SFTT Military Highlights: Week Ending Aug 11, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Tensions High over North Korea
“Military solutions are now fully in place, locked and loaded, should North Korea act unwisely,” President Trump said on Friday, in his latest salvo in the exchange of rhetoric with the isolated regime. “Hopefully Kim Jong Un will find another path!”  The statement, made via Twitter, comes one day after Trump wondered whether he had been stern enough in talking about North Korea earlier this week, when he promised to meet Pyongyang’s threats with “fire and fury.”  Read more . . .

Military Food Rations Amazon

Food Rations May Become a Military Profit Center
Amazon is using everything at its disposal to take on the grocery and food delivery business. The online retailer purchased Whole Foods Market in June for $13.7 billion, announced new meal-prep boxes that challenge Blue Apron in July, and now it’s turning to the military for its next move. According to a CNBC report, Amazon wants to use military food technology to create prepared meals that don’t need to be refrigerated. This would allow the company to store and ship more food more efficiently and to offer ready-to-eat, (hopefully) tasty meals at a lower price.  Read more . .

Is the VA Planning to Close Incomplete Healthcare Applications?
A well-known whistleblower in the Department of Veterans Affairs warned Wednesday that the VA appears to be getting ready to close tens of thousands of incomplete healthcare applications, even though it’s been clear for more than a year that the VA was failing to give veterans a chance to complete these applications. Scott Davis is a public affairs officer for the VA’s Member Services in Atlanta who has testified before Congress about problems within the VA.  Read more . . .

Deja Vu All Over Again at the VA
The Department of Veterans Affairs (VA) has been forced to employ the former Washington, D.C., medical center director for the time being after the employee was fired for failing “to provide effective leadership at the medical center.” Brian Hawkins was fired in July after it was revealed he had sent sensitive information to his wife’s personal email account. However, Hawkins appealed the termination and the federal Merit Systems Protection Board issued a stay on the decision on Aug. 2, allowing Hawkins to build a defense that he was wrongfully let go. VA Secretary David Shulkin pushed back against the stay and has prohibited Hawkins from working around patients.   Read more . . .

Opioids for Veterans with PTSD

Tighter Controls Over Opioid Prescriptions at the VA?
The U.S. Department Veterans Affairs Office of the Inspector General released a report Aug. 1 that recommended non-VA health care providers being paid by the VA to provide services to veterans be required to submit opiate prescriptions directly to VA pharmacies. According to the report, veterans are one of the highest risk pools of people to become addicted to opiates and that veterans could receive treatment in the form of opiates from non-VA doctors without regard for the possibility of co-occurring mental health problems. “Veterans receiving opioid prescriptions from VA-referred clinical settings may be at greater risk for overdose and other harm because medication information is not being consistently shared,” said U.S. Department of Veterans Affairs Inspector General Michael J. Missal. “That has to change. Health care providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”  Read more . . .

Link Between PTSD and Alzheimer’s Disease and Dementia?
More and more evidence is suggesting that developing post-traumatic stress disorder early in life can raise the risk of dementia in old age. New research finds a molecular link between the two conditions, which paves the way for new therapies. An increasing number of epidemiological studies have suggested that people who develop a neuropsychiatric condition such as post-traumatic stress disorder (PTSD) in childhood are also likely to develop Alzheimer’s disease later in life.  Read more . . .

How Combat Vet’s PTSD Affects Families
Soldiers who experience the horror and terror of conflict often return home far different people than they were when they left. Many are angry, suffer from depression, harbour suicidal thoughts or attempt to isolate themselves from the world, hoping to avoid triggers that can instantly force them to relive their experiences. While increasing attention has been paid in recent years to helping armed forces members cope with post-traumatic stress syndrome (PTSD), not as much attention has been paid to the experience and grief of intimate partners and families who experience trauma in trying to deal with the changes a loved one, coping with PTSD, goes through.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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SFTT Military News: Highlights for Week Ending August 4, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

With Eye on Russia, US Military Focuses on Global Exercises
The U.S. military is moving toward more global exercises to better prepare for a more assertive Russia and other worldwide threats, a senior officer said in an interview with Reuters. Air Force Brigadier General John Healy, who directs exercises for U.S. forces in Europe, said officials realized they needed to better prepare for increasingly complex threats across all domains of war – land, sea, air, space and cyber. Some smaller-scale war games with a global focus had already occurred, but the goal was to carry out more challenging exercises by fiscal year 2020 that involved forces from all nine U.S. combatant commands – instead of focusing on specific regions or one military service, such as the Marines.  Read more . . .

Secretary of State Tillerson Seeks Talks with North Korea
In the Trump administration’s first serious attempt at a diplomatic opening to North Korea, Secretary of State Rex W. Tillerson has offered to open negotiations with Pyongyang by assuring “the security they seek” and a new chance at economic prosperity if the North surrenders its nuclear weapons.Mr. Tillerson’s comments came just hours before the United States on Wednesday tested an unarmed Minuteman III intercontinental ballistic missile, sending it 4,200 miles to a target in the Marshall Islands. The Pentagon said the test was not intended as a response to the North’s launch on Friday of a missile that appeared capable of reaching Los Angeles and beyond.But military officials said the test demonstrated that the American nuclear arsenal was ready “to deter, detect and defend against attacks on the United States and its allies.”  Read more . . .

