Combat-related Traumatic Brain Injuries & Cognitive Disorders-Responding to Our Veterans Needs: Response by Jeremy Bourrét
Some have argued that it is very important for many reasons that our country, including new and future counselors, learn the most important and germane lessons from Vietnam (The Conversation.com, 2012). For counselors, it is important to know that PTSD was diagnosed too late for Vietnam Veterans so many who could have received the necessary care and treatment that they deserved. Also, Traumatic Brain Injuries occurred in Vietnam; but, how many Vietnam War Veterans were never diagnosed, misdiagnosed, or diagnosed and treated too late? So, the question is: have we learned anything about mental health and disorders that can also now affect our Iraq and Afghanistan Veterans?
If traumatic brain injuries can be related to dementia (Butcher, Mineka, & Hooley, 2012; Comber, 2010), which the American Psychiatric Association (2000) has acknowledged, some important questions should be asked. For instance, in both the civilian and in the Veteran populations, how are traumatic brain injuries assessed; what criteria are used? First a myth or misunderstanding needs to be addressed:
“Many patients and clinicians assume that the terms mild, moderate and severe TBI refer to the severity of symptoms associated with the injury. In fact these terms refer to the nature of the injury itself… Moderate traumatic brain injuries entail loss of consciousness > 30 minutes, post-traumatic amnesia > 24 hours, and an initial GCS 9-12. Severe brain injuries entail all of the moderate criteria listed above, but with a GCS < 9. [Regarding civilians who not Veterans] …about 80% of all TBI’s in the civilian population are mild traumatic brain injuries (mTBI)… However, some 10-15% of patients may go on to develop chronic post-concussive symptoms. These symptoms can be grouped into three categories: somatic (headache, tinnitus, insomnia, etc.), cognitive (memory, attention and concentration difficulties…” (n.p.).
This can, then, sometimes lead to a person eventually developing any
of some of the various types of Cognitive Disorders (American Psychiatric Association, 2000, Comber, 2010). Also, Summerall (2011), one of the Veterans Administration/Department of Defense’s sources, who has written about TBI’s, has noted about the nature of more intense traumas and injuries which civilians are less likely to experience than combat-Veterans; also, the diagnostic and treatment needs of those with serious TBI’s, like combat-Veterans, are complex:
“Moderate and Severe TBI Patients with moderate and severe brain injuries often have focal deficits and occasionally profound brain damage. … The diagnosis of TBI, associated post-concussive symptoms and other comorbidities such as PTSD, presents unique challenges for diagnosticians” (Summerall, 2011, n.p.).
It has been recommended by the Veterans Administration’s guidelines (Summerall, 2011) that additional factors should be taken into consideration by diagnosticians of various professions, including psychologists, counselors, neurologists, and psychiatrists:
“…Another factor is that these injuries can occur in chaotic circumstances, such as combat, and may be ignored in the heat of events. Clinicians may be presented with vague concerns and little relevant detail about the original injury; whenever possible, clinicians and patients should attempt to obtain supporting documentation. At minimum clinicians should elicit as detailed an injury history as possible. Once the injury history has been established, the patient’s course of recovery and remaining post-concussive symptoms should be documented. [And, given the complexity of diagnosing a poly-trauma client accurately] because of the considerable symptom overlap between post-concussive symptoms and symptoms of many psychiatric and neurologic disorders, this process can be challenging” (Summerall, 2011, n.p.).
It is true that family involvement (e.g., social supportiveness) is extremely necessary to help the poly-trauma patient to begin the process of recovery or the person to begin dealing with the traumas or for a partial recovery that may sometimes be possible with effort and encouragement as well as medical treatment, a team approach:
“Education for the patient and family early in the course of recovery can improve outcomes in patients with TBI and help to prevent the development of other psychological problems. Unfortunately… many patients and their families do not receive education early in the course of illness and may require intervention after symptoms have become well established. Currently, the VA encourages a recovery message when prognosis is discussed, and inclusion of the family in treatment planning” (Summerall, 2011, n.p.).
It is wise advice for treatment providers of returning Veterans and for the civilian population, as well, for providers to be careful in noting and documenting recent or past head traumas (Summerall, 2011). According to Summerall (2011) is an unfortunate fact that for injured Veterans including those who have recently returned from serving their country in combat in Iraq or Afghanistan or will be returning soon and need to seek out treatment by counselors and other professionals:
“…TBI of any severity can disrupt families, in no small part because of family members’ changing roles in response to the patient’s difficulties, even if these problems ultimately improve. Immediate family involvement and education about the course of illness is crucial, and ongoing attention should be paid to family needs as time passes. Supporting families can improve outcomes by ensuring that the patient’s recovery is not hampered by a deteriorating family situation. Many providers will not have the time or expertise to include families in all phases of treatment; again, clinicians should not hesitate to seek out available expertise and support groups early in the course of illness” (n.p.).
