Veterans Benefits Information guide to VA benefits

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Veterans Benefits Information

Overcoming stigma and perceptions

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Dr. Charles Hoge spent nearly 20 years in the military, retiring as a colonel in 2009. His specialties included psychiatry, which he put to use as head of psychiatry and neuroscience research at Walter Reed Army Institute of Research (WRAIR) from 2000-2009 - a time period that included a deployment to Iraq in 2004.

Now a senior scientist at WRAIR and in the Office of the Army Surgeon General, as well as an attending physician at Walter Reed Army Medical Center, Hoge has seen firsthand how the treatments of post-traumatic stress have fallen short during the war on terror. He shared those insights with The American Legion's ad-hoc committee on PTS and traumatic brain injuries in Washington, Aug. 1.

"(Servicemembers and veterans who get) mental health care maybe get one visit or two visits or three visits, and over half are dropping out and not completing a sufficient number of sessions for treatment to be meaningful in terms of recovery," Hoge said. "Despite everything we're doing, the overall reach of treatment for our servicemembers... is relatively low. So then we start asking the question, ‘Why is that happening?'

"Certainly we know there's stigma, which is the concern the individual has about how others will view him or her if they see a treatment - ‘My peers will view me differently, my leaders will treat me differently, it will affect my career' - those are the stigma."

Hoge said that other issues, such as getting off work and getting childcare, also interfere with treatment plans, as do the negative perceptions that servicemembers and veterans have of mental health care.

"Those are things like, ‘I don't trust mental health care. I don't think it's going to work. It's a last resort. It's not for me. If I go see a mental health professional they're just going to prescribe me pills,'" Hoge said. "I can't say 100 percent the reason so many veterans and servicemembers drop out of treatment is because of negative perceptions because we don't have that direct link yet. But we do know that... in a couple of studies now, it's the negative perceptions which are more strongly predicting the utilization of services to begin with. Some of the traditional ways in which we thought about the reasons why veterans don't come into see us we may need to rethink a little bit. It's not just only about stigma; it's also about these negative perceptions."

Hoge said that while it is clear there are evidence-based treatments that work and are mandated in every Department of Veterans Affairs facility, "The problem is that if the veteran doesn't like the treatment for whatever reason and drops out of care, it doesn't matter how good the treatment is," he said. "How do we deliver evidenced-based care in a way that meets the veteran where he or she is and is a way that is conducive to them being most willing to remain in care?"

Just days after briefing the committee, Hoge addressed that issue with an editorial in the Journal of the American Medicine Association that accompanied a study titled "Adjunctive Risperidone Treatment for Antidepressant-Resistant Symptoms of Chronic Military Service-Related PTSD." The study reported that among patients with military-related PTS who show a resistance to serotonin reuptake-inhibiting antidepressants, the six-month treatment with risperidone compared with placebo did not reduce PTS symptoms.

In his editorial, Hoge wrote that simply medicating PTS sufferers isn't the answer. "Improving evidence-based treatments, therefore, must be paired with education in military cultural competency to help clinicians foster rapport and continued engagement with professional warriors," he wrote. "This includes sensitivity and knowledge in attending to difficult topics, such as grief and survivor's guilt stemming from loss of team members, ethical dilemmas in combat, or situations associated with feelings of betrayal (e.g., poor leadership, rape by fellow team member.)

"Significant improvements in population care for war veterans will require innovative approaches to increase treatment reach. Attention to the occupational context, combat physiology, and mental and physical comorbidities is essential. Validating and implementing collaborative care models based in primary care should be a high priority. Matching evidence-based components of therapy to patient preferences and reinforcing narrative processes and social connections through peer-to-peer programs are encouraged. Family members, who have their own unique perspectives, are essential participants in the veteran's healing process and also need their own support ..."

Hoge told the committee that one of the ways to improve treatment reach is delivering care that is most conducive to veterans staying in care. "It may not necessarily be, ‘Here's my prescription for medication' or, ‘Here's my prescription for full-on exposure therapy. Maybe I need to tell them, ‘There are several things that are going to help with treatment. Which one of these are you most comfortable with?'" Really engage the person in that way first."

