As the military wrestles with an alarming number of sexual assaults — an issue former Defense Secretary Leon Panetta called "an affront to the basic American values we defend" — the Department of Defense has adopted a novel technique that fundamentally changes the way investigations are handled.

Hundreds of investigators and prosecutors across all military branches have participated in a special victims unit course at Fort Leonard Wood in Missouri that focuses on a unique forensic interviewing technique designed to elicit detailed descriptions of an attack. 

With traditional methods, this “psychophysiological” evidence has previously been difficult to obtain from both the victim and suspect, but can often break open an otherwise difficult case in which there is little or no physical evidence.

The technique was developed by Russell W. Strand, a former special agent with the Army’s Criminal Investigation Division and current chief in the education and training division at the Army’s Military Police School. Strand began evaluating sexual assault training in 2004 as numerous reports of rape in combat zones and at home became public.

He soon discovered that law enforcement, both military and civilian, expected victims to recount their trauma blow by blow, with precise details that could convince any skeptical jury or judge.

---

That may seem like conventional wisdom, but Strand frequently found victims rarely had such clarity. He consulted experts, immersed himself in neurobiological research, and found that the expectation doesn’t align with the science of trauma and memory.

In the midst of an assault, the brain does not capture every moment of trauma as if it were recording a film. The pre-frontal cortex can "shut down" or become severely impaired. As a result, many victims can’t provide a contextual or linear account of the event, but fragmentary memories, perhaps the tone of the suspect's voice or, when a sense of defeat has set in, a recollection of the way a lamp looked as she or he was being assaulted. In interviews with investigators, Strand said, the lack of a victim’s ability to recall specifics quickly sowed doubt.

“We started looking at that (research) and started looking at what kind of evidence we gather in a sexual assault,” Strand said. “We weren’t collecting the right data.”

Start with memories, not at the beginning
Strand’s technique, which he has termed the forensic experiential trauma interview (FETI), begins with an investigator expressing empathy toward the victim in order to establish trust. What comes next is not a set of rapid-fire questions about the assault. Strand believes that approach, long used by law enforcement, pressures and confuses the victim. Instead, investigators are trained to simply ask what the victim is able to remember about the experience.

Asking the victim to “start at the beginning” — another hallmark of traditional police work  — forces the victim to try to retrieve memories that may not have been encoded in the first place, which can lead to inaccurate or distorted recollections. Some victims may then doubt the memories they do have while investigators wonder if he or she is making up the assault. 

What’s more important, according to Strand, is eliciting the victim’s sensory memories, which helps to create a three-dimensional picture of the attack. It also allows the victim to relate the experience in a way that makes sense and yields vital information that can be presented to a jury.

Dr. Jim Hopper, a clinical instructor of psychology at Harvard Medical School, says Strand is teaching good clinical skills for interviewing traumatized people, adapted for an investigative context. Hopper is a guest lecturer for the course, and teaches the effects of sexual assault on the brain.

Lori Jones, a civilian special agent stationed at Fort Leonard Wood, said that once she was trained in the interviewing technique, she was able to collect much better evidence. If a victim describes feeling “frozen” during an attack, for example, Jones is able to understand that as tonic immobility, a physiological response to terror or trauma that often leaves a person numb, starring in a fixed or unfocused manner and unable to move or cry out.

The interview technique can also lead to unwitting admissions of guilt by attackers. When asked to describe a victim's behavior, suspects and victims have recounted the same details, Jones said.

“One of the biggest blessings in FETI has been being able to take forward an investigation with no tangible evidence,” said Jones. “I have the ability to take this to my supervisor and say, ‘This is what the victim is articulating, these were the things she felt her body doing ... and he saw her doing what she was doing.’”

This critical information has helped Jones educate commanders and prosecutors who falsely assume that a victim’s lack of resistance or inability to immediately call the police, for example, is evidence of lying.

Joanne Archambault, a former investigator and executive director of the nonprofit training, education and policy organization End Violence Against Women International (EVAWI), said that evidence gathered by techniques like FETI are essential in conducting a thorough investigation. The interview is a "big piece of the puzzle" that helps an agent corroborate a victim's account.

"Victims are much more likely to talk to us when they’re being given an opportunity to provide a narrative in their own terms," Archambault said. "You can’t get to prosecution and conviction without that."

'Visionary' technique
There are other investigation techniques that attempt to obtain sensory details from victims, but integrating scientific research on how a victim's brain responds to trauma is a unique element that has won Strand accolades. Last year, EVAWI gave Strand its Visionary Award.

