The War Within: Part I – Always an advocate - Web Exclusive

In a world of acronyms, serial numbers and security-clearance codes, platoons of stressed-out combat veterans march out of their doctors’ offices with yet another number – 309.81 – scribbled on their medical files. With this designation, they will get an appointment with a mental-health professional, and yet another chance to talk about recurring nightmares from their days in Iraq, Afghanistan or the Vietnamese jungle. They will work with their therapists to help break the mental anguish that got them diagnosed with 309.81 – aka post-traumatic stress.

Since long before the diagnosis gained its name in 1980, The American Legion has been an advocate for helping veterans get medical help for dealing with their fears, violence and helplessness. The cause recently gained renewed vigor with the creation of the Legion’s Post-Traumatic Stress/Traumatic Brain Injury Ad Hoc Committee. Formed in October 2010, the group has been regularly meeting, and actively seeking medical direction for helping those in need. And the list of the needy is long.

A story from the January 1994 edition of The American Legion Magazine tells of a Vietnam veteran struggling with the day he killed a young girl. She begged him not to eat her as he held her in his arms and she faded away from the wound of his bullet. The 8- or 9-year-old told him that the Viet Cong had chained her to a tree and handed her a submachine gun to fire at the American cannibals. She had earlier wiped out some troops, but was too weak this time.

After 25 years, the sergeant, a PTS victim, remained haunted. “He has held a multitude of jobs, moved a dozen times, lived through a broken marriage and sleeps only three or four hours a night. … He loves his kids immensely, but in their eyes he is a remote and cold man. … He still dreams about those crumpled bodies, the flies and the terrified eyes of a dying little girl in that jungle clearing.”

Her words still resonate: “No eat me, GI. No eat me.”

The emotional challenges of returning home from battle, and reliving its trauma, are not unique to Vietnam. They’ve been around as long as humans have waged war. Civil War soldiers dealt with “soldier’s heart.” World War I doughboys battled “combat fatigue.” World War II troops returned home with “gross stress reaction.” “Post-Vietnam syndrome” was a label for those surviving tours in Southeast Asia. “Battle fatigue” and “shell shock” are other monikers, but in 1980 the challenges of dealing with life’s major stressors became known as “post-traumatic stress [disorder].” Label it how you like, but the horror stories are much the same for those returning from Korea, Iraq, Afghanistan or any other combat zone.

Before the days of diagnostic codes, an American Legion Magazine editor shared his view on a World War I combat photo. In an August 1959 recap of the Legion’s first 40 years, Robert B. Pitkin stresses the long-standing need for mental-health care. In reference to this image, he writes, “One photo shows doughboys pressing forward on raw nerve in the Argonne in 1918 to break the Hindenburg line. The strain on them is visible. A certain number exhausted their nervous stability and came home insane. ... In World War I, the Army discharged 50,000 for mental illness, after they’d passed the military physical and mental requirements on induction.”

Much clearly happens between induction and discharge. Just ask Miles S. Epling, the Legion’s 1989-1990 national commander, who received a letter from a Vietnam veteran with a wife and three children. The veteran wrote: “I was afraid. I was afraid I’d never go home again. I was 19 years old. One night I was crying. I was alone, and I prayed to God to help me hang in there and make it home.

“In the past 20 years, I have had 15 jobs, moved 19 times and been living at the poverty level much of the time. I have applied for over 300 jobs in the past several years, with no luck.” The words pained Epling, who vowed that the Legion would always fight for the likes of this veteran whose “body was in North Dakota, but his mind was still in the Mekong Delta.” Epling notes that the veteran was diagnosed with PTS and received treatment, but his struggles to survive continued.

Those struggles remain today for veterans returning from Iraq and Afghanistan. Joshua Clark battles ongoing mood swings, and constantly relives the day he narrowly escaped a fatal bomb attack that claimed a civilian, he says in the February 2006 edition of The American Legion Magazine. “I don’t know how people deal with me,” he continues. “Even I sometimes can’t deal with me.”

Lydia Epson, a Navy veteran of Desert Shield and Desert Storm, deals with depression, alcohol, cocaine and the effects of a paralyzing stroke, she says in the same issue. “I had hit bottom. For some reason, I suddenly decided I didn’t want to die, so I got in contact with the VA.” After drug rehab, she entered a PTS program. “The program did not cure me,” Epson says. “I still have rough times. What it did was allow me to start living my life again. … I’ve learned I can live life without hurting myself with alcohol and drugs. I can now walk again with my head up. I’ve gained back my self-respect.”

A PTS diagnosis is certainly not the end of the story for Clark, Epson or any other 309.81 sufferer. It’s merely the beginning of a journey to help find a better life. And the Legion remains dedicated to leading veterans through every step of that journey.

