PTSD and Post Partum Depression: No Equal Defense before the Law?

The following a a guest column written by Bob Krause:

The Iowa Supreme Court's decision on the Heidi Anfinson case casts a new light into the shadows of mental illness and depression. The court ruled that the courts should have entertained evidence of depression and odd behavior that followed the birth of Anfinson's son. Anfinson allegedly drowned the child in Saylorville Lake a decade ago.

Although the tragic occurrence of the murder of Heidi's child by her was heinous, it has been recognized in medical circles and professional circles that an actual form of insanity sometimes occurs after child birth. It is called post-partum depression. The courts of Iowa will now allow evidence of the signs of it to be admitted in court during criminal proceedings.

But there are others in Iowa, some sitting in jail today without treatment, for an equally oppressive form of metal illness that they acquired often in the defense of America. That illness is Post Traumatic Stress Disorder (PTSD), and it deserves a like legal review to post-partum depression.

Today in Iowa, PTSD cannot be used as a defense in an insanity or diminished capacity plea before a jury. Not even military medical records diagnosing a soldier or veteran with PTSD can be entered in defense. It is only after conviction that the court can entertain PTSD records – not to prescribe treatment, but for consideration in sentencing.

PTSD does not have the same sympathetic ring as post-partum depression. But it is with us, and it is common. 480,000 of those returning from Vietnam (15.2% of men and 8.1% of women) had it. 168,000 of those Vietnam vets still have it. Of those, according to the National Vietnam Veterans Readjustment Study of 1988, ½ (around 240,000) were jailed at least once, 35% more than once, and 11.5% were convicted of felonies.

Today, some estimate that 20 percent of soldiers and 42 percent of reservists have returned from Iraq with some kind of psychological problem. Much of this is PTSD related. And the "canary in the coal mine" indicator of pervasive PTSD problems -- Army suicides -- more than doubled since 2001, hitting a 27-year high in 2007.

Many in my generation can relate to this as they saw friends and loved ones that served that bounced slowly down the razor-blade of life, not really quite fitting in after service. This generation will be "blessed" to see much of the same. And, with the high number of Guard and Reserve mobilizations in Iowa, the problem may be more significant.

I do not have Post Traumatic Stress Disorder (PTSD), but as a retired Army Reserve officer from the immediate post-Vietnam era, I have learned about it well over the course of a career.

My eyes first opened to the phenomena as a young captain in the 1133rd Transportation Company, Iowa Army National Guard in Mason City. One of my soldiers, Louis, a Vietnam veteran and a capable sergeant, disappeared early one morning.

Louis had been a tunnel rat in Vietnam. For those of this generation, a tunnel rat was a person that crawled into narrow enemy underground bunkers. It was a death-defying feat for the practitioners, and it had obviously had an impact on Louis.

That day, several years after the fact, Louis flashed back when he crawled under one of our trucks to change the oil. In his mind, he was back in a tunnel in Vietnam in a stand-off with a Viet Cong soldier. In this mental vise, he could not move forward, and he could not move backward. So he froze – for about six hours.

When we found Louis, he was embarrassed by what had occurred, but obviously changed and un-nerved. He quit the National Guard shortly after that, and I am embarrassed that at the time I did not know enough about PTSD to get him proper referrals. But, I was not alone in my lack of knowledge.

That evening, after the troops had left for the day, I asked my recruiting non-commissioned officer, also a Vietnam veteran, what he knew about Louis. Ron was also a Vietnam veteran and had his own little hell to live. Ron's was a traveling flash-back. Once a month or so as Ron was driving down the road, the windshield would suddenly become covered with gore and blood. He would stop the car, take a deep breath, and then start driving again. These episodes came from a mortar attack where the body of a soldier had been smeared across the windshield of the truck he was driving.

But these are just two old events of another generation. We have many good examples that we will be able to point to for this generation. I can assure you that many of these cases will wind up in the courts. Untreated, PTSD symptoms can become more severe. Drugs and alcohol are often part of escape from the pain and insomnia, and these in turn can trigger more grief. Jobs are lost; marriages are ruined, and fear-response mechanisms can breed violence. I have been involved in the periphery of a legal case in northern Iowa regarding such a young man of this generation. He was formally an upstanding businessman prior to a short notice mobilization with his Guard unit. Unfortunately he fell into calamity upon return, in part because of the consequences of the mobilization, and in major part because of his own personal reactions to his own PTSD.

Surely, he deserves the right to tell his case to the jury also, not just the judge, at sentencing.