Archambault, who investigated or supervised 10,000 sexual assault cases at the San Diego Police Department before retiring in 2002, said that law enforcement often has little or no training in interviewing victims of traumatic crimes. As a result, the experience can feel like an interrogation. She has observed a FETI training class, which Strand also teaches to civilian police departments, and says the focus on about trauma and its effect on memory is novel. 

“In a nutshell,” she said, “he’s been dedicated to making improvements in a culture.”

The struggle to understand and address sexual assaults in the military has been very public. Last week, members of the Senate Armed Services Committee excoriated military leaders for permitting an environment that enables sexual assault.

In 2011, 3,192 sexual assault reports were filed, but the Department of Defense says the number is closer to 19,000 based on anonymous surveys of active-duty service members conducted in 2010. Of the 3,192 reports, only cases on 1,518 subjects were brought forward for disciplinary review. 

The Army tracks the number of cases brought forward by prosecutors; anecdotally, Jones said it appears FETI has helped increase this number, but the Army's Criminal Investigation Command did not have those statistics readily available. Those familiar with the technique are hopeful that it is changing pervasive attitudes and assumptions about victim behavior.

In a statement to NBC News, Rep. Niki Tsongas, D-Mass., who chairs a caucus on military sexual assault, called FETI a “step toward more successful investigations and prosecutions.”

The Department of Defense has incorporated the course as part of its multi-pronged approach to prevent sexual assault in the military. "When one does occur, effective processes and trained professionals must be in place to support victims and ensure delivery of justice," Cynthia O. Smith, a spokeswoman for the DoD, told NBC News.

Since 2009, 721 special agents and prosecutors from every branch of the military have attended the training. Another 315 are scheduled to complete the course by the end of this September, and DoD has funded more than 400 seats at the course through fiscal year 2017.

Strand says he and his team encountered some early resistance from investigators accustomed to the traditional interviewing technique, but that dissent has since ebbed.

“We’re over the (point) where more people get it than don’t,” he said. 

Rebecca Ruiz is a reporter based in the Bay Area.

Related:

• Senate panel members suggest overhaul of military justice system 
• Accuser in Air Force sexual assault case 'frustrated' at overturned verdict
• Civil Rights Commission urged to order audit of military sex-assault cases
• Reported sex assaults leap 23 percent at US military academies
• Sex-assault victims in military say brass often ignore pleas for justice

The psychiatry staff at Madigan Army Medical Center was not encouraged to overturn diagnoses of post-traumatic stress disorder to save the government money, according to investigation documents provided to NBC News.

The Army previously said it found no evidence of wrongdoing at the Tacoma, Wash., hospital, but had not released the investigation documents until Friday. As recently as last month, the Army said it would not share the findings and denied Freedom of Information Act requests by local media.

The investigation, conducted last spring, sought to determine whether or not the commander of Madigan, Col. Dallas Homas, exerted any “undue influence” on PTSD diagnoses. Homas was reinstated last July and the investigation documents contain numerous glowing reviews of his leadership and no indication that he pressed the staff to consider the cost of diagnosing a soldier with PTSD.

---

That claim stemmed from a 30-minute presentation given in September 2011 by the hospital’s chief of forensic psychiatry, in which he noted that a PTSD diagnosis could cost the government over $1.5 million in disability payments over a soldier’s lifetime.

The 100-page investigation document contains several interviews with Madigan staff members who say the comment was made in less than a minute and taken out of context.

When questioned about the remark, the commander explained that forensic psychiatrists must take into consideration all factors “that could bear on an individual’s diagnosis,” including financial gain, the document showed.

“... It is clearly being blown out of proportion and used to attack [redacted] and his team,” Homas said. “I have not seen any evidence that concern over saving government money is a driver of arriving or not arriving at a diagnosis.”

In the fall of 2011, some soldiers had complained that their PTSD diagnoses had been switched to conditions like anxiety disorder, which could have affected their medical retirement rating and the amount of their disability payments.

Homas pointed out during the investigation that while 14 soldiers were not diagnosed with PTSD, at least 44 soldiers who entered the medical retirement process were ultimately given that diagnosis.

“If this were about saving money, this section has failed has failed miserably,” he said.

The investigation interviews also revealed that some staff faced tense situations when giving a diagnosis.

“Sometimes some soldiers can get so upset that they might act out in some manner, perhaps expressing threats," the chief of behavioral health said to the investigator. "The easy thing to do is just give the patient what they want. The (forensic psychiatry) clinicians work very hard to do what is right.”

Homas said in his interview that some soldiers made death threats against forensic psychiatrists.