Telehealth for Veterans Rolls Out To General Acclaim
American Telemedicine Association (“ATA”) has long supported the VA’s vision of expanding veterans’ access to telehealth services, facilitating high-quality encounters between veterans and providers, and ensuring that veterans are equipped with the best tools to monitor their health. This includes innovative models that facilitate cross-state practice and enable consumer choice such as the VETS Act (S. 295 and H.R. 2123). “We applaud Dr. Shulkin for demonstrating the value of telehealth today at the White House.” said Gary Capistrant, Chief Policy Officer, ATA. “We encourage President Trump to issue an Executive Order to eliminate the state-by-state licensure model for all federal and private-sector health professional employees servicing federal government programs—notably agencies (such as the VA and the Department of Health and Human Services), health benefit programs (such as Medicare and TRICARE), federally-funded health sites (such as community health centers and rural clinics), and during federally-declared emergencies or disasters.  Read more . . .

Veteran Choice Options Expanded
Thank bipartisan support for helping veterans, or lingering anger over the previous scandals at the Department of Veterans Affairs, but whatever the reason, Congress is managing to get legislation passed addressing veterans’ needs. First, Congress finally worked out a deal on funding for Veterans Choice. If you believe that veterans should be able to seek out and get the best care wherever they prefer, whether it’s within the VA or from a private health care provider, Veterans Choice is a nice half-step, but hardly a sweeping change. (The booming demand for treatment through the program can be interpreted in veterans’ interest in exploring other treatment options.)  Read more . . .

Brain and PTSD Studies

No Surprise Here:  PTSD May Be More Physical than Psychological
The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a study released today that will be presented at the American Academy of Neurology’s Sports Concussion Conference in Jacksonville, Fla., July 14 to 16, 2017. “Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala,” said Joel Pieper, MD, MS, of University of California, San Diego. “These findings have the potential to change the way we approach PTSD diagnosis and treatment.” In the brain there is a right and left amygdala. Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Drs. Paul Harch and David Cifu Spar over Hyperbaric Oxygen Therapy

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Well over a year ago, Dr. Paul Harch, one of the leading experts in Hyperbaric Oxygen Therapy (“HBOT”) published an authoritative report entitled “Hyperbaric oxygen in chronic traumatic brain injury:  oxygen, pressure and gene therapy” for the U.S. National Library of Medicine (Medical Gas Research).

Brain Function after HBOT

In this report (a lengthy extract is printed below), Dr. Harch argues persuasively over the many benefits of using HBOT in treating brain injury:

Hyperbaric oxygen therapy is a treatment for wounds in any location and of any duration that has been misunderstood for 353 years. Since 2008 it has been applied to the persistent post-concussion syndrome of mild traumatic brain injury by civilian and later military researchers with apparent conflicting results. The civilian studies are positive and the military-funded studies are a mixture of misinterpreted positive data, indeterminate data, and negative data. This has confused the medical, academic, and lay communities. The source of the confusion is a fundamental misunderstanding of the definition, principles, and mechanisms of action of hyperbaric oxygen therapy. This article argues that the traditional definition of hyperbaric oxygen therapy is arbitrary. The article establishes a scientific definition of hyperbaric oxygen therapy as a wound-healing therapy of combined increased atmospheric pressure and pressure of oxygen over ambient atmospheric pressure and pressure of oxygen whose main mechanisms of action are gene-mediated. Hyperbaric oxygen therapy exerts its wound-healing effects by expression and suppression of thousands of genes. The dominant gene actions are upregulation of trophic and anti-inflammatory genes and down-regulation of pro-inflammatory and apoptotic genes. The combination of genes affected depends on the different combinations of total pressure and pressure of oxygen. Understanding that hyperbaric oxygen therapy is a pressure and oxygen dose-dependent gene therapy allows for reconciliation of the conflicting TBI study results as outcomes of different doses of pressure and oxygen.

Not surprisingly, Dr. David Cifu, Senior TBI Specialist in the Department of Veterans Affairs’ Veterans Health Administration, gave the standard stock answer from the spin doctors at the VA that:

There is no reason to believe that an intervention like HBOT that purports to decrease inflammation would have any meaningful effect on the persistence of symptoms after concussion. Three well-controlled, independent studies (funded by the Department of Defense and published in a range of peer reviewed journals) involving more than 200 active duty servicemen subjects have demonstrated no durable or clinically meaningful effects of HBOT on the persistent (>3 months) symptoms of individuals who have sustained one or more concussions. Despite these scientifically rigorous studies, the clinicians and lobbyists who make their livings using HBOT for a wide range of neurologic disorders (without scientific support) have continued to advocate the use of HBOT for concussion.

To Dr. David Cifu’s stock VA response, Dr. Harch responded as follows:

The charge is inconsistent with nearly three decades of basic science and clinical research and more consistent with the conflict of interest of VA researchers.  A final point: in no publication has the claim regarding effectiveness of HBOT in mTBI PPCS been predicated on an exclusive or even dominant anti-inflammatory effect of HBOT. Rather, the argument is based on the known micro-wounding of brain white matter in mTBI, and the known gene-modulatory, trophic wound-healing effects of HBOT in chronic wounding.  The preponderance of literature in HBOT-treated chronic wound conditions, is contrary to Dr. Cifu’s statement of HBOT as a “useless technology.”

