VIETNAM VETERANS AND PTSD

FROM:  U.S. DEPARTMENT OF VETERANS AFFAIRS
PTSD and Vietnam Veterans: A Lasting Issue 40 Years Later -

Post-traumatic stress disorder (PTSD) is defined as having flashbacks, upsetting memories, and anxiety following a traumatic event. It was first officially recognized as a mental health condition in 1980, only five years after the end of the Vietnam War. For hundreds of years, these symptoms have been described under different names in soldiers from many wars. However, Vietnam Veterans with these symptoms were the first to have the term ‘PTSD’ applied to them. Despite the passage of 50 years since the war, for some Vietnam Veterans, PTSD remains a chronic reality of everyday life. In 1983, Congress requested that VA conduct a study on the prevalence of PTSD and other postwar psychological problems among Vietnam Veterans. This was the first study to evaluate the prevalence of PTSD among Veterans, and became known as the National Vietnam Veterans Readjustment Study (NVVRS). The NVVRS brought greater attention to the issue of PTSD as it found that as many as 15 percent of Veterans had PTSD.

FIRST INTREPID SPIRIT CENTER OPENS FOR TREATMENT OF TBI AND PTS

FROM:  U.S. DEFENSE DEPARTMENT
First of 9 'Intrepid Spirit' Centers Opens at Fort Belvoir
By J.D. Leipold
Army News Service

FORT BELVOIR, Va., Sept. 12, 2013 - Since the 9/11 terrorist attacks 12 years ago, more than 2.5 million U.S. troops have deployed to Iraq and Afghanistan, and over that same period, more than 260,000 service members have been diagnosed with the invisible wounds of traumatic brain injury and post-traumatic stress as a result of combat-related injuries and accidents
To treat and care for those service members suffering from the most severe forms of traumatic brain injury, known as TBI, and post-traumatic stress, or PTS, the first of nine Intrepid Spirit Centers planned nationwide officially opened its doors here yesterday in a dedication ceremony sponsored by the Intrepid Fallen Heroes Fund, a $100-million campaign funded entirely with donations from public and private sources.
The center has actually been operating for two months and has treated some 80 patients thus far, said Martin Edelman, a trustee with the fund, who acted as master of ceremonies.

Edelman added that the ribbon-cutting ceremony also signified the transfer of the $11 million, 25,000-square-foot center to the Defense Department. A second satellite center will open at Camp Lejeune, N.C., in October, and a third at Fort Campbell, Ky., in mid-2014, he said.

David Winters, president of the nonprofit fund, said there are plans to build and equip satellite centers at Fort Bragg, N.C.; Fort Hood, Texas; Fort Carson, Colo.; and Fort Bliss, Texas; as well as at Marine Corps Base Camp Pendleton, Calif., and Joint Base Lewis-McChord, Wash. All will be built and equipped from donations, Winters said.

All Intrepid Spirit centers will be located at military bases and medical centers around the country to provide medical care for service members meaning they will not have to leave their units and families for extended treatment. The centers are designed to enhance rehabilitation, officials said.

The design and mission of the satellite centers was based on the original National Intrepid Center of Excellence, or NICoE, which opened at Walter Reed National Military Medical Center in Bethesda, Md., in 2010. It's the most advanced facility of its kind in the country and serves as the center of the military's efforts in researching, diagnosing and treating TBI, PTS and related injuries.

Speakers at yesterday's ceremony included Arnold Fisher, honorary chairman of the Intrepid Fallen Heroes Fund; Army Col. Charles Callahan, commander of Fort Belvoir Community Hospital; Dr. Heechin Chae, director of the Fort Belvoir Intrepid Spirit Center, and Intrepid Spirit patient Army Sgt. Maj. Robert Haemmerle, who told the story of his recovery from the extreme, invisible signature wounds he received in Iraq and Afghanistan.

Capping the event and speaking on behalf of senior leadership across all the services, Army Vice Chief of Staff Gen. John F. Campbell reminded the audience that there are still 50,000-plus soldiers, sailors, airmen, Marines, Coast Guardsmen and civilians who continue to be in harm's way in Afghanistan, and many will need the type of help the Intrepid Spirit Centers offer.

"In this short month of September, the Army has already faced close to 50 wounded and in the months of June and July, it was in the hundreds for wounded and that will continue and we seem to forget that," he said. "What makes this event here extra special is to have the opportunity to honor our warriors who have sacrificed so much on Patriot Day, a day of service and a day of remembrance 12 years [after the 9/11 attacks].