The investigating officer wrote that only two individuals, who were ombudsmen, made “unsubstantiated allegations” regarding the forensic psychiatric process. Both were suspicious of changes to soldiers’ PTSD diagnoses, but did not believe Homas advised staff to consider the cost as a factor.

The investigating officer agreed with Madigan staff that the ombudsmen had misunderstood the context of the Sept. 2011 comment.

One ombudsman said soldiers whose diagnoses were reviewed by the forensic psychiatric team were very distressed upon being told they did not have PTSD. In some cases, medical professionals previously told them they had the disorder.

That ombudsman said their lives had been “turned upside down” as a result, and that some evaluations contained language insinuating that the solders were liars and malingerers.

Though the forensic psychiatry team was essentially absolved by the report, the Army has stopped the practice of using such teams to vet PTSD diagnoses; Madigan was the only Army hospital to do so.

“The fact that the Army had to bring in new doctors to reinstate hundreds of PTSD diagnoses for local servicemembers and that they have implemented major behavioral health policy changes nationwide in the wake of the Madigan cases are clear evidence that problems existed on base in properly identifying the invisible wounds of war,” Sen. Patty Murray, D-Wash., said in a statement to NBC News. Murray pushed for the investigation into the PTSD diagnoses at Madigan.

As part of the investigation, a review of 431 Madigan cases — some of which had been overturned — led to PTSD diagnoses for 150 soldiers by last October. The Army recently said that Madigan’s variance rate for diagnoses was not outside the norm. 

Rebecca Ruiz is a reporter based in the Bay Area.

Related:

• Home from war, troops face 'white-knuckled' first month
• Soldier Hard's hip-hop lyrics reveal PTSD's rough edges
• Hundreds of thousands of veteran spur free benefits

 

The results of a months-long investigation into the reversal of post-traumatic stress disorder diagnoses at Madigan Army Medical Center are being kept confidential.

Earlier this month, Army Secretary John McHugh told reporters at Joint Base Lewis-McChord in Washington state that the Madigan findings would not be disclosed.

Days later, the Army denied Freedom of Information Act requests for documents related to the controversy made by three Seattle-area news organizations.

George Wright, an Army spokesman at the Pentagon, told NBC News that “concerns brought up in the Madigan matter will be addressed” in a separate forthcoming report by the Army's Task Force on Behavioral Health.

Wright said he had not viewed that document, which is an Army-wide review of mental health diagnoses as far back as 2001, and could not comment on what information it would include about the Madigan inquiry.

The Madigan investigation, completed last fall, sought to determine whether or not a team of forensic psychiatrists inappropriately changed soldiers’ PTSD diagnoses, perhaps to save the federal government money.

---

In a memo obtained last year by the Seattle Times, a Madigan Army Medical Center psychiatrist gave a presentation to colleagues in September 2011 in which he noted that a soldier medically retired with a PTSD diagnosis would collect $1.5 million in disability payments over his or her lifetime. The psychiatrist warned his colleagues against “rubber stamping” a PTSD diagnosis.

Around the same time, several soldiers screened at Madigan complained that their PTSD diagnoses had been switched to conditions like anxiety disorder, which could have affected their medical retirement rating and the amount of their disability payments. 

A subsequent review of 431 Madigan cases — some of which had been overturned — led to PTSD diagnoses for 150 soldiers by last October, according to the office of Sen. Patty Murray, D-Wash.

Murray pushed for the investigation into the PTSD diagnoses at Madigan — an Army hospital in Tacoma, Wash., that serves soldiers stationed at Joint Base Lewis-McChord — but has yet to see its findings. 

The Madigan investigation was reported by the Seattle Times in January 2012. In May, McHugh announced the Army-wide review, which is said to contain 24 findings and 47 recommendations, and now according to Wright, details related to Madigan. Murray is scheduled to be briefed on the review in the next few weeks, Matt McAlvanah, a spokesman for the senator, told NBC News.

Last year, Seattle-area news organizations asked to see documents related to the inquiry through Freedom of Information Act requests.

Request denied
Patricia Murphy, a reporter at KUOW Puget Sound Public Radio, said the Army denied the station’s attempts to obtain information and subsequently denied an appeal. The Army described the Madigan documents as “pre-decisional,” a legal privilege extended to documents that influence new rules and regulations. In a letter to the station, the Army said this designation is meant to “protect the quality of agency decisions by encouraging frank and open discussions of agency policy.”

Murphy said she understood that the documents might contain sensitive government and patient information, but was hopeful the Army could strike a balance for transparency. “We don’t care about the names,” Murphy told NBC News. “We care about the reasons they were doing this and whether or not this was a cultural issue at Madigan.”

