The Department of Veterans Affairs and Service Dogs

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The Department of Veterans Affairs (“the VA”) receives considerable public criticism for its failure to provide service dogs to Veterans with PTSD and TBI.

As reported earlier by SFTT, the VA provides service dogs to blind Veterans, but has balked at providing service dogs to Veterans who are less than totally physically disabled.  The recurring argument from VA spokespeople is that there is a lack of “clinical evidence” to support the benefits of service dogs.

service dogs for Veterans

Consider this testimony by Dr. Fallon of the VA:

“I would say there are a lot of heartwarming stories that service dogs help, but scientific basis for that claim is lacking,” said Michael Fallon, the VA’s chief veterinary medical officer. “The VA is based on evidence based medicine. We want people to use therapy that has proven value.”

The argument is a brief synopsis of Dr. Fallon’s testimony to the House Subcommittee and Government Reform provided in April, 2016.

Dr. Fallon’s testimony and defense of the VA’s status quo is similar to the testimony of Dr. David Cifu on PTSD therapy and Dr. Alvin Young (aka Dr. Orange) on the lethal side effects of Agent Orange used on the deforestation of Vietnam.

The VA has set itself up as “judge and jury” to determine what range of medical services it will provide to Veterans.  Any “new” therapy that has not been blessed by “evidence based medicine,” is summarily dismissed by the gatekeepers at the VA.  In fact, the VA often uses spokespeople and expensive long-term clinical studies to avoid providing much needed therapy to Veterans.

Furthermore, there is strong evidence to suggest that the DoD purposely manipulated testing procedures on hyperbaric oxygen therapy (“HBOT”) to produce clinical outcomes more to their liking.

As reported earlier,  Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have been largely ineffective in reversing brain damage to Veterans suffering from PTSD and TBI.   And yet, the spokespeople steadfastly defend these therapies and argue that other therapies “lack evidence” to justify their endorsement, read “funding.”

“The VA has very little evidence to show that PE and CPT therapy programs have done much to reduce the incidence of PTSD symptoms among Veterans against the “gold-standard” standardized PCL-M tests currently used by the VA.   The chart below illustrates the point (50 is considered base level):

Veterans Affairs Fails at PTSD

Aside from being very expensive to administer, the “evidence based medicine” supporting the effectiveness of PE and CPT programs currently administered by the VA is SADLY LACKING.”

While the general public and Congressional leaders may buy the pitch from VA Spin Doctors, Veterans are seeking other forms of therapy outside of the VA.  The problem is that few can afford to do so.

The Case for Service Dogs for Veterans

Training a service dog is relatively expensive.  Most estimates suggest that the cost of training a service dog to be in the neighborhood of $20,000.  The training of a dog can last some five months after the dog reaches maturity (about six months) to another 18 months depending on the rigorousness of the training.  In addition to training the dog, the Veteran needs to spend a considerable amount of time with the service dog to develop an effective relationship.

As we reported earlier, Maj. Ben Richards spent seven weeks in intensive training with his new service dog, Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.  Taking into account “training the Veteran” could add considerably more to the overall cost.  For those interesting in learning more about the steps involved in training a service dog, I refer you to this excellent FAQ provided by Psychiatric Service Dog Partners.

While the VA currently does authorize the use of service dogs for Veterans, many State and charitable organizations have sprung to the support of Veterans.  In addition to Ben’s heartwarming story, many other Veterans have benefited from the companionship of service dogs.

Several organizations like 4PawsforAbility and Train a Dog and Save a Warrior,- SFTT Rescue Coalition Partner – are actively training and providing service dogs to Veterans.  These organizations and several others rely on the generous contributions of others to support our Veterans.

While the VA continues to study the benefits of service dogs, new results are not expected until 2019.

One might justifiably ask why it takes the VA 9 years to study the benefits of service dogs for Veterans with PTSD (yes, Congress mandated a study in 2010), but Dr. Fallon and the VA spinmasters will provide you a compelling answer if you are naive enough to buy it.

