Keep ?Sacred Covenant? with the Troops

[thedrifter]

01-22-2004

Guest Column: Keep ?Sacred Covenant? with the Troops



By Stephen L. Robinson



Editor?s Note: This is a transcript of testimony on Jan. 21 before the House Armed Services Subcommittee on Total Force.



Mr. Chairman, before I begin my testimony, I feel it is important to note that this issue only came to light when soldiers voiced their concerns to their immediate supervisors while on medical hold and were told to ?shut up, suck it up and don?t write your Congressmen? about conditions or delays in healthcare. Soldiers then reached out to others to address this problem.



On behalf of the National Gulf War Resource Center (NGWRC), I want to thank the Chairman and other distinguished members for affording us the opportunity to testify before you here today. In years to come, this issue will emerge as one of the most important hearings you will have conducted for Operation Iraq Freedom soldiers.



The major troop rotation planned for the next four to six months has the potential to cause further breakdowns in the already strained military medical treatment and evaluation system. According to military officials, this will be the largest troop rotation since World War II.



While investigations and Congressional hearings are looking for answers, soldiers placed on ?medical hold? will continue to have to deal with a system that is ill prepared to address their needs. It is critical that future soldiers with service-disabling conditions placed on medical hold transition seamlessly from Department of Defense (DoD) Healthcare to a Department of Veterans Affairs (DVA) Healthcare system that is responsive, up to date, and fully prepared to receive the wounded from this and future wars.



Many service members survive armed conflict without being physically wounded and they often return to daily life free of health complaints. Previous wars have also shown us that soldiers can survive war without physical trauma and yet suffer psychological trauma that is no less debilitating than an injury from a bullet or bomb.



The NGWRC believes the health outcomes from this war will present significant problems that appear to have been overlooked or not emphasized as soldiers return from combat operations. Reports issued by enterprising reporter Mark Benjamin from United Press International and verified by the NGWRC were delivered to the Senate National Guard Caucus. Senator Kit Bond, R-MO, and Senator Patrick Leahy, D-VT, then sent staff members to several Army facilities for a first-hand look at the problem. I have attached the initial findings from the Senate National Guard Caucus, as well as their request for a Government Accounting Office (GAO) investigation.



As Executive Director of the NGWRC, my charge is to focus on ensuring that the ?Lessons Learned? from the first Gulf War are implemented. Soldiers of this war should not have to face the significant obstacles Gulf War [i] and other war veterans have faced when trying to receive care after serving their country.



Because of our Lessons Learned focus, the NGWRC was instrumental in forcing the DoD to comply with Public Law 105-85 section 762-767, which requires pre- and post-deployment screening for all returning soldiers. After three congressional hearings and a GAO report, we were successful in forcing Assistant Secretary of Defense for Health Affairs William Winkenwerder to follow the 1997 law and enhance the screening process in a meaningful way.



Based on reporting and physical inspection at several Army installations, it appears that many National Guard and Reserve soldiers were notified and sent to mobilization centers unfit to deploy or with pre-existing disqualifying conditions. National Guard and Reserve Force Commanders decided to deploy as many bodies as possible to the mobilization sites, regardless of their condition.



The failure to screen soldiers prior to mobilization created a situation where power projection platforms such as Fort Stewart were overwhelmed with non-deployable soldiers and returning war veterans. Both groups were then in medical holdover status competing for services and treatments at the same medical facility. Soldiers reported that the Medical Evaluation Board (MEB) process was lengthy and difficult to understand. Commanders reported that because of the high turnover of National Guard and Reserve physicians, they were in a constant battle to train doctors concerning how to process the MEB.



It was also reported that some soldiers were sent to war with disqualifying medical conditions that were ignored or downgraded in order to meet Army Regulations for deployment. While on medical hold, many soldiers reported concern over the high suicide rates and increased rates of Post-Traumatic Stress Disorder (PTSD) from returning war veterans.



We are advising the committee to look at the drug administered by DoD called Larium. Our early research indicates it may play a role in PTSD and suicide cases. Ten years ago, veterans were testifying that exposures of the first Gulf War had made them ill. Ten years were wasted because DoD and others ignored the firsthand accounts of war veterans. We hope the committee will aggressively pursue the recommendations we present today.



