April 30, 2008 by admin.

Top military doctors say six- to nine-month combat tours would reduce stress
By Bob Brewin April 17, 2008
The surgeon generals of the Army, Navy and Air Force told senators on Wednesday that the optimal tour in Afghanistan and Iraq to reduce combat stress should be six to nine months with 18 months at home, far shorter than the cut in tours from 15 to 12 months ordered by President Bush last week.
Army Surgeon General Lt. Gen. Eric Schoomaker emphasized that his was a medical assessment of the optimal length for combat tours and that “operational imperatives dictate [length of] deployments.”
Vice Adm. Adam Robinson, the Navy’s surgeon general, said less time at home between deployments has had a “devastating” effect on troops and their families since the United States commenced operations in Iraq five years ago.
While Air Force personnel in general average much shorter deployments — about three months — Lt. Gen. James Roudebush, the service’s chief doctor, told the hearing that “my leadership pays close attention to rotation and dwell times…I agree that six months, plus or minus” is an optimal deployment length.
The views of the top military doctors on deployment periods and increased time at home dovetail with the opinions of senior military leaders and studies that have shown stress increases with the length of time in combat.
The Army’s chief of staff, Gen. George W. Casey, told the Senate Armed Services Committee in February that “The cumulative effects of the last six-plus years of war have left our Army out of balance, consumed by the current fight, and unable to do the things that we know we need to do to properly sustain our all-volunteer force and restore our flexibility for an uncertain future.” Casey added that “frequent deployments are taking their toll on our soldiers and their equipment.”
Also in February, the Army reported that a mental health assessment team sent to evaluate troops deployed overseas determined that “reports of work-related problems due to stress, mental health problems and marital separations generally increased with each subsequent month of deployment.” Also, the team’s report said, “Soldiers on their third or fourth deployment were at significantly higher risk than soldiers on their first or second deployment for mental health problems and work-related problems.” The team conducted its field studies between October and November 2007.
The military services have boosted the number of mental health professionals in war zones, including psychologists and social workers, the three surgeon generals told the panel. But the same stresses that troops experience from frequent and long deployments have a deleterious effect on recruitment and retention of mental health professionals, Schoomaker told the hearing. Behavioral health personnel, he said “are among the most frequently deployed.”
Schoomaker said the Army tries to meet its target of one behavioral health professional per 1,000 soldiers, but the mental heath assessment team said deployed soldiers reported in 2007 that they had “more difficulty accessing behavioral health services….” Behavioral health specialists also told the assessment team that they saw a significant increase in the advice they gave commanders about mental health issues and at the same time experienced higher burnout themselves.

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April 11, 2008 by admin.

April 2, 2008

Contact Kristal DeKleer at (202) 225-9756 Washington, D.C. – On Wednesday, the House Veterans’ Affairs Oversight and Investigations Subcommittee, led by Chairman Harry Mitchell (D-AZ), conducted a hearing to examine vision dysfunctions resulting from traumatic brain injury (TBI). Recent research suggests that vision problems may be a common and previously unrecognized consequence of TBI.    “Traumatic brain injury is one of the signature injuries for the wars in Iraq and Afghanistan and I am afraid that vision problems are becoming the unrecognized result of that injury,” said Chairman Mitchell.  “We now know that military and VA health care providers must be especially alert to vision deficits resulting from TBI, even when there is no obvious physical injury to the eye.” 

Dr. Thomas Zampieri of Blinded Veterans Association discussed the prevalence of visual impairments and suspected inaccurate vision diagnoses as a result of service during the current military operations, Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF): “As of February 26 of this year, there were 29,317 wounded in OIF/OEF operations, of which 8,904 required air medical evacuation. Another 8,273 military personnel injured in non-hostile action have also been evacuated from Iraq or Afghanistan. Between March 19, 2003 and September 17, 2007, 1,162 of those evacuated had sustained direct eye trauma. This means that 13 percent of all evacuated wounded had sustained direct eye trauma, the highest percentage of eye wounded in more than 160 years of American wars. Based on additional information that we have received during the aforementioned four-year period, mostly anecdotal in nature, BVA believes that perhaps many more than 1,162 service members evacuated from Iraq or Afghanistan have experienced direct eye trauma.”

