"The Departments of Defense and Veterans Affairs must rapidly improve
prevention, diagnosis, and treatment of both posttraumatic stress disorder and
traumatic brain injury," said a presidential commission on the care of
wounded service members. "The VA should provide care for any veteran of
the Afghanistan and Iraq conflicts who has PTSD, and both departments must
work aggressively to reduce the stigma of PTSD."
The President's Commission on Care for America's Returning Wounded Warriors
was co-chaired by former Sen. Bob Dole, a wounded World War II veteran, and
Donna Shalala, president of the University of Miami and former secretary of
Health and Human Services. The commission was established in the wake of
revelations by the Washington Post of poor treatment and bureaucratic
delays at Walter Reed Army Medical Center earlier this year. Dole and Shalala
discussed the commission's report to the president, titled "Serve,
Support, Simplify," at a news conference on July 25.
Only six of the 35 steps suggested by the panel require congressional
action, said the commissioners. The others could be implemented by action
within either or both of the cabinet departments.
The commission also recommended more support for the families of wounded
veterans, better coordination of information between the two departments, a
restructuring of disability and compensation systems, and comprehensive
recovery plans for each patient.
The commission noted that while the VA had experience treating
combat-related PTSD, "knowledge generated through research and clinical
experience is not systematically disseminated to all DoD and VA providers of
"Laudable" efforts to prevent or diagnose psychological
symptoms have overextended the capacity of both uniformed and VA mental health
personnel, they said. Professionals in the armed services have been leaving at
the end of their enlistments, and not enough new personnel have been entering
the services, especially the Army. Attrition of Army psychologists increased
55 percent between 2004 and 2006, for instance. VA hospitals in isolated areas
are also having a hard time recruiting professionals, a problem worsened by
shortages in the civilian sector as well.
The commission echoed the findings and recommendations of other
investigations and task forces, many of which seem to have gone"
nowhere," according to an interview on National Public Radio with
Harry Walters, who is a a former assistant secretary of the Army and served on
one of those commissions.
Like the Department of Defense's recent mental health task force
(Psychiatric News, June 15), the Dole-Shalala commission called for
reducing stigma about mental health within the armed services. Many troops who
spoke to the commission said they feared that reporting psychological symptoms
would harm their careers or delay their return home.
More than 2,700 service members have sustained a traumatic brain injury
preventing a return to duty within 72 hours, according to the commission. The
Department of Defense and the VA should work together to disseminate or
develop practice guidelines for traumatic brain injury and PTSD to all
providers and train military leaders, medical personnel, troops, and family
members to understand these conditions.
The commission also recommended development of "a patient-centered
recovery plan for every seriously injured service member."
Furthermore, each patient should be assigned a trained recovery coordinator
to serve as an advocate to move the patient through the military and VA
medical systems and to serve as a point of contact for families. The
commission said that 20 to 30 coordinators would be needed to deal with the
approximately 3,100 troops seriously wounded so far in Iraq and
Finally, the commission recommended creation of a personal Web page to let
each service member track benefits and confidential health records and make
appointments. Current online information is "disparate, confusing, and
cumbersome," said the commission, and would benefit by a unified
approach from both the Department of Defense and the VA.
Further information about the President's Commission on Care for
America's Returning Wounded Warriors is accessible at<www.pccww.gov>.
The commission's report, "Serve, Support, Simplify," and reports
from its subcommittees can also be accessed at this site. ▪