Team Rubicon

There are very few organizations or people in the world that do truly wonderful things without any expectation of recognition of personal reward.  Team Rubicon is one of the magnificent few.

Team Rubicon is a Disaster Response Veteran Service Organization.  As in responding to disasters in places like the typhoon wracked islands of the Philippines, Haiti, Chile, Burma, Pakistan, Sudan, and in the United States.  They are a growing group of dedicated veterans who bring the skills they learned in uniform (things like flexibility, teamwork, leadership, work ethic, dedication, sense of duty and commitment to duty) to a new form of warfare: fighting against the disasters that ravage communities and threaten the lives of innocent men, women, and children.

They are incredibly agile, and are often among the first relief and assistance agencies to hit the ground.  The credit for such agility is the committed deployability of the members of the team; they have all answered the call to arms for their nation and in doing so have become incredibly motivated, proactive, and prepared to grab their gear and catch a flight to wherever in the world disaster strikes.

Today they are conducting Operation SEABIRD in the Philippines at the same time that Operation HONEST ABE is underway to help with the damage wrought by the tornadoes that blew through the region this past weekend. To say that they do amazing work is an understatement of epic proportions.  They are the best our country has to offer, continuing to serve after hanging up the cloth of the nation.

My hat’s off to them.

To learn more, go to their website.  Also, here is a link to a great story in Stars and Stripes.

A tragic but true story of a Marine in trouble

This morning a friend emailed me a link to a particularly disturbing story.  It is a very well written blog post  in the New York Times that provides an unusually unvarnished look into the dark pit that is PTSD.

There are plenty of articles and blog posts about PTSD bouncing around the internet, but this one is compelling in a way that so many others are not.  In this post the author candidly and openly describes how he attempted to end his own life because the lingering effects of his wartime experiences on his psyche.  He takes the reader with him as he writes the note that his wife will find with his cold and lifeless body and as he swallows an entire bottle of pills.

I won’t give the whole article away because it is too well written and too insightful for my humble efforts to recount it.  You can read it here.  I will say that it is an articulate indictment of how this Marine was treated by his supposed leaders when he reached out for help; if his treatment is indicative of how others are treated when they try to overcome PTSD while still in uniform then a lot of so called “leaders” need to look long and hard in the mirror.

They are not leaders.  They are anything but, and are a wretched example of what some implacable and soulless men and women in positions of responsibility can do to those that they have been entrusted to lead.

Sad.

The tragic loss of a great friend to all veterans: A Goodbye to James Gandolfini

Yesterday, in Rome, a great friend and supporter of the military and of veterans passed away.  James Gandolfini, the iconic actor who redefined the mafioso in cinema and popular culture, died of an apparent heart attack while visiting Italy.

Gandolfini, whose acting performances brought him into the top tier of the industry, was so much more than “just” a brilliantly talented actor.  He was also a compassionate and driven man who cared deeply for the members of the armed services who were fighting in Iraq and Afghanistan as well as the veterans who rejoined society after hanging up their body armor and combat boots.

His contributions to the military are too numerous to recount here, but there are two of his passionate endeavors that have resonated with me personally.

As an actor, he has been at the top of his game for over a decade.  The roles that he has played and the movies that he has made took a level of dedication and passion and professionalism that would have left a lesser man unable to look past his own career.  Fortunately for me and for all who have served, however, he leveraged the professional capital that he had earned and selflessly gave back to those who were wearing the cloth of the nation.

He used his talents to produce two incredibly powerful documentaries, both of which I found to be moving and staggeringly relevant in a time of seemingly ceaseless war.

In 2007 he produced the documentary “Alive Day Memories: Home from Iraq” in which he told the story of soldiers and Marines who were severely wounded and disabled during their tours in support of Operation Iraqi Freedom.  It was not a feel good driveby piece of pseudo-journalism, but instead a heartfelt and heartwrending journey with veterans who had come within an Angel’s breath of dying, yet survived the traumatic violence that robbed them of limbs and, for many of them, hope.  Gandolfini took everyone brave enough to watch inside the lives of those who paid the price of freedom with their arms and legs, and will continue to pay it for the rest of their days.  He pulled back the curtain and showed the tragic realities of war in such impactfully human terms that it brought the cost of war home in an undeniably compelling and emotional way.