Based on the sound work of many charitable organizations training service dogs, it is beyond reasonable for the VA to soft-peddle its failed therapy programs and help these struggling organizations provide service dogs to Veterans.  Wouldn’t it help provide “real” evidence to support their long overdue study?

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Veterans with PTSD: The VA Way or the Highway

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It is easy to find fault with the Department of Veterans Affairs (“the VA”), particularly when it comes to Veterans with PTSD.

Department of Veterans Affairs

Secretary of Defense, Robert McNamara, tried to employ body count statistics to assess our progress in the war in Vietnam.  Similarly, the VA has erected a statistical house-of-cards to deceive Veterans and their loved that the VA has the answers for Veterans coping with PTSD and TBI.

Like McNamara, the VA “knows what is best for Veterans” and has erected insurmountable statistical barriers to prop up their failed strategies.  In effect, the VA is telling Veterans:  “It is my way or the highway!

Paraphrasing a joke: “The VA uses statistics as a drunk uses a lamppost — For support rather than illumination.”

Sadly, it is no laughing matter when we consider the thousands of combat Veterans suffering from PTSD and TBI.  More importantly, reflect on the often tragic consequences for their families and loved ones.

While Congress and the public continue to be seduced by the steady stream of assurances that the VA provides the best possible care to Veterans with PTSD and TBI, the FACTS tell a far different story.

FAKE NEWS from the VA on Veterans with PTSD

Found below is a video of Dr. David Cifu, Senior TBI Specialist at the VA, testifying before a Congressional Committee:

The VA continues to push a stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

– Cognitive Behavioral Therapy (“CBT”)and,

– Prolonged Exposure Therapy (“PET”).

As these “therapy” programs have failed miserably according to independent studies (see below), the VA has “coped” with the problem by prescribing a lethal concoction of prescription drugs which treat the symptoms of PTSD rather than deal with the underlying problem.

And we wonder why we have an opioid epidemic in this country?

REALITY CHECK at the VA

While Dr. David Cifu continues to entertain a Congressional Committee on the efficacy of the VA’s protocols, experience for yourself one woman’s harrowing experience with the VA which eventually led to husband’s suicide:

The story of Kimi Bivins is not the exception to the type of treatment Veterans with PTSD receive at the VA. Based on many similar stories, the VA is failing our Veterans and their loved ones.

I encourage readers to read Kimi’s harrowing description of what actually takes place at a VA facility.

While the folks at the VA casually dismiss anecdotal stories, VA claims that Veterans receive the best therapy possible is simply not supported by the evidence.

No less of an authority that the National Academies of Sciences (Medical Division) reported in a 2014 study entitled “Treatment for POSTTRAUMATIC STRESS DISORDER in Military and Veteran Populations,” that CBT and PET barely made a statistical dent in providing Veterans with PTSD any lasting improvement in their condition.

Consider Maj. Ben Richards‘ compelling evidence documenting the failed experiments at the VA in helping Veterans with PTSD.

Standing behind a well-entrenched bureaucracy of statistical inaccuracies and dogma, the VA goes out of its way to discredit other treatment alternatives. Consider this bitter “scientific” debate between Dr. Cifu and Dr. Paul Harch on the efficacy of hyperbaric oxygen therapy or HBOT in treating PTSD and TBI.

Finding a Middle Ground for Veterans with PTSD?

With so little known about the brain and how to treat trauma, it seems absurd for the VA to insist that they have all the answers.  The evidence clearly suggests that the VA doesn’t have a clue.

Nevertheless, the VA argues that “alternative therapies” that do not pass scientific scrutiny and FDA approval will not be endorsed by the VA.  As we have seen countless times – from body armor testing to hyperbaric oxygen studies – the DoD uses test protocols that deviate from accepted standards.

If the tests are flawed, one is likely to draw the wrong conclusions!

For the vast majority of Veterans with limited economic means, the VA is effectively making life and death decisions based on flawed testing and a reluctance to embrace other treatment alternatives.

