Posted By Thomas E. Ricks Share

By Matthew Collins
Best Defense gender relations correspondent.

On Jan. 10, the Veteran Administration released a report on veteran mental health that concluded that that women were more likely to have their PTSD claims denied than their male counterparts.

This was a landmark day for veterans groups. American Women Veterans and other organizations had been asking for this kind of study for years. VA officials initially put too much emphasis on combat awards, for which many women are ineligible. As Senator Mark Warner, who asked for the VA study, said in a letter to General Shinseki, "The difficulty with these guidelines is that the standards for these decorations vary from service to service and in some cases, unit to unit."

Thankfully, the VA has changed the policy. Now the presumption is that a female interpreter who is attached to a combat unit is exposed to the same hazards and trauma as her male counterparts. Women who had their PTSD claims denied under the old policy will now be able to reapply for benefits. Thousands of women who were initially denied PTSD treatment could now be eligible for VA care.

This announcement came in the same week that a study released by the Military Leadership Diversity Commission recommended dropping the ban on women serving in combat units, sparking of a renewed debate about women in combat. AWV founder Genevieve Chase has called the existing ban largely a matter of semantics. "Commanders have gotten around the policy for years by 'attaching' women to units they cannot be directly assigned to." On Jan. 12, Sgt Zainah Creamer, a female dog handler working with the 502nd Infantry Brigade, was killed in Afghanistan.

Reasonable people may disagree about what roles women should fill in the military. American Women Veterans would like to see the existing policy rewritten to more accurately reflect what women are now doing in Iraq and Afghanistan. A rewritten policy might prevent problems like the VA's old PTSD guidelines. General Casey, Army Chief of Staff, has been hinting about a revision to the existing policy for months.

Whatever comes of the debate, one thing is certain. The enemy will get the final vote.

Matthew Collins is a graduate of the US Naval Academy and spent ten years as a Marine officer. He is a veteran advocate with American Women Veterans.

Insidenova.com

 

HUNTER

3:08 PM ET

January 27, 2011

Man, the semantic hoops troops have to jump through

I've never been one to believe that the VA is the dark empire that it is often touted as. Indeed my experience there has been good, if not great - with full recognition as an O-5 I might be accorded better service than most.

But when I see stuff like this I am just dumbfounded. These aren't sudden epiphanies. These women didn't just start serving in these combat areas yesterday. Neverminding the history preceding, these wars have been going on for 10 years now.

Can we really not figure out that because the soldier isn't wearing a CIB that they don't deserve specific care? That's f*&^ing ludicrous, and I might add just another great justification for getting rid of those stupid little bright baubles [Full disclosure: I don't have a CIB/CAB/CFMB, yippiekayah; but I did log about 18000 miles in Iraq so I might have been stressed about it]

This stuff is just crazy, stupid. AAAARRGGHH. (I'm getting PTSD just thinking about it).

Addendum worth mentioning. I've said it before and I'll say it again. My unit had females in harms' way (one was a HMMWV gunner) they did a great job and I was very proud of them.

 

JPWREL

3:49 PM ET

January 27, 2011

Hunter is right on the mark

Hunter is right on the mark with his outrage particularly about women getting short shrift. My guess is that all the services consider PTSD in the same way private sector insurance companies think of mental illness and that is a condition difficult to diagnose and treat, thus an open ended financial commitment. Gates in the past few years has been wailing about the DOD becoming inundated with healthcare costs more than any other single item and consequently affecting its ability to fund both procurement and operations. It’s not hard to imagination that the services have received that message.

I see a lot of political types out there clamoring for more defense money for sexy weapons projects that employ people in their districts and this is usually irrespective of need or cost. But I don’t see the Lindsay Graham’s or John McCain’s screaming about more money to fix the casualties produced by the wars they champion? If you want to have wars then you are going to break people and their care is far more important than a second engine for the JSF.

 

HUNTER

4:38 PM ET

January 27, 2011

JPWREL I am glad you said that

Because you gave me an excuse to post this offtopic comment:

Remember all the ire I raised when I suggested that the death of the EFV might result in the death of the Marine Corps? Here's a little new story about the EFV - big ticket item. And you guys just thought it was me talking smack.