Later, in 2010, he produced another powerful documentary about the unseen wounds that affect those who fight in war.  “Wartorn: 1861-2010” drew back the curtain on a different and equally debilitating price that veterans face: Post Traumatic Stress Disorder.  Gandolfini provided a glimpse into the psychological damage that is wrought by war on those who fight it from the Civil War to the wars in Iraq and Afghanistan.  As with “Alive Day”, the documentary makes the audience not just view the subject, but to feel it in a way that is unforgettable.

Yesterday, June 19th, 2013 was a day like any other except that on that day a great friend to anyone who has ever sworn an oath to support and defend the Constitution of the United States was taken from the surly bonds of earth.  Although he is no longer with us in body, his spirit joins the likes of Bob Hope and Bing Crosby and other giants of entertainment who embraced the military even though they didn’t have to.

He will certainly join the likes of Hope and Crosby on the other side of the Pearly Gates, for as anyone who has ever heard the words to The Marines Hymn knows the gates of heaven are guarded by the United States Marines.

And they always open the way for one of their own.

Semper Fidelis James Gandolfini.  You will be missed.

An opportunity for Combat Veterans

I have written about the opportunity that Veterans 360 presents for transitioning veterans.  For those who may not have read my prior posts on what they do, here is a refresher:

It is very challenging to make a quick and successful transition from military to civilian life.  There are many obstacles that you encounter along the way, many new things to learn, and a unique set of experiences that you never want to forget.  It can really be daunting and confusing at times for any veteran to make the change back to civvie street.

It is particularly daunting and confusing for those veterans who are struggling with the effects of Post Traumatic and Combat Operational Stress as they leave the military.  Combat veterans, in particular, have a more difficult time making the transition.  I have spoken with many who are making the shift, and one theme comes through in every conversation: “What am I gonna do now?”

Being a transitioning Marine intimately familiar with the realities of PTSD myself I can fully relate.  It is tough to make the change from one way of life to another, and it is much more difficult for those with stress injuries as they wrestle the demons within while trying to adapt to a new life without.

There is an organization that I am affiliated with that aims to help combat veterans successfully navigate the challenges transition.  Veterans 360, a nonprofit organization headquartered in San Diego, is kicking off what I believe is a great program to help combat vets make a successful transition.

Here is their mission:

Veterans 360 has a clearly defined mission: to provide recently separated combat veterans with a carefully developed and managed program of support that will help them develop the professional and interpersonal skills needed to succeed in civilian life. Our goal is that through engagement, education, employment and healing, our student-veterans will utilize what they have learned, manage the resources that are available to them and become equipped for an exceedingly successful transition into civilian life.

They help vets by bringing them into an cohesive and immersive environment for the crucial first two months after leaving the service.  Veterans 360 brings a dozen or so combat vets together, forming a “squad” that will go through an integrated and comprehensive transition program together.  They will work live together, work together, and heal together in an environment that centers around engagement with the local community, education focused on basic skills and vocational training, employment facilitation that will help them find meaningful work, and healing to help deal with PTS.

All of this is accomplished through individual and corporate donations, and not one thin dime of the veteran’s post-service VA or other benefits will be touched.  This is a critical point, as many unseemly organizations and “educational” facilities have sprung up with the cloaked goal to separate the veterans from their money.  Veterans 360 is proudly not one of them.

Veterans 360 is about to kick off their inaugural squad engagement on April 1st of this year.  They are looking for candidates to participate in the program.  The details of the initial effort are listed in their recruiting poster:

Veterans 360 Recruiting Poster

If you are a combat veteran in the San Diego area who is looking for something innovative to help with your transition, check it out!

