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Rough landings: DOD, VA sluggish helping returning veterans, study says

Nearly half of the 2.2 million U.S. troops who served in Iraq and Afghanistan have struggled to readjust to American life in part because the Departments of Defense and Veterans Affairs have been sluggish in helping those coming home in droves, according to a sweeping report released today.

After examining veteran suicides and unemployment as well as the military’s handling of sex assaults, women in uniform and same-sex family issues, the Institute of Medicine said returning service members deserve “timely and adequate care,” yet it cited cases in which the DOD and VA are using unproven diagnostic and therapy tools.

"The (federal) response has been slow and has not matched the magnitude of this population's requirements as many cope with a complex set of health, economic, and other challenges," said co-author Dr. George Rutherford. He chairs the IOM’s committee on the assessment of readjustment needs of military personnel, veterans, and their families. The IOM, an independent nonprofit, is the health arm of the National Academy of Sciences. 

"The number of people affected, the influx of returning personnel as the conflicts wind down, and the potential long-term consequences of their service heighten the urgency of putting the appropriate knowledge and resources in place to make re-entry into post-deployment life as easy as possible,” added Rutherford, head of preventive medicine and public health at the University of California, San Francisco School of Medicine.

Another 34,000 U.S. service members will be flown home from Afghanistan during the next 12 months. The high suicide toll among veterans (22 per day) has drawn recent Congressional scrutiny as have the elevated veteran-unemployment rate and access limits to VA mental health care. Congress requested the IOM study. 

Among the recommendations within the 500-plus page report:

  • DOD and VA must “boost efforts to reduce the stigma” associated with service members or veterans simply asking for help to deal with mental-health issues or with substance-abuse problems.
  • The tool DOD uses to assess cognitive function following a head injury – Automated Neuropsychological Assessment Metrics (ANAM) — carries “no clear scientific evidence” to show that it works. That’s key because more than 200,000 U.S. troops have sustained traumatic brain injuries since 2000 — most non-combat-related. On March 5, Congressional members sent a letter to the chiefs of DOD and VA seeking data to investigate a new theory linking TBIs with the military’s suicide crisis.
  • One of the VA’s “first-line treatments for depression” — Acceptance and Commitment Therapy — similarly “lacks sufficient evidence” to show its efficacy.
  • Research has found that curbing access to lethal weapons prevents suicides, however, “DOD policy prohibits restricting that individual's access to privately owned weapons” — even if a service member is known to be at risk for suicide.
  • DOD and VA should link their databases so that the health records of all service members are available to track their medical conditions from the moment they enter the service through the day any future treatment is eventually rendered by a VA facility. 

"These (recommendations) are meant to be helpful, meant to be more of a roadmap of how to pursue” these issues, Rutherford said. “These are extraordinary challenges that the systems are facing and they’ve gone to extraordinary efforts to try and work with them.

'Demand is large'

“Yeah, it can all be streamlined. Yeah, (the available help) can be matched better to the demands. Yeah, you can improve this stuff. But they are trying like crazy to make it match the demand,” he added. “The demand is large, and it’s growing.”

Compared to past post-war generations, a higher percentage of returning Iraq and Afghanistan Veterans are using the VA for their health care — 56 percent of that population, according to the VA.

"This report provides VA a better understanding of the difficulties some Veterans face as they readjust to home, reconnect with family members, find employment and return to school," read an email from Josh Taylor, a VA spokesman. "Greater collaboration with the Department of Defense (DoD) in the areas of research, treatment and clinical outcomes will further enhance continuity of care as service members transition from active to veteran status."

Pentagon officials will examine the IOM’s suggestions, said Cynthia O. Smith, a DoD spokeswoman.

“DoD appreciates IOM's hard work and will thoughtfully consider the study's key findings and recommendations,” Smith wrote in an email. She added that the agency’s Deployment Health Clinical Center “will work collectively with the VA to provide a joint response to Congress no later than June 2013.” 

The IOM study reports that 44 percent of veterans have had "readjustment difficulties," 48 percent have dealt with "strains on family life," 49 percent have experienced post-traumatic stress, and 32 percent have felt "an occasional loss of interest in daily activities." Those figures were plucked from an earlier Pew Research Center survey. 

"I’m not surprised (by those numbers), talking to my other buddies that have gotten out. I’ve got several buddies that still can’t find jobs but, to be honest with you, I think it's a factor of (their) motivation" to hunt for work, said Ryan Kriesel, 24, an Army tank operator who served two tours in Iraq. He's now a student at the University of Minnesota. He described his own transition as "pretty smooth." 

When it comes to those younger veterans who report a flagging interest in daily life, Kriesel believes some of that may be due to the loss of the emotional rush that once came with combat. 

"Part of it is being back in the civilian world," he said. "There’s not as much adrenaline going on as when you were overseas, out on combat missions several times a day."