Lots of well-intentioned folks want us to take pity on Veterans battling post-traumatic stress, and quite a few of them make movies that are trying to break our hearts as they follow men and women struggling to make sense of the sacrifices they made.

The new documentary “Bastards’ Road” is not one of those movies. Marine Corps Veteran Jonathan Hancock served admirably with the 2nd Battalion, 4th Marine Regiment – nicknamed The Magnificent Bastards – in the first Battle of Ramadi in 2004. He experienced some terrible things and let his life go to hell once he returned home. It’s available now to buy or rent from iTunes, Google Play, YouTube and Fandango Now.

After seeing news reports of other military Veterans who went on long hikes to highlight service-related issues, Hancock impulsively took off on a cross country ruck to visit the men he served with in Iraq and the Gold Star families of those who didn’t make it home.

Filmmaker Brian Morrison went to the same high school as Hancock and didn’t learn about his journey until the Marine was 1,300 miles into his walk. Morrison knew a great story when he saw one and contacted Hancock through mutual friends before joining him on the road.

Fortunately for the documentary, Hancock had spent a lot of time filming himself with his phone’s selfie camera as he tried to work out exactly what he was doing on this trip. The footage from those early days of the trip proved invaluable when making the final version of the movie.

The two men may not have been close before they started working together, but those local ties must’ve helped them connect because Morrison managed to get Hancock to open up in ways you wouldn’t ever expect.

The movie came to my attention when Hancock sent me an email with the subject “you missed a movie in your top ten military movies to see in 2021.” Now, it’s a fact that I get a few direct and often confrontational emails from readers pretty much every day, but there was something about how Jon pitched this film that got my attention.

The movie seems like it’s going to be an inspirational story for the Hallmark Channel at the start, but Hancock slowly comes clean about his post-service issues and behavior as the movie unfolds. Family members share incredibly painful memories of Hancock’s struggles and just how he took things out on those he loved.

How Hancock addresses this behavior with himself and how he makes amends to others in this very public forum separates this movie from other (let’s repeat) well-intentioned documentaries that want to move you with stories of redemption.

Is this Marine redeemed in the end? Yes, but not before he insists that viewers watch him rub his own face in the muck he created. This is the kind of real life that most people are afraid to put on film.

All of this led to a fascinating Zoom interview with Hancock and director Brian Morrison. What was supposed to be an occasion for a couple of nice quotes turned into a wide-ranging conversation about how the film got made, why Hancock opened up and what’s happened in his life since he completed his cross-country journey.

It’s worth bookmarking this page and coming back to watch the whole conversation after you’ve had a chance to see the movie.

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Bill Ebeltoft's life could be divided into three parts: before the Vietnam War, during the war and after the war.

That's how Paul, Bill's younger brother by three years, chose to approach his obituary -- which was published in The Dickinson Press, the local paper of Dickinson, North Dakota, where Paul and Bill grew up.

Bill died Sunday. He was 73.

But, as Paul eloquently begins in the obituary, Bill first lost his life in Vietnam.

"Before Vietnam, Bill was a handsome man, who wore clothing well; a man with white, straight teeth that showed in his ready smile," Paul wrote. "A state champion trap shooter, a low handicap golfer, a 218-average bowler, a man of quick, earthy wit, with a fondness for children, old men, hunting, fast cars, and a cold Schlitz. He told jokes well."

From here, Paul takes the reader on a journey. He spends little time on Bill's actual service in Vietnam -- Paul wasn't a Veteran and didn't feel like he could personally speak to the experience, he told CNN. But it was important to him to focus on who Bill was, and what he became when he returned.

"After being discharged as a decorated hero, Bill had a rough reentry into civilian life. It is not necessary to recount Bill's portion of what is an all-too-common story for wartime Veterans, particularly those of the Vietnam era," Paul wrote in the obituary. "It may be sufficient to say that after a run at business, a marriage and while grappling daily with his demons, his mental faculties escaped him."

A 'drastically different self' afterVietnam

In Paul's retelling, though, the details of Bill's unraveling are left vague. He mentions that his "shaky grip on physical health... slipped through his fingers." He spends some time recounting his inability to comprehend the passing of time, writing "Bill denied that anyone he loved had died; could not understand why anyone would fill with gas at four bucks a gallon when "Johnny's Standard sells it for 27 cents;" and still "drove" his 1968 Dodge Charger."

"Anyone who knew Bill before (the war) would have watched as his family did in dismay, sometimes in horror even, at the decline of a talented, friendly, outgoing, intelligent man into not a lesser self... but a drastically different self," Paul told CNN.

But Paul doesn't diminish his older brother. He instead chooses to remember Bill in the way he thought of himself.

Toward the end of the piece, he writes: "Bill was always a proud man, remembering himself as he was in 1969, not as he became. Who are we to suggest differently?"

When asked about this line, Paul recalled a story about a moment that occurred between Bill and a nurse at his Veteran's home in Columbia Falls, Montana -- where he'd been staying since 1994.

The nurse had just moved to Montana from Kentucky, a fact she had mentioned to Bill. One day, while at work, she was feeling particularly lonesome and sad, for a reason Paul didn't mention.

Bill noticed. He started singing "My Old Kentucky Home." He wasn't known for his voice, but Bill had been a willing singer, Paul said.

He imagines Bill's voice must have been quiet, a little gravelly. But he went through all the verses: "Oh the sun shines bright on my old Kentucky home / Keep them hard times away from my door."

The nurse was moved to tears.

"He wanted to cheer her up," Paul said, finishing the anecdote. "And if you had looked at him, you wouldn't have imagined anything behind the eyes. But there was."

Paul continued, "Who are we to say, 'What a wreckage.' We could say that about homeless people, we could say that about many, many in life who are less fortunate than me. But who are we to say?"

Paul's words have resonated with many

Since publishing the obituary, Paul has received many emails from people he doesn't know, he said. They tell him his writing touched them, speaking of their own relatives and friends with troubles similar to Bill's.

The effects of the Vietnam War, and the way Veterans were treated upon their return, have lingered with so many people, Paul said. His brother's life fell apart afterward, and his wasn't the only one.

Studies have shown that Vietnam Veterans were twice as likely than Veterans of other eras to have elevated levels of depression and anxiety. Other studies have shown that many Vietnam Veterans suffer from post-traumatic stress disorder, and delayed onset is common. About 30% of Vietnam Veterans have had PTSD in their lifetime, according to the US Department of Veterans Affairs.

"That's a sadness," Paul said, when speaking of the difficulties Vietnam Veterans faced upon returning home. "And I hear that sadness in the responses I've gotten."

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S 2189 and HR 1014 will direct the Secretary of Veterans Affairs to establish a pilot program to furnish hyperbaric oxygen therapy (HBOT) to a veteran who has a traumatic brain injury (TBI) or post-traumatic stress disorder (PTS). MVA has reviewed a number of studies concerning HBOT treatment for PTS and TBI and there are positive indications associated with this treatment. Our interviews with MVA members who served in combat or in Special Operations also point to an affirmative correlation between HBOT and PTS/TBI. We believe that HBOT could potentially open up a more successful treatment pathway for these invisible wounds.

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All the money raised from the event went to Mission 22 to help Veterans with PTSD

BOARDMAN, Ohio (WKBN) – A car cruise to raise awareness about Veteran suicide was held in Boardman Saturday.

The event was held by Mission 22, a group that helps with this issue.

All the money raised from the event went to Mission 22 to help Veterans with PTSD.

The organizer of Saturday’s event, Joshua Moyer, says he wants more people to be made aware of the issue, not just because it’s important, but because one of his closest friends was a Veteran who committed suicide.

“Someone called me and told me what had happened, and it was a devastating feeling, and I want no one to ever have that phone call. That is the worst phone call to ever have,” Moyer said.

Mission 22 also helps with Veterans who are suffering with things such as substance abuse.

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Tyson Manker, a Marine Veteran of the 2003 invasion of Iraq, filed a federal class-action lawsuit on March 2, 2018, seeking relief for the thousands of Navy and Marine Corps Veterans of Iraq and Afghanistan who developed post-traumatic stress disorder (PTSD) and other mental health conditions during their military service, only to be separated with a less-than-honorable discharge.

Manker is joined in the lawsuit by the National Veterans Council for Legal Redress (NVCLR), a Connecticut-based organization whose members include Marine Corps and other Veterans with less-than-honorable discharges. The plaintiffs are being represented by Yale Law School Veterans Legal Services Clinic and co-counsel from Jenner & Block.

The case was first reported on by the New York Times and formally announced during a press conference with Senator Richard Blumenthal ’73 at Yale Law School on March 2.

Since September 11, 2001, more than two million Americans have served in either Iraq or Afghanistan. Nearly a third of these service members suffer from PTSD and related mental health conditions, but the military continues to issue less-than-honorable (“bad paper”) discharges at historically high rates, often for minor infractions that are attributable to undiagnosed mental health issues, according to the lawsuit. When these Veterans apply for a change in their discharge characterization to the Naval Discharge Review Board (NDRB) — which handles applications from former sailors and Marines — these Veterans are unlawfully denied without the benefit of Department of Defense policies meant to ease this process, the clinic said.

“The American public needs to know that hundreds of thousands of military Veterans with service-connected PTSD and TBI are being denied support and VA resources because of an unfair discharge status,” said plaintiff Tyson Manker, who fought in the Iraqi invasion and is now an attorney residing in Illinois. “Systemic failures of the military departments have led to widespread legal rights violations of our most vulnerable men and women in uniform, myself included. It is a national disgrace. By taking this action with the courts we intend to restore the rule of law along with honor for thousands of patriots who were treated so poorly by the nation they served.”

In 2014, the Veterans Clinic filed a separate class-action lawsuit on behalf of five Vietnam combat Veterans and three Veterans’ organizations seeking relief for tens of thousands of Vietnam Veterans who developed PTSD during their military service and subsequently received an other than honorable discharge. In June 2015, as a result of the lawsuit, the Pentagon agreed to upgrade each man’s “other-than-honorable” discharge status.

“We made mistakes with how we treated the Vietnam generation, before PTSD was well understood, but now we are doling out the same injustice to the Veterans of Iraq and Afghanistan,” said Garry Monk, Executive Director of NVCLR. Monk’s brother, Marine Veteran Conley Monk, struggled for 44 years after his Vietnam service before finally receiving a discharge upgrade as a result of the 2014 case filed by the Veterans Clinic. “Shame on us. It shouldn’t take years of waiting, an army of lawyers, and a class-action lawsuit to get the Navy to follow the law,” Monk said.

“Heroic Veterans suffering from the invisible wounds of war deserve support and treatment—not the stain and stigma of a less-than-honorable discharge,” added Senator Blumenthal. “The Navy has inexplicably failed to recognize the impact of post-traumatic stress on post-9/11 Veterans who have been discharged because of these invisible wounds with less than honorable discharges. This injustice must be righted immediately for an entire generation of Navy servicemen and women.”

In support of Manker, combat Veteran and U.S. Senator Tammy Duckworth said, “Not every wound suffered by those who serve this country in uniform are as obvious as mine, but all of them require care and treatment just as mine did. We owe it to our Veterans to make sure they get the care they earned – but too many are denied fair access to the care they need because of an unfair discharge status based in antiquated policies that fail to recognize invisible wounds like post-traumatic stress. As a combat Veteran and former VA Assistant Secretary, I know we as a nation can do much better when it comes to caring for our Wounded Warriors, and ending previous policies or punishing those suffering from post-traumatic stress is an important start.”

The plaintiffs are represented by law student interns Samantha Peltz ’17, Jonathan Petkun ’20, West Resendes ’19, and Helen White ’18, and supervising attorneys Aaron Wenzloff and Michael Wishnie '93 of the Veterans Clinic. Established in 2010, clinic students have represented Connecticut Veterans in litigation before administrative agencies and courts, on benefits, discharge upgrade, immigration, and pardon matters.

“The Navy is defying the Department of Defense, Congress, and the Constitution in a way that the other Boards are not,” said Peltz. “In 2017, the Army and Air Force Discharge Review Boards granted approximately 51% of discharge upgrade applications involving PTSD, while the NDRB granted a mere 16% of applications during the same period. The disparity is staggering.”

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SAN ANTONIO — There is a new approach to treating Post-Traumatic Stress Disorder (PTSD) among Veterans that involves no prescriptions or pills.

Robert Torres, 35, a father of three, and combat Veteran who gave 13 years of service to the U.S. made it out safely, but his mind was still on the battlefield.

"I missed the camaraderie, the marines," Torres said. "I missed the brotherhood that was there and I really struggled."

He survived three deployments with the marine corp in Iraq, Fallujah and Afghanistan.

"You feel like you're being watched or you feel like you're being followed or you're constantly looking for exit routes so you're really not able to be in that moment," Torres said. "You're lonely, you're feeling like you lost your sense of purpose."

Robert Torres is fighting the debilitating symptoms of post traumatic stress disorder and a traumatic brain injury. He said he started seeing a psychiatrist and right away, they pushed pharmaceuticals. However, the pills, he said, only numbed the pain and isolated him from the present.

"Not only were those things personally affecting me, it was also affecting people around me," Torres said. "Pharmaceutical therapy only puts a band-aid over what you're dealing with."

Simultaneously, he said he didn't know there were other options.

"I didn't know how to deal with it, didn't know how to handle it," Torres said. "I didn't know how to take care of it so I was in a denial stage for quite a long time."

And in 2014, he almost gave up.

"When I attempted suicide, I had drove myself to the hospital but sat in the parking lot because I couldn't get myself to go in because I couldn't accept the fact that I was dealing with post traumatic stress disorder," Torres said.

Instead of letting his painful experience consume him, Torres said he hopes to show other Veterans how he got help through a life-changing gift.

"There was a gift certificate given to me around that time that brought me to Float SA," Torres said. "It was amazing. It's almost feels like you become a new person - from the aches and pains that your body normally has to you're more mindful, you're more aware of your feelings, your emotions.

The water is saturated in Epsom salt, creating a zero gravity float experience in a calming private pod. Float owner Jeremy Jacob said the goal is to achieve sensory deprivation.

"When you remove all sensory input that's coming into the mind and especially the nervous system because we're constantly taking in stimulus that allows you to shut down amydala, the fight or flight part of your brain," Jacob said. "Lowering the stress hormones, increasing the happy hormones."

After Jacob realized the impact it had on mental health, he started a PTSD program for Veterans.

"In the research that's been done on floating, they found that when you float consecutively and constantly, you get a lot more benefits so our program for combat Veterans with PTSD is 10 floats, over 10 weeks," Jacob said

As a result, Jacob has seen so much success among Veterans like torres that he's trying to work with Veteran Affairs. He says right now, float therapy isn't a treatment option covered by the v-a.. Although some military bases already have the tanks for training...

"It's not something they're able to prescribe," Jacob said. "So there's no payment options to support them so that kind of falls on float centers."

Torres says the natural healing remedy combined with fitness and exercise gave him the hope he needed to keep going..

"I've had back surgery, I've had hip surgery, I almost lost my foot in 2015 in Iraq so I live in chronic pain but when I come out of a float tank, I can't feel any of those," Torres said. "I'm able to do those things with my kids which is huge to me because they're a big part of who I am."

In other words, Torres thinks this device could widen the gap between life or death for some people.

"I would encourage Veterans to give alternative treatments because something like float therapy can be life-changing," Torres said.

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He's teaming up with Guitars 4 Vets charity

Ford is teaming up with country singer Luke Combs to help Veterans of the U.S. Military deal with post-traumatic stress disorder through music.

