DFW Transcript  

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A New Normal: How Is The War Within Transforming Our Force and Families?

By Stefanie Zehnder

Presenting a trademark forum to facilitate discussion, the U. S. Naval Institute and Military Officers Association of America hosted the fourth annual Defense Forum Washington 10 September on Capitol Hill.

Friday's day-long conference, titled “A New Normal: How Is the War Within Transforming Our Force and Families?” was filled with notable speakers, diverse discussion panels, many questions, a few answers, and country music. With nearly 500 people in attendance, the main purpose of the forum was to raise awareness and instigate conversations.

Senator James Webb.  To view a slideshow of the 2010 Defense Forum Washington, click here.

The current pressures on our military members and their families are unique, said Senator James Webb (D-VA), a man with a vast family military history. “Nine years’ continuous deployment have stressed our forces and families in ways we could not have envisioned,” he said. “We truly are in uncharted territory in terms of our own history and the complex nature of the make up of the military and how it is being used. We are seeing the effects of these continuous rotation cycles, multiple deployments, and inadequate dwell time on our people in a way that we may not be able to fully comprehend for decades.”

Quoting a letter he had received from Vice Admiral Norbert Ryan at MOAA, Webb warned the attendees that if we are not better stewards of our military we will be putting our all-volunteer force at unacceptable military risk. “It is our responsibility as leaders and stewards to put a safety net under these those who are willing to go into harm's way for us,” Webb said.

The first panel of the day addressed the recovery of wounded veterans and whether or not needs and expectations are being met. The stories shared varied. Some branches of the military have made the holistic recovery of their troops a priority. According to Marine Sergeant Major John Ploskonka Jr., the Marine Corps is striving to provide support for Marines’ body, mind, spirit, and family – everything they need for a full recovery. However, not all the wounded are given the same honored status. Major General Tod M. Bunting, Adjutant General for Kansas Army and Air National Guard, reaffirmed that a wounded warrior is a wounded warrior, no matter what the branch of service. Furthermore, some wounded veterans and their families find treatment difficult to access, especially for those in the Reserves. For Pamela Stokes Eggleston, Director of Development for Blue Star Families and wife/caregiver of a wounded Army veteran, “Help was not there.”

The Egglestons invested a tremendous amount of self-motivation to obtain the necessary attention, “If it's not there for me, I will get it. If you're not going to give it to me, I will move aside and get it from somewhere else,” she said. As a reservist military spouse, there was little support for her. She still had to go to work and then come home and take care of her husband. Rather than being sensitive to her needs and busy lifestyle caring for her family, the help the Army offered was only available if she took the time to search it out and take it. “Look at the families and what they're going through,” she said.

Her husband, retired Army Staff Sergeant Charles Eggleston, served two tours in Iraq and was wounded in 2005. Awarded the Purple Heart and Bronze Star Medal for his heroic service, Eggleston retired in 2009. However, the military decorations were not the only things he brought home with him from the war. He received three-and-a-half years of treatment at Walter Reed for his post-traumatic stress disorder (PTSD) and mild to moderate traumatic brain injury (TBI), and according to Eggleston, “the seamless transition was not so seamless.” The burden of transition fell on Eggleston and his wife, “You have to figure out how you're going to do this.”

SSG Charles Eggleston, USA (Ret.).  To view a slideshow of the 2010 Defense Forum Washington, click here.

He was frustrated with the uncompassionate system and has since taken the initiative to help other wounded soldiers. “You have to have compassion and empathy. Do it from the heart,” Eggleston said. He now views his purpose as helping other wounded veterans. “We do this and we'll do it again and we have no regrets. I have no regrets about getting injured – I regret losing friends on the battlefield – but I don't regret getting injured.”

Although Eggleston critiqued the Department of Defense, he praised the Veteran's Affairs staff. “The difference between the DoD and VA for me was one hundred fold on the VA side. The DoD treats temporarily, just to get you out the door, but these guys [at the VA] treated me like I was somebody special. Maybe I wasn't special, but they made me feel like a king and my wife like a queen, and they made my family happy that I served. We do have a system at work but there are a lot of loops.”

