The VA is better than most healthcare options

In the past I have railed against the VA. Where the Veterans Administration (VA) has a lot of work to do, it is still better than most healthcare options. I work with a lot of veterans who struggle with the VA system. When asked about their experience with other healthcare systems, most veterans had not utilized the broken medical system in the United States and have nothing to compare it to. Struggling with the VA is not new for most veterans, but in my experience, it is still better than the alternative in many instances. I am not sure if you tried to get into your regular doctor lately, but it has been a nightmare for both veterans and civilians. The one thing the VA is good at and has been working on for years is the use of technology in healthcare. Technology is difficult for some of us who are older. The lack of shifting to tele health is problematic for civilian doctors, many did not invest in HIPPA compliant technology, leaving them scrambling to provide the needed services. I even know a lot of mental health professionals who have refused to shift to an online platform. This is detrimental to everyone.

The Choice program, aka, the Community Care Program started by President Obama has been a huge asset for veterans and the community at large. The VA's budget continually increases and has been increasing since the Obama administration. The Trump administration has been following suit to keep the VA well-funded to ensure we are taking care of like we were promised. Where the VA differs from civilian healthcare options is the VA has invested its money in technology. Unlike civilian medical systems the VA is not required to turn a profit. That is why we did not see any issues for Personal Protective Equipment (PPE) surrounding the VA during the pandemic. It was the civilian hospitals funded by insurance companies and private owners that suffered the most. I have multiple clients who have outside insurance and the VA, when they need medical attention, they choose the VA in just about every instance.    

One of the biggest issues I hear from veterans is how many young doctors the VA has working for them. If you look at it in a positive perspective new doctors have new ideas. They can utilize new technology effectively making the VA system more efficient than their civilian counterparts. The VA has been utilizing telehealth for years and their forward-looking stance is now paying off during this pandemic. Throughout history the military and veterans have been used as Guinea pigs when it comes to medical issues, and telehealth is one of the advancements. In my opinion the VA is on the cutting edge of medical innovations with younger doctors and telehealth. 

When dealing with other healthcare systems you can see the differences. Other healthcare systems only answer to one group, their shareholders. That is why there was a shortage of equipment such as respirators and PPE. It appears the VA had a stockpile of equipment and PPE because they were willing to spend the money where private healthcare systems had a limited stock of needed equipment. It appears the for-profit healthcare systems and doctors’ offices did not want to spend the money for something that just sit there. They did not care about our needs; they gave the money needed to have necessary equipment on hand to their shareholders.   

If you question a veteran about the VA healthcare system most talk positive about their treatment. The same might not be the same for normal hospital. If you want to see what Socialized medicine looks like, just look at the VA. This pandemic might be showing the weakness of the civilian healthcare system, and NO I do not work for the VA, I am just trying to be realistic.   

For questions or comments you can contact me at afterdutyvets@gmail.com or visit our website at www.afterdutyvets.com. I also have 2 books on Amazon if anyone wants to read more about veterans and their struggles. Living the Dream: Nightmares of Military Re-integration and Living the Dream II: Nightmares of Navigating the VA System. 

Veterans need to reframe their PTSD

I have had multiple clients into my office who have been struggling with what is going on in society. So many people in the United States has Post Traumatic Stress Disorder (PTSD) from one cause or another. There are an estimated 8 million of Americans who have PTSD. Wayne’s story about his upbringing and how he had dealt with the situation was interesting. Wayne was raised by an alcoholic and lived in fear of his father most of his childhood. Wayne had a gun to his head multiple time as a teenager. He decided to go into the US Army because he felt he need to get out of his situation. Wayne was in Vietnam during the TET offensive and saw heavy combat while there. Client did not realize how his horrific background and what his father did to him would pay off in the future.