As a layman, Dr. Harch’s detailed rebuttal (see FULL RESPONSE HERE) completely destroys Dr. Cifu’s “non-responsive” comment to the scientific points raised in Dr. Harch’s report.  In my view, it goes beyond the traditional “professional respect” shown by peers:  Dr. Harch was pissed off and, in my opinion, had every right to be.

Not surprisingly, Dr. Cifu has not responded to the irrefutable arguments presented by Dr. Harch.

The discussion of HBOT is not a subject of mild academic interest.  Specifically,  Veterans are being deprived of hyperbaric oxygen therapy because Dr. David Cifu and his cronies at the VA are misrepresenting the overwhelming evidence that suggests that HBOT restores brain function.

Why?  Indeed, that is the $64 question.  

It is difficult to forecast how this academic drama will play out.  Nevertheless, I suspect that David Ciful will eventually be viewed by Veterans as performing a similar role within the VA as Alvin Young, aka “Dr. Orange.”

I hope and pray this is not the case.  On behalf of tens of thousands of Veterans who are denied HBOT treatment for PTSD and TBI by the clumsy and sloppy claims of Dr. Cifu and others within the VA, please “do the right thing” and lend your support to HBOT as a recommended VA therapy for treating brain injury.

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Veterans with PTSD: Community Support and Treatment Alternatives

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Many military Veterans have long given up home that the VA really care that they suffer from PTSD and can’t get the help they need and, more importantly, deserve!   SFTT has chronicled many stories of Veterans who either can’t get timely treatment or are provided a cocktail of potent drugs to deal with the symptoms that than treat the problem.

While there are many fine physicians and care-givers within the VA, it seems that the size of the organization and its inherent bureaucracy seems to get in the way of providing the support our Veterans need to reclaim their lives.  In the absence of this support, many local institutions and individuals are filling the vacuum to help Veterans deal with these problems within the confines of their local community.  While this may not be the “best” solution, it appears to be considerably better than the level of interest shown directly by the VA.   Found below are just a few of these initiatives:

Local nonprofit helps PTSD sufferers

Bilde25Four Letter Word is a nonprofit with local connections that provides assistance to PTSD sufferers who are members of the military special operations community or are veterans.

Lowell Koppert, an Aiken resident, is on Four Letter Word’s board. He also is a Green Beret and a recipient of multiple Bronze Stars. Four Letter Word provides support in the form of gear, training and travel at no cost to PTSD sufferers who get involved in endurance events as marathons and triathlons.

Four Letter Word’s founders believe intense physical activity can minimize the use of medications to cope with PTSD and prevent substance abuse and/or violence.

Based in the south, this is just one of many grassroots organization that has reached out to touch the lives or our brave Veterans.  Getting the message out to others is a way to help these organizations raise money for Vets

via Four Letter Word, local nonprofit, helps PTSD sufferers

Two New PTSD Treatments Offer Hope for Veterans

A couple of years ago, “60 Minutes broadcast a story about two new therapies being used to treat veterans with Post-Traumatic Stress Disorder (PTSD). The treatments are called “Prolonged Exposure Therapy” (PE) and “Cognitive Processing Therapy” (CPT). The new treatments were originally designed for attack and abuse victims.”

Found below is a summarized description of these therapies:

Prolonged Exposure Therapy

“Dr. Kevin Reeder is the man behind the VA program. He explains that the idea is to relive the story of the attack at least five times in a single session, and then listen to your voice on tape re-telling the story. The belief is that hearing the traumatic memory repeatedly will neutralize its power from bubbling up from your subconscious memory and catching you off guard.

“Reeder said that Prolonged Exposure Therapy is designed to help people see “the impact and the meaning that these stories have on their lives.” He also said that these therapies were originally developed for abuse victims, and the symptoms are often similar for post-war PTSD.

“If you have PTSD, with the help of your therapist, you can change how you react to things that trigger traumatic memories. In PE, you work with your therapist to relive the trauma-related situations and verbalize the memories in a safe place and at a comfortable pace.

“Usually, you start with things that are less distressing and move towards things that are more distressing. A round of PE therapy most often involves meeting alone with a therapist for about 8 to 15 sessions. Most therapy sessions last 90 minutes.

“With time and practice, you will be able to see that you can master stressful situations. The goal is that you can learn to consciously control the ‘explicit’ memories and learn how to harness the ‘implicit’ memories when they surface from your subconscious mind. If you have PTSD, Prolonged Exposure Therapy can help you get your life back after you have been through a trauma.”

Cognitive Processing Therapy

“The VA is offering a second experimental therapy called Cognitive Processing Therapy (CPT). Dr. Reeder said that repeated trauma can leave veterans feeling like the world at large is a dangerous place. This therapy method begins with writing an impact statement, which is shared with the group in which veterans talk about “how their lives are still held in the grip of war.”