Last, for our country’s Veterans who had served their country but ultimately were injured by PTSD, TBI’s, and other polytrauma syndromes (and, in some cases, from Agent Orange or Gulf War Syndrome) who served in Iraq, Afghanistan and the baby-boomers who served in Vietnam, we should answer this question: What can we do for all Veterans as future counselors? That is the question as counselors, I believe, we need to raise.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (IV-TR). Washington, DC: Author.
Butcher, J., Mineka, S., & Hooley, J. (2012). Abnormal psychology (14th ed.). Boston, MA: Pearson.
Comber, R. (2010). Abnormal psychology. New York, NY: Worth.
Summerall, E. (2011). Traumatic Brain Injury and PTSD. [Veterans Administration/Department of Defense Website] Retrieved from: www.ptsd.va.gov/professional/pages/traumatic-brain-injury-ptsd.asp
The Conversation.com (2012). Vietnam and Iraq lessons to be learned about mental health and war. Retrieved from: http://theconversation.com/vietnam-and-iraq-lessons-to-be-learned-about-mental-health-and-war-6661
Mike, now go to this great article:
Anyone remember the “Spirit of 106″? Hard to imagine that 1987 is so close but so far away. Nam Vets used to come out by the thousands. I am just now looking at some pictures from the glory days at Reid Park, where there were just over 15,000 in attendance. It can be done again.
So head out to Rillito and bring 100o of your closest friends and help keep Nam Jam as one of Tucson’s most significant cultural events. Attending this event can be your own way of joining in the National Commemoration of the 50th Anniversary of the Vietnam War.
There are times when I think that Nam Jam could be a Southwestern Event. Chapter 106 does have the legal rights to the name. I say, go big!
Home Application for Membership Mission Statement Contact Us
Vietnam Veterans of America, Inc.
Tucson Chapter 106
Contact Jammin’ for Vets Director Steven Kreamer 520-339-3493 or email: firstname.lastname@example.org
Donations are accepted or cans of non-perishable food.
All your gifts will be appreciated.
All donations will benefit transitional homeless Veterans shelters,
their families, many Veteran programs and the community.
**Please be advised that all backpacks, handbags, key chains and closed containers will be inspected by the EVENT’S SECURITY FORCE.
There will be no carry-in of alcohol, illicit drugs or weapons of any type permitted at this event.
THANK YOU FOR YOUR COOPERATION
Email for Jammin’ For Vets Information
Be assured this one will be the buzz in cyberspace. With closer examination I am sure the critics will view this as a two edged sword, as it will also be used to deny benefits. As an infant, if you jumped out of your crib you therefore have a pre-existing condition! Have it readers.
The Pentagon has changed its physical disability policy to include chronic adjustment disorder as a condition potentially eligible for disability compensation.
The Defense Department amended DoD Instruction 1332.38 in April to name chronic adjustment disorder as incompatible with military service, but possibly service-related and therefore eligible for disability compensation.
The change is notable because thousands of service members have been discharged for adjustment disorder, which had been previously characterized as a condition present before troops joined the military, and therefore ineligible for compensation or mental health treatment.
A Defense Department spokeswoman said the change was made to bring the policy in line with the Veterans Affairs Department’s schedule of rating of disabilities.
Critics have charged that the military services used the diagnosis of adjustment disorder in lieu of post-traumatic stress disorder to avoid paying benefits to troops who could no longer serve.
In 2006, 1,453 troops were discharged for adjustment disorder from the services. That figure rose to 3,844 in 2009. In the Army alone, 6,492 soldiers were discharged for adjustment disorders between 2008 and 2010, according to figures obtained by the Vietnam Veterans of America and Yale Law School’s Veterans Legal Services Clinic.
Lawmakers have pressed the Defense Department to examine the more than 31,000 discharges since 2001 for adjustment disorders and personality disorders, another group of mental health conditions considered to presage military service.
Efforts have been made to review at least some of the cases. Last June, then Defense Secretary Leon Panetta ordered the review of thousands of military mental health discharges for those whose diagnoses were changed to a non-compensable condition like adjustment or personality disorders during a medical evaluation board.
In August, the Pentagon’s top doctor issued a memo stipulating that an adjustment disorder diagnosis should not be given if a more specific disorder, like PTSD or personality disorder, also could explain the symptoms.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, said separation for adjustment disorder for those who have deployed to a combat zone requires additional screening.