This is probably done with the intent of protecting Veterans from charlatans and snake oil peddlers, but doesn’t it also block Veterans from receiving promising therapies from legitimate sources?

When dogma or “approved” therapies become the LAW, then it seems unlikely that much progress will be made to help our brave Veterans recover their lives.  The VA would do well to encourage Veterans to seek alternative therapies and provide an interactive sounding board for Veterans to voice their opinions on these programs.

Honesty and transparency and a willingness to accept mistakes is the sign of a responsive institution.   Today, the VA hides behind a dogma based on self-delusion and falsehood.

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Marijuana and Veterans with TBI

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Thomas Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts: A U.S. Marine, a Combat Photographer, and Their Journey Back from War,”  makes an impassioned plea to “make pot legal for Veterans with TBI.”

Cannabis for Veterans with PTSD and TBI

In an “Opinion” piece for the New York Times of September 1, Mr. Brennan states to following:

“Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis . . .

“What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

“But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.”

Personally, I am delighted that Mr. Brennan feels better and is recovering his life, but one man’s (or woman’s) experience with “alternative medication” hardly makes a compelling argument to justify universal endorsement.

Superficially, one could argue that pot is far less “addictive” than opium and the opioid variants currently endorsed by the FDA and the AMA, but I suggest that Mr. Brennan compelling argument touches on a far more important issue:

Officially sanctioned / LEGAL therapies to treat Veterans with PTSD and TBI are not working! 

No one should be surprised that Mr. Brennan and many other brave warriors are seeking alternative therapies – either not sanctioned or “illegal” – because the limited treatment options provided by the Department of Veterans Affairs (“the VA”) are tragically failing the needs of our heroes and their families.

Last week, Maj. Ben Richard’s commented on a disturbing series of videos that trace a widow’s tragic quest to seek help from the VA for her husband who committed suicide when denied alternative therapy.

The tragic suicide of Veteran Eric Bivins is just another example of the abuse of power at the VA that literally makes “life and death” decisions based on a long history of failed treatment programs:  Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

If the only choice for Veterans with PTSD and TBI is institutional abuse and lethal prescription drugs, why not run the risk (illegal or unsanctioned) and seek help that works?  In the case of Mr. Brennan, cannabis might be the answer, but SFTT seeks out programs that may offer life-changing therapies rather than medication that simply deals with the symptoms.

Personally, I don’t think that potentially addictive drugs are the long term answer for PTSD and TBI, but I can certainly understand why many Veterans seek relief outside the limited number of options and callous disregard currently shown by the VA.

Perhaps Secretary David Shulkin can bring about much needed reform at the VA, but the odds are firmly stacked against him.

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Meet Maj. Ben Richards and Bronco, his Service Dog

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I had a delightful lunch yesterday with Maj. Ben Richards and Bronco, his service dog.  Also joining us for lunch were Eilhys England, Chairperson of Stand for the Troops (“SFTT”) and Dr. Yuval Neria, Director of the PTSD Research Program at Columbia Presbyterian.

Maj Ben Richards and Service Dog Bronco

I hadn’t seen Bronco (a labradoodle) before and was interested in learning how service dogs are trained.

After the dogs reach maturity – normally 6 months – they begin an intensive 5 month training program designed to familiarize the service dog with elements of supporting a human being. For instance, the dog has to learn to navigate elevators and escalators and to respond to potential danger signals which could cause panic in the dog’s human companion.

A well-trained service dog is not distracted by peripheral events like the presence of other dogs or animals and will avoid eating food that has been dropped on the floor.

After the service dog has successfully completed his training, the certified service dog is then introduced to his/her human companion.  Ben spent seven weeks in intensive training with Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.

Ben and Bronco have been constant companions for almost a year.  Ben mentioned that it is the first time in 9 years he has been able to sleep without facing the door of his bedroom.  Bronco will also wake him up if he has nightmares or if thunder is approaching which might threaten sleep and trigger an anxiety attack.