According to the VA, there are four components to CPT:

  1. Learning About Your PTSD Symptoms. CPT begins with education about your specific PTSD symptoms and how the treatment can help. The therapy plan will be reviewed and the reasons for each part of the therapy will be explained. You will be able to ask questions and to know exactly what you are going to be doing in this therapy. You will also learn why these skills may help.
  2. Becoming Aware of Thoughts and Feelings. Next, CPT focuses on helping you become more aware of your thoughts and feelings. When bad things happen, we want to make sense of why they happened. An example would be a Veteran who thinks to himself or herself, “I should have known that this would happen.” Sometimes we get stuck on these thoughts. In CPT you will learn how to pay attention to your thoughts about the trauma and how they make you feel. You’ll then be asked to step back and think about how your trauma is affecting you now. This will help you think about your trauma in a different way than you did before. It can be done either by writing or by talking to your therapist about it.
  3. Learning Skills. After you become more aware of your thoughts and feelings, you will learn skills to help you question or challenge your thoughts. You will do this with the help of worksheets. You will be able to use these skills to decide the way you want to think and feel about your trauma. These skills can also help you deal with other problems in your day-to-day life.
  4. Understanding Changes in Beliefs. Finally, you will learn about the common changes in beliefs that occur after going through trauma. Many people have problems understanding how to live in the world after trauma. Your beliefs about safety, trust, control, self-esteem, other people, and relationships can change after trauma. In CPT you will get to talk about your beliefs in these different areas. You will learn to find a better balance between the beliefs you had before and after your trauma.

via Two New PTSD Treatments Offer Hope for Veterans

Clearly, these alternative treatment methodologies are proving to be quite helpful for many Veterans, but does the VA have the capabilities to properly diagnose all Veterans and determine that CPT and PET are viable treatment alternatives.

 

 

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Veteran Suicides: Will it Never End?

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In yet another disturbing article by the New York Times, entitled “In Unit Stalked by Suicide, Veterans try to Save One Another,” author Dave Phillips chronicles the benign neglect of the VA in helping our brave Veterans to cope with the aftermath of war. With no disrespect to Mr. Phillips, a similar article could be written every week detailing the chronic neglect of the VA for warriors at risk of suicide.

While I suppose that there will be much “wailing and gnashing of teeth” over the New York Times article, but will any meaningful change come for the 300,000 to 400,000 Veterans suffering from PTSD and TBI. Based on the evidence, sadly one must conclude that no meaningful reform will occur within the VA.

The experience of one Veteran in dealing the VA is not uncommon from the countless other stories SFTT has heard from other Veterans,

After the eighth suicide in the battalion, in 2013, Mr. Bojorquez decided he needed professional help and made an appointment at the veterans hospital in Phoenix.

He sat down with a therapist, a young woman. After listening for a few minutes, she told him that she knew he was hurting, but that he would just have to get over the deaths of his friends. He should treat it, he recalled her saying, “like a bad breakup with a girl.”

The comment caught him like a hook. Guys he knew had been blown to pieces and burned to death. One came home with shrapnel in his face from a friend’s skull. Now they were killing themselves at an alarming rate. And the therapist wanted him to get over it like a breakup?

Mr. Bojorquez shot out of his seat and began yelling. “What are you talking about?” he said. “This isn’t something you just get over.”

He had tried getting help at the V.A. once before, right after Mr. Markel’s funeral, and had walked out when he realized the counselor had not read his file. Now he was angry that he had returned. With each visit, it appeared to him that the professionals trained to make sense of what he was feeling understood it less than he did.

He threw a chair across the room and stomped out, vowing again never to go back to the V.A.

Indeed, the article goes on to point out the following:

  • – Of about 1,200 Marines who deployed with the 2/7 in 2008, at least 13 have killed themselves, two while on active duty, the rest after they left the military. The resulting suicide rate for the group is nearly four times the rate for young male veterans as a whole and 14 times that for all Americans.
  •  – A 2014 study of 204,000 veterans, in The Journal of the American Psychiatric Association, found nearly two-thirds of Iraq and Afghanistan veterans stopped Veterans Affairs therapy for PTSD within a year, before completing the treatment. A smaller study from the same year found about 90 percent dropped out of therapy.
  • – Mr. Gerard’s experience shows, however, that the system is only as good as the V.A. treatment it is intended to connect to. The night he went to the psychiatric ward at the Indianapolis veterans hospital, he said, he waited and waited for a doctor to see him. After 24 hours, he gave up and checked himself out.
  • – After surviving an ambush in Afghanistan where several Marines were injured, Mr. Gerard said, he was treated for PTSD by the Marine Corps. But when his enlistment ended in 2011, so did his therapy. He tried to continue at the V.A., but long delays meant it was two years before he got any treatment, and even then, he said, he found it ineffective.

Earlier this month, SFTT reported the heart-wrenching personal story of Maj. Ben Richards and What I should have said about Veterans with PTSD and TBI.    His story is not dissimilar to the experiences encountered by the Marine Veterans at the VA and recounted in the New York Times article.  How much more will the American public continue to endure the systematic abuse by the VA and the inability of Veterans to seek alternative treatment outside the VA:

While the New York Times, SFTT and other organizations can continue to highlight the chronic problems in the care given to Veterans, we sadly cannot influence results in a positive direction given the stranglehold that the VA has on the care of Veterans.  We can only encourage the VA to “think outside the box” and allow Veterans the option of seeking alternative forms of treatment not currently prescribed by the VA.

 

 

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What I Should Have Said About Veterans with PTSD and TBI

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Not long ago I had the opportunity to represent the warrior-run non-profit One Mind for Research at a Hollywood Telethon to raise money for Veteran charities. My role in the production was a live, 90-second interview on stage with actor and host Alan Alda. We talked very briefly about my experience as a wounded warrior with a Traumatic Brain Injury (TBI) and a Post-Traumatic Stress Disorder (PTSD). Mr. Alda asked me: what did I expect when I returned home from a combat tour with TBI and PTSI? Perhaps because I was a little intimidated by the Hollywood venue, the big stars, and the brief time allotted, I didn’t deliver the message I would have liked, so I’d like to share with you now what I should have said then.