The military will outline the positive steps it has taken to address certain medical hold issues. Our testimony covers the problems soldiers have reported with specific recommendations to correct these problems for the next rotation of troops to and from Iraq . Because time is limited, I will highlight the most important issues and look forward to the questions of the committee.



* Department of Defense Health Affairs Policies: Four days after the start of Operation Iraqi Freedom, Assistant Secretary of Defense for Health Affairs William Winkenwerder testified on March 25th that pre-deployment screening was not necessary, even though it was required by law and DoD Health Affairs Policy 99-002 issued October 6, 1998.



Under Doctor Winkenwerder?s leadership, the Army failed to pre-screen thousands of deploying soldiers headed to Operation Iraqi Freedom. Unbelievably, one month later Doctor Winkenwerder reversed his position, announcing that screening was suddenly important and that DoD would enhance the post-deployment screening process. This enhancement included more questions on a post-deployment form and some limited emphasis on PTSD screening.



However, the policy reversal continues to ignore things we may be doing to ourselves. Gang vaccinations with the Anthrax and Botulism vaccines, the use of Larium, and the lack of hyper vigilance for the signs of PTSD all combine to create a healthcare crisis if left unattended.



The policies listed below are the most egregious failures of DoD policy and require immediate Congressional oversight:



* Pre-deployment screening not conducted prior to departure from MOB site: The intent of pre-deployment screening is to identify who is fit to deploy, and to document their medical condition prior to deployment. This documentation is critical because it gives a snapshot in time of the soldiers? health that will be used after the deployment to determine if there are any service connected injuries.



Based on conservative estimates, as many as one-third of the citizen-soldiers at one Army base were deployed to the MOB site with service disabling conditions. Because of this fact, garrison commanders suddenly became overwhelmed with returning wounded and non-deployable soldiers. Many soldiers reported that their service disabling conditions were downgraded by local unit commanders during the pre-deployment process. This act in effect ignored established medical diagnosis in order to send the soldier to Iraq.



Congress should investigate the cost to U.S. taxpayers for sending non-deployable soldiers to mobilization sites.



Recommendation: Pre-deployment screening must take place at the home station prior to arriving at the MOB site. The National Guard and Reserve Forces must not send forward anyone who is not fit and qualified to deploy. Soldiers with pre-existing disabling conditions that prevent them from deployment should be rehabilitated, reclassified, left behind, or face the MEB.



The practice of downgrading medical profiles by unit commanders must cease immediately. Congress must address the physical readiness of the National Guard and the Reserve through TRICARE for Guard and Reservists. This will ensure that every member of the Guard and Reserves has adequate health insurance coverage and is medically ready to deploy.



* Post-deployment screening and mental health assessments: Post-deployment screening is designed to record the soldier?s current injuries and determine if mental health counseling is necessary. This screening completes the deployment cycle and the documentation may later be used as evidence for claims with the Department of Veterans Affairs.

Failure of local commanders to ensure this process is completed accurately will harm soldiers down the road when they file VA claims. Another part of post-deployment screening is the mental health assessment. This committee should be fully aware that suicides are up in Iraq and here at home. Just 10 days ago, an Operation Iraqi Freedom soldier hung himself at Walter Reed Army Medical Center. Other reports of suicide have surfaced at military installations both stateside and in Europe.



The NGWRC toured several military installations recently, and most soldiers we spoke with still report that they have received little to no counseling regarding traumatic events experienced during war. Similarly, the medical commanders report saturation in their ability to care for psychological issues.



The commanders are forced to out-source appointments and therapy to the Department of Veterans Affairs or civilian providers. There are shortages in qualified providers, beds and command emphasis to treat those who need counseling most.



Nowhere is this apparent disregard for psychological injuries more apparent than in the case of Sgt. George Andreas Pogany, who was charged with cowardice. Nearly three months after returning from Iraq, he is just now being afforded care for the trauma he experienced in Iraq.