The important issue for Jean Langbein, LCSW, OEF/OIF Program Manager, VA Medical Center, Washington, D.C., was catching signs of trouble in returning veterans before the individuals took matters into their own hands through self-medication or other measures. The VA's job is not easy, as the symptoms of trauma can be late to appear and hard to catch. “We're screening everyone for signs of PTSD and TBI. The importance is not just doing the initial screening, but doing additional screenings as well,” Langbein said. They use evidence-based treatment and try to tailor care. “We offer services like acupuncture and kayaking,” she said. “It’s not cookie cutter, it is very individualized.”

Rich wisdom and understanding to implement individualized treatment is not cheap nor easy to come by, said Ploskonka. “We can't grow a doctor overnight,” he said. “It takes time to get a psychologist to understand and get the experience and the knowledge from these issues that we deal with every day. It's taken time. I know we want quick answers and the solution today for these issues, but that's not always the case. It's taken 25 years for me to get to this point. It's taken a lot of experience and wisdom and knowledge for me and thousands of Marines pointing me in this direction. The same thing has to happen with our doctors and nurses and health care providers.”

The panelists discussed a theme that would recur during many of the following conversations at the forum – stigma against acknowledging issues resulting from combat. It is important to communicate to soldiers that is “it's okay if you're not okay,” said Ploskonka. “You need to get help as early as possible, so that we can give you the coping skills for the PTSD. If you don't get those skills early enough you may cause permanent scarring in your brain and that scarring may prevent those professionals from giving those coping skills. We want to get rid of that stigma up front.”

However, this remains a stumbling block for many soldiers. “The biggest turn off for us in acknowledging PTSD is the threat that they'll take clearance from you,” Eggleston said. “I worked all my life to keep a clearance, so why should they take it from me for something I didn't voluntarily ask for? I didn't commit a crime, I'm not a felon, so why should they take it away from me?”

Langbein added that perhaps the stigma is related to the multiple deployments, and the reluctance of people to seek treatment because they know they have to get ready to return to combat. Struggling veterans tend to think, “I'll deal with it when I come back.”

Another issue was the inefficiencyof medical record-keeping, especially in the transition from being an active soldier under the DoD to being retired and under the VA. Ploskonka shared a few stories about Marines with TBI. “We have people who go through a bottle of shampoo in the morning because they don't remember if they washed their hair or not.” As a result, how can these people be expected to track their medical histories, doctor's appointments, and prescriptions. The tension is in trying to balance communication between systems with the contrasting potential for identity theft.

During the question-and-answer session after the panel, Kristina Kaufmann, a military family advocate and military wife, critiqued the Army's Warrior Transition Units (WTU) without a solid program evaluation. “The concept of the WTU is great, but we need to look at if it is feasible in its current model. Without the proper selection, stafffing, training, and implementation, the soldiers are not set up for success. You have a lot of people in the cadre who are trying to do the right thing, but are overwhelmed with work. We've created all these things with the right intentions, but we haven't really looked to see if they're working.”

The following panel focused on the reintegration process. The experiences of the panelists revealed a diverse cross-section of needs and ways to meet them. Speakers included a wounded veteran whose severe scars made obtaining treatment much easier to find, a wounded veteran whose unseen scars made her PTSD difficult to diagnose and treat, a mother and caregiver of a wounded veteran who made it her mission to help other injured young men, the commanding officer of the Navy's Safe Harbor program, and president of the Brain Injury Association of Michigan.

When Retired Army Sergeant First Class Michael Schlitz suffered wounds from an improvised explosive device (IED) explosion in February, 2007, his chances of making it out of his vehicle alive were slim. As a result of the incident Schlitz suffered burns on 85% of his body, the loss of his arms, and loss of eyesight in his left eye due to a scarred cornea. However, because his wounds were so visible, he was quickly targeted for care. “The minute I walk in a room, eyes usually go on me, and there could be somebody with PTSD, TBI, or other unseen injuries sitting in a corner who might be in worse condition than me. But because [the health care workers] can see my visual scars, I usually get put in before them, and that's something we have to look at and understand as professionals that it's not just on the outside.”

Robbi Schlitz and SFC Michael Schlitz, USA (Ret.). To view a slideshow of the 2010 Defense Forum Washington, click here.

Another concern of Schlitz's was finding the right balance for care. With all his case managers to do his bidding, he was frustrated because at some point he wanted to resume responsibility for himself. Although some of the younger soldiers may want the help, he said, or people with PTSD and TBI may have trouble remembering, there are a lot of wounded veterans have no interest in helping and need to be proactive. “You've got to stop coddling them,” he said. “Just because we're wounded, doesn't mean that we're not soldiers. Make the soldiers act like soldiers.”