Actor Alan Alda played the irreverent trauma surgeon Hawkeye Pierce in the long-running television comedy MASH.

Actor Alan Alda played the irreverent trauma surgeon Hawkeye Pierce in the long-running television comedy MASH.

Alan Alda played the iconic character Hawkeye Pierce in the long-running television series MASH. Alda’s character was an irreverent army doctor serving in a forward Mobile Army Surgical Hospital (or MASH) during the Korean War. The opening credits of every episode included footage of medical evacuation helicopters bringing in a load of wounded warriors from the front. Amidst the pranks and comedy, MASH did a good job of telling the story of what happens once those helicopters landed. I would like to tell you about what happens before those helicopters land.

Two “laws” govern that space. The first is the law of the “Golden Hour.” We believe that if we can get a seriously wounded comrade to the MASH alive and within one hour, then our buddy will make it. In the show, sometimes soldiers didn’t survive after arriving at the MASH and that is also true today, although due to better medical tools the survival rate is much higher today than during the Korean War. As warriors, we can’t control what happens in the MASH. But our responsibility is to get the wounded to the helicopter on time. When one of us is hit, every all can feel the timer begin its count down towards the end of the “Golden Hour.” They are the most unforgiving of minutes.

The title screen and opening credits of MASH featured a pair of H-13 medical evacuation helicopters transporting wounded soldiers from the battlefield to the surgical hospital. Note the wounded soldiers on the litters placed on sponsons above each landing skid.

The title screen and opening credits of MASH featured a pair of H-13 medical evacuation helicopters transporting wounded soldiers from the battlefield to the surgical hospital. Note the wounded soldiers on the litters placed on sponsons above each landing skid.

The second law is recorded in a line in the Warriors Creed: “I Will Never Leave a Fallen Comrade.” To some this may be just another phrase from the canon of military tradition, but among warriors it is a sacred covenant that we make with each other that forms the foundation of a unique and special honor-bond.

Units that have this bond win. Units that do not, don’t.

As a student of the profession of arms, I had read and heard hundreds of accounts of these laws in combat. Many of these tales came accessorized with citations for valor like bronze and silver stars, even Medals of Honor. Remarkably, a large number did not simply because heroism is a daily duty and often goes unrecognized beyond the range of the last rifle round fired.

I would like to share how I learned about the persistent reality of these laws for myself.

My education began as a young lieutenant leading one of the reconnaissance platoons of the Brigade Reconnaissance Troop in the First Brigade (Ready First!) of the 1st Armor Division during a training rotation at Combat Maneuver Training Center (now the Joint Multinational Readiness Center) near Hohenfels, Germany. The brigade had tasked my platoon to conduct a recon and surveillance mission deep into Opposing Force territory. The mission was only part of a training exercise in the good ole’ pre-war days when a faithful warrior could look forward to a painless simulated death that would bring the Valhallan pleasures of a MRE and a nap before administratively resurrecting to roll out again in few hours. Levity aside, I was concerned about the level of risk the mission would have had we been executing in real combat conditions. If any of my troopers were wounded, it would be nearly impossible to evacuate them to a MASH.

I shared my concerns with my troop commander, Captain Jerry Turner. CPT Turner admitted that he had shared the same concerns with his boss, the brigade commander, then-Colonel Michael Tucker. Jerry Turner and Michael Tucker were both men I had learned to trust and respect. They cared deeply about their soldiers. In our middle-of-the-night discussion across a humvee hood in the dark German woods, CPT Turned shared with me the promise COL Tucker had made to us: if we got into trouble, he would roll the entire brigade– some 150 Abrams tanks and Bradley Fighting Vehicles and thousands of soldiers– to come and get us.

That mission was a great success and the platoon contributed to the Brigade crushing the opposing force in simulated combat …and I “died” towards the end of the fight with just enough time left to eat an MRE and take a nap.

When a small team of Army special operations soldiers was forced down in their helicopter during a night-time raid into al Qaeda- controlled portion of Anbar province in Iraq, Air Force F-16 pilot Major Troy Gilbert was on station to provide emergency close air support. As a large al Qaeda force was closing with the isolated Special Forces team,  Gilbert brought his F-16 to tree-top level to strafe the insurgent force with his aircraft's cannon- an extremely high-risk maneuver, but one that Gilbert felt he needed to make to save the US soldiers on the ground. In the darkness, he lost too much altitude during his strafing run and his plane crashed.

When a small team of Army special operations soldiers was forced down in their helicopter during a night-time raid into an al Qaeda- controlled portion of Anbar province in Iraq, Air Force F-16 pilot Major Troy Gilbert was on station to provide emergency close air support. As a large al Qaeda force was closing with the isolated Special Forces team, Gilbert brought his F-16 to tree-top level to strafe the insurgent force with his aircraft’s cannon- an extremely high-risk maneuver, but one that Gilbert felt he needed to make to save the US soldiers on the ground. In the darkness, he lost too much altitude during his strafing run and his plane crashed.

