Thursday, April 01, 2010







"Many men and women return from the war zone successfully and adjust to their lives out of theater, but others have had difficulty in readjusting or transitioning to family life, to their jobs, and to living in their communities after deployment." That statement appears on page one of the 192 page report issued yesterday by the Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families; Board on the Health of Selected Populations; Institute Of Medicine. The report is entitled Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families. The Institute Of Medicine defined the task as (a) "identify preliminary findings regarding the physical and mental health and other readjustments needs for members and former members of the armed forces who were deployed to OEF or OIF and their families as a result of such deployment" and (b) "determine how it would approach [. . .] a comprehensive assessment of the physical, mental, social and economic effects and to identify gaps in care for members and former member of the armed forces who were deployed" in the Iraq and Afghanistan Wars. Among other things, IOM found many programs had been created to help the veterans of both wars; however, little evaluation of the programs had been done. The report states that little attention has been paid to either the costs or helath condition needs in long-term care for TBI. In addition, it notes that there "is the critical shortage of health-care professionals -- especially those specializing in mental health -- to meet the demands of those returning from theater in Iraq and Afghanistan and their family members."

The report refers to all levels of care. Last week, US House Rep Michael Michaud chaired a hearing of the House Veterans Subcommittee on Health and US House Rep Gabrielle Giffords spoke of the bills she is sponsoring HR 2698 and 2699 -- both of which are concerned with treatment for PTSD. The first would provide a scholarship to train VA workers and allow veterans to access PTSD health care at the VAs even if -- especially if -- the PTSD is newly emerging/manifesting. The first bill would put more and better trained workers in the VA and allow the veterans greater access to treatment. The second bill would create pilot pograms that would provide treatment but also track feedback from the veterans and their families in order to devise better treatments. The bills she is sponsoring are both in keeping with the recommendations of the 192-page report. HR 2698 currently has 48 co-sponsors including the Chair of the House Veterans Affairs Committee Bob Filner. At least 13 of the co-sponsors are Republicans; however, the Committee's Ranking Member, Steve Buyer, has not signed on as a co-sponsor.

The report notes a barrier to receiving help: "Stigma, real or imagined, is perceived by military personnel who are (or are considering) seeking care for mental health or substance-abuse problems. And active-duty military and veterans fear that vistis to a mental health provider will jeopardize their careers because of the military's long-standing and understandable policy of reporting mental health and substance-abuse problems to the chain of command."

They will argue that they recommended "a review" of confidentiality policies. Yes, they did. And I will turn around and argue that Deborah Mullen (wife of Joint Chief of Staff Mike Mullen) made stronger remarks on this topic (stigmas as barriers to treatment) in her speech at the DoD-VA Suicide Prevention Conference in DC last January.

As you read through the report, it becomes obvious that there are few solutions offered, just calls for more study. If you doubt that, check out the section on "Identify policy remedies" which reads:

Implicit in much of what the committee has found and has written is that dealing with the population-level consequences of OEF and OIF will require policy changes. The scope of the potential policy rememdies will be targeted at preventing, minimizing, or addressing the impacts, gaps, and needs identified during the committee's work. It is anticipated that this work will generate specific recommendations that may require statutory changes to implement.