Bronco has allowed Ben to feel comfortable enough to attend movies and, in fact, he went to a museum in D.C. by himself for the first time in several years.   The museum visit brought a small to Ben’s face as he recalled that it was the first time he didn’t feel like he had to process potential threats without the attendant anxiety of not being able to do so fast enough.

Ben looked great and it was wonderful to re-establish personal contact with him again.  Ben is a brave warrior who has suffered his own particular demons and is intent on helping others recover their lives from the silent wounds of wars.

Ben’s service dog has brought much needed comfort, safety and stability to his life.

Sadly, the VA is “studying” the efficacy of service dogs in helping other Veterans with PTSD.  This study will not be available until 2019.

What the VA should actually be studying are its own failed programs of Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) which the VA continues to tout as being so successful in helping Veterans with PTSD.

While VA administrators and consultants like Dr. David Cifu can continue to hoodwink Congressional committees with their disingenuous sales pitch, most Veterans have given up on the VA with their substandard and largely ineffectual services.

Many Veterans like Ben are gradually taking matters into their own hands despite threats by the VA to withdraw benefits.  Fortunately, many States, private hospitals and charitable institutions are rushing in to fill the void left by the VA.

Is it too much to expect that the VA step up to the plate and truly support Veterans rather than hand grants to people and institutions who are prepared to parrot a pollyanna party-line based on half-truths and downright lies?

Our brave men and women in uniform deserve better.

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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Veterans and casual observers continue to be mystified why the Department of Veterans Affairs (the “VA”) continues to insist on failed therapy programs to treat Veterans with PTSD.

Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, argues that Veterans treated with Cognitive Behavioral Therapy and Prolonged Exposure Therapy are receiving the best therapy possible to treat PTSD.   There is no reliable third-party verification to support Dr. Cifu’s bold assertion.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”

Frankly,  there is voluminous scientific evidence that HBOT is both a viable and recommended treatment alternative for Veterans suffering from PTSD and TBI.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy or HBOT is available at many privately-owned hospitals in the United States and around the world.  There is compelling scientific evidence that HBOT reverses brain damage.

In fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

In its most simple form, HBOT is a series of “dives” in a decompression chamber (normally 40) where concentrated oxygen is administered under controlled conditions by trained physicians.  There is clear and conclusive evidence that brain function improves through the controlled application of oxygen.  In effect, it stimulates and may, in fact, regenerate brain cells at the molecular level.

HBOT Brain Functionality Over Time

In addition, HBOT is far cheaper to administer than currently approved programs at the VA.   Maj. Ben Richards argues that all Veterans with PTSD and TBI could be treated with HBOT for less than 10% of the VA budget allocated for pharmaceuticals.

More to the point, the annual VA treatment costs for Veterans with PTSD and TBI are roughly $15,000. For this annual expense, many Veterans could receive HBOT.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with HBOT.

Found below is a summary of Dr. Figueroa’s conclusions (footnotes removed):

A large fraction of the current epidemic of military suicides (22+ service members a day take their lives) are more than likely due to misdiagnosed TBI and PTSD. Although the DoD and VA have spent billions (actually, $ 9.2 billion since 2010) trying to diagnose and treat the problem, the epidemic of suicide and mental illness are larger than ever. Drug interventions are woefully inadequate, as more and more studies continue to find that pharmacological interventions are not effective in treating the varied symptoms of TBI or PTSD. In many cases suicide of veterans have been linked through prescribed overmedication.

HBOT is a safe and effective treatment with low-to-no side effects (after all, even the DOD accepted the safety of HBOT back in 2008). Access to HBOT is available within most major metropolitan centers, but the major sticking point is money. Who pays for the treatment?  Those that are willing to pay for it out-of-pocket and state taxpayers picking up the tab for brain-injured service members forced back into society without sufficient care (or forced out on a Chapter 10, when it should have been treated as a medical condition).