The 2019 CMA Male Vocalist and Song of the Year winner is helping Ford give $25,000 worth of instruments to Vets through the Guitars 4 Vets organization, which promotes the use of music as a therapeutic method for PTSD.

Combs will appear in a TV spot ahead of Wednesday night’s CMA broadcast as he meets with one of the recipients and gives them a lesson.

“Ford has supported the military and Veterans for nearly a century, and Luke Combs has paid tribute to the brave men and women of our armed services,” Ford marketing executive Mark LaNeve said in a release on the collaboration.

The donation is part of Ford’s Proud to Honor program, which last week launched a new line of military-inspired merchandise to raise money for the DAV and Blue Star Families charities.

The custom guitars being donated feature camouflage pickguards, Ford logos and the Proud to Honor name.

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For many years, researchers have looked for objective measures to help diagnose traumatic brain injury or post-traumatic stress disorders.

Information from the Defense and Veterans Brain Injury Center’s 15-year natural history study is assisting medical researchers in determining whether a protein found in a patient’s blood could be a promising candidate for future diagnostic tools.

A blow to the head is one of the ways a service member can sustain a TBI, and after witnessing psychologically disturbing events, they may also experience PTSD. Diagnosing these can be complex as they have similar symptoms that can be compounded when both are present.

Since 2000, more than 400,000 active-duty service members have been diagnosed with TBI, according to figures from DVBIC, the Department Department’s center of excellence for traumatic brain injury and a division of the Defense Health Agency Research and Development Directorate. However, a statistic revealing those co-presenting with PTSD has not been compiled.

In a 2018 research review on mild TBI (mTBI) and PTSD, the DVBIC noted that “differential diagnosis will likely continue to be a challenge.”

Jessica Gill, a researcher at the National Institutes of Health, and Dr. Kimbra Kenney, an associate professor of neurology at the Uniformed Services University of the Health Sciences, both located in Bethesda, Maryland, are currently examining patients’ blood to see whether it can help in diagnosing and treating TBI.

“By pairing advances in the laboratory, we are now able to detect very small proteins in the blood that provide key insights into pathology that contribute to long-term symptoms in military personnel and Veterans with TBIs, as well with PTSDs,” said Gill.

At a recent conference, Kenney explained how specific types of blood proteins were significantly elevated among those with concussions, compared to subjects who had been deployed but not sustained TBIs. Blood samples are being collected at Walter Reed National Military Medical Center as part of their research in a study of the natural history of TBI funded by the DoD and Department of Veterans Affairs.

In another project using data from the 15-year natural history study, researchers are examining blood proteins in subjects who had both sustained a TBI and reported PTSD symptoms. Earlier studies had shown that tau and amyloid-beta-42 proteins indicated the presence of TBI; now researchers believe the presence of both proteins could reveal individuals with both TBI and PTSD.

Study participants consisted of 107 service members. Evidence of TBI was obtained from medical records and interviews at Walter Reed Bethesda. Most participants were diagnosed with a mild traumatic brain injury while the remaining subjects experienced an injury unrelated to TBI but did not lose consciousness. Each participant provided a blood sample and completed a detailed questionnaire. Three groups were formed: those with both TBI and PTSD; those with some other injury and no PTSD; and those with TBI but no PTSD.

The researchers found “tau in plasma is significantly elevated in military personnel who have sustained an mTBI and display concurrent PTSD symptomology.” This finding agrees with earlier civilian studies. Following a TBI, tau elevations are associated with poor recoveries and greater neurological problems.

These studies may show relationships between neurological outcomes and changes at the molecular level. “The novel design of the 15-year study provides the first longitudinal data to untangle complex pathological processes that result in lasting neurological and psychological symptoms and impairments,” Gill said. “By better understanding these processes, we can personalize the care we provide to treat military personnel and Veterans to have the biggest impact on their health and well-being.”

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WASHINGTON – House lawmakers unanimously approved a bill that would lay the groundwork for the Department of Veterans Affairs to start funding service dog programs and connect Veterans with canines that could be critical for their mental health care.

The Puppies Assisting Wounded Servicemembers for Veterans Therapy Act authored by Rep. Steve Stivers, R-Ohio, would kick-off a pilot program to issue federal grants to nonprofits that provide service dogs to Veterans suffering from mental health issues, and require the VA to assess the effectiveness of dog therapy.

“Our Veterans fought for our freedom, and I’ve heard from many Veterans who say that’s exactly what their service dog gives them – freedom. They’re free to go to restaurants, to fly on planes, to go to the movies, things that post-traumatic stress [disorder] had made impossible,” Stivers said.

Lawmakers on the House and Senate Committees for Veterans’ Affairs have made tackling Veterans suicide a top priority after years of legislative measures and efforts that haven’t stemmed the crisis. Some Veteran advocacy groups frustrated with Congress’ inability to make progress on the issue have called for more creative thinking.

"Congress continues to ignore damning reports released by [The Journal of the American Medical Association] and others regarding our current mental health approaches failing Veterans. We have not heard a peep about it from this leadership.” Joe Chenelly, national executive director of American Veterans, said in a statement last month. “When it comes to curbing suicide the time to act is now...Every day matters and the status quo is untenable.”

The number of Veterans committing suicide dwarfs combat fatalities since 9/11. Between 2005 and 2017, 78,875 Veterans took their own lives, according to the most recent data from VA. In comparison, about 7,000 troops have been killed in combat in Iraq and Afghanistan combined, across two decades.

Nonprofits are one of the only avenues for Veterans to adopt service dogs. The VA doesn’t provide any funds for service or emotional-support animals but concluded a congressionally mandated study on the benefits of dogs for PTSD care in July, according to Christina Mandreucci, a spokeswoman for the department. The results of one part of the study on whether service or emotional-support dogs can help Veterans with PTSD is expected to be released in the summer, and the results on whether dogs can lead to overall health care savings with fewer hospital stays and less reliance on medication is expected by the end of the year.

“Mental wellness does not have a one-size-fits-all solution, which is why VA must provide innovative and out-of-the-box treatments to help Veterans combat these invisible illnesses and thrive in their civilian lives,” said Rep. Phil Roe, R-Tenn., the ranking member of the House VA committee. “There is no question that the companionship and unconditional love offered by man’s best friend can have powerful healing effects on men and women from all walks of life, including our men and women in uniform.”

There is no vote scheduled yet for the Senate version of the measure.

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Four decades ago, the U.S. Department of Veterans Affairs launched the National Veterans Wheelchair Games with only seven events. Now, video gaming, or esports, will become the newest medal event at this summer’s games.

But Jamie Kaplan, a recreational therapist at the James A. Haley Veterans’ Hospital in Tampa, Florida, has been on the forefront of video game therapy for a decade. In the facility’s gaming room, he has every system from Atari to Xbox One – all modified for disabled Veterans.

“Video gaming was a way for us to bring [Veterans] in – because it was something they are familiar with, something they enjoy doing,” Kaplan said.

Accessible gaming has become the focus of an ongoing partnership between the VA and Microsoft, which debuted their Xbox Adaptive Controller (XAC) in 2018. The device utilizes external buttons, switches and joysticks “to make gaming accessible to players with limited mobility.” Without it, many former service members would be unable to play video games at all.

The XAC, which is available at 24 VA facilities across the country, was the product of years of research and development.

Ken Jones, a mechanical engineer, began rigging gaming devices for injured Veterans on a case-by-case basis after visiting Walter Reed National Military Medical Center Bethesda, Maryland, in 2012. At first, the modifications were simple, but they quickly became more complex as Veterans with more challenging injuries expressed their desire for custom arrangements.

Jones founded the nonprofit Warfighter Engaged to supply the modified devices. It was Jones who created the rigged controller that Sgt. Josh Price used during a hackathon at Microsoft’s Ability Summit in 2015, catching the attention of the tech giant’s executives. Price had lost part of his right arm in a service-related injury.

Working with Jones, end-users and other disability advocates, Microsoft began developing an all-in-one accessible controller as part of their Gaming for Everyone initiative, further enhancing the product at the 2016 hackathon.

Bryce Johnson, inclusive lead at Microsoft Devices, worked extensively on the XAC since its inception. To him, the accessible controller is part of Microsoft’s larger goal of empowering all gamers worldwide. For the first time, the device standardizes a cost-effective, “plug-and-play" custom gaming rig for users and caretakers.

“At Xbox, we believe that when everybody plays, we all win,” he said. “With the Xbox Adaptive Controller, we are making it easier for these gamers to play and connect with the games and people they love.”

“The response from the community has been overwhelmingly incredible and positive, and we are so thankful to those who contributed to the creation of this controller,” Johnson added.

“It’s really good to see. It vindicates what we’ve been saying for years that this is something people need,” Jones said. “Just seeing Veterans now able to interact with their teammates that they played with for years in the military and were basically shut out. Now, to be a part of that community again is really good.”

For troops, "this population definitely has a very strong interest in gaming, in esports, and that world was taken away from a lot of folks...due to physical disabilities,” said Dr. Leif Nelson, VA national director of adaptive sports. “This controller really opened up the door to make gaming accessible to everyone.”

In 2019, Kaplan hosted the first Veterans’ esports tournament in Tampa with good results, and he is planning a Madden NFL 20 tournament on Jan. 31 to celebrate Super Bowl weekend. He hopes to expand similar events to include active-duty service members from nearby MacDill Air Force Base — home of U.S. Central Command, U.S. Special Operations Command, two Air Force wings and dozens of other mission partners — and even local professional athletes.

Kaplan ran video gaming lounges at two nationwide VA accessible events in the last year to introduce esports to the wider Veteran community.

It was at one of these events that Roger Brannon first encountered adaptive esports. Brannon medically retired as a Marine Master Gunnery Sgt. in 2017 after being diagnosed with Lou Gehrig’s disease, also called amyotrophic lateral sclerosis, or ALS, in 2016. Veterans, specifically post-9/11 Veterans, have a higher likelihood of developing ALS than civilians, according to a 2019 research study.

“Before, I couldn’t last 15 minutes with the regular joysticks. When I saw the XAC, I thought, ‘Wow, that could help a lot,'” Brannon said. “I am able to play video games with my son — Star Wars, race car games. We are spending more time together playing video games. It’s now something we can both do.”

Brannon also noted that video gaming with other Veterans at nationwide events provides a welcomed community.

“We’ve gone from just talking online to bringing Veterans in face-to-face with other peers, so they could start to develop relationships with people with similar backgrounds, similar interests and similar situations,” Kaplan said. “It’s not just a way for them to participate within the VA community, but to actually feel a part of their local community.”

To Nelson, the partnership naturally complements the VA’s ongoing adaptive athletics and therapy programs.

“It’s an incredibly crucial part of the rehab continuum,” said Nelson. “After folks go through an in-patient rehab program, then some sort of out-patient rehab, what’s after that? That’s where adaptive sports fit in for us.”

Microsoft’s introduction of the adaptive platform coincided with a 2018 research study that found video game play helps Veterans manage stress levels, cope with ongoing symptoms and enjoy higher levels of self-confidence and camaraderie.

“Adaptive sports can be the springboard to better health, to employment, to getting back to school. Once you know you can achieve something, it raises the bar for all aspects of life,” Nelson added.

As part of the agreement, the VA provides Microsoft with direct feedback from Veteran end-users to be integrated into the next generation of devices.

Jones said the current XAC, however, is remarkable for a first-generation device.

One of the most critical components to the Adaptive Controller is the “Copilot” feature. This 2017 software update allows a gamer to simultaneously use two controllers — one traditional Xbox controller and one XAC — to control a single player. Before, this feature would not have been possible.

This year’s National Veterans Wheelchair Games takes place in Portland, Oregon, from July 3-8 and is cosponsored by the VA and Paralyzed Veterans of America. The video gaming tournament — one of 20+ events — will be the “first-ever fully adaptive esports competition,” according to Nelson. The change signifies the VA’s commitment to fully integrate esports therapy.

“With the Adaptive Controller, it makes everybody equal. It allows these Veterans to feel some sense of normalcy, or how they felt prior to their injury,” Kaplan added. “We don’t want them being their injury. We want them being their individual.”

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HR 105, TBI and PTSD Treatment Act, will direct the Secretary of Veterans Affairs to establish a pilot program to furnish hyperbaric oxygen therapy (HBOT) to a veteran who has a traumatic brain injury (TBI) or post-traumatic stress disorder (PTS). MVA has reviewed several studies concerning HBOT treatment for PTS and TBI and there are positive indications associated with this treatment. Our interviews with MVA members who served in combat or in Special Operations also point to an affirmative correlation between HBOT and PTS/TBI. We believe that HBOT could potentially allow for a more successful treatment pathway for these invisible wounds.

Please contact your elected officials and ask for their support.

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HR 1656, TREAT PTSD Act, will require the Department of Veterans Affairs and the Department of Defense to furnish enrolled members and veterans of the Armed Forces who have been diagnosed with Post Traumatic Stress Disorder with stellate ganglion blocks, should they elect to have them. Serving our nation in the Armed Forces is an incredibly taxing job both physically and psychologically. As such, we strongly believe that active duty members and veterans deserve the best quality of care that our country can provide. The stellate ganglion block treatment is a new but effective method for treatment of PTSD. This bill is a step towards the more complete care that our military and veterans deserve for whatever ailments they have incurred in service to our country.

Please contact your Member of Congress and Senators and ask them to co-sponsor this bill.

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HR 2992, TBI and PTSD Law Enforcement Training Act, will direct the Attorney General to develop crisis intervention training tools for use by first responders related to interacting with persons who have a traumatic brain injury, another form of acquired brain injury, or post-traumatic stress disorder. Often Veterans suffering from post-traumatic stress and traumatic brain injury interface with law enforcement under stressful situations. These crisis response tools will go a long way to de-escalating confrontations and ensuring these damaged Veterans get the assistance they need.

Contact your Member of Congress and Senators and ask them to support this bill.

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Will direct the Secretary of Defense to carry out a grant program to increase cooperation on Post-Traumatic Stress Disorder research between the United States and Israel. No other nation has had the combat experience as the State of Israel. Joint collaboration on Post-Traumatic Stress and its effect is a force multiplier.

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Of the many adaptations American leaders and healers have been forced to embrace during the COVID-19 pandemic, left behind as an unintended casualty has been the critical work to advance mental health care for more than 2 million Veterans fighting daily against Post Traumatic Stress Disorder and Injury (PTSD/I).

Left untreated, PTSD/I can be debilitating, leading to a decline in quality of life and causing significant medical, mental health, interpersonal and social impairment. More threatening though, it has a strong link to suicide, with the lack of effective treatment now seen as a major contributing factor.

Before National PTSD Awareness Month in June ends, U.S. Department of Veterans Affairs statistics reveal that roughly 600 Veterans will die by suicide. The cost of status quo for our Veterans, their loved ones and our nation is unacceptable and unnecessary.

Just as our troops realize that we’re stronger and more successful when we sync our efforts and function as a team, medicine needs to transition to the same mindset; it needs to collaborate as members of a mission-driven care team to provide effective healing for those with trauma.

A great irony in medicine is that as systems evolve to allow for more coordination of care, consumers often voice frustration that their treatment is increasingly fragmented. Health care systems often tout the value of team-based care, but in many cases, meaningful, active collaboration between health care providers is the exception to the rule.