"We are succeeding in recruiting America's finest to serve in all of our military, and that is a direct result of our commitment to programs like this that care for injured soldiers and their families. If we lose that commitment, if we waiver in that commitment, we lose," Campbell said. "We thank all of you for enabling the loyal and experienced warriors and their families who want to continue to serve."

First Lady Michelle Obama later toured the Intrepid Spirit Center and nearby USO and visited with wounded warriors and their families.

'INVISIBLE WOUNDS' TREATMENT

FROM:  U.S. DEFENSE DEPARTMENT 
Director Discusses Innovations in 'Invisible Wounds' Treatment
By Terri Moon Cronk
American Forces Press Service

WASHINGTON, Sept. 13, 2013 - The Military Health System acknowledges that U.S. troops in previous conflicts haven't been subjected to the circumstances that surround 12 years of war in Iraq and Afghanistan, a senior Defense Department physician said here yesterday during a panel discussion at a warrior-family symposium.

Dr. James Kelly, director of the Defense Department's National Intrepid Center of Excellence, talked about his center's advancements in post-traumatic stress disorder and traumatic brain injury – signature wounds from the wars - in a panel discussion titled, "Innovative Mental Health Solutions – Today and Tomorrow."

The annual symposium is sponsored by the Military Officers Association of America and the National Defense Industrial Association.

Kelly cited problems that stem from the pattern of repeated deployments and training between deployments, combined with an all-volunteer force composed of members put themselves in harm's way time and time again. "It is not the pattern we've previously had in our military," he said.

The idea that the younger generation is somehow softer or in some ways more vulnerable doesn't hold water, Kelly said. "These people are tough as nails," he said to a round of applause from hundreds of audience members.

"What we need to do is innovate, look more in depth, and understand them as people and individuals that have been engaged in ways [for which] we simply have no good track record to point to and say, 'Here's what this is about, and here's what to do about it,'" he said.

Kelly said he and his staff learn as they go at the center, conducting research and treating service members in an intensive four-week program.

In a previous interview with American Forces Press Service, Kelly explained that when service members with severe traumatic brain injury do not respond to conventional medical treatment, they can be referred to the National Intrepid Center of Excellence, but they must also have a co-existing psychological health issue, such as post-traumatic stress disorder, depression or anxiety.

Kelly became NICoE's director five years ago. The center got underway when Defense Department officials invited him -- a former neurology consultant for the Chicago Bears football team -- to join a group of doctors to examine how to treat service members who were exposed to blast injuries and other head trauma.

He and the other doctors were "willing volunteers" drawn to military health care and working with service members coming back from both wars because of blast-related injuries and a variety of other causes of concussions, Kelly said.

The need for innovation in research and in treating service members led to a concept of using "virtual reality war," with service members are immersed in a setting with a vision of what happens when they're inside a Humvee going down a road. The seat begins to vibrate as a bomb goes off, and the smell of burning rubber wafts into the vehicle. The hope, Kelly explained, is that while the service members are in a safe clinic setting, the experience can help them get past the traumatic events they brought back from deployments.

This use of virtual reality shows quantifiable metabolic changes deep inside the brain when it's dealing with stress, Kelly said.

"That's just one of the examples of the kinds of things that we're engaged in that is really novel, innovative," he added. "[It] bridges into areas of the mind ... in ways that traditional medicine -- certainly traditional neurology -- hadn't previously."

U.S. ARMY'S TBI, PTSD AWARENESS EFFORT

 

Army Brig. Gen. (Dr.) John M. Cho, Army Medical Command deputy chief of staff for operations, addresses the issues of post-traumatic stress disorder and traumatic brain injury during an awareness event on Capitol Hill in Washington, D.C., June 22, 2013. U.S. Army photo by David Vergun

FROM: U.S. DEPARTMENT OF DEFENSE

Army Initiates Collaborative Effort on TBI, PTSD

By David Vergun
Army News Service
 WASHINGTON, June 24, 2013 - Over the last 12 years, many soldiers have returned from Iraq and Afghanistan with wounds, some visible and some not, a leader in Army Medicine said here June 22.


"The invisible wounds -- post-traumatic stress disorder and traumatic brain injury -- are just as damaging as the visible ones. They impact the families as well as the soldiers," said Brig. Gen. (Dr.) John M. Cho, deputy chief of staff for operations with Army Medical Command.

An Iraq War veteran himself, Cho spoke outside the U.S. Capitol as part of National Post-Traumatic Stress Disorder Day. This year's theme was "Visible Honor for Invisible Wounds."