The continued reports of studies like the DoD/VA sponsored trials allow denial of coverage and provide adequate cover for public officials to claim that more study needs to be done. As we have seen, the conclusions of the authors of the DoD/VA sponsored studies downplay the results of effectiveness. There are sufficient studies (and growing) showing a strong positive effect of HBOT in TBI. More will be forthcoming.

The cardinal rule of medicine is “First, Do No Harm”. With HBOT, this rule is satisfied. Now, by denying or blocking a treatment that has proven restorative and healing effects, countless physicians and organizations, from the VA to DoD, Congress and the White House, could be accused of causing harm. Never mind how many experiments “fail” to show results (even when they actually show success). Failure to replicate a result is just that…a failure to replicate, not a negation of a treatment or other positive results. You can’t prove a negative and there are many clinical trials that do show the efficacy of HBOT.

The practice of medicine and the use of HBOT should not be dependent on the collective unease of a medical profession and the dilatory nature of risk adverse politicians, but on the evidence-based results that we are seeing. Within the VA, there are hard working physicians that are trying to change the culture of inertia and implement effective treatments for TBI and PTSD, using evidence based medicine. Unfortunately, evidence-based medicine only works when we accept the evidence presented to us and not on mischaracterized conclusions of a single study (or any other study). Our veterans, our citizens and our communities deserve better than what we are currently giving them: bad conclusions, institutions too scared to act in the interests of the people it serves and too many physicians unwilling to look at the accumulated evidence.

Indeed, it is time to for Dr. Shulkin to rid the VA of Dr. Cifu and embrace cost-effective treatment therapies which provide some hope for Veterans with PTSD and TBI.

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Will Vincent Viola as Army Secretary Help Veterans with PTSD and TBI?

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By all accounts, the selection of Vincent Viola for Army Secretary by President-Elect Donald Trump has received widespread bipartisan support.  Hopefully, a man of his military record and impressive private-sector track record can bring about competent leadership within the Army.

Vincent Viola

Vincent Viola, Forbes Photo

SFTT certainly hopes so, but is concerned that certain National Hockey League (“NHL”) Florida Panther business connections may cloud his judgement regarding Veterans and active duty personnel that have symptoms of PTSD and/or TBI.

Mr. Viola is a West Point graduate and the owner of the Virtu Financial.  In Sep 2013, Mr. Viola and minority shareholder, Douglas Cifu purchased the NHL Florida Panthers.   “Douglas A. Cifu is the Vice Chairman, Partner and Alternate Governor of Sunrise Sports & Entertainment, the Florida Panthers Hockey Club, BB&T Center, and SSE’s additional operating entities.”

Like the NFL, the NHL is also under the gun for its approach in treating concussions:

As has been the case in the NFL, repeated hits to the head in hockey can cause brain injuries, like chronic traumatic encephalopathy (CTE), a degenerative disease that leads to suicidal thoughts and erratic behavior. But unlike the NFL, which has been heavily criticized for its handling of concussions on the field, the NHL won’t acknowledge the risk of CTE.

Dr. David Cifu (the brother of Doug) is Senior TBI Specialist in the Department of Veterans Affairs (the “VA”).  In recent Congressional testimony (see video excerpt below) Dr. Cifu claims that he has treated “twenty thousand” brain injuries and “provides care for an NHL team” in treating concussions.  Could it be the Florida Panthers?

 

Clearly, Dr. Cifu is out of touch with the majority of physicians who treat PTSD and TBI. In fact, Dr. Cifu is largely responsible for blocking less expensive and far more effective therapy for Veterans suffering from PTSD. Will Dr. David Cifu’s toxic legacy continue after Mr. Viola is appointed Secretary of the Army?

As a counterpoint to Dr. Cifu’s grandstanding at the Congressional hearings, I recommend West Point graduate Maj. Ben Richard’s stunning analysis of how the VA treats Veterans with PTSD and TBI. How sad!

 

Rather than simply point fingers, SFTT has proposed a number of alternative treatment therapies.  One existing therapy, Hyperbaric Oxygen (“HBOT”) has been used around the world for some 50 years and many hospitals currently use HBOT to treat a variety of brain-related traumas.  More specifically, it is the go-to option for the Israel Defense Forces (“IDF”) for soldiers suffering a head injury in combat.

