Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF): Access to Care

1
Operation Enduring Freedom/ Operation Iraqi
Freedom (OEF/OIF) Access to Care

• by Cara Garcia, LMSW
• Phoenix VA Health Care System

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Operation Enduring Freedom/Operation Iraqi Freedom

• Over 1.6 million U.S. Forces have deployed to
  Iraq and Afghanistan.
• 49 Former Active Duty Troops
• 51 Reserve and National Guard
• More than 347,750 (40) have sought care from the
  VA.
• Over the next several years, as more come off of
  active duty status, the number served at the VA
  is expected to increase by as much as 700,000
• The Carl T. Hayden VA Medical Center in Phoenix
  currently has enrolled over 9,000 OIF/OEF
  veterans
• OEF/OIF Veterans make up 6 of the VAs current
  health care population (5.5 million veterans are
  treated annually)
• VHA Office of Public Health and
  Environmental Hazards, August 2008

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Demographic Characteristics of OEF/OIF Utilizing
VA Health Care

• Age Group
• lt20 6
• 20-29 52
• 30-39 23
• gt40 19
• Sex
• Male 88
• Female 12

• Branch
• Air Force 12
• Army 64
• Marine 13
• Navy 11
• Unit Type
• Active 48
• Reserve/Guard 52
• Rank
• Enlisted 92
• Officer 8
• VHA Office of Public Health and Environmental
  Hazards, August 2008 National Center for Veteran
  Analysis and Statistics (NAVAS) February 2008

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OEF/OIF Department of Defense Statistics

• Casualties as of 11/03/2008 4,814
• Wounded in Action as of 11/03/2008 33,325
• Wounded but able to Return To Duty 18,125
• Retrieved 11/04/2008, from http//www.defenseli
  nk.mil/news/casualty.pdf

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Mental Health

• Mental Health is the 2nd largest illness treated
  at the VA for OEF/OIF Veterans (1 is Orthopedic
  injuries)
• More than 100,000 combat veterans have been
  treated for mental health related conditions
  since 2001. Over half were for PTSD.
• There have been an even greater number of
  veterans treated at the Vet Center and in private
  mental health agencies ( both not included in
  these figures)
• Gregg Zoroya, October 18, 2007

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Mental Health

• More than one in four U.S. Troops have come home
  from the Iraq War with health problems that
  require medical or mental health
  treatment. Zoroya, October 18, 2005
• Primary OEF/OIF symptoms and diagnoses being
  treated at the VA include
• PTSD 75,719
• Nondependent Abuse of Drugs 21,201
• Depressive Disorders 50,732
• Neurotic Disorders/Anxiety 40,157
• Alcohol/Drug Dependence 12,780/5,76
• VHA Office of Public Health and Environmental
  Hazards, August 2008

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Traumatic Brain Injury (TBI)

• Signature injury of this war
• Blast injuries are the number one cause of injury
  or death in Iraq
• 69.4 of Wounded In Action caused by Blast or
  Explosion
• 62 of Blast Injuries result in Traumatic Brain
  Injury (TBI)
• 85 of TBIs are closed Head Injuries
• This means only 15 have visible wounds
• The symptoms closely resemble those of PTSD and
  can be easily overlooked by medical staff not
  well versed in recognizing and diagnosing brain
  injury.
• Tuli, August 2007

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Post Traumatic Stress Disorder

• Over 59,000 VA-documented PTSD cases for OEF/OIF
• 1 mental health diagnosis being treated at the
  VA for OEF/OIF veterans
• (Gregg Zoroya, October 18, 2007)
• OEF/OIF Veterans ages 18-24 are more likely to
  receive mental health treatment and/or receive a
  diagnosis of PTSD than those OEF/OIF Veterans who
  are age 40 or older. (Seal, et al., March
  12,2007)
• Experts think PTSD occurs
• In about 30 of Vietnam veterans, or about 30 out
  of 100 Vietnam veterans.
• In as many as 10 of Gulf War (Desert Storm)
  veterans, or in 10 veterans out of 100.9
• In about 6 to 11 of veterans of the Afghanistan
  war (Enduring Freedom), or in 6 to 11 veterans
  out of 100.
• In about 12 to 20 of veterans of the Iraq war
  (Iraqi Freedom), or in 12 to 20 veterans out of
  100.
• 
  