Empowering Veterans with the most effective care, a new model for addressing trauma fuses expertise and strategically sequenced skills of providers. To illustrate the value of this model, Americans should look to a potentially game-changing treatment that teams a biological intervention called Stellate Ganglion Block (SGB) with high quality psychological care, and ease of access through common-sense legislation.

In traditional settings of trauma-focused care, patients engage with a therapist to address deep-seated psychological scars. When patients are struggling with acute trauma symptoms, they’re overrun with adrenaline, and unable to calm down. In this state of mind, they’re not prepared to receive and integrate psychological insights. Living in a state of “chronic threat response,” these patients function in “survival mode,” where decisions are made in a “fight-or-flight” context. We know that this exaggerated hyperarousal is predictive of poor response to standard PTSD treatments.

In use since the 1920s for a variety of conditions, SGB is an injection of a local anesthetic adjacent to a cluster of nerves in the neck, just above the collarbone. When used for trauma symptoms, SGB appears to reset the fight-or-flight system. Used successfully for more than 10 years on thousands of patients to treat post-traumatic stress symptoms with a success rate between 70-80 percent, positive effects can last from six months to many years when paired with effective psychological interventions.

Since 2014, research studies have shown consistently that SGB can reduce PTSD symptoms by 50 percent and is particularly helpful in improving symptoms of irritability, surges of anger, difficulty concentrating, and trouble falling or staying asleep.  Most recently, a randomized clinical trial published in JAMA Psychiatry demonstrated twice the effect of SGB as compared to a placebo injection.  The large magnitude of effect and high success rates of SGB are simply too compelling to ignore, especially when standard PTSD therapies demonstrate disappointing results and weak effect sizes.  It’s not just time to get the word out, it’s time to take action.

The Center for Compassionate Innovation within the VA describes SGB as a “safe and ethical” PTSD/I treatment option. A handful of pioneering physicians in approximately 11 clinics within the VA have begun to offer this procedure. The adoption of SGB as a treatment option across the VA would change – and potentially save – the lives of countless Veterans.

Now, Congress must act. H.R. 5648, the Treatment and Relief through Emerging and Accessible Therapy for (TREAT) PTSD Act, would require the VA to provide SGB therapy as a front-line treatment for Veterans diagnosed with PTSD. Congress must consider this bill swiftly and in bipartisan fashion.

Effective healing requires us to practice collaboratively. Innovation is critical, especially now when trauma, secondary to our global health crisis, is rampant. Mental health care that fuses expertise of those providing psychological and biological interventions like Stellate Ganglion Block hold game-changing promise for relief from suffering. Those who suffer from trauma deserve the best care we can provide – care that is practical, effective, and informed by modern neuroscience. Our Veterans are counting on us to be like them – team up and find a better way.

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NESS CITY, Kan. (KWCH) A Kansas non-profit is trying to reduce Veteran suicides by giving them a life-changing gift.

K9's For Heroes gives service dogs to Veterans who struggle with PTSD. On Saturday, the organization gifted it's second dog to a Veteran in Ness City.

"She's going to be good for me and I can't wait to see how we do together and how the quality of life is going to improve for me," said Annie Henson.

Henson joined the Army in 2011 and now struggles with PTSD.

"I was active duty at the end of last month. I don't do well in crowd situation or people in my personal space so I tend to not go out in public," said Henson.

K9's For Heroes gave hope, a trained service dog, to Henson free of charge.

"Just seeing this dog will have an effect on her and help her to be able to go out in public. Help ease her anxiety, and deal with her new reality," said April Cunningham.

Hope is the second service dog K9's For Heroes has given to a Veteran, but they have eight more training to become service dogs. Their goal is to give 20 service dogs to Kansas Veterans with PTSD this year.

"We'd like to see if we can change the suicide rates in Kansas specifically," said Cunningham.

The organization's top priority is Veterans in Kansas, but eventually would like to grow to help Veterans with PTSD in other states as well.

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In an effort to help combat the national daily average of 20 U.S. military Veteran suicides and to offer an additional treatment solution, VA hospitals across the country have partnered with the national non-profit organization SoldierStrong to offer the StrongMind program.

StrongMind utilizes the virtual reality technology known as BraveMind. The VR technology behind BraveMind was developed by Dr. Albert “Skip” Rizzo and his team at the University of Southern California’s Institute for Creative Technologies, where Dr. Rizzo serves as the director of medical virtual reality. Due in part to the ever-growing popularity of gaming, the use of virtual reality therapy as a way to treat PTSD appeals to younger Veterans who otherwise may not be inclined to participate in traditional therapy practices.

Virtual reality can be used to deliver prolonged exposure therapy – the practice of recalling a traumatic memory while talking through the nuances of that memory with a therapist–an evidence-based method for treating PTSD. However, Veterans dealing with PTSD often find it difficult to summon specific memories of their time in the service. Virtual reality therapy makes the process of recalling such memories easier for Veterans.

StrongMind’s VR program technology creates 14 specific “worlds” of combat scenarios, from a desert roadway to a crowded Iraqi marketplace or a slum in an Afghan city. Therapists can select a specific world based on the Veteran’s traumatic experience and customize it, recreating the scene of the troubling memory in the virtual reality headset, thus placing the Veteran squarely back within the midst of that memory at a pace they can handle.

The protocol may come across as simple in writing, but as Dr. Rizzo notes, “exposure therapy can be difficult.” However, if conducted in a safe and supportive environment, in which the process is overseen by trained VA clinicians, it can help individuals confront and effectively cope with trauma-induced emotions.

“I was skeptical at first,” said Christy Tubbs, a clinician at the Syracuse VA in Syracuse, N.Y. “But it’s an enhancement to treatment that the therapist provides and it will be helping us do our jobs better.”

The StrongMind program’s efficacy stems from clinicians’ ability to customize and control the content presented in the VR headset so precisely that sights, sounds, smells, vibrations–even the weight and sensation of holding a weapon–can create a patient experience that mirrors the traumatic memory or encounter.

Experiencing troubling memories repeatedly in a safe environment works to reduce the brain’s response to them. This approach aims to help Veterans have greater control of their emotions instead of their memories triggering fear and anxiety.

“It gets them to talk about things they’ve never talked to anyone about before,” Rizzo said. “Those memories don’t have the same intense, painful emotional power that they did before. Patients start to feel empowered, to feel that they got it out, and that they can talk about it.”

At VA

The StrongMind initiative has donated 13 VR software and hardware systems to VHA’s innovation centers across the country since September. These include Syracuse VA; Puget Sound VA in Tacoma, Wash.; Hunter Holmes McGuire VA in Richmond, Va., North Texas VA in Dallas, Texas; Michael E. DeBakey VA in Houston, Texas; Audie L. Murphy VA in San Antonio, Texas; Gulf Coast Veterans Health Care System in Biloxi, Miss.; Charles George VA in Asheville, N.C.; Martinsburg VA in Martinsburg, W. Va.; G.V. (Sonny) Montgomery VA in Jackson, Miss.; James J. Peters VA in Bronx, N.Y.; VA Sierra Nevada in Reno, Nev.; and VA Palo Alto Health Care System in Palo Alto, Calif.

During the last week of January, Rizzo and master clinician, Dr. Todd Adamson, conducted training sessions at the Charles George and North Texas VA centers to teach clinicians from 11 VA facilities how to use StrongMind equipment in the clinical process to deliver safe and effective PTSD treatment.

SoldierStrong, which surpassed its initial 2019 commitment to donate VR systems to 10 VA medical centers, hopes to more than double that commitment by the end of 2020. The group has already received requests for the system from eight more VA centers.

To more information about SoldierStrong’s StrongMind program, visit https://www.soldierstrong.org/strongmind/.

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Mantram Repetition Program and compassion meditation

You probably know that symptoms of posttraumatic stress disorder (PTSD) often include anxiety, unwanted memories, anger and avoidance. But did you know that meditation may be able to help? Meditative practices have been linked to decreases in hyperarousal, depression and insomnia.

One example of a meditative practice available through VA is the Mantram Repetition Program (MRP). Mantram repetition can be done anytime, anyplace and for any amount of time. It may be a good choice for Veterans who don’t see themselves sitting and meditating each day.

Veterans can use the tools associated with MRP before going to sleep, walking, waiting or even putting on a seat belt. MRP is also great for beginners who are interested in mindfulness practices.

“I’m trying to open up to people.”

For Veterans who experience challenges in socializing and establishing emotional connections with others, VA also offers programs in compassion meditation. This meditative practice focuses on enhancing Veterans’ sense of connection to other people and compassion for themselves and others.

“I was the kind of person that wouldn’t look or smile at people,” reported a Veteran who participated in a study of compassion meditation. “Now I try to be more tolerant and be friendlier. I’m trying to open up a little more to people I don’t know. I try not to be so judgmental and give them the benefit of the doubt.”

Compassion meditation and MRP offer new approaches for Veterans trying to manage symptoms of PTSD and related diagnoses. So do similar mind-body interventions available through VA. Meditative practices can be used alone or in conjunction with other treatments. A mental health provider can help Veterans choose the approach that might be most helpful for addressing their needs.

“Took the edge off a stressful incident.”

“Mantram repetition provides more of a calming sensation than anything else,” said a Veteran who recently tried MRP. “Mantram repetition took the edge off the feelings that I had about a particularly stressful incident. It caused me to reflect on it more.”

While more research is needed to better understand the relationship between meditation, PTSD and depression, initial studies showed that meditation was well-received by Veterans. VA researchers recently examined more than 270 Veterans who participated in MRP and found that the practice lessened depression and other psychological symptoms.

MRP starts with participants learning the importance of a having a personal mantram and repeating it daily. The tools found on the MRP PsychArmor site include modules that can help Veterans engage with the helpful ways to make self-care important.

Through guided MRP, Veterans can discover:

• Ways to use MRP to slow down both the mind and the body, to turn attention toward emotional self-regulation, to manage symptoms and thus to relax.
• How to live with intention and set priorities.
• Ways to use monotasking – instead of multitasking – to focus on one thing at a time and help manage the symptoms of PTSD.
• When to use MRP to interrupt stress responses – even common spikes, like road rage.

Veterans are encouraged to speak with their VA care team to learn about the many mind-body approaches available through VA. Here’s more information about MRP.

To learn more about VA’s mental health offerings, visit http://www.mentalhealth.va.gov.

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Military movies can often remind Veterans of their service. They can also bring up painful memories of the past.

Air Force Veteran and Silver Star recipient John Pighini is someone who knows both sides of this issue. He recently worked as a technical adviser on a major motion picture that showcased the bravery of service members, but also brought up a painful past. These movies can sometimes show Veterans dealing with their own struggles: anger, paranoia, edginess, regret and survivor’s guilt.

Pighini saw those struggles on the big screen after working on the movie. “It feels like they take post-traumatic stress and they set it right in your lap,” he said. “Don’t go to this movie and not take a handkerchief or tissues with you. You will not make it through.”

PTSD in Veterans

These are the feelings Pighini knows all too well. He served as a pararescueman during Vietnam, which led to his role on the movie as a technical adviser. As members of Air Force Special Warfare, pararescue specialists rescue and medically treat downed military personnel all over the world. These highly trained experts take part in every aspect of the mission and are skilled parachutists, scuba divers and rock climbers, and they are even arctic-trained in order to access any environment to save a life when called.

Dr. Paula Schnurr, executive director for National Center for PTSD in VA’s Office of Mental Health and Suicide Prevention, started studying PTSD in 1984. She said Vietnam Veterans are still dealing with effects because the lack of support when they returned from deployment.

“Vietnam Veterans, like Veterans of earlier wars, were expected to come home and get on with their lives,” she said. Schnurr added the publicly opposed war made Vietnam Veterans’ transition hard to come home.

The National Vietnam Veterans Readjustment Study, completed in 1988 by the Research Triangle Institute, was pivotal for Veterans and the medical community. At the time, it was the most rigorous and comprehensive study on PTSD and other psychological problems for Vietnam Veterans readjusting to civilian life.

The study findings indicated about 30% of all male and 27% of female Vietnam theater Veterans had PTSD at some point during their lives. At the time, that equated to more than 970,000 Veterans. Additionally, about one half of the men and one third of the women who ever had PTSD still had it.

A 2013 National Vietnam Veterans Longitudinal Study showed that 40 or more years after wartime service, 7% of females and 11% of males still had PTSD.

PTSD symptoms may increase with age after retiring from work, or from medical problems and lack of coping mechanisms.

Having a mission

Having a mission can help Veterans deal with PTSD. While working on a recent movie, Pighini recalled the struggles he still deals with–50 years after his Vietnam service.

“The early days, we didn’t know what we had,” he said. “As we get older, we become more melancholy. We’re not busy and we’re not out there on the firing line.”

While filmed in Thailand, Pighini said the smells from Southeast Asia raised the hairs on the back of his neck. Despite the flashbacks, Pighini said he hopes viewers realize the importance of putting a spotlight on PTSD. He added movies also depict the courageousness of military members. In the movie he worked on, the movie told the story of an Air Force pararescuemen who lived by their motto, “That others may live.”

“That means you lay it out,” Pighini said. “You do whatever you need to do to save a life. It’s the ethos we have. It’s what we live by. If you have to lay down your life or one of your limbs or whatever it is, you do it. It means everything.”

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In 2019, Gary Pressley took his own life. Now, his mom is filling a claim against the Veterans Administration.

DUBLIN, Ga. — A Central Georgia mom has filed a wrongful death claim against the Veterans Administration after her son committed suicide last year at the Dublin VA.

In April 2019, Gary Pressley shot himself in the chest, ending his life because he was in so much pain, according to legal documents obtained by 13WMAZ.

This month, Pressley's mother, Rhonda Machelle Wilson, filed a claim against the VA for more than $8.2 million.

"I just wish that they would have found him and stopped him, locked him up, did what they had to do," Wilson said.

Back in 2019, 28-year-old Gary Pressley died by suicide after shooting himself in the chest in the parking lot of the Carl Vinson VA Medical Center.

Documents say he left a suicide note that reads, "This is what happens by punishing already-suffering people."

The back of the note said, "Thank you for the release."

"It was just a battle with the medication, the doctors -- I mean, I watched him cry," Wilson said.

After watching her son lose his life, Rhonda Wilson filed a wrongful death claim against the Veterans Administration for $8,250,006.

One document says the VA referred Pressley to a pain specialist in Stockbridge who got his pain under control, but the doctor stopped treating Veterans because the VA owed her hundreds of thousands of dollars.

"Currently, I'm dealing with four of these different cases actively," Attorney Peter Bertling said.

Bertling, an attorney in California, is handling the claim. He focuses on medical malpractice cases dealing with Veterans and military families.

"This is a situation where it seems to be a pretty clear-cut case of liability. There is really no question of what happened here," Bertling said.

Wilson says she hopes her claim will force the VA to provide more resources for Veterans facing mental illnesses.

"He would have wanted some change to go into effect to make things better for other Vets," Wilson said.

We reached out to the Carl Vinson VA Medical Center for a statement:

VA does not typically comment on pending litigation.

However, Suicide prevention is VA’s highest clinical priority, and the department is taking significant steps to address the issue.

As the Joint Commission explains: “The US Department of Veterans Affairs (VA) has been able to reduce the number of in-hospital suicides from 4.2 per 100,000 admissions to 0.74 per 100,000 admissions on mental health units, an 82.4% reduction, suggesting that well-designed quality improvement initiatives can lead to a reduction in the occurrence of these tragic events.”

The Los Angeles Times recently reported that, when it comes to reducing suicides among certain inpatients, VA “offers some clues as to what might work” for other health care systems.