Through all of Michael Schlitz's time in medical centers and hospitals, his mother, Robbi, learned a lot about the needs of his fellow young wounded soldiers. “When you have someone who is 18 or 19 years old, they don't believe the world is going to reach out and bite them, and when it does it is unfathomable. They still need that mother figure and nurturing” she said. “We don't need to carry them, but just kind of gently shove them in the right direction.”

In stepping in to be Michael's caregiver, Robbi gave up her job and health insurance. Michael's health increased exponentially because of her sacrifice. When he was released from the hospital he was wheelchair–bound, and his wound care took about six hours. After six weeks with his mother, he was out of the wheelchair, and his wound care only took about two hours. “We're not used to asking for handouts, we take care of our own,” she said, “but there are others who really need the help.” Mothers of soldiers who are 18 years old may very likely still have young children in their homes, she said, and cannot afford to make the sacrifices to care for the wounded as Robbi did.

For Mariette K. Kalinowski, a wounded Marine veteran suffering from PTSD after serving two tours in Iraq, her hope for reintegration was linked to recognizing that the effects of experiencing combat were not going to go away. The key for her was finding a purpose in life outside the military. She now helps educate other wounded veterans. In the military she learned how to be self-reliant and also reliant on the team, and she wanted to bring an extension of the battle buddy system to the civilian sphere.

Brain Injury Association of Michigan President Michael F. Dabbs was quick to point out that, “Brain injury is new.” He said, “The phrase 'Traumatic Brain Injury' was not even recognized until Iraq and Afghanistan. Effectively the day that [President Ronald] Reagan's Press Secretary Jim Brady was shot, that day marked the first day of brain rehabilitation as we know it. Prior to that 50% of those who sustained a brain injury ended up in nursing homes, the other 50% died. It was really quite that easy. When we talk about stigma, we're talking about something that is new in the public's mind. It's going to take time for that to change.”

In finding the best treatment for brain injury, Dabbs said that the military cannot do it all. Brain injuries require lifetime care, he said, and unfortunately the rules are not set up to handle that lifetime responsibility. As an example, he said that three quarters of a million veterans live in Michigan, but only one third of them are registered with the VA. “If we're struggling right now to take care of the people who are within the VA system, can you only imagine what would happen if we captured all of those who are eligible?” he said. “The VA cannot handle all the needs of the soldiers. Period. So bottom line, let's start using the assets within the local communities to augment the VA.”

The Navy's Safe Harbor Program is an example of the military providing a lifetime of individually tailored assistance for sailors and their families, said the commander of that program, Retired Navy Captain Oakley Key Watkins III. “We try to look at everything holistically and that all of their needs are properly assessed and being met.” Open to help from anyone who cares about sailors, his desire is to connect wounded veterans with the community through near peer mentors. “We've decided to enroll our guys and gals for life,” and he wants to help returning veterans and their families integrate into communities.

The lunchtime keynote speakers were Army General George W. Casey Jr., Chief of Staff of the U.S. Army, and his wife, Sheila, Advocate for Wounded Warrior Efforts. Their concern was about the unknown cumulative effects of nine years of war on service members and their families.

GEN George Casey, USA and Sheila Casey. To view a slideshow of the 2010 Defense Forum Washington, click here.

“I worry in particular about the family unit,” Mrs. Casey said, “especially the young married family who has not had enough time to build strong bonds and they still have continual deployments bearing down on them.” She also expressed her concern for children building emotional bonds with fathers who are continually called to deployments.

Addressing the often underrepresented support group of wounded troops, Mrs. Casey talked about the need for caring for caregivers. “Caregivers are mothers, fathers, spouses, siblings, and medical professionals, and the common thread among them is that they tend to never say no. They tend to see that their mission is more important than themselves. To the caregivers who are giving all of themselves, I cannot overemphasize to you the importance of finding balance. If you do not take care of yourself physically, emotionally, and spiritually, you are not going to have the energy to take care of anyone else. This is not selfish – it is survival,” she said. “There is no prize for burnout. He who is the most tired at the end of this does not win.”