The American Legion, since its founding in 1919, has helped veterans get help in overcoming the effects of combat-related mental illnesses, most recently post-traumatic stress.

Key chapters in advocacy

1919 – In the year of its birth, the Legion unexpectedly becomes a major advocate for veterans benefits after hearing from members about the dysfunction of governmental agencies.

1921 – Congress establishes the Veterans Bureau after endless pleas from the Legion to “put all the bureaus in one bureau.”

January 1922 – The Legion, pleased with its successful lobbying efforts for disability benefits, applauds Congress for passage of the Sweet Act of 1921. “The burden of proof is now upon the government. If a veteran has developed active pulmonary tuberculosis or a mental disease within two years of the date of his discharge, it is now assumed that the disease is the result of his war service. … But the Legion must stay on guard. It must see the new regulation is observed fully.”

March 1922 – The American Legion Weekly reports on lingering psychological troubles of American Expeditionary Forces (AEF) veterans of World War I. “Medical experts say the shell-shocked soldier got better care in the AEF during the high tide of battle than he is now getting … in this country three years after the war.”

1930 – Further consolidation of the management of veterans affairs comes with the creation of the Veterans Administration (VA), again at the urging of the Legion.

1933 – The National Rehabilitation Committee fights for disability benefits for veterans who suffer from “functional mental and nervous abnormalities.”

1950 – The National Executive Committee earmarks $25,000 for an independent volunteer movement to battle “the greatest remaining health threat – mental illness.”

1968 – The Legion starts the “Our Kind of Guy” program to educate returning veterans on benefits, including those for psychosis.

1978 – The Legion, which worked closely with the author of a scholarly work on the psychological readjustment of Vietnam-era veterans, helps present the book to VA head Max Cleland. Dr. Charles Figley of Purdue University, author of “Stress Disorders Among Vietnam Veterans,” visits Cleland with Robert Spanogle, the Legion’s internal-affairs director.

1980 – Many years of work by psychiatrist Leonard Neff and his colleagues lead to the birth of the official diagnosis of Post-Traumatic Stress Disorder (PTSD). His work on the study of “shell shock” gives the medical world a better comprehension of how trauma can surface much later in life. A VA psychiatrist, he challenges the view that most Vietnam vets are to blame for their problems.

1983-1985 – The Legion, long concerned about problems experienced by Vietnam veterans, partners with Columbia University to survey nearly 7,000 veterans on post-traumatic stress and other health issues.

July 1985 – The American Legion-Columbia University Study of Vietnam-era Veterans reveals that combat vets had lower incomes ($3,000-$4,000 less), higher divorce rates (25 percent vs. 12 percent) and greater unhappiness than noncombat peers.

September 1985 – The Society for Traumatic Stress Studies hears testimony from the Legion about the post-traumatic stress component of the Legion-Columbia study. John F. Sommer Jr., deputy director of the Legion’s Veterans Affairs & Rehabilitation Division, notes that Vietnam vets with intense combat experience had “general health reports more closely resembling men 10 to 20 years older who did not see combat.”

October 2010 – The Legion forms a Post-Traumatic Stress/Traumatic Brain Injury Ad Hoc Committee to “investigate the existing science and procedures, as well as alternative methods, for treating TBI and PTS currently being employed by the Department of Defense or Department of Veterans Affairs.” The committee learns of some successes from Dr. Paul Harch, who established an 80-treatment plan of hyperbaric oxygen therapy.

January 2011 – William Detweiler, past national commander and chairman of the ad hoc committee, comments during presentations to the group: “… there is no single treatment that fits all cases. In fact, it was clear from some of the presentations that medical experts cannot yet agree on a single screening procedure for these disabilities.”

January 2011 – As part of its campaign to drop the word “disorder” from the post-traumatic stress diagnosis, the Legion becomes increasingly vocal on the subject. Bill Schrier, national vice commander, comments: “It’s discriminatory, and it’s narrowing what this (servicemember) can do in his or her life. We have to take the stigma attached to PTSD away.” While others argue that doctors and psychiatrists still use “disorder,” Schrier speaks further about the suffering veterans he sees in his travels around the country. “They have the mentality that they can overcome anything. Why would we want to hang anything on them that’s associated with a disorder? I fight for those young people, and so does The American Legion.”

August 2011 – National Commander Jimmie L. Foster calls for congressional hearings on the use of Risperdal as a drug of choice in the treatment of PTS. “It is alarming that fully 20 percent of the nearly 87,000 veterans VA physicians treated for PTS last year were given a medication that has proven to be pretty much useless,” Foster says. He points to a VA study noting that the drug does not alleviate the symptoms of PTS. “Not only that, but Risperdal is not even approved by the Food and Drug Administration for the treatment of PTS,” Foster adds.