All VA health care facilities now provide same-day services in primary and mental health for Veterans who need them.

We encourage any Veteran, family member or friend concerned about a Veteran’s mental health to contact the Veterans Crisis Line at 1-800-273-8255 and press 1 or text 838255. Trained professionals are also available to chat at www.Veteranscrisisline.net. The lines are available 24 hours a day, 7 days a week.

Just as there is no single cause of suicide, no single organization can end Veteran suicide alone.

That’s why the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) executive order aims to bring together stakeholders across all levels of government and in the private sector to work side by side to provide our Veterans with the mental health and suicide prevention services they need. The EO builds on VA’s public-health approach to suicide prevention, which focuses on equipping communities to help Veterans get the right care, whenever and wherever they need it.

VA’s 2019 national Veteran suicide prevention report is available here: https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5317

David Whitmer

Medical Center Director, Carl Vinson VAMC

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Five Vietnam combat Veterans and three Veterans’ organizations filed a class action lawsuit in federal court on March 3, 2014 seeking relief for tens of thousands of Vietnam Veterans who developed Post-Traumatic Stress Disorder (PTSD) during their military service and subsequently received an other than honorable discharge.

On November 14, 2014, the claims of the five named Plaintiffs were remanded to their respective record correction boards for reconsideration on an expedited schedule ordered by the Court and in light of a Department of Defense policy change issued on September 3, 2014. The Court also dismissed the claims of the organizational Plaintiffs without prejudice to refiling the case. In spring 2015, the respective record correction boards granted upgrades in all five remanded cases. For more information, please follow the links below.

• Resources for Veterans Seeking Discharge Upgrades
• Updates
• Case Filings

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A poll of 2,000 Americans has found that members of the military community -- active-duty personnel, Veterans and their family members -- are twice as likely than civilians to believe persons with post-traumatic stress disorder are violent or dangerous.

And 35% of these "military-connected" individuals believe that PTSD is not treatable, another finding that professionals who treat trauma-related mental health issues find disheartening, said Anthony Hassan, president of the not-for-profit Cohen Veterans Network.

"I was shocked at these percentages and then my mood went to disappointment," Hassan said. "I spent so much time in the military working on reducing stigma and educating our members to make sure they understood these diagnoses and that getting help wouldn't hurt their careers. Clearly we are not making much improvement."

Hassan and other organizations that help service members and Veterans want them to know that PTSD can be treated, an apt message to share for PTSD Awareness Month in June.

"PTSD's impact on mental health still hasn't hit mainstream understanding," said Teralyn Sell, a Wisconsin-based psychotherapist. "There are evidence-based trauma treatments that are available."

According to the survey of 2,000 people conducted by The Harris Poll, 67% of Americans believe that most Veterans have PTSD. Some 74% think most combat Vets have PTSD. One in four believe patients with PTSD are violent or dangerous, and nearly 60% believe that if a person experiences a traumatic event, they will develop PTSD.

In reality, however, studies show that between 13.5% and 20% of Iraq and Afghanistan Veterans meet the criteria for a PTSD diagnosis, as do 12% of Gulf War Veterans and 15% of Vietnam Veterans.

But the majority of those people do not engage in violence, according the the Department of Veterans Affairs.

Two surveys in 2014 of U.S. military personnel and Veterans diagnosed with PTSD found that 9% engaged in severe violence and 25% were involved in physical aggression in the prior year.

But alcohol misuse, younger age, financial instability, combat exposure and a history of violence before military service appeared to contribute to severe violence and aggression.

Veterans with PTSD who did not abuse alcohol were not at significantly higher risk of violence, data showed.

"PTSD is associated with an increased risk of violence," VA researchers have said. "[But] the majority of Veterans and non-Veterans with PTSD have never engaged in violence. When other factors like alcohol and drug misuse, additional psychiatric disorders, or younger age are considered, the association between PTSD and violence is decreased."

Hassan said he thinks perhaps military people think those with PTSD are violent because they hear about colleagues being booted from service for an incident, and if the colleague also has a PTSD diagnosis, they associate the condition with the violence.

He added that service members may believe the condition is not treatable because they know fellow Veterans who have a diagnosis and receive disability compensation for their condition, and then don't get treatment or actively engage in it out of concern they will lose their benefits.

"I don't know how [service members] get stuck on it, how they seem to relate PTSD with violence and reckless behavior, and how they make this assumption that treatment doesn't work when they're told in the military all the time that these aren't true," Hassan said.

According to the Department of Veterans Affairs, effective PTSD treatments include: prolonged exposure therapy, which has a patient confronting the trauma openly and working to tackle situations that have been avoided as a result; cognitive processing therapy, in which a therapist works with the patient to overcome negative thoughts through self-awareness and activities; and eye movement desensitization and reprocessing -- a therapy during which a patient tracks a provider's quick movements or other stimulus while thinking about a traumatic event or experiences.

The science also is evolving for PTSD. A stellate ganglion block -- an injection of an anesthetic into nerves at the base of the neck --reduced PTSD symptoms in 70% of combat Veterans who received it in one study. Providers are using ketamine infusions to treat chronic forms of the disorder. And most recently, a study using MDMA, or Ecstasy, when coupled with therapy, showed promise for treating the disorder.

Misconceptions of PTSD, the people who have it and its treatments can deter people from getting care, which can cause lifelong suffering, Hassan said.

Treatment can lead to a "more productive life," he added.

"Untreated, your life can be unmanageable. People who go for treatment can improve their quality of their life, they can regain pre-crisis or pre-diagnosis functioning and they improve their relationships, at work, at home and with family and friends," he said.

With the pandemic winding down in the U.S. Hassan said he has concerns for service members and Veterans with the diagnosis who have suffered in the past year.

According to the survey, 65% of Americans with PTSD said that the past year, including isolation resulting from the pandemic, the politically charged climate in the U.S. and civil unrest has negatively affected their recovery.

"I want to remind people that if you come and get help, we really can help you improve your quality of life, there's no doubt about it," Hassan said.

Options for seeking treatment in the military include contacting Military One Source at 1-800-342-9647 for guidance on where to seek further treatment, contacting a primary care provider or reaching to behavioral health providers at military clinics and hospitals or, depending on the unit, consulting with an embedded behavioral health team.

Veterans have access to mental health treatment at the VA for at least one year after they leave active duty. They also can seek assistance at a local VA medical center or Vet Center, their primary care provider or community specialists.

The Cohen Veterans Network announced earlier this year that it also has started offering treatment to active-duty personnel at most of their 19 locations with a referral from Tricare.

"Getting help today is certainly for a better tomorrow," Hassan said.

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Rick Perry is returning to politics in an unlikely fashion.

The former Texas governor, two-time presidential candidate and Trump Cabinet secretary threw his support behind a bill that would create a research study into using psychedelic mushrooms to treat Veterans dealing with post-traumatic stress disorder.

The bill was introduced by Democratic state lawmaker Rep. Alex Dominguez and calls for further research into the medical benefits of psilocybin, which is the hallucinogenic chemical found in so-called "magic mushrooms."

In an interview Tuesday with the Texas Tribune, the former state governor admitted that he's "historically been a very anti-drug person" but that he believes psychedelic drugs, provided in medical doses, can be effective in treating depression and PTSD.

"All of that properly done in the right type of clinical setting will save a multitude of lives," Perry, 71, told the Tribune. "I'm convinced of it. I have seen it enough of these young men."

Perry, who served as an energy secretary under President Donald Trump from 2017 to 19, said the bill "may be one of the most hopeful pieces of legislation" Texas lawmakers consider this year.

Dominguez's bill would call for a three-and-a-half year research study into the benefits of psilocybin.

The legislation would also call on the Texas Health and Human Services Commission to collaborate with one university hospital and one Veterans Affairs hospital in conducting its own research while also doing a review of past studies on the medical benefits of the drug.

Psilocybin is still illegal and classified as a "Schedule I" drug by the Justice Department, alongside drugs like heroin and LSD.

However, there's been increased interest in recent years about psilocybin's potential medical benefits when taken in small doses. Medical schools at universities like Johns Hopkins University and University of California-Berkeley have opened research centers in recent years dedicated to studying it.

Oregon became the first state to legalize psilocybin in November.

"We need options. And this is a valid therapeutic option that could help thousands of people," psychotherapist Thomas Eckert, who pushed the state for years to pass the legislation, told The Oregonian after the measure passed last year.

Some U.S. cities — like Oakland, California — have legalized the psychedelic drugs, as well.

The Tribune reports that Texas has been slow to rethinking some drug use, noting the state has cautiously approached legalizing medical uses for marijuana compared with other states.

Perry told the outlet he's had talks with the offices for current Gov. Greg Abbott and Lt. Gov. Dan Patrick about the potential benefits of psilocybin.

The former Texas governor said he hopes Republicans in the state can "get comfortable [that], 'Hey, this is not some recreational drug thing' " but instead is a potential new medication to aid Veterans and others with PTSD.

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A Navy Veteran in the Senate is calling on Defense Secretary Lloyd Austin to break up the logjam delaying upgrades of so-called "bad paper discharges" for Veterans with post-traumatic stress or traumatic brain injury.

In a letter to Austin citing a recent Military.com report on the issue, Sen. Gary Peters, D-Mich., asked for a detailed accounting of how the Pentagon has responded to the law passed in 2017 calling for the service branches to speed up the review process for these discharges.

Other-than-honorable discharges can cut Veterans off from a range of benefits, including the GI Bill and home loans.

"Expeditious review board decisions will give our brave men and women who are suffering from the invisible wounds of war an opportunity to access the benefits they have earned through their service," Peters said in the letter.

"A solution must be found so that transitioning service members as well as Veterans have access to the support they need," said Peters, a member of the Senate Armed Services Committee and a former Navy Reserve lieutenant commander.

Pentagon Press Secretary John Kirby had no immediate response to questions on whether Austin was addressing the issue, but said a written response was forthcoming.

"While I understand that the COVID-19 pandemic has added obstacles for Veterans seeking to have their records corrected due to the backlog at the National Personnel Records Center, these delays and difficulties predate the current pandemic and are concerning," Peters said.

In 2017, Peters sponsored an amendment that passed into law with the National Defense Authorization Act requiring discharge review boards to give "liberal" consideration for upgrades to Veterans who could show that they had been diagnosed with PTSD or TBI while in uniform.

Despite the law, the process has proven to be cumbersome and subject to lengthy delays, and is now the target of two class-action suits against the services to speed up the reviews.

"The long wait times need to be immediately addressed," Danica Gonzalves, program director for the Veterans Consortium Pro Bono Program, a 501(c)(3) nonprofit that has been assisting Veterans seeking upgrades.

Decisions can take more than three years, she said in a statement to Military.com, because of an "unconscionable backlog" of requests for necessary paperwork due to COVID-19 restrictions at the National Personnel Records Center.

The Center "is still not fully functional," Gonzalves said, and the Veterans who could show they suffered from PTSD or TBI "cannot obtain the records they need to apply for a discharge review."

Stephen Jordon, executive director of the consortium and a retired Navy captain, said there was a special urgency to speeding up the process for aging Veterans.

"There is nothing more heartbreaking than seeing a Veteran that passes away with what would have been a successful discharge upgrade case still bogged down in the system," Jordon said.

Military.com last month interviewed several Veterans who received other than honorable discharges although they had been diagnosed by the military with PTSD or TBI. They spoke of the benefits they have been denied, but also stressed the lifetime "stigma" they now feel they bear with a discharge status that essentially says their service did not count.

In his letter, Peters asked DoD to list the total number of discharge status upgrade requests received each year, the average length of time from submission to a decision, and the percentage of discharge upgrade petitions that are granted.

He also asked for details on what DoD was doing to streamline the review process and whether procedures would be standardized across the services on the reviews.

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The most rigorous study to date examining post-mortem brain tissue from those with PTSD has identified molecular changes in the brain that may lead to new ways to diagnose and treat the disorder.

The study appeared online in the journal Nature Neuroscience on Dec. 21, 2020. Researchers with the VA National Center for PTSD, VA’s National PTSD Brain Bank, and Yale University School of Medicine carried out the study.

`This is a historic step in PTSD research’

“This is a historic step in PTSD research that will mean better treatment for Veterans with PTSD,” says study coauthor Dr. John Krystal, director of NCPTSD’s Clinical Neuroscience Division and chair of psychiatry at Yale University. “We have advanced our understanding of the cellular and molecular alterations in PTSD brains, and this brings us closer to designing more effective treatment strategies.”

PTSD develops in some people who have experienced or witnessed a life-threatening event, and includes intrusion, avoidance and hyperarousal symptoms as well as negative thoughts and mood. Besides psychotherapy, current treatments include medications that researchers say are helpful in minimizing – but not eliminating – PTSD symptoms.

The study, led by Dr. Matthew Girgenti of VA and Yale, is the first to pinpoint genetic changes related to PTSD that are specific to gender, and to certain brain subregions.

Women more likely to develop PTSD after experiencing trauma

Understanding how PTSD differs within the brains of men and women is important, because women are more likely to develop PTSD after experiencing trauma. Also, there may be differences in how men and women respond to treatment. The finding underscores the need to develop different treatment strategies for men and women.

The study also showed major differences in how PTSD and depression look in the brain. Some symptoms overlap between the two conditions, and researchers say that about half of those diagnosed with PTSD are also diagnosed with depression. The finding could potentially help clinicians better distinguish between the conditions and offer more effective treatment.

The findings come from the first major research study using brain tissue from the National PTSD Brain Bank. The bank is led by study co-author Dr. Matthew Friedman of the NCPTSD and Geisel School of Medicine at Dartmouth. The program collects, processes, and stores human research specimens and provides them to qualified researchers to learn more about illness in Veterans.

More Information

Click here to read more about VA research.

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To save money and keep patients, VA administrators are overruling decisions by VA doctors and their patients, in some cases cutting off care.

When Christine Russell read the message from the San Diego VA announcing it would no longer pay for her cancer treatment, all the pain came rushing back.

For nearly three years, the federally funded Veterans health care system had misdiagnosed her breast cancer as mental illness, she and her team of advocates contend. After discovering the cancer in late 2018 — when the tumors had already spread — the VA agreed to pay for the former Navy Reserve lieutenant to get her medical care from other doctors in the San Diego area.

Russell filed four federal complaints in early February this year about her ongoing challenges accessing health care, medication and caregiver services through the VA. Days later, a group of San Diego VA administrators mailed her a letter that called her “disruptive” and announced they would no longer fund her appointments outside the VA because her health care was too “fragmented.”

Russell was $30,000 in debt from medical expenses since developing cancer. She couldn’t afford to see her doctors if the VA didn’t pay for it.

“It was like they cut my legs off,” Russell said. “They cut off my lifelines, because all those doctors are my integrative support team. They are why I’m still alive.”

An inewsource investigation in partnership with USA TODAY has found that like Russell, Veterans across the country are caught in the crossfire of the VA’s battle to retain patients and funding since the passage of a landmark health care law known as the Mission Act.

When Congress and then-President Donald Trump passed the bipartisan law in 2018, they said it would ensure American citizens who fight to protect the U.S. can access high quality medical care after leaving the military. When the Department of Veterans Affairs can’t deliver that care for any of six reasons, it’s supposed to pay other health care systems to do it instead.

A review of thousands of pages of department manuals and medical records, along with interviews with dozens of patients, advocates and providers, shows that VA administrators are overruling doctors’ judgments and preventing them from sending their patients outside the VA health care system.