Post-traumatic stress disorder, known as PTSD, and traumatic brain injury, or TBI, are not just military-specific issues, Cho said. "They deserve a national discussion."

A big part of that discussion, he said, needs to focus on reducing the stigma associated with mental health issues.

Besides a national discussion, Cho said, agencies both inside and outside the military need to come together to learn more about identifying and treating PTSD and TBI, as well as preventing it in the first place.

Cho said a PTSD diagnosis is particularly challenging, as "you can't simply get a lab test or take an X-ray to find it."

As part of its collaborative effort, the Army is participating in a $60 million research study for TBI, sponsored by the National Football League, General Electric and athletic apparel manufacturer Under Armour, he said.

Also, $700 million has been allocated toward both PTSD and TBI as the result of a White House executive order for a renewed effort in collaboration with the Veterans Affairs Department and other organizations.

Additionally, the Army has set up seven "restorative centers" in Afghanistan, where TBI can be identified and treated, often allowing soldiers to stay in theater as they improve, he said.

The general explained that PTSD often, but not always, occurs with TBI, and that relationship, too, is being researched. "We're nowhere near where we want to be, however, when it comes to researching PTSD and TBI," he acknowledged. "A lot more needs to be done."

Cho said PTSD affected him personally when his brother, who also is a U.S. Military Academy graduate, returned from Afghanistan suffering from PTSD. He sought treatment and is better now, he said, adding that his brother is telling his story to other soldiers in an effort to get them to seek care.

"We know treatment helps," Cho said. "We can help them get better, and they can continue to serve in our Army with honor and distinction."

As a result of his brother's experience, Cho said, he's a big believer in group therapy, particularly cognitive processing psychotherapy.

Army Chief of Staff Gen. Ray Odierno, unable to attend the day's event, wrote in a letter for the attendees: "PTSD is a combat injury. Veterans suffering from PTSD deserve the same dignity and respect as our fellow wounded warriors.

"With the continued support and encouragement of organizations like Honor for ALL, the Army and this nation have made enormous strides in treating this injury, removing the stigma and instilling dignity in our recovering veterans," Odierno's letter continued. "But more work must be done!"

Honor for ALL, a nonprofit organization sponsoring the event, is dedicated to eliminating the stigma of PTSD and supports research into finding the causes and treatment of the disorder.

 

DOD TOUTS NICoE PROGRAM FOR TREATING SERVICE MEMBERS WITH SEVERE TBI

FROM: U.S. DEPARTMENT OF DEFENSE
Traumatic Brain Injury Treatment, Research Pay Off
By Terri Moon Cronk
American Forces Press Service

BETHESDA, Md., March 26, 2013 - Service members who have suffered severe traumatic brain injuries and psychological ills can benefit from an intensive four-week program at the National Intrepid Center of Excellence here.

Dr. James Kelly, the center's director, said that when service members with severe TBI fail to respond to conventional medical treatment, they often are referred to NICoE's program, which finds the best methods to treat their conditions on an individual basis. The patients must also have a co-existing psychological health issue, such as post-traumatic stress disorder, depression or anxiety, Kelly said.

"If you add together all of those things in a person, that's a very complex human condition," he said. "It is our job to characterize that complex condition ... and its effects on the brain, and look at what works to help them."

The only center of its kind, the Defense Department's NICoE offers a wealth of medical and alternative approaches for such service members, with medical professionals such as neurologists, therapists and counselors working in an interdisciplinary team approach, Kelly explained.

Because the team members are located in the same facility, he added, an occupational therapist and a speech therapist, for example, could see a patient together, discuss different approaches, and learn from each other. And because the teams comprise a variety of specialists, "every day we can ask, 'Did we hit the mark?' and if not, we say "Let's try something different tomorrow,'" Kelly said.

"Whatever patients need, they get," the director said, adding that NICoE does not operate in an assembly-line format, but rather as a "compact, intensive care" outpatient program that treats different patients with individualized forms of care that fit their particular needs.

"There's a whole menu of things we have available to them," Kelly said. "Not everybody gets the same 'dose' of sleep therapy, counseling or acupuncture, [because] everybody's individual needs are addressed."

Another key ingredient in treating service members with TBI is having their family members immersed in the treatment plan whenever possible, the doctor said. "We do our best to encourage [families to come to NICoE] because they are affected as well," he noted.

When service members finish the NICoE program, they are equipped with a thorough discharge summary of their diagnostic evaluations, treatment plans, counseling and rehabilitation work to take home to their doctors, Kelly said.