  National Center for
  Post Traumatic Stress Disorder February 27, 2008

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VA Hospital Benefits and Services for OEF/OIF

• Combat veteran eligibility served after 11
  November 1998, and were deployed to Iraq or
  Afghanistan, entitled to five years of free VA
  medical care for conditions potentially related
  to military service.
• Five-year period of health care begins on date of
  separation from active military service
• To access VAs Health Care System, enroll at a VA
  Health Care Facility by completing a 10-10EZ
  form. Forms are also online at w
• 010ez.
• https//www.1010ez.med.va.gov/sec/vha/1010ez/showF
  orm.aspmed.vhttps//ww.1010ez.med.va.gov/sec/vha/1
  010e/vha/1010ez/
• Must also provide a copy of most recent DD Form
  214 (military discharge papers). This DD214 must
  show (1) combat veteran status, (2) type of
  discharge (honorable, other than honorable, etc),
  and (3) if dental exam was completed
• VA Website www.va.gov

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Importance of Early Enrollment

• Five (5) years from date of discharge to enroll
  at the VA Medical Center.
• Waiting until AFTER the 5 year window, one might
  not be eligible for care. Eligibility after the
  5-year window is based on several factors, with
  one main factor being income. If income is too
  high, one may not be eligible.
• Once enrolled, you are always enrolled. After
  the 5 years expires, you may have a co-pay, but
  you are still enrolled.

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Process

• Once enrolled, Vet will receive 2 initial
  appointments
• (1) Primary Care Vet will be assigned to an
  OEF/OIF provider. He/she will screen Vet and
  refer Vet to specialized care as needed (such as
  orthopedics, dermatology, podiatry, etc.)
• (2) Post-Deployment Health Clinic This
  appointment will assess any possible readjustment
  concerns. It serves as a fast track to other
  services such as Post Traumatic Stress Disorder
  Clinic, Psychiatric Services/Medication
  Management and/or Family Counseling.

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Clinical Reminders

• Iraq and Afghanistan Post Deployment Screen
  assess for possible issues that may arise in this
  unique population. Included are
• PTSD Screening
• Depression Screening
• Alcohol Screening
• Screening for gastrointestinal issues
• Unexplained fever
• The occurrence of rash or other skin problems
• Presence of symptoms including fatigue,
  muscle/joint pain, headaches lasting longer than
  three months and interfering with daily
  activities and work.

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Clinical Reminders

• Traumatic Brain Injury Screen
• Experience/Exposure to Events
• Such as blasts, vehicle accidents, falls,
  etc.
• Immediate Symptoms
• Such as Loss of Consciousness, feeling
  dazed, head injury, not remembering event, etc
• If problems began or got worse
• Such as headaches, dizziness, sensitivity to
  bright light, memory problems, etc
• Presence of symptoms in last week
• Such as those listed in former

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VA Medical Centers

• Phoenix VA Health Care System Phoenix
• Northern Arizona VA Health Care System Prescott
  
• Southern Arizona VA Health Care System Tucson

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Community Based Outpatient Clinics

• 17 Total in Arizona
• Anthem
• Bellmont
• Buckeye
• Casa Grande
• Cottonwood
• Globe-Miami
• Green Valley
• Kingman

• Lake Havasu City
• Mesa
• Payson
• Safford
• Show Low
• Sierra Vista
• Sun City
• Tucson
• Yuma

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Vet Centers

• 6 Total in Arizona
• Chinle
• Hotevilla
• Mesa

• Phoenix
• Prescott
• Tucson

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OEF/OIF Wednesday Night Groups at the Phoenix VA
Hospital

• Every Wednesday night (except holidays) in the
  ACC basement of the Phoenix hospital from 530
  700pm
• 1. Informational Meeting Available for veterans
  and/or family members.
• Answer specific questions related to benefits
  through the VA Hospital and the VA Regional
  Office.
• VA Regional Office present every other Wed of the
  month to assist with filing claims, checking into
  your current claim, claim appeals, filing for
  other benefits, etc.
• Find out about other resources and services
  available to veteran and family
• Led by OEF/OIF social worker/case manager and
  Transition Patient Advocate