This bureaucratic process has ramped up over the past two years as part of an effort to save money and retain patients within the VA, records show.

“That’s tragic and jarring,” said Ryan Gallucci, a national director for Veterans of Foreign Wars, after learning what the VA’s manuals show.

“I think it warrants an organization like ours asking more pointed questions and ensuring the VA is upholding the intent of the Mission Act,” he added.

More than 9 million Veterans are enrolled in the VA, the nation’s largest health care system, which is composed of more than 170 medical centers and 1,000 outpatient offices.

The U.S. is facing urgent demands from Veterans for medical and mental health care. Veterans have faced almost 20 million cancelled or delayed health care appointments during the COVID-19 pandemic, and the U.S. withdrawal from Afghanistan in August has caused crisis hotline calls to spike as former service members have struggled to process the unfolding events.

Dozens of Veterans and caregivers throughout Southern California described their struggles to access health care outside the VA since the Mission Act was passed: A partially blind skin cancer survivor was told to take a dangerous trip to the VA when a new lesion developed, instead of visiting his neighborhood dermatologist. A Veteran with a seizure condition has waited years for a course of treatment outside the VA. Suicidal patients were cut off from what they considered “life-saving” mental health treatments by employees overwhelmed with paperwork — against the advice of the VA’s own psychiatrists.

In interviews, service groups and congresspeople from both political parties said Veterans should be offered the best health care available, and money should not affect the quality of care they receive.

“We just spent trillions of dollars prosecuting this 20-year war in Afghanistan, and by comparison we’re arguing nickels and dimes in caring for the Veterans who prosecuted those wars,” Gallucci said.

The Mission Act has had financial consequences for the VA. Since the law was enacted, more Veterans have left for other health care systems than the VA anticipated, forcing the government agency to shell out billions of dollars for private care. If the trend continues, the VA’s own hospitals could end up with smaller budgets to spend on their services and staff.

In late 2019, the VA began the “referral coordination initiative” to return Veterans to its hospitals. An internal department manual shows the changes are supposed to help the VA make “good financial decisions” and “maintain funding of specialty care” in the future.

Like the VA, private health care systems have financial incentives to retain patients and cut costs. The difference, experts said, is that Veterans represent a unique and vulnerable population that the government has pledged to care for.

“If they have a problem with the budget, they need to come and talk to Congress,” said Rep. Mike Bost, R-Ill., ranking member of the House Committee on Veterans’ Affairs. “They don’t need to go ahead and try to figure out how to take services away from our Veterans.”

Under department policy, VA doctors usually don’t send their patients outside the health care system on their own, records show. They can make recommendations that go through reviews by other staff — such as administrators, clerical workers or clinicians trained by hospital leadership — who can cancel treatment requests and insist patients come to the VA instead.

Following the VA’s new initiative, department hospitals have also set up select teams of health care personnel who can review medical records and use algorithms to decide if patients qualify for care outside the VA before interacting with those patients.

And for Veterans ultimately approved for treatments elsewhere, the VA can require checkups at its hospitals anyway — that includes Veterans facing severe disabilities, burdensome drives or long wait times for VA appointments.

“It basically defeats the whole purpose of the Mission Act,” said Darin Selnick, senior advisor to Concerned Veterans for America, an organization pushing for Veterans to have more access to private health care.

“We need to be Veteran centric,” he added. “It's about what the patient needs, not what the VA needs.”

Selnick helped write the Mission Act, working in the Trump administration and the VA as a health care policy expert to implement the law until July 2020. He read excerpts of the department manuals obtained by inewsource.

“If I was still at the VA and someone showed me this in July, I would have ripped it to shreds and I would have said there’s no way in Hell you’re going to use this stuff,” Selnick said.

The VA received its largest-ever budget this year — an amount that has doubled over the past decade. A national spokesperson said the department has “sufficient funds” to send Veterans out for private care.

VA officials said they are following Mission Act requirements, and treatment decisions are based on patients’ medical needs. They added that the review process is supposed to ensure Veterans can always get their care at the VA if they want to.

Hospital doctors and managers at the VA said they believe they can deliver the most effective care internally, because they offer high-quality services and can more easily coordinate treatments and paperwork.

Dr. Kathleen Kim, the San Diego VA chief of staff, said physicians sometimes incorrectly try to relocate patients for treatments her hospital can offer, and administrators are “regularly educating” them to help keep Veterans at the VA.

“Because of the nature of the Mission Act, the VA is sending a lot of care in the community, and frankly we're worried that we're not going to be able to pay our bills,” Kim said.

The VA has approved over 12 million referrals for outsourced care since the Mission Act was implemented, including 5 million in the most recent 12-month period, according to data the department supplied. inewsource, through a series of records requests and direct inquiries, attempted to determine how many doctors’ requests for outsourced care have been denied by the VA, but the data provided was incomplete.

An August inspector general report highlights the personal impact the VA’s administrative decisions can have. When the San Diego VA stopped paying for ketamine treatments at a private clinic, 28 mentally ill patients experienced unnecessary distress, the report found. Inspectors pointed out the drug’s unique properties for combating severe depression.

Shortly after learning the VA wouldn’t fund her treatments, a former Marine Corps pilot took her life.

“They need to do right by these Veterans,” said Rainelle Wolfe, a full-time caregiver for her husband Kiowa, another Veteran who was cut off from the private ketamine treatments over a year ago.

The San Diego VA has started offering a low-dose version of the drug that many Veterans have not found therapeutic, including Kiowa Wolfe.

Now, the Marine Corps Veteran spends most of his time lingering in bed, reliving trauma from the Afghanistan War.

“We’re not political,” he said. “It’s not in our nature to be political. But keep politics and all this BS out of Veterans’ health.”

Part I: A body on fire

Long before anyone realized she had cancer, Christine Russell walked slowly and painfully to the car waiting for her outside the San Diego VA emergency room. Her body hurt so much she could barely move.

The Lyft driver came out to assist her, then approached a nurse at the hospital entrance to ask if Russell would need any special care during her transport home. As the driver would later retell in a court filing, the nurse assured him the answer was no. The 39-year-old Navy Veteran was “crazy” and imagining her symptoms.

It was mid-2018, almost two years since Russell first felt the unbearable pain in her body. It had become too difficult to drive or take care of herself, so she started paying thousands of dollars out-of-pocket for caregivers to look after her.

In her medical chart from late 2016, Russell’s VA physician wrote that she “displays abnormal anxiety about her health, especially with an unwarranted fear of having a serious disease.”

Russell said doctors told her she had post-traumatic stress disorder and refused to run tests until she tried psychotropic medications. Without a clear explanation for her escalating symptoms, Russell rushed to the emergency room more than a dozen times.

Finally, in the summer of 2018, her new primary care doctor agreed to order a scan of her chest. A radiologist noticed something unusual and asked for more tests.

The diagnosis: stage IV breast cancer.

Her case was complex. Russell suffers from severe allergies and sensitivities, which she believes came from her exposure to hazardous chemicals on a counter bioterrorism mission in the Middle East. Perfumes, highly processed foods and a long list of medications can aggravate her symptoms.

The VA’s course of cancer treatment, chemotherapy pills, was excruciating.

“It felt like my whole body was burning and on fire,” Russell said.

The Veteran was also experiencing hormone imbalances and pelvis pain, which needed tailored treatments that wouldn’t cause their own unbearable side effects. Russell thought she would be better off getting care from specialists elsewhere — doctors she could trust who could better address her complicated symptoms.

Over the next three years, the VA approved a slew of requests for Russell to see at least eight specialists outside the department.

Her symptoms slowly improved. But traveling to her appointments was impossible without the help of an at-home caregiver. The VA tried to provide her with aides, but they didn’t follow the protocols Russell required for her sensitive immune system.

Russell hasn’t been able to get a new caregiver since November 2020, the same month she was supposed to begin radiation therapy. With no aide to assist her, the Veteran never got the treatment.

Months of correspondence with VA employees didn’t resolve the issue. In February, Russell filed complaints with the VA’s inspector general and the White House.

That’s when she lost it all.

In a three-page letter, VA administrators told Russell they would no longer pay for her health care outside the department and insisted she follow the “code of conduct” moving forward. They said she had engaged in “disruptive behavior” by intimidating social work staff with angry voicemails, using profanity and telling them they should be fired for not doing their jobs.

“The multidisciplinary team reviewed your current status and confirmed that your health care is fragmented due to a disproportionate amount of care received in the community,” the letter states.

The administrators said this care was “no longer reasonable or necessary” and would be “limited to services that cannot be provided in a timely manner or are unavailable” at the San Diego VA, “as required by” national policy.

The letter was signed on Feb. 19 by the director of the Veterans Experience Office, the section chief of primary care and the chair of the Disruptive Behavior Committee.

Russell was not consulted about her health care needs before the letter was sent.

“It was a nightmare,” Russell said, adding, “They really didn’t know me or what I had gone through or why I was even still alive.”

She described her reaction as a “heavy mental breakdown” as she struggled with thoughts of suicide and almost checked herself into a hospital for psychiatric care.

But she chose to argue her case instead.

Russell had done it before. When enrolled in the Navy, she filed a complaint about entry fees for military parties, which led officials to relieve her of her duties, escorting her out of Kuwait by military police. She then filed a whistleblower retaliation case, which was substantiated a year later by the Pentagon inspector general’s office.

“I’m always about integrity,” Russell said. “And if I see something that’s not ethical going on or if I see an error, because of what I’ve been through, I’m going to question that error.”

Part II: A Veteran’s best interest

Armed with a copy of the Mission Act and her long clinical history, Russell told the San Diego VA that it was in her best interest to continue her medical treatments elsewhere.

The federal health care system will pay for Veterans to get medical care from other doctors if the patients meet any of six criteria, including long drives or wait times for VA appointments.

The most contentious — and some argue, most critical — reason to send Veterans outside the VA is when it’s in their “best medical interest.” That decision should be made by the Veteran and their “referring clinician,” the law says, and can help address a patient’s unique needs.

For instance, a dermatologist might not specialize in a patient’s skin condition, or a Veteran suffering from military trauma could be triggered by trips to the VA. In these kinds of cases, if it would improve a patient’s health, a doctor could send them to another medical provider.

“Every patient experiences things differently,” Russell said. “And if they’re not getting all their needs met, then it is in their best medical interest to go somewhere else to have all their needs met.”

Russell told the VA that stopping her current treatments would exacerbate her cancer symptoms — and it would put her health care back in the hands of a hospital that didn’t have the expertise for her conditions.

Her VA primary care doctor requested she return to her medical team outside the hospital, the Veteran said, but warned the request probably wouldn’t be approved.

At the San Diego VA, these kinds of treatment requests are usually reviewed by “delegated authorities” who can deny them if they think the hospital’s own doctors can deliver the care.

Kim, the hospital’s chief of staff, said these designated physicians go through regular training, so they understand all the services the VA offers and can make more informed decisions than other doctors.

“Some of it, in my mind, is just a lack of knowledge about what the services are,” Kim said.

San Diego County is home to roughly a quarter million Veterans, the fifth-highest of any county in the nation. Its local VA health care system, which also covers the neighboring Imperial County, serves about 85,000 patients.

Kim, who oversees Veterans health care across the region, said it’s often best for patients to come to the VA, even if that’s not what their doctors want.

“The reality is that does not trump the fact that the service can be provided at the VA within a timely fashion,” Kim added.

For a complicated case, Kim and leaders at other VA hospitals can personally review medical records and decide what’s in a patient's best interest, documents show.

The VA’s many hospitals can rely on different procedures, but nationwide, employees are instructed to follow handbooks. VA spokespeople were hesitant about providing them, saying they were intended for internal use.

Over the past two years, the VA has started putting treatment requests in the hands of “referral coordination teams” made up of registered nurses and other personnel, according to the manuals. A team member is supposed to spend 10 to 25 minutes reviewing a patient’s medical charts and deciding if they qualify for care outside the VA. They can also forward requests to designated physicians for approval.

The initiative “shifts the referral responsibility” so most doctors aren’t choosing to relocate their patients themselves, the documents show, which will “decrease inconsistent and inappropriate” treatment plans.

Hospital leaders are told to monitor health care costs as a “key performance indicator” of success.

“That is not what the Mission Act says,” said Rep. Bost of Illinois about the review process.

“I understand my health care and my doctor understands my health care,” he added. “Between the two of us, we make the decision, not some (team) that’s put in place by some government agency, nor should it be.”

The National VA pointed to federal regulations stating it can conduct reviews of doctors’ decisions so long as they focus on health outcomes. Spokespeople also said that VA doctors still have the power to send their patients outside their hospitals.

To do that, doctors have to use a specific software program that offers a pre-established list of justifications — otherwise it’s not considered a “true” medical decision, according to department manuals.

Once Veterans are approved for care outside the VA, staff are supposed to call them and try persuading them to come to the VA anyway.

Employees are told to follow scripted language that outlines the benefits of staying at its hospitals and the burdens of leaving them. The scripts tell Veterans they will be responsible for transferring their own medical records if they choose a different provider.

“If you wanted to stay in the VA, you always can stay in the VA, but once you’ve made a decision to go to community care, you’ve decided for whatever reason it’s best for you not to,” said Selnick, who helped write the Mission Act

“Doing extra hoops to keep you in the system is counterproductive.”

When the VA stopped authorizing her treatments, Russell was left with two bad choices: pay out-of-pocket or stop seeing the doctors that had helped her through a complex cancer. She chose the expensive option.

With her credit cards maxed out, the Veteran began an online fundraiser for the accumulating bills and turned to her church community for food deliveries.

The cancer has worn on her. Russell, now 44 years old, wakes up disoriented and forgets where she is. It takes her hours to clamber out of bed, and she inches forward around her house with the aid of a cane.

When she manages to leave her home, Russell adorns her outfits with American flags and, with a smile, tells anyone who will listen that she is proud to be an American. She still remembers the enthusiasm she felt 25 years ago as a teenager in Barstow, California, enrolling in the Naval Academy.

Through months of heated conversations, Russell was able to reestablish most of her old doctors.

But maintaining her care outside the VA is an ongoing problem. In August, Russell received a voicemail from her VA primary care doctor’s office. The physician had requested more appointments with specialists outside the hospital, and the requests were denied.

Russell is still searching for solutions.

Part III: Living with demons

The mental health crisis among America’s Veterans can be told through a bleak series of statistics.

One in five Veterans who served in Iraq and Afghanistan suffers from depression or PTSD, and more than half of Veterans who need mental health treatments don’t receive them. About 17 former service members take their lives every day — double the rate of the general public — and the vast majority of Veterans who died by suicide never sought services from the VA health care system.

Recognizing the troubling trend, the government has boosted its focus on mental health in the past few years. The VA has expanded its resources for suicide prevention, and Congress has put forward numerous bills to help address the issue.

But the VA can’t always provide the mental health support Veterans need. Under the Mission Act, Veterans have the same treatment rights for physical and mental health issues. If a patient isn’t benefiting from the VA’s services, their doctor can try to send them somewhere else.

That doctor, however, might not have the final say.

A Veteran's fight for mental health treatment

At the San Diego VA, administrative staff dismissed the warnings of psychiatrists and denied community mental health treatments to suicidal patients, records show. Soon after learning the treatments had been discontinued, one of the Veterans died by suicide.

Over two and a half years, the San Diego VA sent more than 60 Veterans to a private clinic to try the drug ketamine, a therapy for people with severe, treatment-resistant depression. Many of the patients showed remarkable improvements, and VA psychiatrists continued sending them back for sessions.