Recommendation: Post-deployment screening and mental health assessments must be completed with 100 percent compliance. Aggressive mental health counseling and programs must be afforded to the returning soldiers. Congress must conduct oversight now to ensure the programs are implemented force-wide. Soldiers recommend that Veteran Service Officers be allowed access to returning troops. The VSOs should be used to augment existing programs.



VSOs have had combat experience and are certified in benefits preparation. They also provide a friendly shoulder, because they know what the returning soldiers are going through. If DoD cannot aggressively meet the needs of medical hold soldiers, then they should enlist the help of those who stand ready to assist.



Larium use and increased risk for disastrous side effects: Suicides are up at home and in Iraq. Psychological injuries are increasingly more prevalent in this war as compared to the 1991 Gulf War. The product?s manufacturer Roche Pharmaceuticals recommends not prescribing Larium for anyone with ?active depression.? Recently, Marine Corps 2nd Lt. Christopher Shay committed suicide just days before returning home from the region. By all accounts he was top of his class, deep selected for difficult missions, and a dedicated Marine. Lieutenant Christopher Shay took his own life after 12 requests for assistance from his ship?s physician, Capt. Propes, within a thirty-two hour period.



After his death, the family asked why such a talented young man would take his own life and could Larium have had any factor in their son?s death? The response from the military stated that the soldier was not issued Larium and that Larium could not be associated with his death. After conducting their own civilian forensic investigation, the family found out this was not true. The point is, the military is ignoring this drug?s known side effects.



In some cases, they are lying to family members and act as if they are baffled by the high suicide and depression rates. The Pentagon refuses to consider the obvious side effects Larium produces in the combat scenario. The product label clearly states that this drug is not to be given to those who may be depressed. Dr. Winkenwerder recently said, ?Each one of these suicide events are investigated. But we don?t see a trend there in looking at these cases that tells us there is more we might be doing to prevent suicides.?



Recommendation: I challenge this Committee to ask Dr. Winkenwerder if the side effects of Larium were considered in the DoD suicide investigations. I want to know why stateside suicides are not counted in the total number of suicides reported by DoD. Soldiers want to know if Larium is a factor in exacerbating PTSD. Either way, there appears to be a significant increase in both suicides and PTSD.



Public Relations spin and delay will not serve our warriors. Lessons learned from the first Gulf War should make us hyper-vigilant as our soldiers return home, and this drug needs to be investigated to determine if it is harming and in some cases killing our own soldiers.



* Medical Holdover: Active Duty, National Guard and Reserve soldiers are kept in medical hold while they await either medical care or medical disposition. The purpose is to treat soldiers so they might return to duty; assign them a profile; or discharge them from service after their medical conditions have been diagnosed and assessed.



The inspections of several mobilization and demobilization sites uncovered significant problems with the Army?s mobilization system. Commanders from two of those sites will detail their command views on the issue today and what they have done to correct the problem. I would like to focus on the soldiers? perspective, what they think is important, and the suggestions they have given the NGWRC to correct the problem.



* Insufficient housing: There is insufficient housing at most Army bases across the country to house Reservists on medical hold. This issue is not new and was experienced during the 1991 Gulf War.



Recommendation: Accurately plan for the numbers of soldiers who will deploy through the mobilization and demobilization sites. Forecast and budget for returning wounded soldiers. If possible, allow Guard and Reserve soldiers to Med Hold and MEB at their home stations using existing VA facilities for treatment while paperwork is being processed. If all else fails, send soldiers to other installations near their home stations so they can recover while near their families.



Additionally, the soldiers request that the World War II-era housing be upgraded or replaced with 21st century structures.

* Shortage of doctors: Soldiers report a shortage of doctors. This shortage is what created the significant delays in medical care. This problem is compounded by the limited amount of time Reserve and Guard physicians augment the Military Medical Treatment Facilities. Most clinicians and specialists called to active duty were deployed forward, and those remaining in the states can stay on duty for only 90 days before returning to their civilian practices.



Recommendation: Soldiers suggest the utilization of existing Veterans Health Administration facilities near their home stations. They also suggest immediately augmenting facilities that are overwhelmed rather than allowing the system to bog down over time.