"We think highly of the existing system and the health care providers," he added. "Even though we have a unique opportunity that doesn't exist anywhere else, it's an unfair comparison to [put NICoE up against] anything else. I fully recognize our colleagues are doing good work."

Stood up two and a half years ago, NICoE is considered the DOD hub of TBI research, Kelly said. The center also is designed to influence TBI and PTSD treatment in the military health system with its cutting-edge approach.

Located on the campus of Walter Reed National Military Medical Center, NICoE partners in TBI research with other organizations, including the nearby Uniformed Services University of the Health Sciences and the National Institutes of Health, among others in academia, Kelly said.

The concept for NICoE began when DOD invited Kelly, a former neurology consultant for the Chicago Bears football team, to join a group of doctors to examine how to treat service members who were exposed to blast injuries and other head trauma, Kelly said.

NICoE was privately funded by the Intrepid Fallen Heroes Fund, which also oversaw the construction and equipment of the $65 million 72,000-square-foot center. NICoE's research, education and patient care have proven so successful, Kelly said, satellite clinics around the country now are in the works.

"We're being seen as a model to export, rather than just consult, on cases, so the project has led to satellite clinics because of the success of [our] concept," Kelly said.

Like NICoE, the clinics will be built with $100 million in philanthropic donations through the work of the Intrepid Fallen Heroes Fund. The clinics will be built at Fort Bragg, N.C.; Forts Bliss and Fort Hood in Texas; Fort Carson, Colo.; Fort Campbell, Ky.; Fort Belvoir, Va.; and Camp Lejeune, N.C.

NICoE officials estimate each of those clinics will see about 1,200 patients with TBI and PTSD per year. The most severe combat-related cases will still be cared for at the NICoE here.

The clinics also will benefit from NICoE's advanced research practices. Service members fill out questionnaires before and after their stay, Kelly said. "We compare the differences" he added,, "and they are striking."

The staff also observes service members' actions and records vital signs to show changes, he said. Relief from headaches, sleep disturbances, balance issues and vision concerns improves the quality of their lives are noted, Kelly said. Patient data is compiled and used in NICoE's research work to determine which treatments seem to help service members the most.

Another measure of success in the program is when former patients visit NICoE to advise the staff of how much their lives have changed for the better since their treatment, the director said.

Kelly said he sees the future of TBI research as "very specific" to characterize TBI on anatomical, physiological and emotional levels. Researchers also will look at the best forms of intervention that help to relieve symptoms and treat basic issues.

"We need to know what a person's concussion looks like, compared to another's," he said. "Why do some people recover more quickly than others, and what can we do to help them?"

So far, the NICoE staff knows that certain approaches produce success, such as the patients' complete immersion into the intensive care program and the interdisciplinary team approach, Kelly said. And when service members realize they have a TBI diagnosis and accompanying psychological issues that are real and treatable, they feel relieved and appreciate knowing there's something to work on, Kelly said. "They're validated by that," he added.

The center's director emphasized again that his staff's ability to help patients doesn't mean they weren't getting good care before they were referred for the NICoE program.

"Our successes with patients who have been through [another] system should not be seen as a reflection of inadequate care," he said. "Our job is to try something new, and that's what we've done."

BIOGRAPHY: U.S. SECRETARY OF STATE JOHN FORBES KERRY

FROM: U.S. STATE DEPARTMENT

On February 1, 2013, John Forbes Kerry was sworn in as the 68th Secretary of State of the United States, becoming the first sitting Senate Foreign Relations Committee Chairman to become Secretary in over a century.

Secretary Kerry joined the State Department after 28 years in the United States Senate, the last four as Chairman of the Senate Foreign Relations Committee.

Secretary Kerry was born on December 11, 1943, at Fitzsimons Army Hospital in Aurora, Colorado, one of four children of the late Rosemary Forbes Kerry and Richard Kerry, a Foreign Service Officer.

Shortly before he graduated from Yale University, Secretary Kerry enlisted to serve in the United States Navy, and went on to serve two tours of duty. He served in combat as a Swift Boat skipper patrolling the rivers of the Mekong Delta, returning home from Vietnam with a Silver Star, a Bronze Star with Combat V, and three Purple Hearts.

Back in the United States, Secretary Kerry began to forcefully speak out against the Vietnam War. Testifying at the invitation of Chairman J. William Fulbright before the Senate Foreign Relations Committee, he asked the poignant question, "How do you ask a man to be the last man to die for a mistake?" He also began a lifelong fight for his fellow veterans as a co-founder of the Vietnam Veterans of America, and later as a United States Senator who fought to secure veterans’ benefits, extension of the G.I. Bill for Higher Education, and improved treatment for PTSD (post-traumatic stress disorder).