One of them was Kiowa Wolfe, a 38-year-old Afghanistan War Veteran who was medically retired in 2018.

Nine years ago, Wolfe was defending a dam on a mountaintop in the Helmand Province when he took enemy fire. In the commotion, he stood up to get his bearings, and his 6’5” frame was instantly visible. Bullets flew in his direction and sent him tumbling down the side of the mountain.

The Marine returned from war with traumatic brain injury and wounds along his right side that demanded multiple surgeries. But his mental anguish hurt just as much. Intrusive memories of the battle overwhelmed him, and some days he felt he no longer wanted to live.

The VA classified him as 100% disabled, mostly due to his post-traumatic stress.

The government tried more than a dozen treatments, including a variety of medications and therapists. Nothing made a difference. Finally, Wolfe’s psychiatrist recommended ketamine. The VA didn’t offer it, so it paid for him to go to Kadima Neuropsychiatry Institute, a private clinic down the street.

Wolfe felt relief for the first time in years. He managed to walk into a movie theater and take his children to a Blink-182 concert — the kinds of activities he had once avoided at all costs.

“It cut down on the hyper-vigilance, where I’m not just freaking out and my head’s on a swivel everywhere, and I have to check out everybody and everything,” Wolfe said. “I could just actually relax and put my arm around my son and talk to him and act like a human.”

The drug’s effect typically lasts a few days. With the VA’s support, Wolfe returned for treatments twice a week, his wife always by his side.

That changed in October 2019, when a note appeared in Wolfe’s medical record from the VA Office of Community Care, which helps Veterans arrange external medical appointments.

Dr. Susan Trompeter, the former chief of the San Diego office, issued a directive about the mentally ill patients on ketamine therapy. She called the drug “experimental,” said the VA could no longer pay for it and told the hospital’s psychiatrists not to submit any more treatment requests.

Trompeter, whose research focus is women’s reproductive health, did not respond to interview requests.

The VA Chief of Psychiatry pushed back, arguing the hospital could not “precipitously stop these treatments” for patients with severe depression. But the decision had been made, and he relayed the message to mental health staff.

“So please do not discuss/offer this as a possibility to patients until further notice from me,” Dr. Brian Martis wrote in an email. He told them not to “make verbal comments to patients or written comments … expressing your frustration” about the change.

Medical records and emails show VA doctors feared the sudden decision could be dangerous for their unstable patients. One Veteran with a history of suicide attempts was a particular concern.

“We need to ensure he does not have a break in treatment,” one VA doctor wrote in his medical chart. Another warned of the “potential acuity of the situation” and said nobody had followed up with the Veteran.

“I am concerned as this is a HIGH RISK pt,” the doctor added.

Under the Mission Act, patients are allowed to continue treatments outside the VA if they have ongoing sessions, because cutting them off can have negative consequences.

Kadima’s founder, Dr. David Feifel, decided Veterans could keep their upcoming appointments even if the VA wouldn’t pay for them. He did it, he said, because he feared what would happen otherwise.

“Something’s out there that can help you, and now they’re taking it away,” Feifel said. “To have it and then not be allowed to have it makes living with those issues and demons even more difficult.”

After she learned the VA would no longer pay for her ketamine therapy, Navy and Marine Corps Veteran Jodi Maroney died by suicide. inewsource first reported the death last year, prompting an investigation by the VA inspector general’s office.

In an August report, inspectors found the San Diego VA’s denial of care was a “contributory stressor” leading up to her death. But the circumstances were “multifactorial” and “complex,” the report said, and they couldn’t conclude the VA was responsible.

Hospital staff said they faced a “large volume” of referrals when the Mission Act went into effect in mid-2019, according to the report. The health care system needed to sign a new contract to pay for ketamine therapy, but the situation “was overlooked” until the VA missed its deadline.

For three weeks, the VA had no way to pay for ketamine therapy and didn’t explain to Veterans why they couldn’t get their treatments. When Maroney died, the hospital quickly signed off on more sessions.

That lasted about five months. Starting in March 2020, the VA stopped paying for Veterans to get ketamine therapy, even though the hospital’s psychiatrists had requested additional treatments.

For Wolfe, the VA’s decision was tantamount to betrayal.

“It feels like I’m getting stabbed in the back with a bowie knife and getting it twisted,” Wolfe said.

“If I was held to such high standards in the Marine Corps, why are these people getting away with so much with mistreating Veterans?” he added.

Patients pleaded with hospital officials, describing how the drug had saved their lives, and shared suicidal thoughts and dreams with the private ketamine clinic.

Feifel sent frantic messages to VA psychiatrists and administrators, warning of a possible second death if the hospital didn’t act quickly.

“We were under the impression that the VA learned from its mistake and under no circumstance would it follow the same catastrophic path that resulted in that tragic outcome,” Feifel wrote. “And yet, here we are, watching a train wreck in slow motion… AGAIN!”

The VA never replied.

In an interview and emails, San Diego VA administrators have made multiple inaccurate statements about their ketamine program and health care services.

The hospital has repeatedly stated that community care staff don’t make clinical judgments and can’t overrule doctors — they process paperwork and help Veterans set up appointments outside the VA.

Later, national VA spokespeople clarified that these employees do have the ability to review referrals, ask questions about patients’ clinical needs and cancel requests if they “cannot verify the eligibility” of the Veterans.

In VA manuals, community care staff are also instructed to “consider funding availability” when offering treatment options to patients.

In mid-October, the VA announced it will be phasing out community care offices over the next year and restructuring their responsibilities in order to “operate as a high-reliability, Veteran-centric organization.” The VA has not explained if the transition will change how staff process treatment requests.

According to the inspector general report, San Diego’s community care employees chose to cut patients off from ketamine therapy the second time because of “administrative factors,” like outdated forms and misplaced paperwork.

The employees had “resistance to clinical input from mental health leaders” and caused serious distress to mentally ill patients, the report states.

Following the inspection, the San Diego VA hired more administrative staff and assured investigators they would base their decisions on Veterans’ medical needs.

Those needs, as Wolfe would later find out, are up for interpretation.

Part IV: Circling the drain

Wolfe laid in bed, crippled by the memories that had resurfaced since the U.S. withdrew its last troops from Afghanistan.

All he wanted was a moment of relief. But the one treatment he knew would help was the one the VA wouldn’t pay for.

At $300 per visit, Wolfe can’t afford to pay out-of-pocket for regular ketamine therapy. Private donors have funded some sessions, and in times of crisis, the Veteran has shelled out the full cost himself.

Wolfe and his wife Rainelle, who serves as his full-time caregiver, have spent the past year begging the VA to send him back to Kadima for more treatments.

“I do not have the ability to refer Kiowa to Kadima,” Wolfe’s VA psychiatrist wrote in a December message. “I am not involved in any way here at the VA with the implementation or adjudication of any aspect of the Mission Act.”

Medical records show Wolfe’s psychiatrist referred patients to ketamine therapy in 2018 and 2019, before the Mission Act went into effect.

“I know you are both suffering and wish you only health and happiness in the year to come,” the doctor wrote.

The hospital has refused to tell the Wolfe family who has the power to approve his treatment requests. VA doctors have told the Veteran these are “administrative decisions” and they don’t know who’s responsible for making them.

“If you get the answers, call me,” one physician told Wolfe.

San Diego VA spokespeople would not give inewsource the names of the hospital leaders in charge of mental health treatment requests or provide a reason they wouldn’t share the information.

“If they’re not making the decision and not telling you who’s making the decision, how can you even advocate for the Veteran?” said Renee St.Clair, Wolfe’s advocate and former chief operating officer at Kadima.

Veterans have avenues to fight the VA’s health care decisions, but attempting to use them can be a full time job. St.Clair, an attorney, is assisting the family pro bono. She has asked for help from more than a dozen service groups and government officials, including Congressional offices and the VA inspector general.

She also sends weekly emails to VA doctors and administrators asking them to approve Wolfe’s ketamine treatments.

“Kiowa gave so much and is asking so little — a signature on a form which could save his life,” St.Clair wrote in one message.

Veterans can submit clinical appeals to a VA hospital’s patient advocate’s office, which should be reviewed in three days by administrators, and then a second appeal that goes to regional VA leaders.

But Veterans and caregivers who tried contacting patient advocates said staff either didn’t return their calls or didn’t help resolve their issues. The Wolfe family has not gotten responses from the San Diego office, they said.

The VA has never sent Wolfe a written denial of his treatment requests, like its policies describe.

“This is madness,” Rainelle Wolfe said. “I cannot believe that everybody’s acting like their hands are tied and they’re all passing the buck. Nobody wants to stand up and have some integrity and treat Veterans the way they need to be treated.”

Waiting for VA health care

Since the San Diego VA stopped paying for his private sessions in mid-2020, Wolfe has been shuffled through the hospital’s attempts to build its own ketamine program. The ordeal has had disastrous consequences.

Over the course of two months, the VA administered different kinds of the drug at low doses. It didn’t work. Wolfe started backsliding into severe depression. But when the private clinic asked the VA to send him back for more appointments, a registered nurse in the local community care office denied the request.

It was “not clinically appropriate,” she wrote. The VA could provide the treatments he needed.

Then, in October 2020, VA nurses administered ketamine to Wolfe on a gurney in the post-anesthesia care unit. The family recalls that the Veteran’s psychiatrist wasn’t present for the infusions, and he wasn’t allowed to bring his wife or service dog with him.

The experience was traumatic. Wolfe blacked out and entered a fit of rage. He screamed uncontrollably at his wife. When he finally got his bearings, he knew one thing absolutely. He would not come to the VA for another ketamine treatment.

Because of ketamine’s psychedelic properties, the drug’s effects are highly context-dependent. Changing how the drug is administered or delivering it to a patient in an uncomfortable environment could lead to negative outcomes.

Four Veterans said the VA’s program has failed to provide the relief they need.

By personally paying for treatments and obtaining donor funds, St.Clair has helped nine patients return to Kadima for more ketamine sessions. She said at least twelve Veterans have not found the VA’s program therapeutic.

Wolfe’s psychiatrist — considered the San Diego VA’s “local expert” on ketamine — has acknowledged to the Veteran that the hospital’s program is “not the same” as what the private clinic offers.

Despite his towering height, Wolfe speaks softly and slowly, and he leaves most of the talking to his wife and four children. Their home is decorated with military memorabilia, the fridge featuring an old photo of the family patriarch in uniform. Rainelle, who met Wolfe in 2006 when he was 22 years old, has spent much of the past year rousing him out of bed, sometimes unsuccessfully.

“Is it really in his best interest to get all his care at the VA?” Rainelle Wolfe said. “Because he’s slowly circling the drain. He spends the majority of his time in his room in the dark.”

Asked why the VA won’t fund private treatments for Veterans failing out of the hospital’s program, the chief of staff said it was a legal matter.

“The relationship with that clinic has become highly contentious,” Kim said. “And one of the former administrators every Friday sends what I would call a nasty email complaining about this issue. And so at this point, we’ve turned it over to legal counsel.”

In May, the Wolfe family had a brief moment of hope. Congressman Darrell Issa’s office convinced the hospital to take another look at the Veteran’s case.

The VA conducted a “comprehensive review” of his medical needs, according to an email the Congressional office sent the Wolfe family.

The hospital “is confident that it is in your best medical interest to receive your mental health care (there) so that there is a comprehensive and integrated approach to maximize your treatment outcome,” it said.

The review was performed by an unnamed group of VA employees.

Part V: Closer to perfection

The Mission Act was passed in the midst of a fierce political debate over the future of the VA health care system.

The dispute dates back to 2014, when an overwhelmed VA hospital in Phoenix was caught concealing appointment wait times. The scandal prompted new laws and rules that let Veterans access private care more easily.

But navigating health care choices was still a confusing and complex process, and Congress was looking for solutions. Democrats pushed to strengthen the VA with more funding and services, while Republicans wanted to make it easier for Veterans to go to private doctors.

The Mission Act was their compromise. It created a network of approved community providers and expanded the reasons Veterans could visit them. It also funnelled billions of dollars into the VA so the department could cover the expenses.

Now, Veterans can get their primary and mental health care outside the VA if an appointment would take longer than a 20-day wait or 30-minute drive. For specialty care, that extends to a 28-day wait or a 60-minute drive.

“The Mission Act created an environment where all Veterans, no matter where they live, would have access to VA care,” said Rep. Jack Bergman, R-MI, who voted for the law in 2018. “It may not necessarily be at a VA hospital, but at a place close to them where they can actually receive the care in a timely manner.”

But Southern California Veterans said they are still struggling to get appointments with private doctors since the law was passed.

Former service members in rural areas — facing drives of an hour or more for VA visits — said they are routinely told to visit the department’s hospitals to assess whether care is necessary. Veterans facing long wait times said their private care can be cut off after a handful of sessions, and they have to return to VA physicians.

“It’s not working here,” former Army captain Gary Shearer said. “It hasn’t been working for some time.”

Shearer suffers from chronic neck pain and has gone blind in one eye, making each trek to the VA a dangerous burden. He lives in Yucca Valley, almost 50 miles from his VA primary care doctor and 80 miles from the closest Veterans hospital.

Because of the long drives, Shearer qualifies for private doctor’s visits closer to home. But the VA has asked him to return to its own offices for checkups and assessments.

In December, Shearer saw a bump on his forehead that he knew needed medical attention. The Veteran has a 20-year history of skin cancer and had cancerous lesions removed in the past. He wanted the Loma Linda VA to help him schedule an appointment with his neighborhood dermatologist.

The VA said no.

An “approving official” at the hospital reviewed his case, documents show. They decided a VA primary care doctor would have to conduct a skin exam first.

Shearer worried it would take months to go through this circuitous process: schedule an appointment at the VA, endure a long road trip for the visit, convince the doctor to request a dermatology appointment and wait for the VA to approve and schedule the request.

“The longer I waited, the more tissue they were going to have to take,” Shearer said.

The Veteran didn’t want to take any chances, so he went to the dermatologist on his own. Shearer’s lesion was diagnosed as basal cell carcinoma and required an urgent surgery with a price tag of $3,000. It was too steep for him to pay out of pocket, but he was able to use his private insurance plan to cover the cost.

About one-quarter of working-age Veterans — more than 730,000 people — don’t have a second medical payment option like Shearer does. If he didn’t have a backup insurance plan, the Veteran said, he would have to rely on the VA’s medical decisions.

Shearer has a long list of grievances against the federal health care system. The VA cut down his weekly neighborhood chiropractor visits to only 12 sessions per year, despite his severe spinal injury from a military tank accident.

The back pain feels like “someone has taken a ball bat and beat me around the rib cage,” the Veteran wrote in a complaint to the VA.

Shearer said he waited more than 50 days for an answer from the Loma Linda VA about extending his chiropractor appointments. The facility told him it could award up to eight more sessions per year if he agreed to drive all the way to the hospital for a pain assessment.

The former Army captain has sent many letters, ripe with colorful turns of phrase and religious proverbs, to the VA’s patient advocates. They led nowhere.

“The Mission Act, you say,” he wrote in one complaint. “What Mission Act? It is only a dream.”

VA manuals say Veterans can receive an unlimited number of outsourced treatments, but only if reviewers deem them “clinically appropriate.”

Dr. Peter Kaboli, a VA physician in Iowa and health care administration expert, said having the department conduct reviews — and encouraging patients to come to the VA when possible — is better for Veterans and the future of the health care system.