* Not listening to soldier issues: Soldiers are required to obey the orders of the president of the United States and the orders of the officers appointed over them. They are not required to follow orders that are unlawful or orders that place them in an ethical or moral dilemma. Should there be an occasion in which a soldier believes such an order has been issued, he should see fit to challenge the order and may even refuse to perform until the issue has been addressed with the proper authority.



The order to ?shut up, suck it up and don?t write your Congressmen? clearly fell into this category.



Recommendation: Listen to your soldiers. The complaints received at each installation we visited spanned the entire rank structure from private to command sergeant major, and from 2nd lieutenant to lieutenant colonel. The soldiers suggest that a permanent Reserve or Guard liaison be responsible to address all soldier issues to the local garrison commander.



* Medical Evaluation Boards: Medical Evaluation Boards are a complicated and paper-driven process. The MEB requires soldiers to produce documentary evidence of service-related injury. The pre- and post-deployment screening, along with medical records and evaluations, will be used to determine the disposition of the soldier.

Soldiers deployed with pre-existing medical conditions now face MEB: In visits to three military installations, we encountered many soldiers who we sent to Iraq with service-disabling conditions because commanders downgraded their existing profiles. Many soldiers successfully completed combat operations in Iraq where these service-disabling conditions were exacerbated.



Upon return to the United States and in out-processing, these soldiers reported their exacerbated conditions and were told the conditions were not service-connected because they were pre-existing. Then to add insult to injury, many were boarded out of the military for the same condition that should have prevented them from deploying in the first place.



Recommendation: Local commanders must be striped of the ability to downgrade profiles for the purposes of deployment. The GAO may need to investigate this practice and determine the extent it has prevented soldiers from obtaining a true diagnosis and disability rating for the service connected injuries they suffered while serving their country.



* Shortage of doctors to process MEBs: Critical Skills Retention Bonuses do not create incentives that encourage National Guard doctors to volunteer for long rotations. Doctors rotate every 90 days. Once they become proficient the next doctor rotates in and must be trained.

Recommendation: The National Guard and Reserve doctors who will be tasked to conduct MEBs need to be proficient prior to deployment. The National Guard and Reserve should consider deploying with administrative experts who can assist the garrison and their own soldiers through the process. Additionally, the military needs to develop and distribute a MEB self-help guide at the demobilization site.



* Bottom Line: The problems faced Armywide related to Medical Hold soldiers should never have happened in the first place. It is unclear what action, if any, would have been taken had the conditions at these bases not been exposed by UPI and NGWRC and then aggressively investigated by Senators Kit Bond and Patrick Leahy.



Educating military personnel about their rights and responsibilities should they be placed on medical hold will do much to alleviate the frustration and anger that are born of uncertainty. Another key to preventing future situations like the one at Fort Stewart is having enough medical and administrative resources available to meet the needs of reserve and active duty personnel.



The military needs to aggressively investigate and correct deficiencies before they become major problems. The Army response to the Fort Stewart catastrophe is to be applauded. However, crisis management should not be the norm when it comes to the proper medical care and treatment of our war-wounded veterans.



DoD directives must spell out plainly that Reserve soldiers should not be penalized, but rather encouraged to promptly report medical conditions that affect their ability to deploy. Reserve unit commanders must be required to immediately follow up these claims with physical examinations to determine medical status of individuals before units are activated.



Borrowing a line from Command Sgt. Major Michelle Jones, a top Reserve NCO, ?The reason that soldiers won?t re-enlist is not because they?re mobilized, but the way they are treated on active duty.? We can do better. We owe it to the soldiers and we owe it to the nation.



If we fail, then we jeopardize the concept of the all-volunteer force. The military and the government must uphold the sacred covenant made between soldier and country.



Following a 20-year career in the U.S. Army, Stephen L. Robinson became the executive director of the nonprofit National Gulf War Resource Center, which serves as an advocacy organization for veterans of the Gulf War and current conflicts.

http://www.sftt.org/cgi-bin/csNews/...3.1306931498078


Sempers,

Roger