Nevertheless, the VA continues to avoid endorsing HBOT for lack of sufficient clinical evidence.  As SFTT reported last week, Xavier A. Figueroa, Ph.D. has written extensively in a well-researched article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” which refutes many of the “convenient” studies by the VA.

HBOT in chronic TBI

While other new therapies may emerge, HBOT currently provides tangible improvement in brain function.  Furthermore, it can be provided at a fraction of the cost of currently administered VA programs.    Best of all, it is available at hundreds of hospitals around the United States (SFTT highly recommends that all HBOT treatment protocols be reviewed to insure proper application).

On behalf of our men and women in uniform and the tens of thousands of Veterans currently suffering from some form of brain injury, we are hopeful that Secretary Vincent Viola can put an end to current dysfunctional leadership within the VA.

Please, no more time for glib lobbyists like Dr. David Xavier Cifu.    Secretary-elect Viola, our brave heroes need you to act NOW!

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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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Dysfunctional VA or a Paradise for Veterans?: Pause for Reflection

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Stand for The Troops (“SFTT”) has long been critical of the manner in which the Department of Veterans Affairs (the “VA”) treats Veterans with PTSD and TBI.  Other critics have singled out long wait times for Veterans seeking treatment and other issues that have prompted Congressional inquiries.

Sadly, one can no longer discuss this issue dispassionately considering that many stakeholders and political candidates seem to be positioning themselves on one side of the debate or the other.  With a $170 billion budget and over 200,000 employees, a decision to make the VA more responsive to the needs of Veterans is never a black or white decision.

J. David Cox

J. David Cox

Like many 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,”

According to U.S. Rep. Jeff Miller, a Republican from Chumuckla, Florida, and the chairman of the House Committee on Veterans’ Affairs as reported in Military.com

The exchange perfectly encapsulates the corrosive influence government union bosses are having on efforts to reform a broken VA. It’s a never-ending cycle in which pliant politicians and federal agency leaders bow to the boss’s demands to preserve the dysfunctional status quo of our federal personnel system, which almost guarantees employment for government bureaucrats no matter how egregious their behavior.

The problem with union bosses like Cox is that they are more interested in protecting misbehaving VA employees than the veterans the department was created to serve.

The problem with VA leaders like McDonald is that, in their perpetual quest to placate big labor’s powers that be, the taxpayers and veterans they are charged with serving are paying the price.

Frankly, it is tough to find fault with Representative Miller’s assessment of the situation.  If we want meaningful reform within the VA to provide Veterans with the support they deserve, then we need to confront entitled thugs like David Cox and others that block long overdue change.

It will not be easy, but we must admit that the VA is fragile – if not broken – and we need to fix it to provide Veterans with the level of care they deserve.

Veterans with PTSD and the VA

As regular readers of Stand For the Troops newsletter are aware, we are keenly focused on the level of care and treatment provided to Veterans suffering from Post Traumatic Stress.

Based on our research, we have found that the care and treatment provided by the VA leads to no lasting benefit to the thousands of Veterans affected by PTSD and TBI.  We reported on this earlier, but it is worthwhile watching a video of Maj. Ben Richard’s explain the failure of the VA to provide meaningful solutions:

This sobering assessment by Maj. Richards was featured a couple of months ago in our article entitled “The VA Can’t Handle the Truth, So Why Bother.” SFTT’s goal is not to throw rocks at the VA, but to insure that Veterans get the needed treatment they deserve.

It is hardly reassuring that some Veterans find it necessary to swim with sharks as an alternative therapy for PTSD, but it is evident that the lack of responsiveness and credibility of the VA has driven Veterans to embrace other solutions.

The Big Questions for Taxpayers and Government Leaders

Will the much needed reform within the VA be held hostage by self-serving labor leaders like J. David Cox and disingenuous medical practitioners like Dr. David Cifu?