COL Tucker’s promise remained tucked away in the recesses of my memory until the end of November 2006. I was about to take command of a Stryker-equipped Cavalry Troop in 3rd Brigade (Arrowhead!), 2nd Infantry Division in Iraq. We were in the process of moving from Tal A’far to Baghdad. While we were on the march, an Air Force F-16 providing close support to an Army special forces unit securing a downed helicopter in a sparsely populated section of the nearby Anbar province crashed during a low-level night strafing attack. The pilot was unaccounted for and possibly still alive. Just as COL Tucker had promised, we rolled an entire brigade (the Stryker infantry battalion I was attached to, an Airborne infantry battalion and a heavy cavalry squadron) to find and rescue him. Thousands of soldiers to save one.

Unrested, the battalion paused only enough to unload baggage and take on fuel before heading out along roads so infested with IEDs that US forces had up to that time effectively abandoned the road network and relied almost solely on helicopter air assaults. We spent three days scouring the area. My Troop searched every structure and vehicle within a hundred-square kilometers. We even forced the dump trucks traveling from a nearby quarry to dump their loads to ensure no body could be concealed in them. In the end we were able to confirm that the pilot had died in the crash. His name was Major Troy Gilbert. He left behind a wife and five children. We didn’t know that at the time. All that mattered was that he was one of us and we were going to get him back, one way or the other. It was not the ending we had wanted, but we had fulfilled our covenant to each other that we would never leave a fallen comrade behind.

We paid a price to do so. During the mission one of our Strykers hit an IED. Specialist Billy Farris was killed and several others were seriously wounded. Inspired by his stepfather who had served in a Ranger Company in Vietnam, Billy had joined the Army immediately after graduating from high school in Phoenix, Arizona. His consistently superior performance had earned him a coveted position in the battalion scout platoon, and he had been recently honored as the Soldier of the Quarter. Billy also left behind a young son.

To a bureaucrat, who measures value with a financial ledger, the mission was a waste of resources. To a warrior, who understands both the true value and the true cost of the honor-bond, the mission was a necessary sacrifice.

Members of Bronco Troop, 1-14 Cavalry, search for Major Troy Gilbert in Anbar Province Iraq.

Members of Bronco Troop, 1-14 Cavalry, search for Major Troy Gilbert in Anbar Province Iraq, November 2006.

A few months later it was my turn to make and keep that promise. My Troop had just redeployed to the city of Baqubah, at that time the center and proclaimed capital of al Qaeda in Iraq. During a fiercely contested mission to search for weapons caches in a suburb of the city, al Qaeda ambushed one of my scout platoons and the platoon of combat engineers clearing the attack route through the city. At a narrow bend in the road, an IED built into the exterior wall of house exploded and disabled the lead engineer vehicle. As the platoon moved to recover the damaged vehicle, a large force of insurgents engaged them with RPGs, machine guns and AK-47s in the fiercest ambush we had experienced. Five of the combat engineers were wounded, some of them severely. The countdown toward the Golden Hour had begun.

The thundering explosions and rattle of automatic weapons fire brought silence to the Troop radio net as the routine reporting and chit chat between crews disappeared to clear the net for the inevitable contact report. The scout platoon leader was experienced, aggressive and cool-headed but his report was not good. The two platoons were surrounded and out-numbered. They had casualties, some seriously wounded. The outcome was in doubt.

“Hold on. We will come for you.”

My quick fragmentary order to the rest of the Troop was redundant before it was issued. Everyone had heard the report. Everyone knew what had to be done. Everyone was already moving.

As we reached the beleaguered platoons, my First Sergeant, who had already earned a Purple Heart earlier in the tour, moved his armored medical evacuation vehicle into the kill zone. In a scene worthy of a Hollywood blockbuster, the scout platoon leader, Captain Aaron Tiffany, with his vehicle’s gunner, Sergeant Josiwo Uruo, and the platoons’ trusted Iraqi interpreter, Monroe, ran under heavy fire to the severely wounded soldiers and dragged them to the waiting evacuation vehicle.

The Medical Evacuation Vehicle, now escorted by a pair of Strykers, raced to the helicopter landing zone fifteen kilometers away. Medical evacuation helicopters had been called and were enroute. Inside the armored, eight-wheeled Stryker ambulance one of the wounded soldier’s heart stopped beating. The young medic in the vehicle, SPC Brian Mikalanis, beat the soldier’s heart for him, almost forcing him to live through the precious minutes to the door of the waiting helicopters. Before the Golden Hour ticked away they reached the medevac helicopters with five wounded soldiers still alive. A few minutes later the pair of helicopters landed at a real-life MASH where a real-life Hawkeye Pierce finished saving those soldiers’ lives.

Sergeant Josiwo Uruo willing exposed himself to heavy enemy fire that had already wounded five soldiers to rescue our wounded comrades. He was later killed while again exposing himself to enemy fire in order provide covering fire for members of his team.

Sergeant Josiwo Uruo willing exposed himself to heavy enemy fire that had already wounded five soldiers to rescue his wounded comrades.

Bronco Troopers had fulfilled their covenant. We had come for our fallen comrades. But again, not without a price. All five of the wounded combat engineers made it home alive, but Sergeant Josiwo Uruo, a courageous young man from Guam with an ubiquitous grin, did not.