They may feel they have met their mission's mandate but what it reads like is "there are problems, we recommend further study." In other words, kick the can. Or maybe hot potato. Though weak on solutions, the study does provide interesting raw data such as the fact that 1.9 million members of the service have been deployed to either Afghanistan or Iraq for over 30 days since 2001. That these 1.9 million have been deployed "in 3 million tours of duty". 7,944 women served in Vietnam while "over 200,000 women" have served and are serving in Iraq and Afghanistan (accounting for 11% of the personnel). Non-reserve personnel? Nearly half the officers "are over 35 years old" compared to the reserve officers figure of 73.6% "are over 35 years old." Well over half the reserve, non-officer members are 30 or less while in the non-reserve category, 85% are under the age of 35 with the greatest number being between the ages of 20 and 24. That group makes up 43.9% of the Army (non-officers, remember), 45.9% of the Navy, 39.1% of the Air Force and 65.6% of the Marine Corps. For the non-officers in the reserves, there is no one age group that consistently tracks across the branches. In the Army national Guard, the largest portion (30%) are between the ages of 20 and 24 and that is true also for the Army Reserve (32.1%) and the Marine Corps Reserve (58.1%); however, for the Navy Reserve, most members (24.3%) are between the ages of 35 and 39 (with the second highest being the ages 40 to 44), ages 40 to 44 make up the largest percent of the Air Force Reserve (18.4%). That's all the reserve branches except for the Air National Guard and their highest percentage is 16.6% which is the percentage of their deployed members ages 20 to 24 but it is also the percentage of their deployed members age 35 to 39.

With no distinction made between officers and non-officers, service members deployed to Iraq and Afghanistan have been "66% [. . .] white, 16% black, 10% Hispanic, 4% Asian, and 4% other race." That's reserve and non-reserve. Of the non-reserve, 55.2% are married and that number is 49% for the reserves. Children? 43% non-reserves are a parent and reserves? They aren't tracked. Which appears to echo the RAND Corporation critieria for their recent study which Anita Chandra discussed with Congress last month. Reserves and non-reserves (the report calls it "active component" but I've heard too many reserves note that they are active and have been active month after month) share one thing in common, for both over 60% of the Navy branches have been deployed to either Iraq or Afghanistan. For non-reserves, that is the highest of any branch. For the reserves, the Air Force Reserve has deployed even more with over 80% of their members have been deployed to either Iraq or Afghanistan. [See Figure 2.5 and 2.6 of the report for more on that breakdown.] The report notes:

The rate of domestic violence is higher in military couples than in civilian couples. Marshall et al. (2005) reported that wives of Army servicemen reported significantly higher rates of husband-to-wife violence than demographically matched civilian wives. Although it has bee nreported that spousal abuse has declined over the last few years, domestic violence still affects 20% of military couples in which the service member has been deployed for at least 6 months (Booth et al., 2007).

On the topic of families:

The conflicts in Iraq and Afghanistan have taken a toll on the children of US troops deployed there. Children of US troops deployed to Iraq and Afghanistan reportedly sought outpatient mental health services 2 million times in 2008 (Andrews et al, 2008). Impatient visits by military children have increased by 50% since 2003. Additionally, an increase in the rate of child maltreatment has been reported since the start of the conflict. Rentz et al (2007) conducted a time-series analysis from 2000 to 2003 to investigate the effect of deployment on the occurrence of child maltreatment in military and nonmilitary families. They reported a statisically significant two-fold increase in substantial maltreatment in military families in the 1-year period after Septemeber 11, 2001, compared with the period before then. A recent study of over 1,700 military families (Gibbs et al, 2007) found that the overall rate of child maltreatment, especially child neglect, was higher when the soldier-parents were deployed than when theyw ere not deployed. Because of the demographics of those who are serving in Iraq and Afghanistan (older service members who are married and have children), the number of children who have been affected by these conflicts is clearly larger than in past conflicts.

Julie Sullivan (Oregonian) examines the report with a focus on Oregon service members, "Nearly 51 percent of the returning soldiers told commanders they have no job waiting. More than 170 have no permanent address. And, an exhaustive new national report finds that the most challenging transition for their families will come after they arrive." Gregg Zoroya (USA Today) boils the report down to the VA "has no way of determining long-range health care costs for the veterans of the war in Iraq and Afghanistan".