In 1976, Secretary Kerry received his law degree from Boston College Law School and went to work as a top prosecutor in Middlesex County, Massachusetts, where he took on organized crime, fought for victims' rights, and created programs for rape counseling. He was elected Lieutenant Governor of Massachusetts in 1982, and 2 years later, he was elected to the United States Senate where he served for 28 years.

In 2009, Secretary Kerry became Chairman of the Senate Foreign Relations Committee, assuming a leadership role on key foreign policy and national security issues facing the United States, including Afghanistan and Pakistan, nuclear nonproliferation, and global climate change. His service as Chairman built on his previous Senate work that included helping to expose the Iran-Contra scandal and leadership on global AIDS.

As Chairman of the Senate Select Committee on POW/MIA Affairs, he worked to learn the truth about American soldiers missing in Vietnam and to normalize relations with that country.

In 2010, as Chairman of the Foreign Relations Committee, Secretary Kerry was instrumental in the ratification of the New START (Strategic Arms Reduction Treaty) Treaty, a vital nuclear arms reduction agreement with Russia that helps steer both countries away from dangerous nuclear confrontations.

In his 28 years on the Senate Foreign Relations Committee, Secretary Kerry chaired the Asia and Middle East subcommittees where he authored and passed major legislation on international drug trafficking, international money laundering, humanitarian aid, and climate change, and he helped negotiate the UN’s genocide tribunal to prosecute war crimes in Cambodia.

He also held senior positions on the Finance, Commerce, and Small Business committees, as well as served as a member of the bipartisan Joint Committee on Deficit Reduction, where he worked across party lines to try and reduce the country’s debt and strengthen our economy. Prior to his departure from the Senate, Secretary Kerry was the seventh-most senior Senator.

Secretary Kerry was the Democratic Party's nominee for President of the United States in 2004.

Secretary Kerry is the author of best-selling books, including A Call to Service: My Vision for a Better America and This Moment on Earth, a book on the environment which he co-authored with his wife, Teresa Heinz Kerry. Together they are proud of a blended family that includes two daughters, three sons, and three grandchildren.

PTSD AND TBI STUDY TO RECEIVE $100 MILLION

Photo:  Veteran Affairs Secretary Eric K. Shinseki

FROM: U.S. VETERANS AFFAIRS DEPARTMENT
VA, DOD to Fund $100 Million PTSD and TBI Study
From a Department of Veterans Affairs News Release

WASHINGTON, Sept. 19, 2012 - The Department of Veterans Affairs and the Department of Defense today announced they are investing more than $100 million in research to improve diagnosis and treatment of mild Traumatic Brain Injury and Post-traumatic Stress Disorder.

"At VA, ensuring that our veterans receive quality care is our highest priority," Veteran Affairs Secretary Eric K. Shinseki said. "Investing in innovative research that will lead to treatments for PTSD and TBI is critical to providing the care our veterans have earned and deserve."

The two groups, The Consortium to Alleviate PTSD and the Chronic Effects of Neurotrauma Consortium will be jointly managed by VA, and by the Congressionally Directed Medical Research Programs, on behalf of the DOD.

More than 15 percent of service members and veterans suffer impaired functioning as a result of PTSD. CAP will study potential indicators of the trauma, as well as prevention strategies, possible interventions, and improved treatments. Biomarker-based research will be a key factor for CAP's studies.

A primary goal of CENC is to establish an understanding of the after-effects of an mTBI. Potential comorbidities also will be studied; that is, conditions associated with and worsen because of a neurotrauma.

"PTSD and mTBI are two of the most-prevalent injuries suffered by our warfighters in Iraq and Afghanistan, and identifying better treatments for those impacted is critical," Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson said. "These consortia will bring together leading scientists and researchers devoted to the health and welfare of our nation's service members and veterans."

On Aug. 31, President Barack Obama signed an executive order to improve access to mental health services for veterans, service members and military families. As part of that executive order, Obama directed DOD, the VA, the Department of Health and Human Services and the Department of Education to develop a National Research Action Plan that will include strategies to improve early diagnosis and treatment effectiveness for TBI and PTSD. He further directed DOD and HHS to conduct a comprehensive mental health study, with an emphasis on PTSD, TBI, and related injuries to develop better prevention, diagnosis, and treatment options.

VA, which has the largest integrated health care system in the country, also has one of the largest medical research programs.