As we discussed his situation and his upbringing, I offered a possible positive out of the negative upbringing. I made the comment that his upbringing and living with his alcoholic father prepared him for Vietnam. I explained how his hypervigilance probably saved their hides in combat and on patrol in the jungle. People with PTSD are more aware of their surroundings than the average person. They are always looking for the dangers. Once I asked Wayne to think back of situations he was in and if his hypervigilance saved him and his people. Wayne went home and came back to session the next week with a different attitude. Wayne had discovered that he had spotted multiple trip wires and boobytraps because he was so hypervigilant. 

Since the conversation with Wayne I have had multiple discussions with others with combat and non-combat veterans with PTSD. I have even run the thought by civilians with PTSD. It appears that they had a revelation around the idea that their PTSD could be a good thing and not all bad. The idea of PTSD being looked at as a positive has been extremely helpful for some. In any instance where there are crowds someone with PTSD will be more aware of their surroundings. By being hypervigilant they can observe suspicious behaviors before others.  By having PTSD it allows the use of your PTSD to your advantage, helping make you and your family feel safe.

I know it is emotionally draining to be that hypervigilant all the time, but what happens is after a while your brain gets so used to looking for danger it becomes second nature and the hypervigilance runs in the background of your brain allowing you to enjoy the event. Look at it this way, you do not have to think when you drive your car… why because it is second nature and your brain does it automatically. You can train your brain to do the same thing in crowds over time.

I know this will not work for everyone, nothing does. But what it can allow is being able to try something different and go into situations and keep telling yourself… I am same my PTSD is keeping me safe. When I explained this to Wayne, he thought and said… you know I think it has already helped me and I did not even realize I was doing it. I even had another client call it a “Super Power” The ability to see danger before it happens.   

Employers Don’t Understand the VA System

One of the issues my clients deal with is the lack of money usually brought on by their Post- Traumatic Stress Disorder and not being able to gain employment because of it. While they struggle to gain employment, they can wait for their Veterans Administration (VA) disability to be completed. It takes the VA a long time to get a veteran’s disability rating completed as they struggle physically, mentally, emotionally, and financially during the wait. I consistently tell my clients that they need to file a claim as soon as possible once they get out of the military. It appears to be easier for the disability rater at the VA to approve your claim quickly if it is submitted when you separate. The evidence is there, and the VA can’t argue that the problem is not service connected if it was documented while on active duty. I have been told that after a veteran is separated a year it is harder to get a disability approved because the disability can be blamed on something outside the service.

The longer a veteran wait to file the claim the more the process gets in the way. It is possible to get the claim processed in your favor, it just takes longer, and you continue to struggle finically.

This struggle is especially true for the older veterans whose medical issues have started to become a problem as they age. I have heard from too many veterans that they have not completed their disability claim because they would have to miss work, some have even said they were worried about being fired for missing work to deal with the VA and the system.

Once I retired from the Air Force, I ran into a major problem with an employer. They were unaware of the amount of time it took to deal with the VA, even after I told them.

As with every job you just start you have not accrued any leave or Payed Time Off (PTO). This makes it hard to deal with your VA appointments or any other appointments for that matter. As we know the VA can be on their own time and don’t care about your needs. I had to go to the VA on a consistent basis once I separated for my disability claim, multiple appointments at differing times on different days. I even submitted the claim while on terminal leave and it still caused an issue.

Because I was a “good troop” I followed the VA’s direction, not realizing that I could have re-scheduled the appointments. I thought that I was held to the appointment they set.

I found out the hard way that Employers do not like you taking off for VA appointments. Often,they believe you are looking for another job because they don’t understand how the VA system works. When it comes to employment, we need to tell our employers that we will be having VA appointments that you need to go to for your medical benefits. If they are unaccepting of the need it might be best to look for other employment. You have to you really ask yourself if you want to work for someone like that anyway? I did find another job as quickly as possible, I just had to be available, and it was a much better job.