Still waiting for the call that may never come…

My last post left all of us hanging in anticipation of a call from the VA in regards to my disability claim.  You see, I had called and called the VA’a customer service number during the day with no luck whatsoever.  After finally getting up waaaaay before the crack of dawn I called again and finally got ahold of a VA representative.  We reviewed my case, and he agreed that something was amiss.  He promised that a representative would call in the next ten working days to let me know what was up.

I cheerily hung up and waited by the phone like a thirteen year old waiting for a girl to call and invite him to the Sadie Hawkins dance.

Well, it is now working day number nine.  No call.  No dance.

I have been holding my breath so long that I have gone from blue to purple.  They are not late yet.  One day to go!

I wonder if they will call?

The anticipation is killing me!  If they do, I will write a post to tell you how it went.  If they don’t, I will write a post to tell you how it didn’t go.

I think I see a zero dark thirty phonecall to the VA in my future…again.

Back to the Veterans Administration, Part 3: This is not the appointment you were looking for…

In my last blog entry I promised that I would update you on how my first official appointment with the VA went, and, well, that appointment has come and gone.  It was interesting, but not really what I had expected.  Or what I was hoping for.  It was, however, insightful because it provided a glimpse into the road that lay before me as a “customer” of the VA healthcare system as well as introducing me to many of my fellow veterans who frequent the local clinic.

The appointment was with the VA Clinic’s PTSD Services unit.  As I wrote in my last post, I spent an hour or so with my designated social worker whose job it is (among other things) to assess whether or not I needed to be evaluated for the effects of combat stress.  Her assessment was based on our meeting as well as the sixteen page questionnaire that I completed beforehand.  Since the questions were all about combat, and having spent a whole lot of time in and around a significant amount of combat in two different war zones, she determined that it was certainly appropriate for me to go for an evaluation.

A week later, I returned to the clinic for my first appointment: the Post-Traumatic Stress Disorder Services Orientation.  I wandered into the clinic’s Mental Health Services waiting room and, after checking in, was handed yet another set of forms to fill out.  After ten minutes of answering questions about my propensity for self-harm, manic episodes, and depression, I was finished.  Just in time, too, because as my government issued pen scratched out the last checkmark a young woman opened the waiting room door and asked those of us waiting for the PTSD orientation to follow her.

I joined a rather eclectic group as we accompanied her to a smallish room ringed with chairs padded with leather seats and backrests colored in the oddly disturbing green that is prevalent in hospitals and movies about psychiatric institutions.  They must have got them on sale somewhere, because I don’t think they would match anyone’s home decor.  To their credit, though, they were actually pretty comfortable.

Out of the twenty odd-colored seats ten or so were filled by my fellow attendees and me.  There was an elderly veteran of the Second World War, Korea, and Vietnam (as his hat proudly proclaimed), a man in his sixties, a few gentlemen in their 50’s, a young woman who never took off her sunglasses, a tattooed young man barely out of his teens, and me.  Not at all what I was expecting, to be honest.  I had figured that my meeting would be with young veterans from the recent decade of war, but to my surprise we veterans of Iraq and Afghanistan were in the minority.  There were three of us, one veteran of Desert Storm, the aforementioned WWII vet, and the rest were from the Vietnam War.

I know this because the young woman who led the session (another clinical social worker) had us introduce ourselves before we began the session.  In addition to asking where we served, she asked us to share why we were here.  The recently discharged veterans were pretty obvious, but the others were a surprise.  Each of them had been referred to the session by their primary care provider, which I found to be fascinating.  After hearing their introductions and listening to their conversations it became evident to me that many of these veterans were just now entering the VA medical system.  To me, that was a surprise because I had never really considered not entering the system.

That reveals a tremendous difference between the experiences that “new” veterans have in juxtaposition to the “old” ones.  Our transition process from active duty included a mandatory introduction to the VA, along with an education in the basics that the VA provides.  Many veterans of WWII, Korea, Vietnam, Desert Storm, and the Cold War received no such exposure to the Veterans Administration.  As a result, thousands and thousands of veterans who are eligible for help and care never bothered to pursue it until they really need the services that the VA provides.  Unfortunately, for many of them, the help that the VA provides ends up trying to make up for years or decades of neglected conditions.  That was the explanation for why so many of the people in the room with me were there for the first time despite having removed their uniforms back when Disco Fever ruled the dance floor.