This year, approximately 3,400 researchers will work on more than 2,300 projects with nearly $1.9 billion in funding. Specific information on the consortia, including the full description of each award, eligibility, and submission deadlines, and general application instructions, are posted on the Grants.gov and CDMRP websites.

SECRETARY PANETTA'S REMARKS ABOARD THE USS JOHN C. STENNIS

Photo:  USS John C. Stennis.  Credit:  U.S. Navy
FROM: U.S. DEPARTMENT OF DEFENSE

August 22, 2012
STAFF: Afternoon, sir. How are you?

SECRETARY OF DEFENSE LEON E. PANETTA: Thank you very much. Good to be here. Spent some time at Fort Lewis a long time ago when I was in ROTC at Santa Clara. So ever since then I've spent a lot of time up here in Seattle.
　

From a defense point of view this is really a -- a community that is one of the -- one of the -- the very best in terms of supporting the military mission. There are a lot of different missions that are supported here, and I have tremendous thanks and respect for the people of Washington and the way they support our military mission.

　
So I'm glad to be here and happy to answer your questions.
　

Q: (Inaudible) -- shifted Navy or other assets to the Mediterranean or Syria region at this time?

　
SEC. PANETTA: Not at this time. We've -- we have deployed a force to the Middle East, and obviously the Stennis will -- will join that force. And the focus of that is to be prepared to deal with any contingency that develops in the Middle East.
　

Q: How much of this has to do with the conflict between Israel and Iran? Is this a positioning effort?
　

SEC. PANETTA: It deals with a lot of threats in the Middle East right now. Obviously Iran is one of those threats that we have to -- we have to be able to focus on and make sure that we're prepared to deal with any threats that could emerge out of Iran.
　

Secondly, it is the turmoil in Syria, and we're obviously following that closely as well.

　
There also are tanker threats that come from Iran that threaten some of the tanker -- the oil traffic that goes through the straits, and that's another concern.

　
So there are a number of issues in that region. It is -- you know, we're gone through the Arab spring there. The results of that present both challenges and opportunities. And all of that is the reason we maintain the force that we have in the Middle East.
　

Q: (inaudible) -- two-carrier requirement that was going to end in September and now is definite or is there a new end date?
　

SEC. PANETTA: You know, we're looking at what we need in order to deal with the potential challenges that we face in the Middle East. I can't give you a time frame as to how long we'll have to maintain that -- that presence. But clearly maintaining two carriers in that region was important to us in order to have the ability to confront any contingency.

　
Q: Do you have any more details about the kind of assistance the military can provide to Jordan or Turkey in the case of Syrian refugees?

　
SEC. PANETTA: You know, dealing with Syria, obviously we've tried to focus on three areas of importance. One is to do what we can to assist on the humanitarian effort, and I think the president pointed out we've done about $81 million, $82 million. But we're also working with Jordan and with Turkey to try to deal with the refugee flows and try to help them as best we can.
　

Secondly is the -- the whole threat of chemical and biological weapons. There are sites in Syria. We're concerned about the security of those sites. So we're continuing to monitor those sites and work with both Turkey, as well as Jordan and Israel to ensure that -- that none of those weapons fall into the wrong hands.

　
STAFF: Couple more here, guys.

　
SEC. PANETTA: And let me just mention, the third one is the -- is obviously working with the opposition to try to give them what assistance we can. Basically we're providing nonlethal assistance at this time, but we're working with other countries to try to give them what support they can get in order to try to confront the Syrian army.
　

Q: Is there any possibility for a no-fly zone in the region at this point?

　
SEC. PANETTA: Well, you know, we've developed contingency plans for all kinds of possibilities there. But as I -- as I said, that's not on the front burner right now.

　
Q: Sir, is the U.S. any closer to declaring whether or not the Haqqani Network is a terrorist organization?
　

SEC. PANETTA: That's -- that's a decision that the State Department has to make with regards to making a recommendation on that. And I think it's probably best one that is addressed to them.
　

Q: Mr. Secretary, you testified that you're having -- you've called for investigations into the system-wide review of PTSD diagnoses. Is that close to being completed, or when might we see results from that?

　
SEC. PANETTA: Well, obviously, it -- you know, the concern sprang out of a situation here at McChord that told us that there was some misdiagnoses that had taken place.
　

Actually as a result of that I've asked all of the services to review all of their diagnosis to see just exactly whether the same thing has occurred elsewhere, and that's -- that's ongoing right now.
　

Also, there is an ongoing investigation here as to what took place at McChord, making sure that -- that we do everything possible to find out what happened and try to make sure we're taking steps to avoid that happening in the future.
　

