Giving Vets Their Due

On December 22, 2005, Joshua Omvig, a 22-year-old reservist from Davenport, Iowa, committed suicide with a gun in his pickup truck, after returning from a tour of duty in Iraq a year earlier. He suffered post traumatic stress disorder, a common problem with soldiers returning from Iraq and Afghanistan.

Omvig's parents, Randy and Ellen, began lobbying for comprehensive PTSD care for all veterans; they even used his memorial webpage to lobby for mental health care. Omvig became a symbol in committee hearings for veterans suffering from PTSD. The Joshua Omvig Suicide Prevention Act was signed into law last week. On this Veterans Day, nearly two years after Omvig ended his own life, and more than six years after the invasion of Afghanistan, it seems appropriate to step back and survey the state of veteran benefits.

The exact number of Iraq or Afghanistan veterans experiencing PTSD is unknown. In 2004, the Associated Press estimated as many as one in eight returning soldiers might experience symptoms related to combat stress. The percentage of soldiers who encounter combat stressors like being ambushed or receiving rocket fire is estimated to be about 90 percent of those serving in Iraq, according to the National Center for PTSD, which is part of the Department of Veterans Affairs. Of the 1.5 million troops that have returned from Iraq, the VA estimates that at least 283 soldiers have committed suicide after exiting the military; 147 have killed themselves while stationed in Iraq or Afghanistan. Suicide rates for soldiers once they have returned are double the rates during deployment.

The Omvig bill mandates a comprehensive suicide reduction plan. It calls for mental health training for VA professionals, a 24-hour suicide and information hotline and increased availability of mental health workers, and the tracking of veterans for further research. When soldiers receive treatment for mental problems such as PTSD and other forms of stress, their suicide rates are no higher than in the civilian population getting treated for depression, according to a joint study from the University of Michigan and the VA. The challenge, though, is making sure those veterans who need treatment get it. A 2004 study estimates the number of veterans who are uninsured because they lack access to the care they are eligible for was close to 1.7 million. Additionally, many soldiers resist treatment or help because of social stigma; they view themselves as models of bravery and masculinity and fear a perception of weakness.

The bill also sets aside separate funding for veterans who suffer from trauma resulting from sexual assault. As the New York Times reported in March, PTSD rates for women in the first Gulf War were nearly double that of their male counterparts. Recently released army statistics show sexual trauma rates among women in the military range from 21 to 23 percent, compared with about 1 percent of men.

"There are real barriers [to diagnosis and treatment] while these women are still in the military. The perpetrator may be higher ranking, or in the same unit. They don't want to be ostracized from their unit," said Kerri Childress, spokeswoman for the VA's Palo Alto Health Care system. To address this, the VA has started the Women's Trauma Recovery Program, one of three inpatient treatment programs specializing in treatment for both standard combat stress and trauma from sexual assault for women. "It's kind of the ugly underbelly of the military. Combat stress is unavoidable, but not sexual trauma. That is absolutely avoidable."

The Palo Alto program typically lasts three months, and there are 10 beds in the women's program, compared with 41 in the men's program. There isn't a wait list, "per se," as Childress said, because women are treated as a group, or cohort. "Applicants are assigned an admission date that aligns with the next cohort start date," Childress said. The latest cohort was composed entirely of Iraq and Afghanistan veterans. In the meantime, women are encouraged to seek outpatient treatment, which can be less disturbing to daily life than a multi-month inpatient treatment program. "These women shouldn't wait to get help," Childress said.

The Joshua Omvig bill provides for sexual trauma and PTSD treatment, but the battle to put that funding into place has been a long one. House Veterans Affairs Committee Chairman Bob Filner (D-CA) said, "We live in a culture that undervalues mental health treatment, and the military is even worse. If you have PTSD, you face no promotion, or losing your job. There's a whole dynamic that we need to change."

Filner says that they've pushed for $13 billion in extra care, a more than 30 percent increase since Democrats took power. But veterans advocacy groups like, say that the VA remains vastly underfunded -- and the problems go deeper than just funding.

Currently, treatment for soldiers falls under the purview of two different departments. Active duty forces like the Army, Navy, Marines, and Air Force are automatically covered by the world-renowned VA system once they exit the military. The National Guard and reserve forces can receive treatment from the VA, but aren't automatically covered. Instead, they can opt in to a DoD health insurance program called Tricare. But if a Guard or Reserve veteran can't hold down a job due to mental problems like PTSD, they can be denied coverage. The original argument that "weekend warriors" should get inferior benefits no longer holds water. Now, reservists are serving more and more active duty tours. Filner said the committee plans to work on legislation hooked to the next defense authorization bill that would bring the National Guard and Reserve under the care of the VA.

Although Congress' major focus has been on veteran health care since the Walter Reed scandal early this year, a next battle will be over GI Bill benefits. Currently, National Guard soldiers cannot access their education benefits after they leave service, where active duty forces can access GI Bill benefits up to ten years after exiting active duty. Before the war in Iraq, this was never an issue, since most of the time guard and reservist soldiers spent was at home. Earlier this year, Rep. Vic Snyder (D-AK) introduced legislation that would combine care and education benefits to close the gap between the two types of forces, but it has languished in committee. Filner talked of a plan to expand the GI Bill early next year, what he called "A GI Bill for the twenty-first century." The proposed bill would extend the same post-military benefits to the Guard and Reserve.

It's easy to get Republican votes on extra funding for veterans once the legislation is in Congress, but the administration hasn't presented leadership in the budgets they submit. Amending the problems with veterans health care and education benefits will take a lot of funding that had remained fairly stagnant in the decades before the war. But Susan McAvoy, spokeswoman for the Omvig bill's House sponsor, Rep. Leonard Boswell (D-IA), is hopeful, "This is an issue that crosses party lines, no matter what your thoughts are on the war, both parties want to see their veterans taken care of."

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