"Post-deployment health," Hoge said, needs to be thought of in a "holistic manner. There's a gradual movement toward that. Those sorts of programs where there's better case management... and team care within the primary-care structure, that's now rolling out across the VA, and I think that's a very positive direction."

During the committee's two days of meetings, it also heard from VA's Drs. Joel Kupersmith, Matthew Reinhard, Julie Chapman, Sonja Batten and Alison Cernich, Matthew Stiner of Justice for Vets, and from Legion staff for briefings on the System Worth Saving program. The committee also considered potential resolutions to guide the Legion in its further investigations into PTS and TBI.

Check back at in the coming days for more stories from the committee's meetings.

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30 air rifle competitors take aim Aug. 4-6

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The 21st annual American Legion Junior Air Rifle Championship gets under way Aug. 4-6 at the USA Shooting Range located at the Olympic Training Center in Colorado Springs, Colo. During the event, 30 competitors shoot in either the precision or sporter category with a .177 caliber air rifle in three positions: standing, kneeling and prone. The top eight shooters in both the sporter and precision category will move on to the finals. During the finals, one contestant will win the championship title in his or her respective category along with a $2,500 scholarship donated by the Sons of The American Legion.

The opportunity for contestants to shoot on professional grounds is in large part thanks to the Legion's longstanding relationship with, and respect from, the United States Olympic Committee (USOC).

"The American Legion has a particularly strong partnership with USA Shooting as evidenced by the many Olympians who have come through the ranks of their marksmanship program," said Jeanne Picariello, chair of the multi-sport organizations council for the USOC. "I became aware of the Legion's interest in USOC membership through my role on the USOC Nominating and Governance Committee. The Legion delivered an inspiring presentation to the committee stating their intent to support Olympism worldwide and at home. I was an early advocate for the Legion, and they received a positive vote for membership into the USOC."

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Military Service Requirements for VA Loan Eligibility

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Wartime - Service During:

  • WWII: 9/16/1940 to 7/25/1947
  • Korean: 6/27/1950 to 1/31/1955
  • Vietnam: 8/5/1964 to 5/7/1975

You must have at least 90 days on active duty and been discharged under other than dishonorable conditions.  If you served less than 90 days, you may be eligible if discharged for a service connected disability. 

Last Updated on Wednesday, 01 September 2010 07:39

Legion supports wounded vets' job security

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American Legion National Commander Jimmie L. Foster wrote a letter July 22 to Rep. Lloyd Doggett of Texas, supporting his "Wounded Veteran Job Security Act" draft legislation.

If passed, the bill would prohibit discrimination and acts of reprisal by employers against veterans who must temporarily leave their jobs to receive treatment for service-connected illnesses, injuries and disabilities. The measure would further strengthen provisions of the Uniformed Services Employment and Reemployment Rights Act (USERRA).

Passed by Congress in 1994, USERRA protects the rights of servicemembers to be reemployed after returning from active duty, including reserve or National Guard members.

"It was the intent of Congress by enacting USERRA," Foster wrote in his letter, "that no veteran be denied employment, reemployment, advancement or discrimination in employment for serving their country.

"Servicemembers who honorably defend their country depend on USERRA to protect their civilian jobs when they are activated and sent to war. This amendment to USERRA will enhance that protection."

Joe Sharpe, the Legion's Economic Division director, said that Doggett's proposed bill addresses an inequity that has long existed in the work force. "We need this protection for our disabled veterans, to make sure they aren't being treated unfairly by their employers. These men and women have sacrificed enough already for their country. They don't need to be harassed in the work place for making those sacrifices."

Doggett's bill has yet to be introduced in the House of Representatives for consideration.

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Eligibility for the VA Home Loan Frequently Asked Questions

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Q: How do I apply for a VA guaranteed loan?

A: You can apply for a VA loan with any mortgage lender that participates in the VA home loan program. At some point, you will need to get a Certificate of Eligibility from VA to prove to the lender that you are eligible for a VA loan.


Last Updated on Monday, 30 August 2010 09:45

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Did you know?

Military Funeral Honors ceremonies must be scheduled in advance.

The law requires that every eligible veteran receive a military funeral honors ceremony, which includes the folding and presentation of the United States flag and the playing of “taps,” upon the family’s request. This Department of Defense program calls for the funeral director to request military funeral honors on behalf of the veteran’s family.