I sent, obviously, high level individuals from the Pentagon who have visited here to try to look at the situation. We've made some changes. I'm awaiting further recommendations as to what we can do to do everything possible to make sure that that kind of misdiagnosis doesn't take place.

　
STAFF: Last one. Anyone?

　
Q: (Inaudible) -- for this region. (Inaudible) -- Pacific Rim.

　
SEC. PANETTA: I would assume that Bremerton's going to stay busy for a long time to come as a result of having to focus and project our force into the Pacific. That's -- that's going to -- we're going to need the kind of shipyards and maintenance and backup that Bremerton provides.

　
STAFF: Thank you all very much.

　
SEC. PANETTA: Okay.

VETERAN'S PERSONAL STORY OF POST-TRAUMATIC STRESS DISORDER

FROM:  VETERANS ADMINISTRATION “VANTAGE POINT”
Back from the Abyss, and Ready to Serve Again
April 13, 2012 by David Daugherty
I experienced many difficulties transitioning to civilian life. With uncontrollable drinking, anger issues and post-traumatic stress disorder (PTSD), the perfect storm was brewing in me every day. When my volatility finally erupted, I couldn’t understand the fear and anger on peoples’ faces. I ran the streets for a very short while but the people out there made it clear I needed to go. Even though I felt dirty and low down in my heart, I still carried myself with the dignity and honor that the military provided me. Anyplace I went, except for Afghanistan and Iraq, I felt like a fish out of water.

When I finally began reaching out for help, I kept ending up in institutions. If something triggered me, it was like being in a firefight and calling to my buddies, but it seemed that everyone I called to only responded with disgust.

I found myself in the dark place between the judicial and mental health systems. Nobody could help me. Finally, when I was hospitalized, a doctor demonstrated how I was one step away from the abyss.

I had to shrug off the judgment of others, look past the fact that I was becoming an outcast, and accept the fact that society had no hope for me. An Iraq Vet I never met before picked me up the day I was discharged from the hospital and brought me to a halfway house.

I was shocked from the experience and only felt safe with my back to the corner in a large chair in that house. I had a Bible and the book Alcoholics Anonymous. During the day I stole food (mostly popcorn) and coffee from the kitchen while the other men were at work. I was nearly paralyzed with anxiety, the prescription medication made it worse, and the coffee calmed me slightly.

Over the last three years I’ve slowly built back up. I attained Chapter 31 (Vocational Rehabilitation) to earn credentials that will empower me to show others the way up and out. But there have been a lot of dark and lonely days. I’m not kidding when I say that it was one of those dark days of discouragement that I discoveredThe Mission Continues. I was able to understand why the founder did what he did.

I applied for a fellowship because I knew it would give me a leg up as an institution that would key in on my military strengths. After a few months of working with a Fellowship Program Associate who was tenacious about bringing out those strengths and applying them in a challenging, unfamiliar environment, I began to realize that The Mission Continues is not only uniquely equipped to understand me, their talk about “the next greatest generation” is not rhetoric. It’s real.

I am serving my fellowship at Sulzbacher Center for the Homeless in Jacksonville, Florida. After almost five months in my fellowship I am seeing how the choices I make to stay well and productive directly impacts the people around me. I get charged from seeing the tangible results of my efforts in helping individuals and strengthening various programs and service organizations. My hope is to see these individuals turn around and help someone else, and to see these alliances among programs and service organizations continue to draw people together for the greater good.

David Daugherty served 17 years in the military. He is a Veteran of the United States Air Force, and is currently inactive in the Army National Guard.

MILLIONS OF NURSES TO BE TRAINED FOR PTSD AND TBI HEALTH CARE

FROM:  DEPARTMENT OF DEFENSE
Three Million Nurses to Receive PTSD, TBI Training
 April 11, 2012 by Alex Horton
One of the challenges of diagnosing and treating complex injuries like post-traumatic stress and traumatic brain injury is the sheer amount of qualified medical personnel who can recognize the often subtle signs of trauma.Joining Forces (which celebrated its one year anniversary today) is looking to solve part of that issue by training a corps of nurses in the coming years.

Over three million nurses will be trained on how to recognize and respond to PTSD and TBI, which will immediately impact the care of Veterans.
From Stars & Stripes:

Amy Garcia, chief nursing officer of the American Nurses Association, said the new initiative should have a more immediate impact on veterans care, because officials can introduce the lessons into professional development courses, medical journals and other nursing resources in a matter of weeks, not years.
…
“Our goal is to raise awareness of these issues, teach nurses to recognize the signs and symptoms, and help reduce the stigma of seeking care,” she said.