“Is there going to be an incentive to bring care back to the VA?” Kaboli said. “I think so, because I think we do it cheaper in most cases, and we do it as good if not better in most cases.”

Patients described their anguish when they have suddenly faced denials of care and letters demanding they return to Veterans hospitals. Some said they have waited months or years for the VA to set up or renew appointments with private doctors.

Warner Springs resident John Seymour, who lives an hour and a half from the closest VA facility, has waited two years for the VA to arrange a treatment plan for his debilitating illness.

Seymour suffers from a plethora of conditions that are commonplace among America’s Veterans, including PTSD, diabetes and severe spinal injury. He has also developed non-epileptic seizures from psychological distress, which cause uncontrollable spasms and leave him unable to communicate.

A VA neurologist diagnosed Seymour’s seizures about two years ago and recommended he try cognitive behavioral therapy, but the doctor didn’t submit a treatment request.

Over time, Seymour’s symptoms grew more extreme. He collapsed in the bathtub, unable to breathe, and in a similar incident, ended up in the emergency room. He waited months for another neurology appointment, which was cancelled twice.

In March, the Veteran’s VA primary care doctor offered to send in a treatment request, which was routed to the VA Office of Community Care. It’s still pending.

Amy Warix, the Veteran’s wife and full-time caregiver, said the VA has taken so long on the request that staff couldn’t find it in their computer system. Warix had to call her husband’s doctor and have the request resubmitted.

Now, when she asks for updates, Warix gleans little information.

“They can’t say, ‘No, you don’t get the care,’ and they can’t say, ‘Yes, you will get the care,’” she said. “They’ll just say, ‘It is processing.’”

Warix spends hours on the phone with the VA trying to manage incomplete medical requests.

She spent seven months asking the VA to restart visits with a private psychologist when they were suddenly cut off in November — just after her husband had shared thoughts of suicide. She is still waiting for the VA to approve more appointments with a neighborhood dentist to finish urgent work that began in March.

“He’s a patient that needs continuous care,” Warix said. “So I always have a referral that I am chasing down because they haven’t finished processing yet.”

Since the Mission Act launched, the VA decided to handle outsourced health care requests itself — taking over the job from its contractors — so its employees could have direct contact with Veterans about their needs. But the department was critically understaffed and unable to handle the workload, according to federal reports from the Government Accountability Office.

The staffing shortage has impacted Veterans seeking medical care. In mid-2020, patients were waiting an average of three weeks for the VA to process specialty care requests and six weeks until their community appointments. By comparison, referrals from one VA doctor to another took one week.

National spokespeople said Veterans with urgent needs are prioritized, and processing time for non-VA treatments is now under two days.

Lawmakers have sent numerous inquiries to the VA asking why Veterans in their districts are facing long waits for community care. In June, 10 Congresspeople from Washington told the department that their constituents were waiting two months for the VA to arrange health care visits and receiving little communication about the delays.

“We request your immediate action to resolve these issues and improve access to care,” the letter said.

Washington representative Dan Newhouse, who co-authored the letter, said Veterans account for roughly half of the calls he receives from residents in his rural district. The VA never responded to the concerns he and his colleagues raised.

“This is an effort to get closer to perfection on something that I think overall has been a big improvement, but can be better,” Newhouse said. “We all want to do better for our Veterans.”

Congresspeople from both political parties said the VA does a good job delivering health care, and pointed out that many of their constituents love the medical services they receive. A VA survey shows 90% of patients would recommend the health care system to another Veteran.

The VA performs as well as private hospitals on measures of quality, including cancer screenings and blood pressure control. Compared to civilians in the private sector, Veterans face shorter wait times to see VA doctors.

But like in every hospital system, some patients will need treatment the VA can’t provide.

The federal department dates back more than a century and has its roots in the Revolutionary War. For decades, the VA has purchased private care to help ailing Veterans.

“In most medical centers, there’s something they’re going to have to refer you out for at some point,” said Gallucci from VFW. “It’s unrealistic to think that VA can provide everything.”

Gallucci served eight years in the U.S. Army Reserve and was deployed to Iraq in 2003. Now, he helps other former service members access benefits through the VA.

“It’s not a question of, ‘Is VA care or community care better?’" Gallucci said. “It’s about how do these systems complement each other, how do they work to effectively deliver care that Veterans need?”

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SARASOTA, Fla. – What happened to 26-year-old Icarus Randolph sounds like the rehash of a tired script: the Fourth of July in an African American neighborhood, a call for assistance, white cops respond, tensions escalate in the front yard, gunfire erupts as the entire family recoils in horror and another young black man gets wheeled on a gurney to the coroner’s office.

This one occurred in Wichita, Kansas, on Independence Day 2014. But the incident may well exceed the scope of a #blacklivesmatter scenario.

“We don’t think it was racial, but we don’t know what that cop may have seen when my brother came out of the house,” says Elisa Allen of Wichita. “My brother had that 1,000-yard stare, like he was somewhere else. I wish I had grabbed him and hugged him and he might still be alive today.”

Maybe the wars in Afghanistan and Iraq were in that 1,000-yard distance. Maybe he was back in the Camp Pendleton brig, waiting in disbelief to be drummed out of the Marine Corps on an other than honorable discharge for getting busted for marijuana.

To hear his sister tell it, her little brother had never recovered from the stigma of being treated like a criminal by the military. Insisting he was suffering from post-traumatic stress disorder, the former Marine had appealed for a status upgrade before being shot to death in Kansas.

The fate of Randolph and others like him is now at the heart of a class-action lawsuit aiming to erase the blight of “bad paper” discharges against post-9/11 Veterans diagnosed with PTSD, traumatic brain injury and associated service-connected issues. And in a ruling that could ultimately impact hundreds of thousands of Veterans, a federal judge has rejected the Navy’s motion to throw the litigation out of court.

In New Haven, Connecticut, on Nov. 7, U.S. District Judge Charles Haight Jr., gave the green light to lead plaintiff and Iraq war Veteran Tyson Manker to proceed with discovery actions against ex-Navy Secretary Richard Spencer.

Ejected from the Marine Corps in 2003 with an other than honorable discharge for marijuana use, Manker is charging the Navy with an institutional bias against sailors and Marines struggling with the largely unseen traumas of duty.

“Essentially, the rule that I want to come from this case is, if you have a PTSD diagnosis or something like (traumatic brain injury) and you apply for a discharge upgrade, it’s automatic,” says Manker, whose story was included in a 2018 Sarasota Herald-Tribune special report, “Warriors Rise Up.”

“There should be no discretion from the board, from bureaucrats, to overrule the decision of a private doctor or a VA doctor. And I think that’s where we’re headed.”

This soldier aced the new Army Combat Fitness Test: You'd never guess he has chronic kidney disease

One-third of those who served?

The litigation, Manker v. Spencer, is supported by the National Veterans Council for Legal Redress and the Yale Law School Veterans Legal Services Clinic.

The Yale students are arguing that nearly a third of the 2 million Americans who’ve served in Afghanistan and Iraq came home mentally or emotionally impaired by the experience.

If the suit prevails, Manker says Congress should codify any new standards into the Uniform Code of Military Justice, which could extend protections to Veterans beyond the boundaries of the 9/11 generation.

“I’m elated for Tyson. He deserves this,” says Joanne Mills of Sarasota. “And I want Peter’s name cleared – he deserves it, too. This has been a nightmare for 40 years.”

Mills’ first husband, Vietnam-era Navy Veteran Peter MacRoberts, committed suicide a week before Christmas in 1978, shortly after the Navy denied his third appeal for a status upgrade. She says her troubled husband never recovered from being branded as an “undesirable” after being arrested in 1969 for drugs, including a $10 bag of marijuana.

Class-action suits are difficult to win, but there is a precedent concerning the Army. In 1979, some 10,000 soldiers had their OTH discharges automatically upgraded after a federal court ruled that drug urinalysis results used to expel them had been illegally employed.

In 2017, Yale students filed a class-action complaint against the Army Discharge Review Board for perceived biases against soldiers with PTSD. Like the Manker suit, Kennedy v. Esper has also survived a motion to dismiss.

Bad paper, according to Marine Corps Veteran and student adviser Todd Mihill at George Mason University’s Antonin Scalia Law School, is “the equivalent of either a misdemeanor or felony conviction for substance abuse” on a Veteran’s record.

In the civilian-sector job market, that military black mark “seems to tilt the playing field decidedly in favor of those who have not served,” Mihill added, and it may “preclude a transitioning service member from acquiring gainful employment.”

‘Reaching fair and consistent results’

Noting how discharge review boards had been rejecting more than 95 percent of Veteran upgrade requests since the turn of the century, Defense Secretary Chuck Hagel in 2014 instructed the military to give “liberal consideration” to petitions involving PTSD, with the intent of “reaching fair and consistent results.”

Records disclosed in 2016 by the Freedom of Information Act indicated that applications for PTSD/TBI-related upgrades in the Army subsequently rose 45 percent, with the Air Force nudging up 37 percent. The Navy, however, granted upgrades to just 15 percent of the applicants. Its rejection of Manker’s 2016 application prompted him to go to court.

His unit had gone into Iraq with the initial invasion force in 2003. Its performance under fire in Baghdad and Karbala earned it the Presidential Unit Citation; Manker, at age 21, was promoted to corporal. But by December, he had been bounced out of the Marines with an OTH.

On the front end of a 30-day leave to the States, Manker and two junior Marines blew off steam by smoking marijuana. Although his urinalysis turned up clean – he smoked only once – one of his buddies flunked the test and rolled on Manker. He confessed during a lengthy interrogation that threatened him with 50 years in prison.

The OTH cost him his G.I. Bill, his pension, a $50,000 signing bonus, his rank (he was demoted to lance corporal) and a $1,500 fine. Despite the nightmares and hypervigilance, Manker and his unit all declined Deployment Health Assessment Assistance before leaving Iraq after being informed that such an appeal for help would automatically delay their trips home. He says the group was subsequently given a clean bill of mental health.

A doctor diagnosed Manker with PTSD within months of his leaving the service. He was referred to VA care, but his severance conditions made him ineligible. Manker went on to earn a law degree and is now a practicing attorney in Washington, D.C.

After a re-evaluation in 2017, the Illinois native finally qualified for VA assistance with an “other than dishonorable” upgrade. Citing multiple service commendations earned in Iraq, however, Manker calls his current status an unacceptable half measure. Smoking marijuana, he says, was his attempt to mitigate PTSD induced by his service.

PTSD wasn’t even on the books when Peter MacRoberts hanged himself. The American Psychiatric Association accepted it as a diagnosis two years later, in 1980. Manker says MacRoberts’ issues should have qualified him for an upgrade under Hagel’s “liberal consideration” directive, and he vows to help Mills clear her husband’s name.

“Peter served his country honorably for nearly three years, and he should get credit for that,” says Mills, who has been grinding through the appeals paperwork with an assist from the Disabled American Veterans. “His grandchildren will never know their grandfather, but I want them to know he was a good man.”

Twenty per day

Veterans are killing themselves more than 20 times a day in the new century, and checking out was definitely on Icarus Randolph’s mind in 2013 when he first attempted to get a status upgrade from the Navy.

“I am mostly anxious, nervous, depressed, stressed, angry, thoughts of suicide, feelings of self-hate,” he wrote, hoping to qualify for professional help from the VA. Randolph noted he had not “adjust(ed) well to civilian life and applied that ‘death before dishonor’ mindset. Sometimes I feel as if I need to keep those ways of thinking in my mind.”

Elisa Allen says her “sweet brother” was just 17 when he joined the Marines after high school graduation in 2007. He came home “a changed man” following his 2010 OTH discharge for marijuana, feeling “really lost, alone and ashamed.” His presence was fleeting, and he preferred to sleep on relatives’ floors rather than on couches or beds.

Randolph was never violent, says Allen, and he never talked about what he saw or did overseas. “I think he wanted to shield us from all that.” Unable to hold a job, “making really bad choices,” he began drinking heavily, and experienced “mental lapses” that resulted in hospitalization and run-ins with the law.

In 2014, with Independence Day fireworks popping and snapping across the neighborhood, family members summoned police after Icarus began speaking disjointedly “as if speaking to God and the trees,” according to the family. The encounter ended in the yard when an officer, feeling threatened, shot Randolph to death at close range. A knife was found near the body.

Eight relatives, including Allen’s three children, watched him die. She says a daughter, once an honor student, has been expelled from school with emotional problems. She says her son is afraid of people in uniforms.

“My brother still doesn’t have a headstone,” Elisa Allen adds. “My sister and I had to pawn everything to pay for the bulk of his services because we didn’t have any insurance.”

The city declined to prosecute the officer. The family continues to appeal.

On Jan. 11, 2016, Randolph’s survivors heard back from the Navy Discharge Review Board. “After careful consideration of all the evidence,” wrote the panelists, “the board felt that the subject’s PTSD should have mitigated the misconduct he committed since it outweighed the severity of the misconduct.”

The Navy recommended a general discharge under honorable conditions for the late Icarus Randolph. The final decision is still pending.

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Post-traumatic stress disorder (PTSD) can occur as a reaction to living through some type of trauma. Physical or sexual assault, witnessing a murder, and being an active participant in war are all common examples of events that can trigger PTSD. What all triggering events have in common is that the person who later develops PTSD felt extremely unsafe.

According to the Department of Veterans’ Affairs (VA), approximately 60 percent of men and 50 percent of women experience at least once traumatic event in their lifetime. The VA also states that between seven and eight percent of the population will experience PTSD at some point in their life. Approximately eight million people deal with PTSD annually, which breaks down to 10 percent of women and four percent of men who experience trauma later go on to develop PTSD.

Common PTSD symptoms

• Flashbacks, intrusive thoughts, or recurring dreams about the trauma.
• Feelings of intense distress when exposed to people or situations that bring back memories of the trauma.
• Physical reactions such as screaming or shaking in response to memories or triggering events.
• Dissociative feelings that make it seem as though the PTSD sufferer is living through the traumatic event all over again.
• Blaming oneself if another person died or sustained serious injury in their presence.
• Persistent anger and fear.
• Inability to remember details of the traumatic event.
• Unrealistic expectations of self and others.
• Taking little to no pleasure in activities they used to enjoy.

The 10 Tips You Need to Support Your Loved One

PTSD can be especially challenging for families to deal with when soldiers return from a war zone. The transition from military to civilian life can already be difficult, but Veterans with PTSD and their families struggle even more. Families naturally want to know what they can do to support loved ones with PTSD. We hope the 10 tips below can help start the healing process.

1. Educate yourself about PTSD.

Before family members can support a loved one with PTSD, they need to have a thorough understanding of it. This is true whether you’re a spouse, parent, child, or sibling of a Veteran with PTSD. You will have a much better understanding of what your family member is facing by reading books, doing online research, and talking to other families who have gone through PTSD to get their perspective.

Families with children at home should explain PTSD to them in an age-appropriate way and allow them to ask questions and express frustrations. This resource can be especially useful in providing a broad overview of PTSD and its treatment options.

2. Be available to listen.

Veterans with PTSD sometimes just need someone to listen to them without interruption or judgment, and this is an excellent way for family members to show support. The more you can do that, the more likely it is your loved one will open up and feel comfortable talking about the distressing experience. Since anxiety can be a big part of PTSD for some Veterans, your family member might need extra reassurance that you’re there to support them, and they can’t do anything to drive you away.