PTSD was a Huge Part of the Wild West

I am presently in Southern Arizona and went to Tombstone to check it out. The old west has always been an interest of mine. Tombstones historical significance and the lore it has is what drives people there, me included. While there I had a realization while walking around and going into the saloons. I noticed the huge mirrors behind the bars and thought to myself, I know why that’s there. So many of the gunfighters, lawmen, and cowboys during Tombstone’s heyday had to have Post Traumatic Stress Disorder (PTSD). Their actions and behaviors look familiar to people who have PTSD today. The hypervigilance of the gunfighters, lawmen, and cowboys are legendary and documented. Those who lived in the old west and were willing to discuss their upbringing disclosed some tough situations they had been in before they came west. Most of these men and women were tough customers and brought up in a world of violence either by war or circumstance. Most of them had their lives threatened and had seen the carnage of war or life. America was a violent place and folks died young from the civil war until the turn of the century. Many of them had their parents die at a young age placing them in horrible where they were often treated like slaves. Some were old enough to find their own way but that too had its own issues and dangers.

Those who came west usually had some type of trauma in their past. A lot of those who came west served in the civil war on both sides and found an uneasy complacency once they got there. The west was lawless at the time and many of the lawmen had been or were gunslingers themselves. The evidence that surrounds the lore of their hypervigilance is numerous. During most of the firsthand stories, novels, and movies there is an indication that the gunslingers of the old west had PTSD. They sat with their back to the wall so they could see the door and who was coming and going allowing them to feel safe. This is a sure sign of their hypervigilance and an indication that their PTSD was alive and well. The huge mirror in most bars were present allowing them to see behind them helping them feel safe. They had to be hypervigilant, they had been taking risks and needed to be aware of their surroundings. Gunslingers and lawmen had a lock on taking chances. Their risk taking has been written and described by authors and screen writers for over 150 years. What can be riskier than being a gunslinger or lawman in the wild west. Many of the noted train, bank, and stagecoach robbers were taking huge risks with their lives. The constant threat to their lives is a sure sign they were searching for the adrenaline rush they needed in their lives because of their PTSD. It did not matter which side of the law the gunslingers where on, they were reaching for the rush they needed.

When you take a closer look, you can see how the gunfighters, lawmen, or just those who came west had similarities to today’s veterans with PTSD. The hypervigilance and risk takingexhibited by those from the wild west and today show how long PTSD has been around. When we think about survival and PTSD, we don’t think about what the old west was like and how parallels existed between those who had PTSD in the old west and our veterans of today. There are a lot of similarities when you take a closer look, and a lot can be learned from those who lived to tell the tails of the old west. To some their PTSD kept them safe, they utilized their resources and hypervigilance to survive. Just as those who have PTSD now can do.

The 24-Hour News Cycle and PTSD

Sean came into the office discussing how he struggles with getting out of his house due to his Post Traumatic Stress Disorder (PTSD). I have been working with Sean for a couple of months,but he continues to struggle to leave his house even to get groceries. Because of his severe paranoia and deep seeded trust issues Sean struggles to leave his house and doesn’t have an ytype of relationships. He was married once, before he went to Iraq, but once he returned his lack of trust and paranoia drove his wife away. He disclosed that every time he leaves the house, he has a panic attack for fear of something bad happening. Sean said that there is so much “evil “out there that he does not want to leave his house fearing something bad will happen. I see a lot of paranoia and trust issues with people who have PTSD. But what is the reason for the irrational fear. I have a theory.

My theory is the 24-hour news cycle causes a lot of stress on people who have PTSD and feeds into their trust and paranoia issues. The 24-hour news networks have opened the floodgates of hostility in the world to everyone. Before the 24-hour news cycle we were sheltered and only saw what the media decided to show. Now we can see the horrors happening in real time where we never saw or heard about it in the past. It has not been until recently, the last 30 years or so, that we have seen such an issue with PTSDand its symptoms. It has always been around and written about as far back as medieval times, butPTSD issues have exploded in the last 40 years or so. People have always had PTSD, but it was not classified as a mental issue until 1980. Simultaneously the 24-hour news cycle started. It is an interesting coincidence that the advent of PTSD as a mental disorder and CNN starting to have news 24 hours a day started in the same year. It looks like they grew up together and affected the way we see things and the way we live our lives.