So to answer your question, Mr. Alda, when I returned home from Iraq as a wounded warrior with TBI and PTSD, I expected to be treated with the same commitment and urgency by the medical providers at home in the Departments of Defense and Veterans Affairs that we expected from each other in any and all combat zones.

Unfortunately, my expectations and the expectations of thousands of other wounded soldiers and veterans like me have not been met.

They have not been met because the organizations responsible for caring for our wounded warriors not only do not share, but likely do not even comprehend, the honor-bond between warriors. Their creeds are written on their walls, not in their hearts.

This reality was brought to public attention in 2007 when journalists revealed the terrible living conditions and treatment being inflicted on Army wounded warriors by ambivalent Army Medical Corps bureaucrats– many of them superficial soldiers covered in warriors’ uniforms with hearts concealed beneath the camouflage fabric but bereft of any warrior honor-bond. Army leaders found the organizational ethos of the medical corps so antagonistic towards the warrior values espoused by the Army’s own creed that they made the unprecedented decision to bring in a combat arms officer – a warrior – to fix the problem. They brought in my old commander Mike Tucker, by then a major general, to take charge of and fix Walter Reed. I suspect Tucker knew as much about hospital administration as I do, which is very little. But he knew what he had taught me a few years earlier- that warriors do not leave their fallen comrades behind.

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ARCHI’s ACRES – Sustainable Employment for Veterans through Sustainable Agriculture

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COLIN AND KAREN ARCHIPLEY ARE TWO-TIME NATIONAL TREASURES!

 

The first occasion was defending the nation as a Marine Corps husband-wife team. Colin was not only a Marine Rifleman, he was a Marine noncommissioned officer. While media pundits and politicians focus on super fighter jets, unmanned drones and the Hollywood virtues of thermobaric Hellfire missiles, combat soldiers know that the most lethal, versatile and effective weapons systems in the American arsenal are sergeants. In combat they are responsible for making the very first tactical decisions, usually before anyone else even knows what’s happening. They can turn a bad plan into a brilliant victory while without them the best plans are often worthless. In my experience, the collective quality of these professional warriors defines a unit’s “elite-ness” more than any other factor. 

 

Former Marine Sergeant Colin Archipley and his wife Karen founded the Veterans Sustainable Agriculture Training Program to help other veterans achieve meaningful employment in sustainable agriculture.

Former Marine Sergeant Colin Archipley and his wife Karen founded the Veterans Sustainable Agriculture Training Program to help other veterans achieve meaningful employment in sustainable agriculture.

Sergeant Archipley repeatedly led Marine Infantrymen at the point of contact in Iraq, including through the brutal fighting in Fallujah in 2004. After three combat tours, the Archipleys decided the time was right to serve in other ways and the seeds of what would grow into a second national treasure were literally planted.

 

Before Colin deployed to Iraq for the third time in 2005, the Archipleys purchased a small 200-tree avocado farm, which they christened “Archi’s Acres.” The three-acre farm is nestled in a scenic semi-rural valley near Escondido, California, right behind the Marine Corps base at Camp Pendleton where Staff Sergeant Archipley was stationed.

The Archipleys might have been content nurturing their avocado trees and growing tomatoes if not for their first month’s $850 water bill – which sent them searching for a more financially sustainable way to run their farm. 

 

Archi's Acres. Two hydroponic green houses and avocado tree orchards framed by the 'Back 40' of Camp Pendleton in the background.

Archi’s Acres. Two hydroponic greenhouses and avocado-tree orchards framed by the ‘Back 40’ of Camp Pendleton in the background.

They discovered a solution to more than just their water-bill problem in hydroponic farming. When Colin returned home from his final deployment, they built a greenhouse and started growing basil. The soilless organic hydroponic system they built uses only one tenth of the water needed for an equivalent crop on a traditional farm and Karen was able to secure contracts to supply their organic produce to local super markets, including several Whole Foods stores.

 

Colin left the Marine Corps in October 2006 but wanted to maintain more of a connection to the Marines than afforded by the view from their home and farm of the hills of Camp Pendleton’s “Back 40.” That desire germinated another place for the Archipleys on the list of America’s national treasures — the Veterans Sustainable Agriculture Training program– VSAT in proper military acronym form.

 

Through the VSAT program, Colin and Karen share their knowledge and experience with transitioning Marines and other veterans and help them replicate the success of Archi’s Acres. The six-week course they developed and teach not only provides veterans with enough knowledge of hydroponic greenhouse agriculture and the technical skills to set up and run their own greenhouse-centered farms, the Archipley team also teaches them the business and marketing skills to succeed as a business as well as a farm.

 

The greenhouses at Archi's Acres feature soilless, hydroponic growing systems and are automated to adjust for weather conditions.

The greenhouses at Archi’s Acres feature soilless, hydroponic growing systems and are automatically adjust to weather conditions.

The program’s title as a ‘training’ program insufficiently describes what the program really achieves. Even a lengthier descriptor such as a “seed-to-market sustainable organic agriculture entrepreneurial incubator” falls well short of the mark because VSAT provides far more than a skillset and post-graduation support.

