BlackFive

Col. Sackett's office sent out a PDF file for us to read before the meeting:

Download debunking_myths.pdf

That's the document to which my question refers.

GRIM:  I am looking over the document that OASD sent out -- the debunking myths document -- I gather it's from your office -- about the TSGLI program. It says, myth number two -- you are familiar with this document?

COL. SACKETT: Yes.

GRIM:  Myth number two: A health care provider's statement is all that is needed to verify a TSGLI claim. While TSGLI claims won't be approved without a statement from a health care provider, additional documentation must be provided to substantiate the claim.

In order to convey to our readers what kind of documentation they are likely to need, could you give some examples of additional documentation and talk a little bit about the process for any of our readers who may need to apply?

COL. SACKETT: Certainly.

The kinds of documentation which that really pertains to is activities of daily living. Typically, if it's Losses 1 through 43, it's pretty clear if you have a physical loss that a doctor makes a statement and writes on the claim form, they have a physical loss, which of course would be supported by operating room narrative summaries. However, for the activities of daily living, you would need something that would allow us to determine duration of each ADL impacted. So what that means is tying it back to a time frame such as 30, 60, 90 or 125 days. That's duration. Then the two ADLs -- we'd have to say, well, what was the level of impact, meaning that they were completely dependent on another to do this.

Now the documents that we have found most commonly support that duration of each ADL impacted are occupational therapy/physical therapy-type reports. Also, because of traumatic brain injury, neurological reports are very, very helpful. Nurse's notes, as well, because typically nurses will be taking care of a patient in the hospital and from day to day going in and logging their progress or lack of. And so those are probably right on top, which would take care of the ADL issue. I think that would probably be the most common documents that we would use.

GRIM:  And just to assist both our readers, and also of course your own office, in getting the right documentation, how do you go about getting that? Because of course I've been to hospitals and whatnot myself, and I don't recall ever receiving the nurse's note. How do you apply to receive that?

COL. SACKETT: Okay, typically, we cannot do that simply because of HIPAA and Privacy Act. Therefore, it's unfortunately incumbent on -- and this has put a little bit of a burden on the soldier and the medical side, but typically the servicemember needs to go to the personnel administration division of each hospital and procure a copy of their records.

And within those records they should have a copy of all the treatments that they've had with relation to either their physical loss or their ADL loss.

There are some other helpful tips in the transcript, and again, if you have questions or problems (or comments), leave them here.  I'll make sure they get where they need to be.

What we call 'PTSD issues' are something all of us who know combat veterans think about.  It's not covered by TSGLI at this time, though as the Colonel noted, they are looking at ways to deal with it.  Prof. Lubin began this topic with a question about how TSGLI dealt with PTSD currently.

COL. SACKETT: Well, for TSGLI currently, the only thing that would fit in is if perhaps they had traumatic brain injury or they had some other thing. But as far as post-traumatic stress syndrome itself, TSGLI has not allowed for that loss at this point in time. However, Veteran Affairs is working towards adding additional losses and additional, let's say, means to bring others such as post- traumatic stress syndrome into the TSGLI program.

Now, in Combat-Related Special Compensation, or CRSC, it is covered. So for instance, you have an individual who for whatever reason did not qualify for one of the losses in TSGLI and they've been in the service -- they're a senior-ranking NCO or officer and they've got 20 or more years -- then they could then apply for CRSC, and under the guise of the PTSD injury immediately be awarded for that type of injury due to its link to a combat-related scenario.

A. LUBIN: What about a kid who's -- what about a kid who's 19 comes back now? Would he qualify or is he just SOL until Veterans Affairs --

COL. SACKETT: Well, there are a couple of things that are developing, and one, of course, if you're talking back to the post- traumatic stress syndrome, there's pending legislation to bring medical Chapter 61 retirees into that program, and they're looking between one and 19 years at that type of program. But all that is pending legislation.

A. LUBIN: Okay. Pending -- has it -- is this subject to vote in Congress or VA proposing it, or can you tell us the status?

COL. SACKETT: Certainly, certainly. Well, Army can propose that; I have proposed it through my chain of command through Department of Army. And DOD, in turn, proposes it if they chop off on it, propose it up to Congress. The VA, in addition, depending on which program we're referring to here, they propose it.

But in essence, I have proposed both TSGLI and CRSC legislative improvements to the program, as well as meetings with the VA and the other services, to ensure that we meet the needs of the soldier or retiree.

I followed this up with a question about how to treat combat veterans who have PTSD, but who may avoid talking about it.  Currently, for Federal and local governments alike, any hint of 'psychological difficulty' can end not just your current but any future career.  That creates problems of its own:

GRIM:  Andrew Lubin reminded me of this with the question about post-traumatic stress disorder. I talk occasionally to Marines who are back from Iraq, particularly some of the guys who fought in Fallujah in 2004, and a lot of them didn't want to apply for any sort of benefits or any sort of assistance with PTSD and, you know, any similar thing, on account of fear -- a very justified fear -- that it might interfere with their future employment prospects or other sorts of things.

In looking at considering ways of dealing with this problem in the future, are you taking steps or recommending steps to ensure that people who feel like they need maybe to seek a little help are not going to then be penalized for seeking help in the future?