Before the 24-hour news cycle the television, stations went off the air around 2 am, depending on where you lived. We did not have access to the news like we do now. There were only 3 or 4 stations, news was not their main concern. Now we have stations who have news 24 hours a day and watch terrible events happening live. If someone can’t sleep because of their nightmares they can turn on the news and feed into the negative energy that woke them up. What happens on the East coast can be seen in real time on the West coast and gets played over and over in a loop to cover the 24-hours. The 24-hour news cycle feeds the PTSD in some people making them have disproportionate paranoia because everything looks so bad. But the statistics show that crime is down, it’s not as bad as it looks.

According to the Brennan Center for Justice the national crime rate is about half of its peak in 1991. Since then violent crime has fallen 51 percent and property crime has fallen by 43 percent.The 2013 violent crime rate was the lowest it has been since 1970. Since 1993 the violent crime rate has dropped from 79.8 percent to 23.2 percent per 1,000 residents of the United States. With the violent crime rate at such a low level those with PTSD should be struggling less with their PTSD symptoms because of the lower crime rate, they should feel safer. So, what is causing the increase of PTSD disabilities?

The only thing I can think of is the access to news through the 24-hour news cycle. Before the 24-hour cycle most cities and areas would get about a half an hour of local news and weather and another half an hour of national news. News organizations did not have 24 hours to program for their news. Then came CNN who was able to make money with having 24 hours of headline and “breaking” news. So many kidnappings and murders were not seen on the TV in the past. They could not fit in the half an hour of news. The 24-hour news cycle made us aware of all the “evil”out there. I truly believe the 24-hour news cycle and the 24-hour news channels has played a part in the uptick of people’s PTSD symptoms. This is making it harder for them to live their lives because they fear the “evil” they see on TV. Of course, that is not all that has caused the increased in PTSD symptoms but that’s for another column.

Could it be C-PTSD?

I have been working with an Army veteran who has a different form of Post-Traumatic Stress Disorder (PTSD). He has never been to combat, has never been beaten, or had a single event that, by definition, might have caused him to have PTSD, even though he has most of the PTSD symptoms. Steven is a 35-year-old Army veteran with a tough childhood. Steven was a military brat whose father was in the Navy and always gone on long deployments. Steven was left at home with his alcoholic mother who left him alone with a babysitter who locked him in the basement and fed him little food while his father was deployed, and mother was partying. Steven has a lot of holes in his memory and does not remember much of his childhood. It appears Stevens PTSD symptoms come from his childhood but exacerbated by the military. This upbringing has caused him to have a different form of PTSD called complex PTSD (C-PTSD). Instead of a single event that can cause PTSD, C-PTSD is a series of traumatic events, or one prolonged event, it appears Stephen fits that bill.

Presently the American Psychiatric Association (APA) does not recognize C-PTSD as a diagnosis. This does not allow mental health therapist to “officially” diagnose a client with C-PTSD. Recently C-PTSD has been accepted by mainstream psychological therapist even though the APA does not accept it as a diagnosis. Many clinicians accept the diagnosis because of all the trauma we see in our practices that does not meet the official diagnosis of PTSD. The Diagnostic and Statistical Manual (DSM) covers the (APA)’s recognized disorders and is slow to adapt to this new diagnosis. This leaves a lot of Americans with C-PTSD to not be diagnosed or incorrectly diagnosed, at times with personality disorders. However, C-PTSD is recognized by the World Health Organization and made the decision to include C-PTSD as its own separate diagnosis in 2018.

Combatting C-PTSD is comparable to treating PTSD. The complexity of C-PTSD adds different layers to the disorder and treatment, but it is similar. Steven has a lot of trauma in his life but no single incident that can be defined by one traumatic event required for a PTSD diagnosis. He has a lot of smaller traumatic incidents that have built up over time making it more like CPTSD and not PTSD. In the United States there is a lot of childhood trauma not meeting the criteria for PTSD but match the requirements for C-PTSD. Steven has a lot of trauma to unpack, but it can be done. According to the International Classification of Diseases revision 11 (ICD-11), in addition to experiencing all of the normal symptoms of PTSD, people with C-PTSD may also experience:

Difficulty Controlling Emotions

•  Experiencing an emotional flashback. This is when you have intense feelings that you originally felt during the trauma, such as fear, shame, or sadness.