MARINE CORPS TO SECRETARY GATES: ‘WE’RE RELEVANT’ - The Marine Corps is at a crossroads.
The "Soldiers of the Sea" have been fighting on land for a decade in Iraq and Afghanistan. The Corps' amphibious troop carrier has just been canceled; its new fighter jet was postponed.
And the Marine Corps itself is finishing up its own review, asking this basic question: What should the Marine Corps look like in the 21st Century?
No More Landing On Enemy Beaches
The Marine Corps has made a name for itself storming beaches: Barbary Coast and Veracruz, Iwo Jima and Inchon.
"For many years now, its core mission has been forcible entry, meaning going ashore in the face of hostile fire to claim enemy beaches and then push inland quickly before defenders regain their balance," says defense analyst Loren Thompson. He says those days may be over.
That's because Defense Secretary Robert Gates has done something that pirates in the 19th century and Japanese troops in World War II couldn't do — he has the Marine Corps reeling.
If the Marine Corps is no longer going to do opposed landing on enemy beaches in the face of hostile fire, then its role will be significantly diminished in the future. (Source: NPR)

 

GOLD STAR FATHER

5:03 PM ET

January 27, 2011

EFV

Is this the same Loren B. Thompson, PhD that stated on 12/15/2010:

"However, the Marine vehicle is a good example of what's wrong with the commission's list of "illustrative" weapons cuts, because killing a program isn't the same thing as killing a requirement. The Marines will still need to get from ship to shore, and it's getting awfully hard to do that in the slow, antiquated amphibious vehicles the service operates today. That means that if EFV goes away, the Corps will have to spend a lot of money on other approaches to meeting the military requirement -- first by upgrading legacy vehicles, then by developing new ones. So killing the EFV won't save the government much money, and quite likely will cost the Marine Corps many lives. "

Lexington Institute
'Deficit Commission Ideas Would Waste Money, Not Save It'
Author:Loren B. Thomson PhD

 

JPWREL

8:15 PM ET

January 27, 2011

"...Secretary of the Navy

"...Secretary of the Navy James Forrestal, who was inspecting Green Beach on Iwo Jima that morning in 1945, saw the Stars and Stripes go up atop Mount Suribachi and heard the beleaguered troops below come alive with whistles and cheers and shouts of joy. He turned to Marine General Holland M. Smith and said, 'The raising of that flag on Suribachi means a Marine Corps for the next five hundred years!”

Hunter the American people (and Congress) express a deep and abiding reverence for the United States Marine Corps more than any other of our nations armed forces. It’s reputation; its legends and its myths have created an image in the minds of Americans that compares with nothing else in our armed forces. When there is trouble abroad its ‘Send the Marines’. Yeah, I understand the Army resents the hell out of this but it is what it is.

 

HUNTER

9:17 PM ET

January 27, 2011

Pleez

JPWREL. We already covered the resentment piece...I don't have any. Not a stitch, for the Navy maybe, but not the Marines, got plenty of Marine buddies. Just using logic. But I do think you have a way too high opinion of the USMC and the American public's reaction to it as well. Most Americans don't care enough to care about your precious Corps.

All I was doing was reiterating a point I made a few weeks ago with the support of people who get paid lots more than I do to make that point. As for the other post, I don't think there was any cognitive dissonance between what Thompson said then and now. What did I miss?

Closer back on topic, you made mention of sacrificing personnel and personnel issues to big ticket expensive weapons programs. So which is more important, keeping a relevant Marine Corps by supplying them with a viable "from the Sea" platform? Or caring for the damaged Marines (and other servicemembers) of these wars? I think it clear that in the future that may be a real choice that someone will have to make. May not be the only options out there, but things are looking increasingly grim...so my Hobson's choice my be more accurate than any of us want it to be.

 

JPWREL

11:15 PM ET

January 27, 2011

Hunter asks, “So which is

Hunter asks, “So which is more important, keeping a relevant Marine Corps by supplying them with a viable "from the Sea" platform? Or caring for the damaged Marines (and other service members) of these wars?”

You seem to be posing a Hobson’s choice. Your statement suggests a choice between the future existence of the USMC or funding the proper care of the damaged people of our armed forces. I reject that choice and say we are going to need to take care of both our casualties and preserve the USMC.

Now if you are suggesting that the Marines should be smaller, lighter, faster and logistically more durable then I am in total agreement. This country has no need for two army’s and three air forces. Personally, I would reassign all Marine fixed wing aviation to the U.S. Navy and consolidate all the armed services ‘special operations forces’ under the USMC banner. The Marines need to be brought back to their core mission of forced entry from the air and sea. The dollars saved from relinquishing aviation would fund needed amphibious lift modernization and a ship to shore combat platform that is actually affordable and tactically viable.

If Tier 1 and 2 SOCOM units cannot be brought into the Corps then they should be separated and set up as an independent service with its own funding. In fact I think that happening in the next twenty years is highly probable as much of the business of the conventional Navy, Marines and Army is concentrated in highly professional SOCOM forces whose missions are more discreet and technically complex and do not require massive weight.

 

HUNTER

3:10 PM ET

January 28, 2011

Hobson's choice

Well I stated as much in my second post, I called it out as a Hobson's choice. So other than me poking a stick at your beloved service we seem to be in total agreement. Marines need to get back to their core Corps purpose. EFV or something like it is probably necessary. I like your other recommendations...no issues.

