly help Veterans suffering from PTSD and TBI.   This is a huge problem for Veterans and their families and one needs to “think outside the box” or the confines of VA orthodoxy to embrace new treatment alternatives.

It is terribly sad that the VA has become a political ping pong ball to the chagrin of many Veterans. The release of the Commission on Care report recommending 18 major reforms within the VA triggered an immediate backlash from employees and lobbyists who felt threatened  by the findings.

J. David Cox

J. David Cox

Like others, “I was appalled by the outburst of J. David Cox, the President of the American Federation of Government Employees, who threatened VA Secretary with ‘physical violence.’Cox was ‘prepared to whoop Bob McDonald’s a – -,’ he said. ‘He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you.'”

Against this particularly toxic background, it is difficult to know whether a new VA Secretary will be able to implement the reforms outlined in the Commission on Care report.

Former U.S. Senator Scott Brown to Head Department of Veterans Affairs?

According to recent information, former U.S. Senator Scott Brown of Massachusetts is apparently a front-runner for the post of Secretary of Department of Veterans Affairs in the new Trump administration.

As reported in the Boston Herald and several other respected media sources, Scott Brown is

 . . . under consideration for the Cabinet post of Veterans Affairs secretary — said he would create a 24-7 manned hotline for suicidal soldiers, take back bonuses and raises awarded to incompetent VA staffers and outsource PTSD and other serious mental health cases to private professionals.

“People are hurting and they need some real help,” Brown said last night, hours after he spoke with President-elect Donald Trump. “There are some great angels working in the VA right now and they need a morale boost.”

If true, this could very well accelerate outsourcing the treatment of Veterans suffering from PTSD and TBI to private healthcare providers.   Sen. Brown is quoted as saying, “The VA’s trying to do it all — they can’t. We need to outsource that and get those people help right away.”

There is no way of knowing whether Sen. Brown will be offered the job of VA Secretary or will be confirmed to this “cabinet-level” position, but implementing the steps recommended by the Commission on Care would be a major step forward in getting Veterans the help they deserve.

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Swimming with the Sharks and Veterans with PTSD

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Last month, the New York Times published an article entitled “Scuba, Parrots, Yoga:  “Veterans Embrace Alternative Therapies for PTSD.”  The article focuses on Veterans with PTSD who seek alternative treatment programs.

shark and veterans with ptsd

In this article, author Dave Phillips, suggests that Veterans with PTSD (Post-traumatic stress) are seeking alternative treatment since conventional treatments approved by the Department of Veterans Affairs (the “VA”) are not working:

Traditional medical approaches generally rely on drugs and controlled re-experiencing of trauma, called exposure therapy. But this combination has proved so unpopular that many veterans quit before finishing or avoid it altogether. This has given rise to hundreds of small nonprofits across the country that offer alternatives: therapeutic fishing, rafting and backpacking trips, horse riding, combat yoga, dogs, art collectives, dolphin swims, sweat lodge vision quests and parrot husbandry centers, among many, many others.

According to Mr. Phillips, one group of Veterans has even taken up swimming with sharks to help “overcome fears and build new experiences that put traumatic memories in perspective.”

Now, it is difficult to say whether swimming with sharks or parrot husbandry have any long term beneficial impact for Veterans, but it does speak volumes for the lack of treatment alternatives currently offered by the VA.

Prescription drugs and exposure therapy seem to be standard treatment procedures within the VA.  Sadly, the VA gatekeepers strongly discourage Veterans from seeking alternative programs provided by the private sector and charitable organizations (mostly small).

Hiding behind the cloak of “not FDA approved,” “lack of supporting clinical studies” or other bureaucratic protocols, the VA has effectively blocked many Veterans from seeking what many consider to be more effective treatment without the drug side-effects.

In fact, the VA has established itself as “Il Supremo” or the “Supreme Authority” in deciding what is “right” and proper for Veterans seeking help to cure themselves and re-integrate into society.

For many reasons, Veterans are finding that the VA’s recommended treatment for PTSD has its limitations and, in many cases, undesirable side-effects.  In fact, as we reported last week, the VA track record in treating PTSD is abysmal.

While VA administrators argue that they are open to “alternative therapies,” there is little in SFTT’s experience to suggest that the VA is openly encouraging Veterans to seek treatment outside the VA.  Quite the contrary, the gatekeepers at the VA consider alternative therapies as “black magic” with little or no scientific basis for support or VA funding.

As such, many Veterans are left to their own devices to find programs that may meet their particular needs rather than the VA pro forma cocktail of prescription drugs which masks symptoms and is often lethal.

While alternative PTSD treatment programs have grown exponentially,  it is difficult to gauge the efficacy of these programs given the vast differences in one program from another and the level of supervised care provided.  Who is to say whether swimming with sharks is better than parrot husbandry or which program may be best suited for a particular Veteran.

