Dealing with a changing world

Cultural and logistical changes in the military and the challenges they create were the central themes of presentations at a day-long conference of the Legion’s Veterans Affairs & Rehabilitation Commission Monday.

“Expectations are changing,” said leadoff speaker Dr. Robert L. Jesse, Principal Deputy Under Secretary for Health at the Department of Veterans’ Affairs . As an example, Jesse spoke of new relational differences between patients and physicians as exemplified by his octogenarian father and his own son. “My father expects to wait for a long time in a doctor’s waiting room,” he said, “but he doesn’t mind because, to him, a doctor’s visit is a social occasion.

“On the other hand, if my son has a two o’clock appointment, he expects to be seen at two o’clock. If more than 15 minutes go by, he’s slumped in his chair in disgust.”

Health-care professionals’ views of those they serve are changing, too – at least at the VA – said Jesse. “We don’t think of patients as customers – people who consume health care – but as partners with us. (We believe) patients should own their health care and invite us to be part of it.”

Jesse spoke proudly of the VA’s efforts to focus on preventative care, improve accessibility to medical facilities, and to better serve veterans needing health care. “Improving our work is our work,” he said. In closing, he noted that “vets are changing” and spoke of the need to meet a new generation’s unique needs.

Among the new generation of veterans’ unique needs is treatment of and compensation for injuries that are “beyond the physical”, in the words of the conference’s second speaker, Danny Pummill. Pummill, the Deputy Director for Policy and Procedures at the Veterans Benefits Administration, centered his talk around the VA’s increasing recognition of the long term effects of service-connected hazards and injuries and of what are now being popularly called “the invisible wounds of war,” such as the sometimes permanent consequences of post-traumatic stress and traumatic brain injury. In his role with VBA’s Compensation and Pension Service, he admitted that, no matter how generous a monetary award is, no amount of money make some things well. He cited the words of a soldier who had lost both arms in battle: “How do you compensate for a dad not being able to hold his kids?”

Not uncommonly, the emotional devastation caused by PTS and TBI manifests itself in inappropriate, anti-social and even criminal behavior. This was the topic of a presentation by Jack O’Connor, coordinator of the Veterans Treatment Court in Buffalo, N.Y. This program, begun a little over three years ago, gives selected law-breaking veterans a chance to rehabilitate themselves.

The Buffalo Veterans’ Treatment Court is a collaborative effort between the Buffalo Police Department, the Buffalo VA health-care system and the Buffalo criminal court system. In this setting, a tough but compassionate judge, Robert Russell, hears the cases of veterans who have committed non-violent offenses – most related to substance abuse. If selected for the program, offenders are sentenced to one year of very closely monitored probation. They must remain completely drug and alcohol-free during that time, be employed, and commit no criminal offenses, even of the most minor nature. “It is not a get out of jail free program by any means,” said O’Connor. However, if an offender meets these requirements, the original charges against him or her are dropped or reduced. Thus far, nearly 60 veterans have completed the court program and none have been rearrested.

O’Connor said that the program pioneered in Buffalo has gained nationwide interest. There are now 65 such courts in the country, he said, and 30 more in startup stages. Veterans Courts are fiscally beneficial, said O’Connor. Compared with the alternative cost of incarceration, allowing offenders to avoid jail time realizes significant savings. He cited examples of cost savings to the California and New York criminal justice systems alone as being $43 million and $254 million respectively, thus far. As a footnote, O’Connor revealed that the greatest number of new veterans court cases involve Vietnam vets. “Forty years later,” he said, “something is happening.” He said he hopes the work of the Veterans Courts will help reveal the root causes of these late blooming troubles.

To today’s warriors returning from Iraq and Afghanistan, the war that continues to trouble some of its veterans – the ones who now stand before a judge in veterans courts – might seem like ancient history, But, to retired Brig. Gen. Wilma Vaught, it is not. North Vietnamese guerrillas were just beginning to infiltrate South Vietnamese villages when Vaught joined the Air Force in 1957.

Vaught, one of the most decorated women in U.S. military history, was among a four-person panel discussing the rapidly changing role of women in the military at the VA&R meeting. Joining her was Command Sgt. Maj. Frances Rivera from Walter Reed Army Medical Center and former Black Hawk helicopter pilot Tammy Duckworth, now the VA’s Assistant Secretary for Public and Intergovernmental Affairs. The panel was moderated by Brig. Gen. Peter Hinz from the Maryland Army National Guard. In introducing the panelists, Hinz joked, “I wondered why they wanted me, a man, to moderate a women veterans’ discussion. I think it’s because they know I don’t talk much.”

The women did talk. They told of the new roles of women in the military and, in the theaters of Iraq and Afghanistan where combatants are not separated by traditional battle lines, the routine exposure of women to combat. Panelists noted the irony that women can be legally “attached” to combat units, but not “assigned.” Nevertheless, said Rivera, “We’re kicking down doors and taking names,”

Duckworth recalled the relative ease by which she was accepted as a woman in the U.S. Army, even during flight training and operations. By contrast, Vaught told how women, a quarter of a century earlier, had been shunned by the military establishment and relegated almost solely to medical and clerical positions.

Duckworth, a former combat chopper pilot, began her remarks with a heartfelt tribute to Vaught and her pioneering role in seeking rightful recognition of women veterans. At discussion’s end, Vaught returned the favor by noting Duckworth’s courage, fortitude and achievements despite losing the lower portion of both legs and part of an arm in an Iraqi insurgent rocket attack on her helicopter six and a half years ago. Vaught said, to her visibly moved compatriot, “My number one hero is Tammy Duckworth.”

Duckworth, Vaught and Rivera all allowed that women in the ranks are growing vastly not only in numbers, thanks to the needs of an all-volunteer force, but in importance. As for women veterans, Vaught said she cannot understand how military retirees, including women, can just sit idle. In a loud and clear command voice, she ended her remarks by saying, “America needs you to be active as veterans!”