General Casey highlighted the timeliness of this forum: “Tomorrow is September 11. Nine years at war. We believe that nine years at war has changed us in ways that we know and in ways that we don't yet know or have yet to fully appreciate. We need to start thinking our way through that. One thing that I see is that people always want to get back to the good old days, and I have to tell folks that we're never getting back there. The new normal is going to be fundamentally different.” The United States is at war with a global extremist network, he said, and it is a long-term ideological struggle, one for which we are preparing ourselves for persistent conflict.

The cumulative effects of the last nine years of war are going to be with us for a while, he said. “We've lost over 3,200 soldiers, and they have left over 20,000 surviving family members. We've had over 27,000 soldiers wounded, and 7,500 of those soldiers are severely wounded and will require long-term care. Since 2000, we've diagnosed almost 100,000 soldiers with some form of traumatic brain injury, and since 2003 we've diagnosed 45,000 with PTSD,” he said. “It takes 24-36 months to recover from a one year combat deployment, and the reality is that we're closer to having one year out and one year at home. This has accelerated the cumulative effects.” Furthermore, General Casey said, “the Army is out of balance, and half of our reserves and guardsmen are combat veterans.”

Panelists (from left): COL David Sutherland, USA, Gabe Downes, SSG Brian Beem, USA, Bruce Gans, MD, and Stephen Cochran. To view a slideshow of the 2010 Defense Forum Washington, click here.

The final panel of the day addressed the new normal and finding hope for the future. Because the conduct of war is changing, the way the wounded are treated has to change with it. The moderator had personal experience with life after combat. Stephen Cochran joined the Marines as a Recon Scout in Afghanistan and was wounded on his second tour. His back was broken in six places, but through treatment he was able to walk again. After his recovery, he pursued a country-music career put on hold and now tours the country to help others make the best out of bad times.

Army Colonel David W. Sutherland assists wounded veterans in finding hope for the future by affording them closure and giving them an opportunity to return to bases where they had been stationed. Sutherland said, “I saw the power of the change it can make if you view the service members as individuals.”

Panelist Gabe Downes is a wounded veteran caring for his wounded spouse, former Army Corporal Sue Downes. The Downeses have trouble obtaining support because they live in a rural area and are two-and-a-half hours away from the nearest base. There is hope for people like him, said Bruce Gans, MD, Executive Vice President and Chief Medical Officer, Kessler Institute for Rehabilitation, New Jersey. Progress is being made in telehealth, he said. This remote-access technology provides assessments and therapy. “We have to deploy these and use them creatively.” Furthermore, Gans said, “There are emerging techniques to make the anatomy of what's going on inside the head more visible. We can show the physical evidence of those folks suffering with TBI and PTSD.”

The day came to a close with an address from Assistant Secretary of Veterans Affairs for Public and Intergovernmental Affairs, L. Tammy Duckworth. A Major in the Illinois Army National Guard, Duckworth served in Iraq as an assistant operations officer and also flew combat missions as a Black Hawk helicopter pilot. During a mission north of Baghdad in 2004, her aircraft was ambushed and a rocket-propelled grenade struck the helicopter she was co-piloting. She continued to attempt to pilot the aircraft until passing out from blood loss. As a result of the attack, Duckworth lost both of her legs and partial use of one arm. She received many decorations for her actions, including the Purple Heart, the Air Medal, and the Combat Action Badge.

The Honorable Tammy Duckworth. To view a slideshow of the 2010 Defense Forum Washington, click here.

“This forum has addressed extremely important issues that many of our military members and their family members face today: the treatment and care of our physically and psychologically wounded troops, the struggle our injured service members encounter when they return home, and the struggles

of family members of the wounded experience.” The strain a returning injured service member puts on a family is incalculable. With advances in medical technology and treatment more veterans are surviving their injuries. “We as a nation owe it to these warriors that they have the opportunity to live their lives as they wish,” she said. Echoing President Barack Obama, she added, “We have a covenant to keep with our veterans.”

Simple things like buttoning one’s shirt and walking to the mailbox can become huge obstacles. Recovery to a new normal can last an entire lifetime, but life does settle into a new normal. “Life today isn't the same as it was before,” she said, “but it is good.”

Duckworth's priorities are to end homelessness with veterans, improve access for rural veterans, and improve the seamless transition and collaboration between the DoD and VA. Through the Caregivers and Veterans Omnibus Health Services Act, she hopes that caregivers and veterans will be given the honor they deserve for their dedication and sacrifice.