 

The key to VSAT’s extraordinary potential is how Karen and Colin structured their program. From the outset they teamed with the nearby state university Cal Poly Pomona to get nationally-recognized accreditation. The university awards 17 college credit hours on completion of VSAT. The Archipleys also specifically engineered VSAT to meet the US Department of Agriculture’s experience requirements —  completing VSAT is equivalent to one year of farm management experience or a four-year degree in soil science — and so qualifies for a USDA-guaranteed farm loan. Combined with start-up equipment discounts the Archipleys negotiated with several leading national suppliers of agricultural equipment, meeting the requirements for a government-guaranteed loan provides Vets with the all-important financial resources to go into business as well as the technical know-how.

 

The Archipleys’ foresight enables Vets to take advantage – with their existing educational benefits – to cover the program’s $4,500 tuition. Since VSAT is a college-accredited program, Vets and even active duty service members can use the GI Bill, VA Vocational Rehabilitation or tuition assistance.  Several Veteran-serving nonprofits such as the Marine Semper Fi Fund, DAV and Armed Services YMCA also provide tuition grants for qualifying veterans.

 

Although not exclusively for Vets and transitioning service members, over 80 percent of their students are Veterans and many are struggling with invisible wounds and other service-connected disabilities.

 

“Agriculture is blind to invisible injuries,” Karen told me. And that was what first interested Stand for the Troops in Archi’s Acres— leading them to dispatch me on assignment to visit the Archipleys in the summer of 2014. Karen and Colin where successfully solving some of the biggest challenges of disabled-veteran employment AND healing.  Simultaneously.

 

Invisibly wounded warriors face substantial barriers to achieving full and persistent employment. According to the experienced former military physicians who created the Veteran-serving nonprofit  Military Disability Made Easy, a typical combat Veteran rated at only 50 percent disabled by Posttraumatic Stress Disorder:

 

“… may try to work, but will not be able to hold a job for more than 3 or 4 months because of their inability to remember or follow all directions or other similar reasons based on the symptoms or circumstances described under this rating. (In other words, they wouldn’t lose their job simply because they have anger issues and would regularly get in fights. A person like that could also not hold a job more than 3 or 4 months, but they would still be considered able to work). This individual would only be hired for jobs like cleaning, picking up trash, or other simple-task jobs.”

While the Americans with Disabilities Acts legally obligates employers to make reasonable accommodations for Vets with combat disabilities like PTSD, the reality is that there is little understanding among employers or even among Veteran-employees of how to accommodate invisible injuries with their multiple insidious, inconsistent and difficult to predict mechanisms of disability. In many cases even reasonable accommodations are simply not enough.

 

But where even the best intentioned accommodations fail, Archi’s Acres succeeds. The keys are flexibility and scalability. For a combat Vet functionally impaired by invisible wounds, greenhouse agriculture enables a level of flexibility uncommon in most jobs. While nature dictates that some tasks must be done at certain times, for the most part a Vet can adapt his schedule to his own needs, health and abilities, providing the most effective and timely workplace accommodation. The owner of an Archi’s Acres-style hydroponic greenhouse agriculture business is able to scale both the scope of the business and his or her personal workload. A greenhouse farm as small as one-tenth of an acre can be run profitably. Alternatively, a Veteran with a larger farm or limited in the number of hours he or she can work can hire employees to do the work the Vet cannot. At the time I visited them, the Archipleys employed one full-time and two part-time employees to work their three acres (expanding to six) of avocado trees, tomatoes and greenhouses, freeing Karen and Colin to focus most of their time on running the VSAT program.

 

By June 2014 the Archipleys had coached and mentored 240 graduates through their VSAT program. Two-thirds of the those graduates now either own or manage farms. Impressively, Karen and Colin have been able to do so much for Veterans within the framework of a self-sustaining B Corporation (a special category of for-profit corporation that provides a significant public benefit) instead of a donor-dependent non-profit which means the Archipleys will be able to continue independently serving the Nation’s Veterans for years to come.

 

To learn more about Archi’s Acres and the VSAT program, visit their website at Archisacres.com, and watch this five-minute video and this 24-minute documentary.




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Predictive Modeling to Prevent Veteran Suicides

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A study entitled “Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs,” has recently been published online by the American Journal of Public Health.  In the extract cited below, the VA claims that predictive modeling can help identify Veterans with a high risk to commit suicide and, therefore, provide enhanced intervention to prevent Veteran Suicides:

 Objectives. The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions.

Methods. Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year.

Results. Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%.

Conclusions. Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions. (Am J Public Health. Published online ahead of print June 11, 2015: e1–e8. doi:10.2105/AJPH.2015.302737)
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302737

Assuming the findings our correct, this is a great tool in helping to provide targeted preventative treatment to those Veterans.

Veteran Suicides Still at Crisis Levels

While many public and private studies have provided hope that Veterans can reclaim control of their lives, veteran suicides continue to remain at near crisis levels.  Since the historic 2010 US Army study on veteran suicides and suicide prevention, most evidence continues to suggest that 22 veterans commit suicide each day.

Senator Richard Blumenthal (Democrat of Connecticut) is quoted as saying “When you have 8,000 veterans a year committing suicide, then you have a serious problem.”

Many other government leaders on both sides of the aisle echo similar views, but there has been little meaningful improvement in veteran suicide rates over the past five years.

While we are hopeful that the diagnostic modeling with bring targeted relief to long-suffering Veterans, past experience would suggest that VA is slow to implement change and many Veterans will not receive the help they require.

It has become very fashionable to blame the VA for all problems – real or imagined – but clearly more must be done to address this alarming problem.

 

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