VA nurses are well trained in identifying PTSD and TBI, so this will mostly impact private care facilities that haven’t trained in these areas. But if a nurse at a private hospital comes to work at VA, it’ll be a big boost to have prior knowledge of two of the most pressing medical issues we work to address.

HORSES AND PTSD RECOVERY PROGRAM

FROM AMERICAN FORCES PRESS SERVICE

Horse Therapy Helps Veterans Break Through PTSD

By Terri Moon Cronk
American Forces Press Service

WASHINGTON, April 5, 2012 - A Pentagon Channel documentary sheds light on how military veterans with post-traumatic stress disorder are finding help through the power of horse therapy.

"Recon: Unbridled" highlights "Horses for Veterans," at Flag is Up Farms in California, an intensive three-day program designed to help veterans of all ages who have PTSD, free of charge.

"I think No. 1 is to work with veterans who have given up on life," said Monty Roberts, a renowned horse whisperer. Roberts uses his horse-friendly "Joining Up" techniques on abused and mistreated horses, and adapts it for self-isolating veterans who have post-traumatic stress.

Roberts' program is about learning to trust people by choosing to, rather than by force, he said. By using the language of the horse or the stress of the veteran to communicate, he added, his program engenders trust.

"When they trust you, they will migrate toward you, rather than going away [out of fear]," he said. "Horses are flight animals. They are frightened of everything they don't understand. If they don't trust it, they need to get away from it, and that's how a veteran feels, too."

The old style of "breaking" horses often involved using violence to force them into submission, but Roberts' style, which he calls "gentling" or "natural horsemanship," is nonviolent.

"They get nothing from the fight, so they literally give up," he pointed out.

Veteran Alejandra Sanchez is on her fourth visit to Flag is Up Farms, but remembers her first time like it was yesterday.

"I have never been so scared in my life," she said. "I wasn't even that scared when I was in Iraq. My anxiety was through the roof, because I had to face that I had post-traumatic stress.

"Every night you knew when the sun set, action was going to happen," she continued, recalling her service in Iraq. "I remember coming to the oddly weird term of 'I might not make it.'"

Sanchez faced her fears head-on in the "Horses for Veterans" program.

"You have to work with people you don't know, and you already have trust issues," she said. "It definitely brought out all of the symptoms I face, but at an intense level I normally haven't dealt with." Sanchez said she had to learn to calm herself down for the horses to learn to trust her. "The horses would not respond to me if I was anxious, angry or violent," she said.

Veteran Alicia Watkins isolated herself from friends and family and lost everything she had after she returned from tours of duty in Afghanistan and Iraq. She was homeless, living in her car for a year, and said she'd lost her dignity.

"I know what it's like to get to the point where you no longer want to live," she said. "I remember going on convoys and not being able to handle it." By the time she returned home in 2007, she'd had many near-death experiences, she said.

When she accepted an invitation to attend Roberts' program, she showed up huddled in layers of jackets, a hoodie and sunglasses. Roberts worked with Watkins to help her earn the trust of a horse after he saw room for extreme change in her, he said.

"Hearing him talk about training the horses, I began to realize how horses and my PTSD were ... the same," Watkins said. She said she related to the horses' "flight mentality," because that's what she saw in herself.

"To reprogram the horses to be domesticated was something I could identify with," she said, noting they had been neglected or abused by former owners. "I found something that could almost immediately erase the pain and suffering of all those years. "Within an hour, I was a totally different person."

When her horse began to trust her and obey her commands, Roberts said, Watkins "became the most exuberant, outgoing participant."

"The change in her was like night and day," he said. He invited her back to train for three days with a new class of veterans.

Watkins said she saw herself in the new class of veterans. "To see that shell open up and see that person transform, it's so beautiful to watch yourself in someone else," she said. "'I feel like a victim' becomes 'I feel like a victor.'"

After working through her isolation and related issues with PTSD in "Horses for Veterans," Roberts said, he thinks Watkins is gaining the ability to think through her problems.

Today, more than 30 Veterans Affairs medical centers participate in horse therapy for service members and veterans with challenges ranging from mental and emotional to physical.

"The horses we see that were traumatized and abused never forget it," Roberts said. "But you can mask it over with good behavior, and that's the same with veterans. They're not going to forget the trauma they went through. Their positive behavior outweighs it."

"Horses for Veterans" has given veterans such as Sanchez and Watkins a new start.

"To see how horses can come back to a place of reconnection and bonding lets me know I can recover from this," Watkins said. "I can be the new old me."