Anyhow, back to the session.  After introductions, the social worker ran through a dozen or so power point slides that described the multitude of programs that the VA offered in the clinic.  This particular clinic was focused on combat veterans who were at risk for PTSD, and the services that they provide were all focused on countering and healing the effects of combat stress.  She started with textbook (according to the American Psychiatric Association, who writes such things) definition of PTSD, which included things like experiencing traumatic events, re-experiencing previous trauma, hyper-vigilance and hyper-arousal, and avoidance of things that remind you of traumatic events.  Considering that everyone in the room has served in combat, the probability that at least some of these symptoms would apply to us rocketed up to about 100%.

After the explanation of what PTSD was completed she assured that recovery from PTSD was possible.  They offered over a dozen different methods to assist with recovery; including individual and group sessions on topics like anger management, coping, spiritually based recovery, couples and family therapy, anxiety disorders, and women’s groups.  The goal of each program is to help the veteran reach a positive outcome within three months, with a positive outcome being that the veteran being better able to cope with his or her condition.

Not surprisingly the clinic was overwhelmed with veterans who needed help.  The wait time to join in the programs was eight weeks or more.  The social worker explained the process for getting into one of the groups, and that is where I realized that this was actually not the appointment I was looking for.  Actually it was not even really an appointment, but instead just an introduction and orientation to the clinic.

Towards the end of the session she explained that for us to participate in any of the offerings we would have to set up another appointment in which we would actually meet with a healthcare provider who would then assign us to a group.  An intake appointment, she called it.  That was the first indicator that this was not the appointment I was looking for.  The second indicator was her announcement that the clinic did not have anything to do with disability claims.

As you know from my previous posts, I was actually hoping to get my disability claim back on track.  It had been five months since I had been notified that the claim had been partially settled and that I should wait to be contacted by the VA for further evaluation.  After spending almost half a year listening to the sound of no telephones ringing I called the VA to get the ball rolling.  I had wrongly assumed that once I was in the system that the claims process would proceed as a matter of course.

Nope.

I would need to call another number for that, or I could stop by the Veterans Service Office that happened to be just across the hall.  They would be able to help those of us working on our claims, she said, but unfortunately not today because their office was closed.

D’oh.

She then reviewed all of the forms that we completed prior to the session, and then she called each of us out individually to set up appointments for the intake interview.  I was a bit disgruntled, but resigned myself to just go with the flow and left the session with an appointment for an intake appointment some six weeks in the future and the phone number to the clinic’s VSO office which would help me with my claim.

I also left reminding myself that the VA was a bureaucracy and that patience was a virtue.  I was still disgruntled, though, and not feeling particularly virtuous.  So it goes.

__________

Lessons Learned:

1.  The medical side of the VA is different from the disability claims side of the VA.  Make sure to stay engaged with your VSO to ensure that your claim is moving forward, and also be specific with the VA representatives when you are making your appointments.  I was not specific enough because I made some errant assumptions, and as a result I have lost another month or two of forward progress on my claim.

2.  Be ready to devote a lot of time to the VA.  There are great programs available, but it will take a long time and plenty of seemingly repetitive red tape, paperwork, and meetings to actually see a provider.  Breathe deep, think happy thoughts, and go to your happy place.  Time will pass and you will get the help you need.  It will just take a lot more time than you would like.

3.  Ask questions up front.  Had I asked whether or not this appointment would help with my disability claim I would have saved some valuable time.  Assume nothing!

Back to the Veterans Administration, part 2: Entering the system

I left you, my dear readers, hanging with my last post.  When we last connected I was about to go to my first live and in-person post-retirement Veterans Administration engagement.  After months of waiting for a call that never came I shouldered the responsibility for my own situation and, after more than a few phone calls, set up an appointment to become a customer of the VA.

The instructions were simple enough.  I was directed to arrive at the local VA clinic at ten in the morning, and upon my arrival I would be meeting up with the Benefits and Enrollment specialist.