The diagnosis “requires an evaluation for PTSD, must be corroborated by a peer or higher level mental health professional and endorsed by the surgeon general of the military department concerned,” Woodson wrote.
In March, Rep. Tim Walz, D-Minn., introduced a bill that would have required the Pentagon to review all of the discharges for personality or adjustment disorders since Sept. 11, 2001. That legislation has not moved, but the fiscal 2014 defense authorization bill calls for the Government Accountability Office to evaluate the use of personality and adjustment disorder discharges by the services since Jan. 1, 2007.
Both Iraq and Afghanistan Veterans of America and the Wounded Warrior Project have pressed Congress to pressure the Pentagon to review the thousands of discharges of personnel for personality or adjustment disorders.
Women’s groups like Equality Now and the Service Women’s Action Network also have charged that the two diagnoses are being misused to discharge sexual assault victims.
A Pentagon spokeswoman, Army Lt. Col. Catherine Wilkinson, did not disclose how many troops have been or would be affected by the change.
She added that the military services initially thought there would be “thousands of cases.” But a DoD review of the criteria necessary to determine a diagnosis of chronic adjustment disorder showed the standards the services used to for their estimates were only a small part of the overall requirements needed to determine a legitimate diagnosis, Wilkinson said.■
Compliments of Catholic War Veterans.
This Saturday from 7:00pm to 9:00pm at the Arizona Military Museum at 5600 East McDowell (Papago Park Military Reservation)—Vietnam Veteran Art Exhibition. Art related to Vietnam and the war presented by artists who are veterans of the Vietnam War. It is special; it is unusual; and there are some really interesting and well-done works of art. Free admission. Free beverages and “eats”—and fine art for one to consider. Buy some art and 70% goes to the artists and 30% goes to the museum. The artists will be present. Even if you don’t want to buy art—come and see it. Try it—you’ll like it!
As a result of the number of 100% Permanent and Total ratings there are occuring,I am frequently asked about an earnings cap. Here is the simple answer.
Can I Work?
Veterans who are in receipt of Individual Unemployability benefits may work as long as it is not considered substantially gainful employment. The employment must be considered marginal employment.
- Substantially gainful employment is defined as employment at which non-disabled individuals earn their livelihood with earnings comparable to the particular occupation in the community where the veteran resides.
- Marginal employment is generally deemed to exist when a veteran’s earned income does not exceed the amount established by the U.S. Census Bureau as the poverty level for the veteran only. For more information on the U.S. Census Bureau’s poverty thresholds, see http://www.census.gov/hhe…ut/overview/measure.html
It is rare opportunity to be able to congregate with the very people for whom we fought in Vietnam. The ARVN soldier was of many ilks. General Dao was a Ranger and one of the most dedicated of all soldiers. The Rangers and the Vietnamese Marines were well trained and could be trusted to complete their missions. They are also the ones who continued fighting the Communists forces after we pulled out. We promised them supplies and bullets in 1973-73. Yet the new Congress in 1974 cut off all aid of any kind, resulting in an onslaught of boat people, many of whom reside in Tucson to this day. General Dao was in a re-education camp for 17 years.
Catholic warriors that we are, the swapping of rosaries was a bit tearful. Now we swap oil exploration technology of the South China sea.
I always knew that war was not for rice! It is no wonder China, Russia, France and yes Japan are all showing interest in Vietnam’s oil. So it is not over yet.
REMEMBRANCE ABOUT THE VIETNAM WAR
By: ARVN Major General Le Minh Dao (Ret.)
General Anthony Zinni,
Ladies and Gentlemen:
First and foremost, I would like to thank the Organizing Committee for this event for giving me the opportunity to return to this great state of ARIZONA, and most importantly for allowing me to meet the Veterans of the Viet Nam War and my fellow Vietnamese soldiers of the ARVN: I always respect and appreciate all of you.
The great President Ronald Reagan, who forced the Soviet Unions to abandon the arms race, brought down the Berlin Wall and ended the Cold War at the bargaining table and not on the battlefields, had this to say about the Viet Nam War:
“The Viet Nam War was not so much a war as it was one long battle in an ongoing war, the war in defense of the freedom which is still under assault. This battle was lost not by those brave American and South Vietnamese troops who were waging it, but by political misjudgments and strategic failures at the highest levels of Government”.
