Veterans Protest Reduced Medical Exams for Returning Soldiers

The two articles below show once again how this administration supports our soldiers for the media, but forget about them once they come home.

A "Force Health Protection Law" was enacted after the failure of the Department of Defense to monitor the health of soldiers who fought in Desert Shield/Desert Storm. More than 145,000 were exposed to low levels of chemical warfare agents in March 1991, but the DoD covered up the exposure information and delayed medical research and treatment. Now, in violation of the law and contrary to the best scientific advice, the senior medical officers are compounding the mistakes made by the DoD and the Veterans Administration by reducing health screenings for returning Iraqi Freedom veterans. Our own senior military medical leadership is failing active duty personnel and veterans.... again.


Article #1

Veterans Protest Reduced Medical Exams for Returning Soldiers

WASHINGTON -- The Army is scaling back the medical exams offered to soldiers returning from Iraq and Afghanistan, discouraging routine blood tests, electrocardiograms and X-rays, according to a Pentagon memo.

The directive from Brig. Gen. Richard Ursone, an Army assistant surgeon general, is drawing criticism from some veterans organizations. Rather than scaling back on medical exams, these critics say, the Pentagon ought to be making them mandatory and more comprehensive to enable earlier diagnosis of the kinds of medical problems faced by veterans of the first Gulf War 13 years ago.

In a Jan. 20 memorandum to regional medical commands, Ursone said: "Performance of routine screening laboratory, radiologic and electrocardiographic tests in this setting is extremely low yield and is discouraged."

Even if giving those tests is "supported by evidence based medicine," Ursone said in his memo, they "may be deferred if the soldier is without symptoms and the laboratory tests will delay release from active duty." The directive applies to soldiers leaving active duty from all Army units.

Pentagon public information officers, when asked about the memo, could not say whether the new medical exam policies are being implemented for the other military services.

Mike Duggan, American Legion deputy director for national security, said the veterans group views the Army decision as a step backward.

"Our position has been and continues to be that soldiers, active or reservists, deserve to have a complete physical when they leave the service," Duggan said.

The military currently requires only that soldiers answer a health questionnaire both prior to and after deployment overseas, with an actual medical exam being optional.

"You leave it up to them and they are, quite understandably, in a hurry to get out," Duggan said. "But getting a complete exam can be so important in terms of diagnosing any medical problems, including some that might not have active symptoms."

Jack Trowbridge, deputy commander for administration at Bayne-Jones Army Community Hospital at Fort Polk, La., said that while the post-deployment physicals have been scaled back since Jan. 20, the military is still able to assess if there are any medical problems demanding immediate follow-up.

"We make sure they are fit to go back home," Trowbridge said.

Denise Nichols, a Denver nurse, experienced medical problems including fatigue and low red blood cell count after serving with a Army Reserve unit in the 1991 Gulf War. She has been pressing for complete medical exams -- both pre- and post-deployment. Her view is that the physicals, along with good recordkeeping, could provide the keys to understanding the types of unexplained medical ailments that affected her and other Desert Storm veterans.

"I don't know if the fact that they are cutting back on medical exams, or not collecting all the information they should before and after deployment, surprises me," Nichols said. "After the Gulf War, we tried to mandate by law that they do these things, and keep good records, and they keep on ignoring it."

In 1997, Congress required that Defense provide "pre- and post-deployment medical examinations," but the Pentagon decided a self-administered survey would be sufficient.

Rep. Lane Evans, D-Ill., ranking Democrat on the House Veterans Affairs Committee, said the Defense Department "must do a better job ensuring that it is assessing the health needs, including mental health needs, of service members."

Evans said Congress' General Accounting Office recently concluded that the Defense Department wasn't even doing a good job compiling the limited information from the questionnaires.

Bruce Alpert can be contacted at bruce.alpert@newhouse.com

Article #2

Officials gathering data, but advocates push for more

WASHINGTON -- To help diagnose veterans expected to suffer from physical and mental problems long after leaving service, government health officials are gathering medical data, individual soldier histories, and other information on the thousands of American troops in Iraq.

Some veterans' groups, however, fault the government for not being proactive enough. They contend insufficient data is being collected to prepare for future consequences of serving in an environmentally and psychologically hazardous combat zone. They also charge the Pentagon is not providing timely information to the Department of Veterans Affairs, which cares for soldiers upon discharge.

Government officials say they are not necessarily expecting a new version of the mysterious "Gulf War syndrome" that caused physical and mental ailments in tens of thousands of veterans of the 1991 war, but they are not discounting the possibility.

"This is different from Persian Gulf One because of the length of time soldiers have been there," said Dr. Terence M. Keane, director of the behavioral sciences division of VA Boston Health Care System. "The data will be valuable to us on many levels, from the exposure to toxic substances and to significant combat stressors."

Learning from mistakes made during the 1991 Gulf War, when doctors and researchers lacked the battlefield and medical information necessary to diagnose veterans' illnesses, the Departments of Defense and Veterans Affairs are compiling blood samples, detailed histories of each soldier's whereabouts, and information about which weapons were used in which places and when.

No particular health problems stand out among Iraq veterans so far, and officials do not expect a repeat of the Gulf War, in which oil fires, exposure to chemical weapons depots, and a variety of experimental drugs and vaccines may have contributed to severe fatigue, headaches, muscle and joint pains, dizziness, asthma, rashes, and memory loss.

Nevertheless, "every war is going to have some walking wounded," said Susan Edgarton, a staff member on the House Veterans Affairs Committee. "We don't have enough data yet, but we are doing better screening this time."

The government has a variety of new programs in place. One, the Veterans Health Initiative, documents exposure to hazardous materials and is establishing a database for further study. The goal is "to increase recognition of the connection between military service and certain health effects, the VA recently told Congress.

As of March 9, the government had compiled a database of 107,540 soldiers who served in Iraq or the surrounding region since October 2002 and have since left the military. Of those, 13,580 have sought care at VA medical facilities and about 2,800 have been diagnosed with a physical or mental condition. Officials said the data so far does not indicate any higher incidence of illness than in the general population.

"We are working with DoD to develop processes whereby pre- and post-deployment health assessments will be available electronically to VA physicians and claims examiners," according to the February VA report. "A service member separating from military service and seeking health care through VA today will have the benefit of VA's decade-long experience with Gulf War health issues."

A particular area of concern is the onset of psychological problems related to combat stress.

"There are not a significant number of heavy firefights," said Keane, but unlike previous wars with well-defined battle lines, "there isn't much of a sense of safety wherever you are and that is one of biggest problems."

Despite the efforts to collect sufficient epidemiological data, some veterans groups believe more is needed.

"I am not satisfied that they have learned their lesson," said Stephen Robinson, director of the National Gulf War Resource Center, an advocacy group in Silver Spring, Md.

He noted that among the 300,000 troops expected to serve in the the conflict, many of them did not have blood drawn beforehand for future reference, as stipulated by law, and only now are all troops being screened both before their departure and upon return.

He also accused the military of failing to provide timely data on individual soldiers' activities. "The VA needs that so they can forecast," Robinson said. "While there have been some strides to correct some of the mistakes, there are other glaring mistakes that have yet to be addressed."

As pointed out previously on this blog, those who should be advocating for us in the military medical community, have continuously failed to do so. It won't be enough to clean house in the White House. We need new thinking and proactive leadership in the DoD, the VA, and the military medical community, led by those who intend to fight for us and our medical needs, especially returning GIs who need medical and mental health therapy. This is not a "resources" issue. It's a moral and ethical issue - and it reflects shame, not honor, on those responsible.