Bob Krause is a retired lieutenant colonel in the US Army reserve. He is past state president of the Reserve Officers Association and past state chair of the Iowa Democratic Veterans' Caucus. He is currently roving ambassador for the Iowa Democratic Veterans' Caucus.

Bush Signs Joshua Omvig Veterans Suicide Prevention Bill into Law

With the stroke of a pen President George W. Bush signed the Joshua Omvig bill into law, ending a drawn-out political chapter that overcame a procedural hold in the Senate. The bill was introduced in the House by Rep. Leonard Boswell, D-Iowa, who named the bill after one of his constituents, Joshua Omvig of Grundy Center. Omvig committed suicide in Dec. 2005 after returning from an 11-month deployment in Iraq.

“By directing the Veterans Administration (VA) to develop a comprehensive program to reduce the rate of suicide among veterans the law will help thousands of young men and women who bravely served our country,” Boswell said in a press release following Bush’s Monday signing. “The Joshua Omvig Veterans Suicide Prevention Act not only honors Joshua’s service to his country but ensures that all veterans receive the proper mental health care they need.”

Boswell also had words of praise of praise for Joshua’s parents, who have been relentless advocates for the bill’s passage. “I commend Joshua’s parents, Randy and Ellen Omvig,. While suffering this personal tragedy they went on to help other veterans and their families, and have advocated for improving all mental health services at the VA,” he said.

Boswell’s efforts were picked up in the Senate by fellow veteran, Sen. Tom Harkin, D-Iowa, who helped push the measure through the Senate. "As a nation we cannot stand idly by when the needs of our brave soldiers are not being met," Harkin said. "We have a responsibility to truly support our troops by ensuring they have the services they need during their time in active service, and after they return home."

The bipartisan bill unanimously passed in the House March 21 by a vote of 427-0 before moving on to the Senate where it hit a procedural snag. Led by Harkin the bill was expected to overwhelmingly pass before going into the August recess until it hit a road bump. Sen. Tom Coburn, R-Okla. put the bill on hold, citing duplication and second amendment concerns that Harkin called (stronger verb) "bogus." Undeterred, Harkin kept fighting for the bill's passage and solicited fellow Sen. Chuck Grassley, R-Iowa, to help persuade Coburn to lift the hold. The bipartisan effort paid off and the bill cleared the Senate hurdle Sept. 27.

Grassley was pleased Bush signed the bill as well. “Today’s action helps give veterans who are suffering mental anguish a place to turn when all else seems lost,” he said in a statement “These are brave men and women who need to know that there is help out there and they deserve medical treatment just like any other veteran.”

The Joshua Omvig Suicide Prevention Act (H.R. 327) is designed to help address Post Traumatic Stress Disorder (PTSD) among veterans by requiring mental health training for Veterans Affairs staff; a suicide prevention counselor at each VA medical facility; and mental-health screening and treatment for veterans who receive VA care. It also supports outreach and education for veterans and their families, peer support counseling and research into suicide prevention. The VA had been implementing a number of these programs, but not in a timely manner, whereas the Joshua Omvig bill mandates these programs and subsequent deadlines as a means of expediting the process for returning veterans.

After Long-Fought Battle, Veterans Suicide Prevention Bill Passes

For many combat veterans returning from war, the battle doesn’t end on the battlefield. It continues at home with the mental scars. As soldiers return from duty in Iraq and Afghanistan, many are ill-equipped to deal with emotional issues stemming from deployment, and sensing no other way out, they tragically take their own lives.

Congress, led by the tireless efforts of the Iowa delegation, has taken measures to reduce the high suicide rates among veterans. After a long-fought battle, the Joshua Omvig Veterans Suicide Prevention Act (H.R. 327) overcame its last congressional hurdle Tuesday when it passed in the House for the second time by a vote of 417-0.

Introduced by Rep. Leonard Boswell, D-3rd District, the bill directs the Department of Veterans Affairs to develop and implement a comprehensive program addressing suicide prevention. The bill is named after Joshua Omvig, from Grundy Center, Iowa, an Iraq War veteran who served in the Army Reserve and took his own life in December 2005 after an 11-month deployment.

“I’m very pleased that both chambers have passed H.R. 327, and it’s now ready to be signed by the President,” Boswell said in a press release. “A recent article in USA Today reported that the number of Iraq and Afghanistan war veterans seeking treatment for post-traumatic stress disorder (PTSD) from the VA has jumped almost 70 percent in the past year. The time to act is now.”