COL. SACKETT: Well, from our standpoint, you know, with HIPAA, we do not forward this information to anybody. So if they come directly to us, this information stays between me and the claimant. But as far as it going outside, I realize that stigma out there. I mean, we've seen this very clearly with CRSC, where many veterans did not submit for PTSD from World War II because of the stigma attached, and from Vietnam -- you name it. And so I think for a retiree, it's not so much of an issue, but you're right to say for TSGLI, that could be an issue if this program were to allow for it.

However, one thing that you have to be aware of is now the services, the medical command -- and I don't want to speak outside of my area -- but I do know they are working very proactively on the ground in Iraq and Afghanistan with what they call the MACE test -- M- A-C-E -- and it's a Medical Analysis Cranial Examination, I believe. And this is something also that AW2, Army Wounded Warrior, has addressed specifically and could probably provide you more information on how they're handling the stigma of PTSD.

GRIM: It's not the stigma so much as it is the statutory aspects. You were talking about informing, you know, people about what legislation you might need to address. I was wondering if this is something that you've considered.

For example, if you're a former Marine and you apply for a job with Homeland Security, one of the questions they're going to ask you under oath is, you know, have you had medical treatment for psychological issues? That's something that, if you're talking about legislation, you might want to think about in order to make sure that people are willing to come forward and get help if they feel like they need it. I was just wondering if it is something that your office is considering, and to what degree you have addressed it.

COL. SACKETT: You know, the one reason I like going out of the office and talking to soldiers and various TDY trips is to get that kind of feedback. You know, if you stay inside your office and just execute the program, you don't get feedback like that, and so that kind of feedback is truly invaluable because I hadn't looked beyond the program scope to think of what impact that would cause to future employment for any service member with PTSD. I know within the service, that's been a concern, but now I think the service in itself is starting to take that into account. You have individuals coming back from Iraq, Afghanistan, who do have various forms of posttraumatic stress syndrome and now will be identified, whether they like it or not, right up front.

But then again, these individuals are going to stand for their career purposes and will be getting secret clearances and top-secret clearances.

So I can't but think that that will be taken into account in the DOD level and that you're certainly right. That needs to go forward into general society through the Congress. And that's a very good proposal and I'll see what I can do with that.

...

A. LUBIN: Colonel, to follow up on Grim's question, which followed up on mine, what about -- you know, I'm not thinking of the retiree who really has no stigma except maybe his, you know, wife is pushing him to do this. But the kid who's 19 or 20 comes back and wants to see the doc and suddenly, you know, because word of this -- it's all supposed to be secret but of course it never is -- leaks out that, you know, Lance Corporal Schmuckitelli is going for a PTSD problem and his career has kind of ended at that point.

Is there anything with the medical services to work on PTSD being as equally acceptable as having your hand shot off?

COL. SACKETT: Well, I have to say, from everything I've seen with the Army Medical Action Plan and the different communities that in MEDCOM are working that this is something that they're very concerned, first of all, to identify. If these individuals aren't identified that they have perhaps exposure to post-traumatic stress syndrome, and then they go down range to their unit and into a new company commander and new first sergeant, and all of the sudden there are behavior problems and they don't know why, and then they just X them out of the military -- well, by having this identified in their medical record, these are the kind of things that will indemnify them and actually protect them and keep them in their career.

So from that standpoint within the Army, I think there's more protection being built into the system by early identification and treatment. And a lot of that early identification and treatment will really lend itself to proactively healing a lot of that situation that otherwise, left to its own, just magnifies.

A. LUBIN:  Have you talked to any of the Marine medical people on this? Because I would -- I'm thinking of my son coming back from two tours. And first time came back from OIF 1, and they went through the things -- went through the surveys on the ships. You know, as the kids are -- and as Ryan said, no, we never saw no bodies; we saw no action; we -- you know, they would have killed themselves rather than talk about stuff like this.

COL. SACKETT: That's very true, very true. Yeah, there's -- go ahead.

A. LUBIN: Yeah, Grim, I can't speak to the Army; you can. But I mean, knowing my Marine friends, they'll -- matter of fact, I got an e-mail from a father yesterday, said, hey, my son has come back; he seems to drink more than before he left for Fallujah. Yeah, no shit, Oscar. You know, there seems to be a mindset that PTSD is not an acceptable wound.

GRIM: Yeah, I've heard lots of reports of increased drinking, although I'm not sure how much that has to do with PTSD and how much that has to do with hanging around exclusively with other Marines for a long time.

A. LUBIN: (Laughs.) I'll get you for that.

LT. CMDR. DEWALT: This is Brook DeWalt. I would just also just like to add as a resource for you all the issue of the stigma aspect was recently addressed by SecDef Gates, and if you go on-line to dodvclips.mil, it is addressed. He was in a -- I believe it was one of his weekly roundtables with the media, and the first few minutes of it on whatever the main issue was he did address the stigma issue. And so I believe that's going to be a resource for you all if you want to check that out. It's listed on there. It's in the first couple minutes of one on "Support and care for the wounded.

I think this is the clip to which Commander Dewalt refers:

Download 40cee4153c1994826b5d8457a00c03fb36005c70.wmv

Col. Sackett's office has written us back about three times since we did this roundtable last week, so I know they are very interested in reaching out to you.  If you have comments or suggestions, thoughts or concerns, leave them here.