So arrive I did, right on time.  I walked into the lobby of the recently built and still sparkly building and sauntered up to the reception desk.  To my chagrin, there was no one at the desk, so I rather aimlessly just leaned on the counter until somebody arrived.  There were two chairs behind the desk after all, and they looked recently abandoned.

After a few minutes of pointless leaning I decided to find someone who could help me.  I wandered past the reception desk and into the halls beyond.  After walking from one side of the building to the other in hopes of randomly finding the office I was looking for I gave in and asked an employee (whom was readily identifiable by her hospital scrubs and prominently displayed VA Identification badge) for help.

“Go to the lobby and check in with the girl up front,” said she.

After explaining the absence of said girl, the employee shrugged and pointed back the way I came.  “Just go back to the lobby. Someone will call for you.”

I was not particularly optimistic that said calling would occur, but I meekly headed back to the lobby anyway.  Joining a few other patient souls in the chairs that ringed the perimeter of the room, I found a copy of Time Magazine from the previous year to fill my time as I waited for the call that I was not certain would come.

After ten minutes of reading about Time Magazine’s view of the world circa October 2011, a door that previously gone unnoticed burst open.  An energetic gentleman with short graying hair and an startlingly positive outlook on life fairly leapt onto the scene and immediately started asking each of us in the lobby why we were there.

After a staccato interchange between the people sitting next to me, he turned in my direction and asked if he could help me.  I explained that I was there to meet with the enrollment section.  He smiled and said “That’s ME!” and pointed me towards the still-open door and one of the vacant offices on the other side.  “Take a seat, I’ll be right there.”

So in I went, clutching my sheaf of medical records and other documents, wary to see what would happen next.

John, as I learned his name to be, had obviously introduced a few people to the VA system before I showed up.  Probably thousands of people.  He had it down!  He handed me a sixteen page long questionnaire to fill out and began firing questions at me faster than a belt fed machine gun.

“Retired?”  “Yep.

“How long were you in?”  “Twenty seven years.”

“Social?”  (As in what was my social security number, which is the key that opens my files in pretty much every government database).  I gave him my precious nine digits.

“Marine?”  “Yep.”

“What did you do in the Marines?”  “Where do you live?”  “Do you have TRICARE?”

Each question was accompanied by his furious banging on the computer keyboard as he entered my information into the computer.  I was trying to complete the form as he talked, which he noticed.

“Don’t worry about that right now.  That is for the social worker, who I will introduce you to in a few minutes.”

Social worker?  Really?  What was that all about?

“For now, let’s just get you in the system…”and from there we were off on a journey of questions and answers that lasted ten or fifteen minutes.  I won’t subject you to the lengthy details, but here is a rundown of the pertinent ones for those of you who will be headed to the VA:

– The difference between TRICARE and the VA.  He patiently explained that TRICARE is insurance, and the VA provides traditional medical care, just like your regular family physician.  While that statement sounds obvious, the ramifications are significant.   If you are injured in an accident or have an emergency away from your normal VA provider, TRICARE takes care of it because that is what insurance is for.  The VA is not insurance, so you would be in trouble when the bills came due for emergency treatment because the VA does not pay for such events because the VA is not insurance.  Kapisch?

– Online enrollment.  I had previously enrolled into the VA healthcare system because they had thoughtfully sent me an email several months ago.  The email, which suspiciously looked like spam (but wasn’t) encouraged me to register via the VA website by following this link: https://www.1010ez.med.va.gov/sec/vha/1010ez/  I filled out the form, and I am glad that I did because it reduced the amount of time I spent with with the enrollment specialist by at least half.

– The Packet.  The sixteen page packet that he handed me was the OIF/OEF/OND (Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn) enrollment questionnaire.  In a nutshell, it was a long questionnaire that asked a lot of questions about my mental health, combat experiences, and exposure to traumatic brain injury (TBI).  The form would be used by my social worker.  More on that later.