Monday's snapshot covered the Commission on Wartime Conracting in Iraq and Afghanistan in DC which heard about abuses and problems to do with KBR and also heard from KBR. Kat covered the hearing in "Commission on Wartime Contracting," Ava covered it at Trina's site with "Fraud and waste" and Wally covered it at Rebecca's site with "The arrogance and waste of KBR." The Commission's attention isn't the only negative attention KBR is receiving this week. The US Justice Dept issued the following today:

WASHINGTON -- The United States has filed a lawsuit against Kellogg Brown & Root Services (KBR) alleging that the defense contractor violated the False Claims Act, the Justice Department announced today. The suit, filed in U.S. District Court in Washington, alleges that KBR knowingly included impermissible costs for private armed security in billings to the Army under the Logistics Civil Augmentation Program (LOGCAP) III contract. The LOGCAP III contract provides for civilian contractor logistical support, such as food services, transportation, laundry and mail, for military operations in Iraq.
The government's lawsuit alleges that some 33 KBR subcontractors, as well as the company itself, used private armed security at various times during the 2003-2006 time period. KBR allegedly violated the LOGCAP III contract by failing to obtain Army authorization for arming subcontractors and by allowing the use of private security contractors who were not registered with the Iraqi Ministry of the Interior. The subcontractors using private security are alleged to have also violated subcontract terms requiring travel only in military convoys. The government's lawsuit further alleges that at the time, KBR managers considered the use of private security unacceptable and were concerned that the Army would disallow any costs for such services. KBR nonetheless charged the United States for the costs of the unauthorized services.
"Defense contractors cannot ignore their contractual obligations to the military and pass along improper charges to the United States," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "We are committed to ensuring that the Department of Defense's rules are enforced and that funds so vital to the war effort are not misused."
This case is being brought as part of a National Procurement Fraud Initiative. In October 2006, the Deputy Attorney General announced the formation of a National Procurement Fraud Task Force designed to promote the early detection, identification, prevention and prosecution of procurement fraud associated with the increase in government contracting activity for national security and other government programs. The Procurement Fraud Task Force is chaired by the Assistant Attorney General for the Criminal Division and includes the Civil Division, U.S. Attorneys' Offices, the FBI, the U.S. Inspectors General community, and a number of other federal law enforcement agencies.
Along with the Justice Department's Civil Division, the Defense Criminal Investigative Service, Army Criminal Investigation Division and FBI participated in the investigation of this matter. This case, as well as others brought by members of the task force, demonstrates the Department of Justice's commitment to helping ensure the integrity of the government procurement process.

NOW on PBS begins airing on most PBS stations Friday night (check local listings) and this week's program:The number of inmates in American prisons is outpacing the system's ability to hold them all. In one startling example, California prisons hold well over 50,000 more inmates than they're designed for, even though the state has built a dozen new prisons in the last 15 years. One of the biggest reasons is rampant recidivism. On Friday, April 2 at 8:30 pm (check local listings), NOW goes inside an Illinois prison that may have the answer to California's problems. With its innovative plan to keep released inmates from coming back, the Sheridan Correctional Center is trying to redefine "tough on crime" by being the largest fully dedicated drug prison in the country. The approach involves aggressive counseling, job training, and following the convicts after they get out. Can their novel approach keep convicts out of jail for good?

And we'll close with this from Tom Over (OpEd News) report on the activities of World Can't Wait and speaks with Debra Sweet, national director of World Can't Wait:Sweet said that during the Bush presidency, protests against the wars in Afghanistan and Iraq had a lot more people participating. "A Presidential candidate and then a president was brought forward who represented on the surface something very different. This was change we were supposed to believe in and huge numbers of people, including anti-war leaders, put all their energy into electing Obama, regardless of the fact that he was promising to expand the war in Afghanistan," Sweet said. Perhaps interestingly, as Sweet and I spoke, Public Enemy's "Don't Believe The Hype" played on the PA system. Also interesting was that Sweet uttered a combination of words-- 'hoodwinked and bamboozled ' -- Malcolm X used to famous effect, which was made more famous by way of Spike Lee's film about the civil rights leader. "A lot of people have been hoodwinked and bamboozled. Many of us weren't, but we need to be all that much more visible and protesting now, because even more than ever, we need a movement that says 'no' to this whole package of continuing the Bush direction," Sweet said.

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