“I commend Joshua’s parents, Randy and Ellen Omvig, who have suffered this personal tragedy, but have helped endless veterans and their families,” Boswell added. “They have advocated for improving all mental health services at the VA and have assisted countless veterans navigate the VA system.”

Although suicide rates are difficult to confirm and accurately gauge, the VA inspector general in a report last May noted that Veterans Health Administration mental health officials estimate 1,000 suicides per year among veterans receiving care within VHA and as many as 5,000 per year among all living veterans.

"Unfortunately, suicide prevention has become a major part of our responsibility to both active duty and to our veterans," Bob Filner, D-Calif., chairman of the Veterans' Affairs Committee, told the Associated Press. "It's a terrible statistic," he said. "As many Vietnam veterans have now committed suicide as died in the original war. That's over 58,000."

The bill, authored by Rep. Leonard Boswell, D-Iowa, is designed to help address PTSD among veterans by requiring the Veterans Administration to develop and implement a comprehensive veterans suicide prevention program, provide 24-hour mental health care services to veterans, and requiring that a suicide prevention counselor be available at every VA facility.

“Post Traumatic Stress Disorder is the hidden combat wound. Veterans suffering from PTSD are often the last to know they have a problem,” Rep. Bruce Braley, D-1st District, said in a statement. “In the past, many veterans returning from war have suffered silently from this illness without the help and support they need.”

“Joshua Omvig’s experience puts a human face to PTSD. His death stands as a stark reminder of the impact PTSD can have on veterans and their families,” Braley added. “Passing the Omvig bill into law is so important because veterans coming home and suffering from PTSD deserve the screening, treatment and resources they need to ensure their long term mental health.”

The bipartisan bill unanimously passed in the House March 21 by a vote of 427-0 before moving on to the Senate, where it hit a procedural snag. Led by the efforts of Sen. Tom Harkin, D-Iowa, the bill was expected to overwhelmingly pass going into the August recess, until it hit a procedural road bump when Sen. Tom Coburn, R-Okla., put a hold on the bill, citing duplication and second amendment concerns, which Harkin said were “bogus.” Undeterred, Harkin kept fighting for the bill’s passage and solicited fellow Sen. Chuck Grassley, R-Iowa, to help persuade Coburn to lift the hold. Their bipartisan effort paid off, and the bill cleared the Senate hurdle Sept. 27.

Before the vote, Rep. Dave Loebsack, D-Iowa, delivered a speech on the House floor in support of the bill. “I rise today in strong support of the Joshua Omvig Suicide Prevention Act,” Loebsack said. “This bill was one of the first that I co-sponsored as a new Member of Congress. I did so because I believe that we have a moral obligation to care for those who have worn our country’s uniform. I urge the president to quickly sign it into law so that these vital mental health services can reach our nation’s veterans.”

Originally posted on "Iowa Independent"

Grassley Calls for Review of Armed Forces Mental Health Policy

Sen. Chuck Grassley, along with a bipartisan group of Senators, sent a letter to Secretary of Defense Robert Gates, calling for an independent review of the personality disorder discharge process in the Armed Forces. The letter was prompted by a story in the Washington Post titled “The War Inside,” which chronicled the struggles of Army Specialist Jeans Cruz, a soldier suffering from Post Traumatic Stress Disorder.

“Soldiers are putting their lives on the line to protect us. They deserve to know that if they become injured, physically or mentally, while serving our country they will be cared for upon their return,” Grassley said. “We must learn from cases like Specialist Cruz’s and ensure our men and women in uniform receive this care for all ailments, including mental health disorders

Cruz suffered from Post Traumatic Stress Disorder and was given a personality disorder discharge which classified his condition as pre-existing to his combat experience in Iraq This discharge prevents Cruz’s from receiving disability benefits and medical care from the Department of Veterans Affairs. The senators are concerned that this is a widespread problem in the military.

In February of this year, Grassley along with Senator Tom Harkin introduced the Joshua Omvig Veteran Suicide Prevention Act. Omvig was a soldier from Iowa who committed suicide after serving his country in Iraq. The legislation directs the Department of Veterans Affairs to implement a comprehensive program to prevent suicide among veterans. The program will identify symptoms of mental health disorders, encourage veterans to seek help, and train VA employees in the best practices for suicide prevention. The legislation is expected to be considered by the Senate Committee on Veteran’s Affairs.