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OEF/OIF Wednesday Night Groups

• 2. OEF/OIF Support Group provides education and
  support for OEF/OIF service members.
• Led by PTSD readjustment counselor and a
  substance abuse addictions counselor.
• (SE Clinic in Mesa also offers OEF/OIF Veterans
  Support Group)
• 3. OEF/OIF Family Support Group provides
  education and support for OEF/OIF family members,
  friends, significant others, etc.
• Led by OEF/OIF Outreach Social Worker and OEF/OIF
  family therapist
• (SE Clinic in Mesa also offers a family OEF/OIF
  support group on Thursdays evenings)
• Kids Corner is available

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Southeast Clinic (SEC)

• OEF/OIF Veterans Support Group (closed group,
  meets at 3pm on Thursdays)
• OEF/OIF Family Support Group (open meeting,
  meets on Thursdays from 530 700pm)
• Social worker at the SE Clinic can make
  referrals to a support group.
• Also beginning TBI Clinic and TPA services

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National Suicide Prevention Hotline

• 1-800-273-TALK (8255)
• Press 1 for Veterans

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Other VA Groups, Services, andResources Available

• SAC Program Offered at both the SE Clinic and VA
  Medical Center. Addresses substance abuse issues
  and can satisfy some court mandated treatment
  requirements.
• Military Sexual Trauma Is offered through the
  Vet Center and the VA Medical Center. Individual
  and group counseling available.
• Marriage and Family Counseling Offered at both
  the SE Clinic and the VA Medical Center.
• Speech/Language Pathology work with OEF/OIF vets
  with deficits in memory, attention/concentration,
  verbal expression, auditory comprehension, voice,
  motor speech and/or swallowing as a result of
  TBI/polytrauma.
• Once evaluated, patients are provided
  speech/language/cognitive therapy to improve
  these skills and may be appropriate for memory
  aids (day planners, PDAs).
• They have also been able to provide them with
  computer therapy software for their home use.

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Other VA Groups, Services, andResources Available

• Anger Management Classes Any OEF/OIF vet with
  anger issues qualifies. These classes also
  fulfill the obligation for those veterans who are
  court ordered for anger management treatment.
• OEF/OIF Families of Fallen Heroes Family
  Bereavement Support Group.
• The Vet Center offers counseling to combat vets,
  as well as to any veteran who has experienced
  MST. They also provide bereavement counseling
  for veterans as well as family members, located
  in Phoenix Mesa
• Amputee Support Group This groups if for
  amputees or those facing an amputation.

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Other VA Groups, Services, andResources Available

• Pain Clinic no established pain clinic at our
  VA can fee base out to community clinics
• Chronic Pain Management Group This group is
  offered through medical psychology.
• Brain Boosters for those OEF/OIF vets with a
  more mild or moderate TBI this is a 10-week
  course
• Topics covered include TBI education, memory
  skills, attention, executive functions, sleep
  hygiene, PTSD, emotions, personality, etc.
• Family members (adults) are also encouraged to
  attend

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OEF/OIF Team at Phoenix VA

• Brenda Burke OEF/OIF Pharmacist
• James Christensen OEF/OIF PA in Primary Care
• Debbie Dominick OEF/OIF Program Manager
• Sheri Evans OEF/OIF Nurse Case Manager
• Cara Garcia OEF/OIF Community Outreach Social
  Worker
• Dr. Michael Garrett OEF/OIF Secondary TBI
  medical doctor
• Jose Hernandez OEF/OIF Administrative Assistant
• Cherie Maxson OEF/OIF Nurse Case Manager
• Joan McCarthy OEF/OIF Marriage and Family
  Counselor
• Michael Owens OEF/OIF Social Work Case Manager
• Jay Rathbun OEF/OIF Marriage and Family
  Counselor
• Dr. Anais Sonder OEF/OIF Primary Care Physician
• Adriana Tarazon OEF/OIF Psychologist
• John Thompson OEF/OIF Transition Patient
  Advocate
• Pat Tuli OEF/OIF Social Work Case Manager