Do we have the courage to change the VA system for the benefit of our brave heroes?

Can we agree to promote VA programs that work, improve those programs that are not effective and reform or radically change existing programs and protocols that simply do not work?

For all Americans, it is time to reflect on the kind of support we truly want to provide to Veterans.

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Throwing Snowballs at the Department of Veteran Affairs

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Many years ago I was reading a biographic sketch of the late Canadian Prime Minister, Pierre Trudeau.   According to the biography, teenager Trudeau was arrested by the Chinese police for throwing snowballs at a statue of Mao Zedong in Tiananmen Square.

Chairman Mao

He was released by Chinese police after explaining that “it was a Canadian tradition to throw snowballs at statues of famous people.”    I have no idea if this story is true, but it would not surprise me as the brilliant and iconoclastic Trudeau had a glib answer for most everything.

As readers of Stand For the Troops (“SFTT”) news are aware, we are not satisfied with how the Department of Veterans Affairs (the “VA”) treats Veterans with PTSD and TBI.  As reported last week, Maj. Ben Richards cites numerous internal and external studies demonstrating that VA protocols in treating Veterans with PTSD and TBI have not been effective.

For the well-being of our Veterans and their loved ones, we can only hope that our well-meaning “snowballs” will ultimately have some effect on breaking through the entrenched bureaucracy at the VA.

Sadly, this is unlikely to be the case.  But if hundreds, thousands and tens of thousands of concerned Americans were lobbing snowballs at the VA through their elected officials in D.C., “a thousand flowers might bloom.”   I apologize to Chairman Mao for misquoting him.

If you listen to Dr. Xavier Cifu’s moronic defense of the VA’s “evidence-based” PTSD therapy programs to a Congressional committee, you get the sense that his “own personal opinion” is far more important than any scientific evidence.

Needless to say, not everyone within the VA is as oblivious to its shortcomings  as Dr. Cifu.  For instance,  Paula Schnurr, who heads the National Center for PTSD, which is part of the VA, says

. . . she’s “not concerned about veterans seeking alternative strategies in addition to effective strategies,” as long as the alternative doesn’t replace a method with more evidence behind it.

Schnurr says 90 percent of VA centers across the country do offer some sort of alternative treatment for PTSD. And many have been studied through clinical trials — some, like meditation and yoga, with promising results.

Schnurr also points out one approach to trauma, once approached with broad skepticism, is now on the VA’s list of approved treatments. EMDR — devised in the late 1980s — uses bilateral eye movement, looking side to side, during cognitive behavioral therapy. Only after about a dozen clinical studies did Schnurr feel comfortable recommending it.

“I’m convinced the treatment works; I’m not sure why,” she says.

But as long as the treatment is based on rigorous science, she says, that’s evidence enough.

Ah, there are those magical words again:  “rigorous science.”  What do those words actually mean?   Could the “observational model” be flawed?  At least, Ms. Schnurr has an open mind.

Is the Department of Veterans Affairs too Big to Succeed?

As we have seen last week, the VA continues to use flawed procedures to treat PTSD and TBI yet insists that the “treatment is based on rigorous science.”  Gosh, if the VA’s own internal and external audits demonstrate that standard therapies are not effective in helping Veterans with PTSD and TBI to achieve better outcomes, why not explore other alternatives?

Some weeks ago, we analysed the VA under the microscope of Nassim Taleb’s theory of Antifragility.   Even a superficial analysis of the VA suggests that the organization is Fragile and, in my opinion, far too big to succeed in its mission.

Veterans Cartoon by Gary Varval

Cartoonist Gary Varval

As if on queue, the New York Times asks the question:  Did Obama’s Bill Fix Veterans’ Health Care? Still Waiting.

When President Obama signed a sweeping $15 billion bill to end delays at Department of Veterans Affairs hospitals two years ago, lawmakers standing with him applauded the legislation as a bold response that would finally break the logjam.

It has not quite worked out that way.