– Explanation of how the clinic works.  This particular clinic is divided into three teams (Red, White, and Blue…pretty catchy!) and each team had a staff of its own.  In my case I became a member of Team White, and with my assignment came my choice of primary healthcare providers.  Since I did not know any of the doctors personally, I happily chose the one with the next available appointment time (which happened to be a month away).

– My first appointment with the doctor would be a “welcome aboard” type of physical examination, and I would be required to visit the lab and submit various bodily fluids beforehand.  Joy.

– Appointments.  In order to set up an appointment, I would not be allowed to call the doctor or the clinic directly.  I must call central appointments (via a 1-800 number) in order to contact someone at the clinic.  That is pretty much the same as life in uniform, so it wasn’t a shock, but it is annoying.  If I want to ask the doctor about a medication, for example, I need to call central appointments and leave a message for him.  Then, when he gets the message and has the time, he is supposed to call back.  I hope I don’t have any time critical severe allergic reactions!

-ID Card.  Towards the end of the interview he announced that it was time for me to get my VA ID.  I sat up straight and looked at the camera that was mounted above his computer screen, and when he said smile I did so.  In a week or two my card should show up in the mail, and then I will know just how stupid I look.  No second chance for a new picture!

As soon as John was done with me he guided me to another office and introduced me to a very nice woman who would be my social worker.  She asked if I had completed my form, and as I had not she gestured for me to take a seat and fill it out.

I did so, and after ten minutes of scribbling I knocked on her door.  She invited me in, and after taking the sheaf of papers from my clutches she began her own interview.

Now, you should understand that this is probably the first time in my life that I have ever been in a room with a social worker.  I have met people in that line of work in the past, but never have I actually been professionally engaged by one.  Honestly, I had no idea what social workers actually did, but after spending a half hour with a pro I was pleasantly surprised to learn that they fit a niche that is needed in the VA: helping veterans who are having difficulty transitioning back to the civilian world deal with the often confusing processes that come with  the title “veteran”, not to mention little things like PTSD, TBI, and other psychological issues.

At any rate, she had the unenviable task of manually inputting the responses I scribbled on my questionnaire into the computer database.  Obviously some parts of the VA could use a little modernization, but she explained that she actually got more out of re-inputting the data because she could interact with the client (me, in this case) and flesh out her perspective on the information.  This is important because she was evaluating things with real impacts on veterans, such as combat stress problems and indicators of violence, self harm, and suicide.  She was there to make sure that we, the combat veterans, were looked at objectively and offered the appropriate levels of care.

After an hour or so spent chatting with the social worker, she led me to the appointment desk at the combat stress clinic.  The results of my survey indicated that meeting with them would be a good idea, and to be honest I believe it is a place that all combat veterans need to visit.  The wars of the last decade have seen an unprecedented  level of stress on the military forces, with many veterans deploying to war time and again, and then again, and again.  The frantic deployment tempo means that many veterans bring issues and problems home, and the VA is there to help deal with them.  Going to the clinic is the first step along the way to getting better, and whether you think you need it or not you should stop by.

So now I am officially in the VA system, and I have several appointments in the future that I will tell you all about.  Stay tuned!

___________

Lessons Learned:

1.  After your claim settled, either partially or in full, you should be receiving an email inviting you to enroll in the VA via their website.  Initially I thought the email was spam, but after several attempts I finally paid attention and registered.  Doing so greatly streamlined my in-person registration process.  As an aside, they used the email address that I provided months earlier as I was transitioning out, so it behooves you to make sure that you provide an address that you will utilize for a long time to come.

2.  The VA is just like every other government bureaucracy.  Get ready to do some things twice, and if your are lucky, three times or more.  It is just the way it is.  Suck it up and march on.

3.  It will help for you to bring whatever documentation from the VA you have accumulated thus far.  I recommend that you buy a pocket folder or folio to keep everything in.  Even better, get yourself a dedicated filing system for all of the stuff that you are amassing because if you don’t you will end up with a disorganized pile of documents approaching the stature of the Eiffel tower.  If you don’t believe me, just look at the pile next to my desk at home.