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Books Worth Reading on the Topic

• Courage After Fire (2006)
• Keith Armstrong, Suzanne Best, Paula Domenici
• Down Range to Iraq and Back (2005)
• Bridget Cantrell Chuck Dean
• While Theyre At War The True Story of American
  Families on the Homefront (2006)
• Kristin Henderson

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Additional Information

• Service Connection
• Disability compensation is a monetary
  benefit paid to veterans who are disabled by an
  injury or illness that was incurred or aggravated
  during active military service. These
  disabilities are considered to be
  service-connected. Disability compensation varies
  with the degree of disability and the number of
  veterans dependents, and is paid monthly.
• 
  Federal Benefits for Veterans and Dependents 2008
  Edition
• Veterans Benefits Administration
• 3333 N. Central Ave
• Phoenix, AZ 85012
• 1-800-827-1000

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My Contact Info

• Cara Garcia, LMSW
• OEF/OIF Community Outreach Social Worker
• Phone [phone], x7499
• Email cara.garcia_at_va.gov
• Address 650 East Indian School Road, Phoenix, AZ
  
• 85012

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The End

• QUESTIONS?
• COMMENTS?
• THANK YOU!

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Bibliography

• Armstrong, Keith Best, Suzanne, Domenici,
  Paula. (2006). Courage After Fire.
• Berkeley, CA Ulysses Press.
• Cantrell, Bridget C and Dean, Chuck. (2005) Down
  Range to Iraq and Back.
• Seattle, WA Wordsmith Publishing.
• Donn, Jeff and Hefling, Kimberly. (September 29,
  2007).Coming Home Wounded-
• The Price. Associated Press
• Henderson, Kristin. (2006). While Theyre At
  War The True Story of American
• Families. New York, NY Houghton Mifflin Company
• National Center for PTSD. How Common is
  PTSD?
• www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_how_c
  ommon_is_ptsd.html?printable-templatefactsheet
  retrieved September 30, 2008
• Seal, Karen Bertenthal, Daniel Miner,
  Christian Sen, Saunak Marmar, Charles. (2007,
  
• March 12). Bringing the War Back Home Mental
  Health Disorders Among 103,788 US Veterans
• Returning from Iraq and Afghanistan Seen at
  Department of Veterans Affairs Facilities.
  Archives of
• Internal Medicine, 167, 476-482.
• Street, Amy and Stafford, Jane (2005). Military
  sexual trauma Issues in caring for veterans.
• National Center for PTSD. Retrieved November 2,
  2007 from
• http//www.ncptsd.va.gov/ncmain/ncdocs/manuals/ira
  q_clinician_guide_ch_9.pdf?opm1rrrr1519srtde
  chorrtrue

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Bibliography

• Tuli, Patricia (2007, August) The OIF/OEF
  Virtual Clinic, Carl T. Hayden VA Medical Center.
  
• Power Point Presentation,Slide 5.
• U.S. Casualty Status. Retrieved Februrary 11,
  2008 from
• http//www.defenselink.mil/news/casualty.pdf.
• VHA Office of Public Health and Environmental
  Hazards. January 2008. Analysis of VA Health
  Care
• Utilization Among US Global War on Terrorism
  (GWOT) Veterans. Power Point Slides, Retrieved
• February 11, 2008.
• Walter Reed Army Institute and Research Land
  Combat Study. (No date provided). From
• 2007 Presentation on Divorce and Marital
  Concerns of OIF.
• Zoroya, Gregg. (2007, October 18). Veteran
  Stress Cases Up Sharply. USA Today.
• Retrieved October 19, 2007 from
• http//www.usatoday.com/news/washington/2007-10-1
  8-veterans-stress_N.htm
• Zoroya, Gregg. (2005, October 18).One in Four
  Iraq Vets Ailing On Return. USA Today.
• Retrieved November 5, 2007, from
• http//www.usatoday.com/news/world/iraq/2005-10-18
  -troops-side_x.htm?POENEWISVA