 

GOLD STAR FATHER

3:55 PM ET

January 27, 2011

Hold on a minute

First off, there is no "Veterans Administration" anymore. It went away at the end of the Reagan Administration. The organization, still known as the "VA", is actually the Department of Veterans Affairs. The Department is made up of sub-administrations: health, benefits, and cemeteries. It is a presidental cabinet position. The big guy, GEN Eric Shinseki, is known now-a-days as Secretary Shinseki.
In regards to this alleged injustice to female veterans, the adjudicators at the VA assign service-connected disabilities by the diagnosed illness. And as the report (linked above) states, female veterans are more apt to be given a diagnostic code for depression, vice PTSD. This diagnosis is a function of a medical professiona. Not necessarily so for depression, but under the recent rule changes regarding PTSD, PTSD must be diagnosed by a VA, or VA contracted, doctor. The element of the stressor incident that triggers the PTSD in a patient, has been loosened. None of this really goes back to gender bias or targeting. And, as the report states, the same rating scale--the severity symptoms description--is the same for depression as it is for PTSD. a 30% service connected (SC) veteran with depression gets the same monthly award as a 30% SC veteran with PTSD and both are afforded free VA care for their respective disabilities.
Far too many advocates and veterans (and sadly veterans organizations) get locked into the must-have PTSD diagnosis. That is assigned by the medical professional, not the veteran-patient, an organization, the VBA (Veterans Benefits Administration) or advocates.

 

HUNTER

4:45 PM ET

January 27, 2011

Notgonna argue with GSF

GSF I know this is your territory so I dare not assault a high ground position with superior fields of fire...but if you had PTSD and someone diagnosed you with depression...wouldn't that make you sad/mad?

While I am sure there are plenty of servicemembers who want to get some money for their trouble, I'm guessing most just want to get better. Proper diagnosis is the first step there...is it not?

Now changing tactics...wouldn't it be nice if we prepared our soldiers ahead of time to prevent PTSD and/or depression? Wow, that would be cool. Sadly the current Resiliency training doesn't meet the requirement.

 

GOLD STAR FATHER

5:12 PM ET

January 27, 2011

You answered your own question

"Proper diagnosis". If you "had" PTSD, and you went to see the wizard and he/she diagnosed you with something else, say "depression", then you have depression, not PTSD.
The symptoms of the various mental health illnesses are very similar and overlapping. It takes a professional to make the diagnosis. There seems to be a red badge of courage with PTSD, as if it is the combat that explains a post-deployment behaviour. Conversely, "depression" stinks of a stigma of weakness. None of this should be this way, both are resultant from (or can be) a traumatic experience. And again, the VA rating schedule is the same for both diagnastic codes.
This is not a gender thing. And its apples and oranges with the issue of females in combat arms.

 

KC999

5:47 PM ET

January 27, 2011

more hazards then just combat

The changes described are laudable. However, PTSD is caused by factors other than just combat hazards. The statistics are clear women serving with the military (with a combat unit or not) face the threat of sexual assault. Sexual assault is a significant trauma and can lead to PTSD.

 

GOLD STAR FATHER

6:03 PM ET

January 27, 2011

MST

Men face sexual trauma as well in numbers that would absolutely surprise you. Not all are diagnosed with PTSD; many receive depression diagnoses. Worse, if you will, their reactions to the MST result in bogus personality disorder diagnoses which is not compensible by the VA. Women get personality disorder diagnoses too, many undeserved.
Wanna guess why the VA claims and appeals backlog exists?

 

OTHER RANKS

11:33 PM ET

January 27, 2011

How timely

In other VA news, today was the last day for the first group of OEF/OIF and post-1998 combat theater veterans to enroll automatically in VA health care without a service connected ailment.

 

RBB

11:07 AM ET

January 31, 2011

GSF makes good points

There is significant hazard in lumping all service related behavioral health issues under the rubric of PTSD.

And I agree with him that that is where we are headed because (ironically) PTSD is now becoming respectable -- a "red badge of courage" to prove you were "in it." Even though "it" may have been a historically low bar of stress.

There are a lot of sources of deployment stress, and different soldiers have different capabilities to deal with them:

- routine, violent action
- the stress of steady, low-grade dread from present, but unlikely personal danger
- individual trauma from sexual assault, or solider abuse
- personal life, including separation anxiety, family/marriage, relationships, money, debt, etc.

And there are lots of overlap, to be sure.

Conflating the symptoms and treatment (and disability assessments) of the kids involved in the wide range of deployment related stress is a huge mistake, and is going to open the door to benefit abuse like we've never seen.

I don't think we should design a system where a young man melts down after his wife leaves during his deployment -- and receives a lifetime of PTSD disability comparable to the kid who lost his leg.

Behavior health treatment, sure -- but not disability. And that is where we are headed.

 

GOLD STAR FATHER

9:38 PM ET

January 31, 2011

Right on.

Right on.

 

Thomas E. Ricks covered the U.S. military for the Washington Post from 2000 through 2008.

Read More