Here is a copy of the letter sent to Gates:

Dear Secretary Gates:

We urge you to conduct a thorough and independent review of the personality disorder discharge process across the Armed Forces. We are concerned over continuing reports from Veterans’ Service Organizations, the media, and individual U.S. service personnel that personality disorder discharges have been implemented inappropriately and inconsistently. There are indications that personality disorder discharges are being used as a tool to discharge expeditiously U.S. service personnel who have service-connected injuries, such as Post Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI). Even more troubling is the perception that the U.S. military is using these discharges to avoid disability and medical benefits payments.

The Washington Post deftly illustrated an example of this problem on June 17, 2007, in a piece entitled “The War Inside.” According to the Post—after serving a combat tour in Iraq —Army Specialist Jeans Cruz returned to Ft. Hood, Texas, crippled by the mental anguish of his combat experience. Notes from his medical files indicate “major depression,” and “anger from Iraq, nightmares, flashbacks.” The Army was so concerned that it even went so far as to have Spc. Cruz sign a “Life Maintenance Agreement,” a document stating that he agreed “not to harm himself or anyone else.” But the Army ultimately discharged Spc. Cruz with a “personality disorder,” in essence finding that Spc. Cruz’s medical problems had nothing to do with his service in Iraq

Since personality disorder discharges are considered “pre-existing,” personnel discharged under these provisions cannot collect disability benefits and may not receive medical care from the Department of Veterans Affairs f or these “pre-existing” illnesses. Spc. Cruz experienced this first-hand. On August 16, 2006, Spc. Cruz received a letter from the VA stating that he had been denied disability pay.

To make matters worse, military personnel given a personality disorder discharge who have not fulfilled their service contracts can find themselves forced to repay thousands of dollars in re-enlistment bonuses back to the federal government. This can result in debilitating debt for military personnel and their families—many of whom supported our forces over many years of service and endured significant strain as a result of frequent and protracted combat deployments.

Defense Department records indicate that over 22,500 personality disorder discharges have been processed within the past six years. While this represents a small percentage of overall discharges, their inappropriate use and debilitating impact on personnel once discharged is cause f or grave concern.

Another egregious example of misuse was chronicled by reporter Joshua Korson March 29, 2007, in a piece entitled: “How Specialist Town Lost His Benefits.” A copy of the article is attached for your review. On October 19, 2004, Spc. Jon Town was injured and sustained major loss of hearing in a rocket attack in Ramadi, Iraq. His injuries ultimately resulted in memory loss and depression, ending his military career. But instead of sending Spc. Town through the medical board process—an in-depth medical review of a service member’s fitness that often results in the award of disability payments and allows injured personnel and their families to remain eligible f or medical benefits after active service ends—the command at Ft. Carson, Colorado, elected to give Spc. Town a personality disorder discharge. This action deprived Spc. Town of disability benefits and guaranteed VA care f or his injuries once he was discharged from the Army.

While the Army claims to have thoroughly evaluated and reviewed the Town case, we understand that neither Spc. Town or his fellow soldiers, who were aware of the rocket attack and his resulting injuries, were contacted to discuss the case. Hence in this situation, and we fear potentially in others, the Army review was inadequate and anything but thorough.

Consequently, serious questions remain unanswered about the use, or abuse, of the personality disorder discharge and a chain-of-command that allows the inappropriate use of the discharge to continue even as members of Congress from both parties seek to review the practice and the media points out the glaring inconsistencies in the manner in which the personality discharge is administered.

Like many veterans’ advocates, we are skeptical about an administrative process that suddenly diagnoses military personnel who have long and honorable military careers, such as Spc. Cruz and Spc. Town , with pre-existing personality disorders that reportedly become apparent only after combat service in Iraq and Afghanistan . We are particularly concerned that combat forces at the unit level and above are inadequately equipped to diagnose, treat, and work with personnel assessed with brain-related injuries, and that the mechanisms tasked with handling the discharge process and meeting unit manning requirements are also overwhelmed.

Therefore, we urge you to conduct a thorough and independent review of the personality discharge process and to implement appropriate measures to prevent the repeat of cases like Spc. Cruz’s and Spc. Town’s in the future. We also urge you to support the creation of a Special Discharge Review Board to assist the Board f or Correction of Military Records for each service in reviewing petitions from personnel discharged for personality disorders with honor able service records in Iraq and Afghanistan.

As the Walter Reed Army Medical Center hearings demonstrated, the American people will not tolerate substandard treatment and rehabilitative care for those who have served. As members of the United States Senate, we have an obligation to ensure that our service personnel and their families receive the benefits and care they are entitled to. We are eager to work with the Department of Defense on the issues we have outlined and look forward to hearing from you.