•  Experiencing severe depression, thoughts of suicide, or have difficulty controlling your anger.

Detachment from Trauma (Dissociation):

•  Dissociation is the mind's way of coping with an intensely traumatic experience. Those who experience dissociation may feel detached from their surroundings, their actions, and their body.

•  Experiencing gaps in their memory surrounding the original trauma or an everyday task that reminds them of the trauma they experienced.

Changes in Self-Perception

•  Complex PTSD can cause a person to view themselves in a negative light. This negative self-image can include feeling as if they are different from other people and feelings of helplessness, guilt, or shame.

Preoccupation with Perpetrator

•  It is not uncommon for people with C-PTSD to become fixated on their abuser. This can include becoming obsessed with the abuser, dissecting their relationship with the abuser, and becoming preoccupied with revenge.

Difficulty with Personal Relationships

•  Someone with C-PTSD may develop unhealthy relationships because they find it difficult to interact with and trust others.

Changes in Beliefs

•  People exposed to chronic or repeated traumatic events may lose faith in humanity and previously held beliefs.

The Importance of Accountability

Jessie is a Vietnam veteran who suffers from Post-Traumatic Stress Disorder (PTSD). Jessie has been married 3 times and is presently married to his 4th wife Lisa. Jessie stated that once he returned from Vietnam his anger was way worse than it was before his deployment. Jessie came to see me because of his PTSD on Lisa’s demand.  Lisa had threatened to leave him if he didn’t get the help he needed for his issues. Lisa had seen Jessie’s anger and fears him when he was drinking.  Lisa did not know what had happened with his prior relationships but after a while she discovered his temper, she put 2 and 2 together.

Jessie had been struggling for 40 years since Vietnam, some of his family made excuses for him acting the way he was with his temper, others gave him a pass for his actions. Jessie had a lot of PTSD signs, but no one knew what they were seeing at the time. They just chalked it up to Jessie being Jessie. He has been unable to go into a crowd for years, he gets antsy and short with people, sometimes to the point of confrontation. He has nightmares, gets triggered by smells, sounds, and certain situations while driving. His hyper vigilance is legendary to those who know him.

Once I started digging into his past, I found out that Jessie had a horrific childhood background. Jessie was raised by a violent alcoholic father who beat Jessie, his mother, and siblings at every turn. Jessie had a low draft number, so he decided to join the Navy before he was drafted. He joined hoping to get away from his alcoholic father and the turmoil at home. Jessie did what so many others have done in the past, joining the military to escape their home situation. Jessie went into the Navy strait out of high school thinking he would be on a ship; little did he know he would become a Seabee assigned to a ground unit at Cam Ranh Vietnam. We see a lot of people who volunteer for the military to escape a domestic violence or violent neighborhood situation. These folks are often more susceptible to PTSD because they come in with a traumatic background. Some come into the military with PTSD or the PTSD “seed” increasing their chance of getting PTSD or making it worse. It appears that is what happened to Jessie.  

Jessie had been pulled over multiple times for driving under the influence (DUI). He was able to escape the penalties for a DUI for years, but once the crackdown on DUI’s took place led by the Mothers Against Drunk Drivers (MADD) campaign, he had gotten two. Jessie did some jail time for his DUI and continued to struggle with his drinking. His drinking keeps causing him problems and has affected his relationship with Lisa. Jessie struggled to hold down a job because if his temper, drinking, and inability to do certain tasks. He could not be in crowds or work in confined spaces. Jessie had a good work ethic and skills he learned as a Seabee, so he started his own business. He worked doing odd jobs, being a handy man, and whatever was needed for years while making a decent living doing it. 