3. Don’t pressure your loved one to talk.

Everyone is different in their reactions to PTSD. Some want to talk about their experience right away while others may need months or even years before they feel ready to even mention their trauma. This can be frustrating for family members who just want to see their loved one get better.

Unfortunately, pressuring someone to talk before they feel ready will only backfire and cause resentment on both sides. The best thing you can do is to let your family member know that you’re available to support them and will be there to listen when they feel ready to talk.

4. Plan activities to do together.

Engaging in normal activities and routines such as taking the kids to the park or going for a drive on the weekend can help keep your loved one’s mind off the trauma and improve their mood. While you should take the initiative to plan enjoyable events, keep in mind that some activities and environments might be triggering and worsen the PTSD symptoms. For example, spending a quiet day at a friend’s cabin would be a better choice than attending a loud rodeo with thousands of people in attendance.

5. Help your loved one seek support.

People with PTSD sometimes feel ashamed or embarrassed about their struggles, especially if people they were close to did not make it home or suffered debilitating injuries. Let your loved one know that PTSD can happen to anyone and that seeking help is a sign of strength, not weakness. If they’re open to receiving help, you can offer to take over finding resources and scheduling appointments. You could also consider attending doctor appointments with your family member if they’re receptive to that type of support.

6. Anticipate PTSD triggers.

Seeing someone you love experience symptoms after a triggering event can be distressing. The experience can also catch you off-guard at first because you don’t know the person’s triggers or what type of reaction they will produce. Your family member may not know their own triggers until they happen, making the situation especially challenging. Although PTSD triggers can differ for everyone, here are some common examples.

Common PTSD Triggers

Hearing media coverage of similar events.

• Passing certain milestones such as anniversary dates of the trauma.
• Experiencing sights, smells, or sounds that remind them of the trauma.
• Being in a hospital, receiving medical treatment, or attending a funeral.

As you learn what seems to bring up your family member’s PTSD symptoms, it will be easier for you to avoid triggering situations.

7. Take care of yourself.

For as much as you need to support the Veteran with PTSD and the rest of your family, you also need to take care of yourself. You might consider joining a support group for family members of Veterans with PTSD or getting individual counseling. These resources could help your children as well. Be sure to look after your own health and continue to engage in activities you enjoy separate from the rest of the family.

8. Make a crisis plan together.

Panic attacks and night terrors are just some symptoms your loved one may experience due to PTSD. The best way to deal with a crisis involving the Veteran is to create a plan outlining exactly what to do. For example, get that person to a safe, quiet spot to relax after experiencing a particularly distressing memory and then check in with a therapist or support group as soon as possible.

9. Try to minimize stress.

Keeping the stress in your home to a minimum can help your family member relax and come to terms with the trauma. Home should be a place of comfort, and daily routines can help facilitate those feelings. Avoid inviting anyone over who might upset the recovering Veteran, either intentionally or unintentionally. Not placing heavy demands or responsibilities on the person with PTSD as they ease back into family life can also be helpful.

10. Know when to seek immediate help.

Sadly, PTSD can lead to crisis situations. If your family member is threatening to harm themselves or others, take it seriously and seek help immediately. You can call 911 to transport your loved one to a hospital for evaluation or bring the Veteran to the hospital yourself if the person in crisis will cooperate.

You can also receive immediate help for the Veteran in your family by calling the Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) and pressing 1 to connect to someone with specific training to help Veterans.

Remember Hill and Ponton is Here to Support Veterans and Their Families

Hill and Ponton, a disability services law firm serving the Veteran community, understands your family is facing an enormous challenge dealing with PTSD. Please don’t hesitate to contact us at 1-888-373-9436 for additional resources on a VA disability claim based on a diagnosis of PTSD.

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Dr. Sheila Rauch is a VA leader in PTSD treatment and the director of mental health research and program evaluation at the Atlanta VA Health Care System. For more than two decades, she’s been training providers in VA, the Department of Defense, and the civilian sector in models for treating patients with PTSD.

One of those models is called prolonged exposure for primary care.

Prolonged exposure is one of the premier trauma-focused, cognitive-behavioral therapies used in VA for patients with PTSD. It often requires referral to a mental health clinic and is based on someone thinking about the traumatic events he or she has experienced – at a time when everything is fine – to help them realize those memories are not harmful and that people can do things they want to do with less fear. Case in point: Being in a crowded area where you can’t see people behind you may trigger anxious feelings, but it doesn’t mean something bad will happen.

Researcher: Many PTSD patients avoid mental health clinics

Anger, guilt, sleep problems, and re-experiencing trauma through flashbacks and nightmares are common symptoms for Veterans with PTSD.

Prolonged exposure for primary care (PE-PC) uses essentially the same concepts in a briefer format, with a less demanding in-session time commitment (four to eight 30-minute sessions versus 8 to 15 90-minute sessions). Plus, all of the treatment is done in a primary care setting.

In Rauch’s view, many patients with PTSD who are referred to mental health services will not follow up, for one, because of the stigma that exists with going to mental health clinics. The time commitment also deters many people from taking part in the traditional form of prolonged exposure, she says. She thus supports use of prolonged exposure for primary care on a wider scale in VA, noting that 155 providers are now trained to administer it.

Major declines in PTSD symptoms

Following a clinical trial that showed PE-PC is more effective at reducing PTSD symptoms than weekly phone check-ins with a provider, Rauch led a small study that focused on how that treatment works in a VA primary care mental health setting. The study included 18 patients at the Atlanta VA, 16 of whom completed the treatment protocol: four to eight 30-minute sessions. Two-thirds of the sample met the full criteria for PTSD at entry. The rest did not but had PTSD symptoms they wanted to address in primary care. The participants attended five sessions on average.

The results showed major declines in PTSD symptoms from the first to the last treatment session, according to the PCL-5 checklist, a self-report measure that is used in health care to assess the 20 most commonly recognized PTSD symptoms. The research, published online in the journal Cognitive and Behavioral Practice in October 2020, included two case studies that provided “compelling evidence” the treatment helps reduce PTSD symptoms.

Currently, Rauch is leading a larger study that is examining functional outcomes in Veterans with PTSD who receive PE-PC, compared to those who receive standard PTSD treatment in primary care. She spoke with VA about prolonged exposure for primary care.

VA Research Currents: What exactly is prolonged exposure for primary care and why is it necessary?

Rauch: Prolonged exposure for primary care is a brief version of the front-line PTSD treatment prolonged exposure. It provides treatment to patients with significant PTSD symptoms that they want to address in a primary care setting. Although it calls for fewer and shorter sessions, it is still a demanding treatment, as we ask patients to approach their worst fears. They also work a lot in between sessions by writing and reading about their traumatic memories. Most people with PTSD will never seek care for PTSD, and even those who do are unlikely to receive a first-line treatment, such as prolonged exposure or cognitive processing therapy. Providing this brief but effective treatment in primary care – where most people with psychological difficulties will receive their mental health care – can greatly increase access to effective PTSD care. More complicated cases call for specialty mental health services or people starting on certain medications who can later be managed in primary care.

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Strategies that help older Veterans

New challenges appear with age. Those challenges can make the symptoms of posttraumatic stress disorder (PTSD) more noticeable, cause them to come back after many years or even to occur for the first time.

“It really wasn’t until after I retired and moved to be with my family that the [PTSD] symptoms began to be bothersome and disrupt my life, disrupt my family’s life,” says Mary Martin, an Air Force Veteran.

Don’t assume that these changes are a given or that it’s just what happens with getting older. Memories or impacts of trauma can be addressed at any age. You’re never too old to get help, and older adults can benefit from effective PTSD treatments, even for people who experienced trauma decades ago.

It’s common for older adults to minimize and deny the pain they experience from past traumas. They’re more likely to try to cope with these issues by themselves instead of seeking mental health treatment. However, strategies that once seemed to help with PTSD symptoms can be more difficult to maintain as people get older.

Common challenges and strategies

Dr. Elissa McCarthy, clinical psychologist at the National Center for PTSD, and Dr. Joan Cook, associate professor of psychiatry at the Yale School of Medicine, shared some common challenges faced by older adults and strategies for how to deal with those challenges:

• CHALLENGE: More free time. Increased amounts of free time can make unpleasant memories more frequent.
• STRATEGY: Create structure and maintain a routine or organized schedule. Spend more time on hobbies or doing other enjoyable activities that you may not have made time for earlier in life. For example, learn to play an instrument, bake, start a blog or make a scrapbook with old photos.
• CHALLENGE: Loss of purpose. Retirement can be challenging if work was a large part of your identity.
• STRATEGY: Learn new skills or volunteer. For example, many older Veterans enjoy giving back by mentoring Servicemembers or younger Veterans.
• CHALLENGE: Loss of loved ones.
• STRATEGY: Having a network of supportive people is important. Maintain relationships with people you care about and make new friends, too. For example, look for social groups who enjoy your hobbies or an activity you want to learn.
• CHALLENGE: Changes in physical ability.
• STRATEGY: Replace hobbies with other similar activities. For example, if poor eyesight makes reading difficult, try audiobooks or podcasts instead. For those who are homebound or have limited mobility, there are other options, like telehealth, for receiving counseling and care from home.
• CHALLENGE: Medical problems. Living with untreated PTSD can make other mental and physical health issues worse.
• STRATEGY: Don’t assume this is how aging needs to be, be proactive in managing health conditions and get treatment for PTSD symptoms that arise.

Symptoms may worsen

As people age, their PTSD symptoms may suddenly appear or become worse, causing them to act differently. It may be unsettling to see these changes in a loved one, but it’s nothing to fear. Changes are common and treatment can help. If a loved one is living with PTSD, these tips can help:

• Take time to understand what friends or loved ones went through and what they’re now experiencing as they live with the symptoms of PTSD.
• Be supportive and nonjudgmental. Think about how to respond better if a loved one says they’ve experienced trauma or may have PTSD. Responding negatively, even unintentionally, can shut someone down. Thank them for sharing their personal story with you.
• Connect them with care. If being the main support person for a loved one becomes too much to handle, connect them to help and remain in a loving, supporting role. Don’t forget that loved ones need help and support, too.
• Give hope. Understand that symptoms can come and go throughout different times in a person’s life. Remind loved ones that they’ve successfully coped in the past, and can do it again.

Visit the National Center for PTSD website for information, videos and tools to help manage PTSD. For more information on older adults with PTSD, download the Understanding PTSD and Aging booklet.

If you care about someone with PTSD, download the Understanding PTSD: A Guide for Family and Friends booklet to learn more about how to support your loved one and take care of your own needs.

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His calling in life: showing people there is another way

hese days, Jeff Henson is doing what he believes has been his calling in life. He’s showing people who have attempted or have had thoughts of suicide that there is another way.

The Air Force Veteran (pictured above) is a volunteer at Save A Warrior. The nonprofit provides counseling in mental health, wellness and suicide prevention to Veterans, active-duty military and first responders. More than 1,100 men and women have gone through the program since it began eight years ago.

Many of these people, Henson explains, are missing “their family, their tribe” with whom they once built a friendship and camaraderie in the military or elsewhere. A lot of them not only have PTSD, he says, but PTSD and moral injury, which is essentially a conflict with one’s personal code of morality.

A Veteran may feel guilt, shame or self-condemnation for violating his or her moral beliefs in combat by killing someone, witnessing death or failing to prevent the immoral acts of others.

The will to live

Henson believes moral injury is a form of “complex PTSD” that can also stem from negative circumstances in one’s childhood.

“We introduce a Veteran to a tribe of 12 other Veterans who came to Save A Warrior at the same time as total strangers. They can leave as ‘brothers’ with an understanding that it’s not always what happened down-range that has them stuck in life. We provide hope and magic that is the will to live.”

Henson has been there himself. Diagnosed with PTSD and void of hope, he went through the Save A Warrior program in 2016 while in Veterans’ treatment court in Orange County, California.

Flashbacks from the Gulf War

His court time stemmed from a domestic violence incident in 2013. At the time, he was experiencing many of the classic PTSD symptoms: nightmares, mood swings, anxiety, depression, isolation and flashbacks. When the incident happened, he had flashed back to a moment when he unintentionally witnessed a decapitation in the Saudi capital, Riyadh, during the Gulf War in 1990, and he lost control.

Study links PTSD with criminal justice involvement

Earlier this year, a VA study in the Journal of Traumatic Stress found that Veterans with PTSD — compared to those without — are six times more likely to experience run-ins with the law.

The researchers say it is unclear what is driving the ties between PTSD and criminal justice involvement. They say the general strain theory may partially explain the results. That theory asserts that the risk of criminal behavior is higher among people who have experienced traumatic events and report negative effects, such as high levels of anger or irritability,

It gave me hope

Meanwhile, as part of getting his life back together, the 59-year-old Henson is pursuing a doctorate in psychology at the California Institute of Integral Studies.

He’s also trying to give back to the organization that gave him so much.

“Save A Warrior did not save my life, but it gave me hope,” he says. “It’s the difference between `being alive’ and `living.’ It’s also about being of service. I’m one of the shepherds who helps people through the process that I went through.

“When we’re kids, we’re told by our parents not to use four-letter words,” he adds. “I dispute that because hope is a four-letter word. And hope is powerful.”

Click here to read more of Henson’s story.

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Imagine, if you will, having the power to temporarily escape your current reality for a virtual one.

While this might sound like an introduction to Rod Serling’s “The Twilight Zone, our story of U.S. Navy Reserve Veteran Sharon Thompson has a happy ending.

“Virtual reality puts me in a different atmosphere, almost like my own little world,” Thompson said. “I felt happy — like I was there, and the experience was real.”

Thompson was one of the first Veterans to try the new virtual reality systems donated by Soldier Strong. Her sessions included paint by number and matching objects of similar shapes and colors. The virtual reality simulator consists of a headpiece to view the altered reality and sensors hooked up to each hand, bicep and back.

“Virtual reality is another tool in our kit to help Veterans with post-traumatic stress disorder and cognitive impairments improve relaxation techniques and range of motion,” Carl Vinson VA Medical Center Recreation Therapy Supervisor Jane Helsing said. “We can monitor and track progress on a tablet controlling the programs being used by the Veteran.”

Data collected through these interactions can be compared over time to illustrate therapeutic progress, and other, more challenging programs can be added to enhance therapy sessions and achieve loftier goals.

Thompson, who deployed to Iraq, struggled with PTSD after redeploying home and is currently receiving inpatient treatment at the Dublin VAMC domiciliary.

“Virtual reality exposure therapy facilitates the emotional engagement of patients with PTSD during exposures to the multiple sensory stimuli made possible by the virtual environment, bypassing symptoms of avoidance and facilitating control on the part of the therapist,” according to a research paper titled “Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review.”

“VRET can be particularly useful in the treatment of PTSD that is resistant to traditional exposure because it allows for greater engagement by the patient and, consequently, greater activation of the traumatic memory, which is necessary for the extinction of the conditioned fear.”

One of the benefits to incorporating virtual reality into PTSD and cognitive impairment therapies is that it provides a safe and welcoming environment. Focusing on the virtual world enables Thompson to temporarily disconnect from reality, allowing her to pursue her therapy calmly and happily. While Thompson is enjoying herself, Helsing is busy analyzing the data being recorded and looking forward to comparing the new data against previous sessions to gauge improvement.

Thompson is one of the few Veterans to spearhead new virtual reality therapies to help shape the interconnection of treatment and tech for the future. This happy ending was even beyond the imagination of World War II Army Veteran and Twilight Zone creator Rod Serling, who would no doubt be proud.

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