Although veterans say they have seen improvement under the bill, it has often fallen short of expectations. Nowhere is the shortfall more clear than in the wait for appointments: Veterans are waiting longer to see doctors than they were two years ago, and more are languishing with extreme waiting times.

According to the agency’s most recent data, 526,000 veterans are waiting more than a month for care. And about 88,000 of them are waiting more than three months.

What we are seeing, is increasingly discouraging outcomes for Veterans no matter how much money we allocate to “fixing” the problem.  In economics, one simply refers to this as “decreasing marginal returns on investment.”  This is not to say that some Veterans have not benefited with this new taxpayer largesse, but we should have received far better results if the VA were not so big!

So, if you are wondering what to do on this warm summer day, just pick up a few snow balls and gently lob them in the direction of our Congress and Senate in D.C.    Facing up to the realities that the VA is failing our Veterans is at least the first step toward helping these brave warriors reclaim their lives.

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The VA Can’t Handle the Truth So Why Not Lie

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In a moving round-table discussion hosted by Stand for the Troops (“SFTT”), Maj. Ben Richards provides a devastating overview of why the Department of Veterans Affairs (the “VA”) is failing to provide adequate care to brave Veterans suffering from PTSD. Let Ben explain why in his own words:

Drawing from internal and external VA studies, Maj. Richards exposes the great fraud perpetrated by the VA that claims to be providing adequate treatment to Veterans who suffer from PTSD and TBI (“traumatic brain injury”). Clearly, those in VA management are well aware that current treatment protocols to treat PTSD and TBI are seriously flawed.

Why is it necessary, for VA spokespersons like Dr. Xavier Cifu to articulate banal nonsense to Congress that seeks to provide better treatment for our Veterans? More to the point, why don’t those in authority within the VA simply acknowledge that “we don’t have the answers,” rather than persevere supporting treatment therapies that simply don’t work and may, in fact, be harmful?

Everyone realizes that egos and big money are on the line, but shouldn’t the well-being of our men and women in uniform and Veterans come first?

SFTT has long been partnering with several alternative treatment therapies designed to provide Veterans with options. Sadly, most of these protocols are not endorsed or supported by the VA. We long ago concluded that the entrenched bureaucracy within the VA appears to be far more interested in promoting its own path to wellness rather than acknowledge that other alternative therapies may provide benefits.

As Maj. Richards points out, the recommended VA treatment protocols do not work and those in VA’s management know that they are ineffective. Therefore, it seems evident that Congress and others must look beyond the VA to provide Veterans with PTSD therapy alternatives.

There is a growing awareness around the country that the VA is simply out of step with reality and several states are taking matters into their own hands to provide privately funded therapy programs.  In particular, Maj. Richards is able to avail himself of Hyperbaric Oxygen Therapy in his home state of Minnesota.

Also, it was recently reported that a Joint study by Tel Aviv University, IDF, Walter Reed Army Institute of Research and National Institutes of Health finds computerized training before deployment could prevent PTSD.

In fact, Dr. Yuval Neria, a Special Advisor to SFTT’s Medical Task Force,  explains that computerized training protocols may help patients cope with PTSD more effectively.

Biased Threat Attention Computerized Training Protocols

Dr. Yuval Neria, Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center, and Director of Trauma and PTSD at the New York State Psychiatric Institute presents his Attention-Bias-Modification Treatment (ABMT) designed to implicitly modify a PTSD patients’ biased threat attention via computerized training protocols.

 

SFTT helped fund these experimental studies by Dr. Yuval Neria.  In the video above, he describes in scientific terms some promising breakthroughs on computerized training protocols to assist both Veterans and civilians cope with PTSD.

While I guess we should take some solace in the fact that Veteran suicides have now fallen on a daily basis from 22 to 20, the fact remains that we have tens of thousands of Veterans who are receiving inadequate treatment.  The suicide of one Veteran is too many, so let’s hope that the Department of Veterans Affairs wakes up to the challenge rather than disparage other treatment alternatives.

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