I value and agree wholeheartedly with Col. (ret.) Joseph E. Abodeely on his remark on Vietnam:
“Viet Nam veterans were treated like war criminals and made “scapegoats” when they returned home after risking life and limb and psyche for their country. The media and Congress contributed greatly to this, but they have never admitted their guilt and have never treated the Vietnam veterans as the heroes they really were. Instead, they made “heroes” out of the victims of the war such as draft dodgers and anti-war protestors”…
During my 22 years serving in the ARMY, I had many opportunities to fight alongside the American troops, in the 3rd and 4th Tactical Zones, and I had witnessed the bravery of the American Troops. They fought like lions and they died like medieval warriors. At their return to the rear base, to continue with their civic duties in the pacification tasks, in various Rural Development Programs, the American troops had accomplished above and beyond the regular soldier’s mission. The American Troops were the ambassadors of Peace, of Love and of Humanity. They had won the heart and mind of the People. The People of South Viet Nam are forever grateful to the American soldiers, who embody the Values of a True American.
I would like to mention a very important point that we want to remember: The American Soldier had won all the battles in the Viet Nam War!
During the Anti-War period happening under Nixon’s presidency, the media had poisoned public opinion with these defeating slogans of “Bring Our Troops Home”
When the U.S. soldiers came home from the War they were treated unfairly: they were insulted, ignored, and they never had a welcome home parade!
But the Veterans of the Viet Nam War had suffered through all this with great DIGNITY.
For the Vietnam Veterans, some had continued their military careers, becoming Leaders in their fields, some had risen to be valued Officers, Generals! Some had retired from their military careers, and started new careers in Politics, becoming Leaders in the Administrative, Legislative and Judicial branches. The American Viet Nam Veterans are contributing to this country tremendously.
We shouldn’t forget the Veterans of the Viet Nam War who were traumatized by their experience in that far away land: they couldn’t adjust to this “new country” that had sent them there by the draft system, and had rejected them after they accomplished their duties…
These Veterans had faded from the News. They suffered in silence, losing their spouses, their families, their childhood friends that they had left to go to war. They became homeless or just were forgotten! NOW is the time to recognize the True Value of the Veterans of the Viet Nam. It’s better late than never to request the American people to show their appreciation of the sacrifice of the Vietnam Veterans.
They are our true Heroes!
About the Soldiers of the Republic of Viet Nam
The majority of them are farmers, honest laborers in an underdeveloped country. Even though these soldiers are poor in material things, they are rich in their LOVE of the Motherland. They fought against the Communist aggressors from the day the Communist Movement had taken hold of North Viet Nam in 1945 until the whole country was invaded by the Communists in 1975.
Until the American and Allied troops came to Viet Nam they had fought side by side with the ARVN.
The ARVN usually went to battles with a half full stomach. Their sacrifices were enormous: around 270,000 soldiers were killed; more than 700,000 were wounded, in a country with 21 million people during that period.
Just as the American soldiers, the Vietnamese soldiers didn’t lose any battle.
When the Paris Accord was signed in 1973, very swiftly, to allow the American troops to withdraw from Viet Nam and to bring the P.O.W.’s home, the Communists from the North had still remained in the South. Then the U.S. Congress had voted to end any kind of AID to Vietnam, they had signed the DEATH Penalty to Viet Nam.
The Vietnamese Soldiers had continued to fight to the very end, up to April 30, 1975. With the collapse of South Viet Nam, the whole country fell in complete darkness.
The ARVN were punished severely in the so-called Reeducation Camps.
President Ronal Reagan remarked:
“…Ending a conflict is not so simple, not just calling it off and coming home, because the price for that kind of Peace could be a thousand years of darkness for generation’s Viet Nam born”
Ladies and Gentlemen:
I came to the U.S.A. to re-unify with my family on April 1993, after suffering for 17 years of extreme revenge in the hands of Communists from North Viet Nam!
At Dulles Airport, VA, a female news anchor asked me about my impression when coming to America. I answered right away “I just escaped from Hell on Earth and reached Heaven on Earth”
Three weeks after that, I went to visit the Viet Nam War Memorial at Washington, D.C. I strolled around the Black Wall for many hours, the Wall that commemorated over 58,000 Fallen Heroes of USA. I remembered their bravery during their fights for my beloved country. I remembered these P.O.W.’s and M.I.A’s still in Viet Nam, without a chance to come home…
I stood in front of Col Jack Taylor Demsey who was killed in 1967, and Captain Lyell Francis King, killed in 1966. They were my comrades-in-arms at the 4th Tactical Zone and I whispered:
” I will never forget you, my friends. Viet Nam will always remember and admire you”. Saying those words, tears streamed down my face.
Peace be with you all. God bless our great nation, the United States of America.