Navy veteran Glenn Minney testified to his experience with getting treatment for vision problems following a mortar blast during his military service at Haditha Dam in Iraq. Minney was wounded on April 18, 2005 and was initially treated for direct injury to his eyes, not for brain injury.  Only after having an MRI at the Wounded Warriors Barracks at Camp Lejeune, North Carolina, ten months after his initial injury, did he learn he “was suffering from a severe TBI.  All the medical centers I described above and not one had performed any sort of MRI, CT Scan, or even an X-Ray…It was then they discovered I had a loss of brain tissue in the parietal lobe as well as the occipital lobe (which works the eyes). I went through several neuro-psych exams to determine the extent of my injury, and after several tests, it was determined that the TBI was also a major cause in my loss of sight. The eye healed from the surgeries, but it was also the optic nerve that was damaged as a result of the TBI that was now a concern.  In 9/06 I was officially retired from the Navy, and I was rated at 100 percent disabled.”

Staff Sergeant Brian Pearce and his wife, Angela, testified to a similar experience.  Sgt. Pearce suffered significant injuries in an Improved Explosive Device blast in 2006, including TBI.  Sgt. Pearce still has 20/20 vision, but as a result of the TBI, he is legally blind.  As he testified, “[i]t is my brain that will not allow my eyes to function appropriately.”  Sgt. Pearce needed recognition of the nature of his injuries and seamless cooperation on his care between VA and the Department of Defense.  Partly due to a failure to appreciate the nature and extent of his TBI-related visual dysfunction, Sgt. Pearce and Angela encountered obstacles and delays in obtaining proper treatment. 

The Subcommittee heard from VA clinician-researchers about their ground-breaking research into the connections between TBI and visual dysfunction.  The panelists offered recommendations to improve screenings and assessments for veterans with vision issues and also discussed technological advances in equipment and rehabilitation programs.   This technology, which includes the development of computerized visual stimulation devices, is available to veterans, though on a limited basis.

In recognition of the importance of identifying and treating eye injuries and vision dysfunction in injured service members, Congress included a provision in the 2008 National Defense Authorization Act which directs the Department of Defense to create an eye care center of excellence which is required to “collaborate to the maximum extent practicable” with the VA.  Reports from both Departments and testimony from hearing witnesses suggested that progress on this eye care center has so far been limited to developing a computerized registry of those suffering from vision deficits.

“We cannot wait any longer to implement these new technologies and make them available to our wounded service members and veterans,” said Bob Filner (D-CA), Chairman of the House Committee on Veterans’ Affairs.  “Our veterans did not wait for research results before navigating an alley in Iraq or patrolling a village in Afghanistan.  They did not perform a cost-benefit analysis before implementing the orders that were given to them.  We owe these heroes prompt and bold action.”   

Witnesses:Panel 1

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Staff Sergeant (Ret.) Brian Pearce, U.S. Army Combat Veteran

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Angela M. Pearce, Wife of U.S. Army Combat Veteran

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HM1 (FMF) (Ret.) Glenn Minney, U.S. Navy Combat Veteran

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Thomas Zampieri, Ph.D., Director of Government Relations, Blinded Veterans Association

Panel 2

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Randolph S. Marshall, M.D., M.S., Professor of Clinical Neurology, Director, Division of Cerebrovascular Diseases, Columbia University Medical Center, Testifying on behalf of NovaVision, Inc.

Accompanied by:

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Navroze S. Mehta, President/CEO, NovaVision, Inc.

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Mary Warren, M.S., OTR/L, Associate Professor of Occupational Therapy, Director, Graduate Certification in Low Vision Rehabilitation Program, University of Alabama at Birmingham, Testifying on behalf of Performance Enterprises and Dynavision 2000

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Gayle Clarke, Chief Executive Officer, Neuro Vision Technology Pty. Ltd.

Panel 3

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James Orcutt, M.D., Chief of Ophthalmology, Veterans Health Administration, U.S. Department of Veterans Affairs

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Barbara Sigford, M.D., Ph.D., National Program Director for Physical Medicine and Rehabilitation, Veterans Health Administration, U.S. Department of Veterans Affairs

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Glenn Cockerham, M.D., Chief of Ophthalmology, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs

Accompanied by:

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Gregory L. Goodrich, Ph.D., Research Psychologist, Western Blind Rehabilitation Center, VA Palo Alto Health Care System, U.S. Department of Veterans Affairs

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Colonel (P) Loree K. Sutton, M.D., Director, Department of Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, U.S. Department of Defense
Accompanied by:

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Major General Gale S. Pollock, Deputy Surgeon General for Force Management, Chief, Army Nurse Corps, U.S. Department of Defense

Prepared testimony and a link to the webcast of the hearing is available on the internet at this link:  http://veterans.house.gov/hearings/hearing.aspx?newsid=219.

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