Story URL: http://news.medill.northwestern.edu/washington/news.aspx?id=139097
Story Retrieval Date: 5/21/2013 2:47:57 AM CST
Alfred T. Palmer/Courtesy of Library of Congress
The heavy smell of Asian food was in the air. Street vendors were selling fresh groceries, parents were buying their children cheap good-luck charms, and the chatter of everyone could be heard throughout the square. It was like any other day for Sgt. Gil Rivera, who vividly recalls the midday scene.
Suddenly, Rivera heard some voices speaking in Vietnamese. A soldier in the Vietnam War, he was ready to kill the passersby, whose voices were coming closer and closer.
But he didn’t have his gun. And he wasn’t in Vietnam. In fact, he was in New York – in Chinatown.
The incident occurred about 30 years after the Vietnam War. Rivera, who served in the U.S. Army, said what happened to him was a reaction caused by Post Traumatic Stress Disorder, or PTSD, a mental illness that can result from being in a terrifying situation where one’s physical well-being is threatened.
Post Traumatic Stress Disorder is not to be confused with Post Traumatic Stress, or PTS, which results directly from a traumatic event or from trauma. Although many who suffer from PTS personally underwent a terrible experience, PTS can also be caused by witnessing a traumatic event. Patients are diagnosed with Post Traumatic Stress Disorder when PTS symptoms last for a month or more.
Although many experience PTS, it does not always rise to the level of a being a disorder. Symptoms of PTS include being angered easily or having unpleasant emotions triggered by sensory perception such as sound or smell.
It took Rivera three decades to get the help he needed and is now fully pensioned. Unfortunately, his case is an all-too-common one.
“I hadn’t heard Vietnamese spoken since Vietnam,” said Rivera, 63, who now lives in Prince Frederick, Md. “Honestly, if I had a gun who knows, maybe I would have shot those people.”
Rivera is one of more than 1 million veterans who suffer from PTSD. But Rivera is lucky that he received any help at all.
On Aug. 17 at the Veterans of Foreign Wars National Convention in Phoenix, President Barack Obama said he plans to do more when it comes to veterans’ health care.
“We are a country of more than 300 million Americans. Less than one percent wears the uniform,” he said. “As we protect America, our men and women in uniform must always be treated as what they are: America’s most precious resource.”
Obama said he plans to do much more financially for veterans who suffer from mental illnesses resulting from war.
“Every dollar wasted in our defense budget is a dollar we can’t spend to care for our troops,” Obama said. “For so many veterans the war rages on – the flashbacks that won’t go away, the loved ones who now seem like strangers, the heavy darkness of depression that has led too many of our troops to take their own lives. Post Traumatic Stress and Traumatic Brain Injury are the defining injuries of today’s wars. So, caring for those affected by them is a defining purpose of my budget…we will not abandon these American heroes.”
In his speech, Obama promised to pour billions of dollars into veterans’ health care while “restoring access to VA health care for a half-million veterans who lost their eligibility in recent years.”
Back when Rivera first noticed signs of his PTSD during the war, the disorder wasn’t even recognized as an illness.
“It took me about 30 years to find out I had PTSD,” Rivera said. “In those 30 years I tried to control my own nightmares, I worked long hours and slept very little, I got in into fist fights, arguments, I drank like a fish…once I found out what it was because I studied it, I was able to take control of it.”
Nevertheless, Rivera continued to resent the Department of Veterans Affairs for disregarding his illness.
“We got no help from the VA, from anyone,” he said.
And many veterans still don’t today.
According to a report issued by Harvard University in 2007, there are over 1 million American veterans without health insurance and 3.8 million members of veteran households who are also without health insurance – and the number continues to grow.
Rivera said the VA forces veterans to bend over backwards to prove they have current problems caused by a war that took place decades ago.
“What I’ve seen… at the VA is that they give you a lot of lip service about how they treat the vets,” said Rivera, who also helps counsel veterans finding difficulty getting benefits. “When you see them on TV saying how much we want to help you, blah, blah, blah, that’s all bull.”
According to Rivera, the reason is that the VA does not want to provide so many people with benefits.
“They give you a hard time and make it as hard as possible,” he said.
For example, Rivera said many veterans who have skin issues, kidney problems, prostate cancer or even diabetes believe their health issues resulted from exposure to Agent Orange. Because they cannot prove the symptoms are directly linked to the herbicide exposure, the VA denies the veterans coverage.
However, representatives from the Department of Veterans Affairs hospitals say that it isn’t so. In fact, they claim to encourage veterans to seek proper care at designated hospitals.
“When military personnel receive deployment to Iraq and Afghanistan, once they completed that deployment, they are guaranteed five years of care from the time of their deployment,” said Kate Chard, the director of the PTSD Division at Cincinnati VA Medical Center.