Despite these shortcomings, the VA would be wise to gather as much information as possible to evaluate the efficacy of these “alternative” treatment programs rather than simply dismiss them because there are no clinical trials or replicable results.

As the VA tries to redefine itself to provide more effective treatment programs for Veterans with PTSD, SFTT remains hopeful that the VA embraces other treatment alternatives and provides financial support to private foundations which try to make a difference in the lives of our brave Veterans.

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Mixed Signals for Veterans with PTSD

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It is reassuring to learn that Brig. Gen. Donald C. Bolduc encourages troops under his command to seek help when dealing with the symptoms of post-traumatic stress.

Many in the military believe that headaches, depression and mood swings are simply job fatigue symptoms and that it is “not macho” to seek out treatment.  As Gen. Bolduc knows, these common wartime symptoms may be a clear signal of post-traumatic stress (PTSD) or traumatic brain injury (TBI).

In a recent article featured in the New York Times, Gen. Bolduc made the following observation:

General Bolduc wants soldiers under his command — who are stationed in some of the continent’s most difficult parts — to know that seeking help will not hurt their careers. In his opinion, PTSD is the same as a broken arm.

“The powerful thing is that I can use myself as an example,” General Bolduc said. “And thank goodness not everybody can do that. But I’m able to do it, so that has some sort of different type of credibility to it.”

SFTT applauds Gen. Bolduc for taking the lead in encouraging troops under this command to seek out help without the repercussions of a punitive career backlash.  Nevertheless, effective treatment options for PTSD are severely limited by current DoD protocols.

Nowhere is this more evident than within the Department of Veterans Affairs (“the VA”). Currently, the VA provides two forms of cognitive behavioral therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy.

Also, to address the symptoms of PTSD the VA may authorize “selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).”

As SFTT has reported on numerous occasions, masking the symptoms of PTSD through cocktails of powerful prescribed drugs has not proved successful and may in fact have triggered suicidal incidents.

In fact, the track record of the VA in treating PTSD has been notoriously ineffective as Maj. Ben Richards pointed out recently in this comprehensive discussion of VA procedures to treat PTSD and TBI:

Contrast Maj. Richards experience, with VA spokesman Dr. David Xavier Cifu to a Congressional Committee:

Personally, I find Dr. David Cifu’s treatment recommendation: “get back to activity as soon as possible” to be particularly disturbing. Not only is Dr. Cifu’s judgement questioned by his peers, but even the NFL has instituted “concussion” protocols which REQUIRE a mandatory rest period after a concussion.

In effect, a battlefield commander could encourage troops under his command to “get treatment,” yet the medical gatekeepers could simply prescribe antidepressants and quickly put the troops back into harm’s way.

Gen. Bolduc is to be complimented on his leadership, but the medical support in the military and VA needed to effectively treat men and women in combat for brain-related issues doesn’t seem to be on the same page.   How sad!

Why?  Good question, but one can only speculate on the “right” answer.

NFL and the Concussion Settlement

While the VA continues to “whistle Dixie” as the lives of Veterans and their loved ones continue to deteriorate, the leadership of the NFL is finally beginning to acknowledge the terrible harm done to professional athletes caused by repeated concussions.

Joe Nocera of the New York Times reports that a “Crack Appears in N.F.L.’s Concussion Settlement.”   NFL leadership has fought tooth-and-nail to hide the corrosive effect of repeated concussions from its players and the public.   Nevertheless, thanks to the courageous effort forensic pathologist Dr. Bennet Omalu, popularized in the film “Concussion” starring Will Smith, the NFL acknowledged that Chronic Traumatic Encephalopathy or C.T.E. was a serious health concern.

chronic_traumatic_encephalopathy

Now, a Doctor at Boston University’s Chronic Traumatic Encephalopathy Center believes that “I really do foresee being able to diagnose C.T.E. pretty accurately while people are alive sometime in the next five to 10 years,” he said. “Hopefully, even earlier.”

While this is helpful, one must ask what preventive measures can be introduced into football now to prevent C.T.E. from occurring in the future.  More to the point, if C.T.E. is predictive, what about the large number of professional players who have settled with the NFL to keep this problem from gaining traction with the public.

The Leadership of the NFL and the VA Have a Problem

The leadership of the NFL and the VA can continue to stonewall investigative committees and deceive themselves, but lives are at risk.  Isn’t it about time that the leadership of both organizations step up and “own the problem” and do their best to help players and servicemembers recover their lives?

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Please Pick Up the Phone at the Suicide Crisis Center

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It is fashionable these days to pick on people or institutions that promote a “political” agenda.  Mind you, there are plenty of targets worthy of scorn and outrage, but righteous indignation and self-promotion discourages meaningful dialogue.

As a 501 (c)3 non-political educational foundation, Stand For The Troops (“SFTT”) often focuses on the shortcomings of military and political institutions that fail to meet their obligations to support military personnel and Veterans.