One night, Jessie crossed the line and hit Lisa in a drunken rage. Lisa laid down the law with him. Lisa flat out told him if he did not get help, she was leaving. Jessie was 70 years old and could not see himself being alone, so he promised to get help. Lisa explained to Jessie and me in their initial session that she understood his PTSD played a part in his actions, and she would stay if he got help. Lisa had forced Jessie to make the needed changes. That’s how Jessie ended up in my office  

It took Jessie over 40 years and a wife that supported him, loved him, and held him accountable for his actions to get the help he needed. Lisa had decided that she was unwilling to let Jessie continue to blame his PTSD for his actions. Lisa decided to make Jessie take responsibility for his actions. Jessie appears to be headed down the right path. At 71 years old he is finally able to live the quiet life without drama and the constant battles in his head, and Lisa is still with him.  

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For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

Giving a Pass is Not Always Best

Dave served in the Air Force for 6 years and has a combat tour in Iraq. He struggles with his Post Traumatic Stress Disorder (PTSD) because of a roadside bomb that hit his convoy while in a supply convoy. Dave’s PTSD is well known throughout his family and his small town. Dave has been pulled over by the local police several times for a Driving under the Influence (DUI) but was given a pass because of his military service and PTSD. They would make him park his car and drive him home, there were no repercussions for his actions. Dave has been self-medicating for years, using alcohol while trying to live with his PTSD. Dave looks back at his time in the military and remembers the stigma in the military for seeking mental health help. Dave hangs on to the idea that it is more acceptable to drink than go see a “shrink”. Dave had support in the military from his buddies, they helped him hide the seriousness of his drinking while he was in. Dave understood the ramifications of a DUI in the military but seems to have forgotten them once he got out.  Dave felt like he was alone once he separated, he drank alone, and pushed his family away. Dave’s first DUI pass happened while on his way to get more alcohol. Dave saw his drinking as a way to deal with his PTSD. But self-medicating is not helping, it just caused a larger problem.   

Often, people feel they are doing the right thing by giving veterans a pass for their discretions thinking it would help. Self-Medicating is a huge issue in the veteran culture for those with PTSD. Self-medicating causes a host of issues people overlook because of their service to the country. Dave keeps getting passes for his actions because people feel “sorry for him” because of his combat PTSD. Dave’s spouse, Darlene even allows Dave to drink around the children, when Dave acts up, she blames the war, not Dave for his actions. Darlene is not alone. So many people give folks with PTSD a pass because of their own guilt of not sacrificing themselves. So often spouses feel they can’t leave the spouse with PTSD because they will be leaving a “war veteran” or leaving “a tortured soul”. Darlene feels stuck but continues to coddle him and make excuses for him even though Dave has become a danger to himself and others because of his drinking.

Others in society give Dave a pass, this includes the local police. This is especially true in a small town where everyone knows everyone. Dave could get the help he needed if people would just force his hand and hold him accountable for his actions. Dave should have spent a lot of time in jail because of his DUI stops, but he has gotten a pass by the police. Dave might have gotten help if Darlene had left with the children vowing to not come back until he is better. Dave keeps getting passes from his family, community, and police endangering himself and everyone in the community.

What so many people forget is the cost for giving a pass to someone who needs help. This cost can be the children in the home getting PTSD from domestic violence cause by substance abuse, to believing the parental relationship with alcohol is normal. It is also an issue because if the police or society give a pass for the DUI or the physical assault caused by the misuse of drugs or alcohol will make the person believe he/she will get a pass and keep doing the negative behavior.  By giving the pass they are being enabled making it ok to behave badly. In the end there is a larger cost to society. Your guilt or feelings of shame are not warranted and can cost yourself and society dearly. If Dave had not been given a pass for all his transgressions, he might be alive today. Dave was killed while driving while drunk. I did not know he was struggling, he lived in Ohio and we did not stay in constant contact. I had not talked to him in 2 years and found out we lost him after a phone call from another buddy. Darlene called me a couple of months after his death and told me his story and what happened. We lost Dave because no one held him accountable for his actions. It might be easier to let things slide. It might even make you feel better because you “cut someone a break” but in the end, giving a pass is not always best.

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For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.