If the five-year window has passed, Chard said veterans may file claims in a veterans service office. After a veteran files a claim, a therapist reviews it. The veterans may also bring supporting documents, deployment records, employment records, documents of medication problems and anything else to strengthen their case. They may also provide evidence of where they were stationed during their service and whether there was combat in the area, which could lead to PTSD.
Brain Morris, 36, a litigation attorney at the John Marshall Law School in Chicago, said he constantly deals with veterans who are not getting sufficient care – or any care, for that matter.
“Getting affordable…medical and therapeutic care is probably [veterans’] biggest hurdle,” Morris said. “As an institution, the VA certainly tries to assist everyone they can, but their budget constraints and personnel constraints often times result in a standard of care that is unacceptable.”
Morris, who was diagnosed with PTSD from a tour in Iraq as an Army Reserve major, said the problem is primarily a resource issue, as most VA medical centers do not have enough high-quality doctors on staff.
Additionally, veterans with emotional effects of war depend on the VA for the costs that private insurance companies won’t cover. Without the VA, many veterans cannot afford mental-health expenses. According to Morris, many times the VA will label a veteran’s disorder as a preexisting condition, not caused by warfare.
As a result, Morris said many veterans find themselves with three options.
“They can go back to the VA and accept the level of care from them, whatever that is, or go to the outside world, use private insurance and pay the difference, or they don’t get any care at all,” he said.
Morris, who was a legal assistant in Baghdad in 2005 and counseled soldiers under Gen. David Petraeus, is no stranger to PTSD. He plans to deploy to Afghanistan in the next couple of months.
Morris said because of his PTSD, he actually prefers to be in a combat zone rather than go through the anxieties and pressures of “ordinary” life.
“You feel normal [on the battlefield], you don’t feel like an oddball…you don’t have the need to explain anything,” he said. “The military takes most of the decision making in your life away from you, so in some ways it’s much easier than living in the real world where you get up every day and go to work.”
And that’s another thing, Morris said – not many people take the time to understand what it’s like to suffer from PTSD.
Chard, the VA official, said as soon as a veteran believes he has a problem, he should immediately look into whether or not he is eligible for care.
“There’s always an office they can go to,” Chard said.
According to the VA, the only ways to not qualify for care would be if a veteran received a dishonorable discharge or had injuries or illnesses that are not in any way related to his or her military service.
“I have many stories where patients came back from Vietnam and then they immerse themselves in work, got divorced or retire, and realize, ‘Oh gosh, I never went to the VA, I never had myself established, what am I going to do?’ And then they establish a claim and lo-and-behold, they are found to have full-blown PTSD and they have coverage,” Chard said.
According to Chard, 70 percent of those treated properly for PTSD get better, another reason she said it’s very important to get treated.
“You need to get in that window of eligibility,” she said. “Just because you didn’t go [get help from the VA] when you came home, that doesn’t mean there’s no hope for you…it doesn’t mean you’re not eligible.”
When someone does not qualify for care, Chard refers the patient to a Vet Center.
“The centers are a lot smaller…they have peer support groups where you can get that connection … [it’s] a nice augment…for patients not eligible for VA care,” she said.
Morris disagrees – especially when it comes to treating veterans who just served in Iraq.
“The problem with Vet Centers is that they’re pretty much filled with Vietnam vets,” he said. “A lot of Vietnam vets are drug and alcohol dependent, homeless and the Vet Centers are filled with these individuals.”
Morris acknowledged that there are many Vietnam veterans who are willingly to help younger vets, but “their time is taken up by so many Vietnam vets it doesn’t create a welcoming atmosphere to those who are 20 to 30 years younger.”
“People who are younger don’t want to be surrounded by Grandpa,” Morris said. “They think, ‘Grandpa is drinking alcohol because he served in 1968 and he needs to move on. I better not be fighting a war that grandpa fought – I don’t want to listen to him all day.’”
However, Rivera, who also counsels veterans suffering from PTSD, thinks that just having someone to listen to you can make all the difference.
Although now fully pensioned under the VA, Rivera still volunteers his time to helping his fellow veterans because he feels his country lacks in that area.
Although there is much work to be done, Rivera said he’s impressed with Obama’s attempt to fix this problem.
“This new administration is putting a lot of money into VA services, so things are slowly beginning to change,” he said.
Rivera hopes more drastic changes will happen sooner rather than later – especially for the soldiers who suffer from mental anguish every, as he does.
“I can’t control the feeling – it’s like a hallucination,” Rivera said. “It’s like I’m actually there at that moment…I feel the heat, I smell the smells, I’m in combat and in that moment it’s real. But in the back of my head I know it’s not.”