In particular, SFTT has been most critical of the level of care provided by the Department of Veterans Affairs (“the VA”) to Veterans.  We get no pleasure in citing the many shortcomings of the VA, but it seems like every day one scandal or another emerges which captures national attention.

A few days ago, we learned that the VA’s “Crisis Line” to prevent Veteran suicides appeared to be woefully unresponsive:

An insider memo newly uncovered by the Associated Press indicates that more than one-third of calls to the national suicide hotline for troubled veterans are not being answered by front-line staffers because of poor work habits and other problems at the VA.

This follows an Inspector General Report in February which cited numerous problems in the Crisis Line now managed by the VA.

It is interesting to note that a little over a year ago the DoD suspended funding for a Veteran Suicide Hotline run by Vets4Warriors, to centralize the function within the VA.

Priggee Cartoon from Denver Post

Reading the IG’s report and recent disclosures that Veterans in crisis are underserved by the VA, this decision to close down an effective and privately-run Veteran Suicide Hotline now doesn’t seem to be a great idea.

Frankly, I am tired of listening to President Obama (or any other President for that matter) state that “I don’t want to in any way pretend that we are where we need to be,”  after having increased the VA budget by 85% during his presidency.

Any sane citizen would simply conclude that we are simply wasting valuable resources within the VA that could be more efficiently deployed to provide Veterans with support and treatment that might make some difference in their lives.  Let’s face it:  If VA employees at Crisis Centers don’t pick up the phone or respond to text messages, then no amount of money is going to solve the problem.

The VA appears to be a broken institution that has simply lost its way. It is hard to conceive of a more responsive and efficient VA, with the likes of J. David Cox, the President of the American Federation of Government Employees, seemingly more interested in defending the status quo of his constituency rather than encourage radical reform in a bloated bureaucracy.

The battle lines have been drawn and it is difficult to see how Veterans – who don’t seem to have much of a voice in the final outcome – will receive better treatment and care from an institution that is reeling out of control.

The VA has strayed far from its mission to fulfill President Lincoln’s promise “’To care for him who shall have borne the battle, and for his widow, and his orphan’ by serving and honoring the men and women who are America’s Veterans.”

va_payroll

More to the point, the Department of Veterans Affairs has effectively disavowed its five core values that “underscore” the VA’s mission: Integrity, Commitment, Advocacy, Respect, and Excellence.

Integrity: Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage.

Commitment: Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities.

Advocacy: Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.

Respect: Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it.

Excellence: Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.

The VA’s “core values” are simply words that appear to have little in common with the “dignity and respect” we should show our Veterans.   How sad!  More importantly, how tragic it is that little will be done to restore today’s VA to an institution that we can all admire and respect.

President Lincoln’s “promise” is little more than a soundbite at a political rally.

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NFL Reluctantly Opts to Research Concussions

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In yet another token concession to those concerned with repeated trauma of concussions on NFL players, Commissioner Roger Goodell announced a new initiative “intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries.”

As reported by CNN, Goodell said:

. . . the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research — in addition to the $100 million previously pledged by the league to medical and neuroscience research.

The Play Smart Play Safe initiative also requires hiring a physician to serve as the league’s chief medical officer.  The physician will work with each team’s medical staff and establish an independent scientific advisory board to consider head injury research proposals.

Concussions and, more importantly, chronic traumatic encephalopathy ( or”CTE’) continues to be a subject that is only whispered about behind closed doors at the NFL.  Nevertheless, it is a problem that will not soon disappear and SFTT remains hopeful that researchers will be able to improve the safety of the game and provide insights into how this horrific “sport” injury can be prevented and,  hopefully, treated more effectively.

chronic_traumatic_encephalopathy

While the NFL has been slow to address this problem, the Department of Defense and the Department of Veterans Affairs (the “VA”) have been even slower.  Consider what SFTT stated in March, 2016 in its article entitled “NFL Preempts Veterans with Brain Injuries“:

With hundreds of thousand of Veterans suffering from brain trauma, isn’t it about time our political and military leadership quit burying their heads in the sands and deflect public scrutiny by investigating the NFL, which has Congressional immunity from antitrust regulation?  What a strange but convenient retreat for our feckless political leadership.

If the NFL owners had any sense, they would embrace the battle against brain trauma and work with the military to help both its gladiators and the brave men and women suffering from PTSD. Indeed, this public relations initiative could help deflect “public” outrage and provide the medical profession and others with the resources and impetus to deal with the silent wounds of war.

While the causes of brain trauma are different, shared research could go a long way in helping both Veterans and NFL players deal with the problems of repeated concussions.  No one expects easy answers, but the military has collected a wealth of data on concussions over the last six years from sensors implanted in helmets of soldiers serving in combat.

The first step in solving a problem is to admit you have a problem.  Sadly, both the NFL, the VA and the DoD have been slow to address this most serious problem and one wonders how committed either organization is to do so.

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