The Army has said that Madigan was the only Army hospital to employ a team of forensic psychiatrists who vetted PTSD diagnoses and said it had stopped that practice.

Last February, it announced that the hospital’s commander, Col. Dallas Homas, was reassigned during the inquiry. The Army reinstated Homas several months later after finding that he did not "exert any undue influence on PTSD diagnoses." The Army provided that document to KUOW in response to a FOIA request. 

The Army also issued new guidelines for PTSD screening last April, discouraging staff from using testing to identify patients who might be "malingering" or faking their symptoms, an approach some soldiers claimed was utilized at Madigan. 

Despite these corrective actions, critics of the decision to withhold the Madigan findings say that transparency is key to restoring trust in the Army’s ability to accurately diagnosis and treat PTSD.

Tom Tarantino, chief policy director of the advocacy organization Iraq and Afghanistan Veterans of America and a former Army captain, said that keeping the report confidential reflected a “shocking amount of tone deafness.”

“I don’t want anybody to release information that violates HIPAA, privacy or endangers national security, but there has to be some sort of accountability,” Tarantino said. He also fears that withholding the findings sends the wrong signal to soldiers who worry that the problems at Madigan could be widespread and might not seek mental health care as a result.

“You have to actually show patterns of behavior and convince people that you’re willing to change.”

Wright said the Army wanted to make public its report on behavioral health “as soon as possible,” but that it was weighing the feasibility of the recommendations and how to implement them.

“We expect that work to be completed shortly,” he said, “and then we will be able to share not only the findings, but the way ahead.”

Rebecca Ruiz is a reporter based in the Bay Area.

Related:

• Home from war, troops face 'white-knuckled' first month
• Soldier Hard's hip-hop lyrics reveal PTSD's rough edges
• Hundreds of thousands of veteran spur free benefits

President Obama issued an executive order Friday tasking the Department of Veterans Affairs to expand its suicide prevention and mental health services.

Under the order, VA is expected to increase its veteran crisis line by 50 percent by the end of the year; ensure that a veteran in distress is given access to a trained mental health worker in 24 hours or less; and launch a national 12-month suicide prevention campaign to educate veterans about available mental health services.

---

The order reinforces some initiatives that VA has already undertaken.

 

In April, VA announced that it would hire 1,600 mental health clinicians to meet surging demand, and the order instructs the agency to use loan repayment programs and scholarships, among other strategies, to recruit those professionals by June 2013.

The order also asks VA to create at least 15 pilot projects in partnership with the Department of Health and Human Services to address unfilled mental health staff vacancies and long wait times. The pilots, to be created within 180 days, will test the effectiveness of partnerships with community and rural health clinics as well as substance abuse treatment centers. 

Related: Military hopes antidepressant nasal spray will prevent suicides

Previous estimates have indicated that at least 6,000 veterans died by suicide annually in recent years; data from the Centers for Disease Control and Prevention show that about 18 veteran suicides occur daily.

VA Secretary Eric K. Shinseki praised the order in a statement released Friday morning, saying that the agency would work to implement its requirements immediately.

"History shows that the costs of war will continue to grow for a decade or more after the wars have ended," Shinseki said. "The mental health and well-being of our brave men and women who have served the Nation is the highest priority for the Department of Veterans Affairs."

Related: Monthly Army suicides reach all-time high in July

The order targets not only immediate concerns about mental health care staffing and suicide prevention measures, but also long-term goals in understanding the science behind combat-related psychological wounds like post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Along with the Department of Defense and other federal agencies, VA is directed to develop a research plan that includes efforts to better diagnose and treat PTSD and TBI.

The president delivered the order Friday as part of his visit to Fort Bliss in Texas, which marks the two-year anniversary of the end of combat operations in Iraq. He addressed troops at the Army post and held a roundtable discussion with service members and their families.

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

More content from NBCNews.com: 

• Isaac could be blessing and curse in drought areas
• US ends investigation of terror detainees' deaths without charges
• NY priest apologizes for saying child is often seducer in sex abuse cases
• One of most dangerous cities in US plans to ditch police force
• Ex-Marine Angela Madsen on her journey from homelessness to the Paralympics

Follow US News from NBCNews.com on Twitter and Facebook

 

 

For many of the hundreds of thousands of veterans awaiting a decision from the Department of Veterans Affairs on disability and pension claims, the agency's backlog can lead to a period of financial hardship during the transition back to civilian life.

Ron and Karen Sanquist experienced this first-hand when Ron, a National Guardsman who had been deployed to Iraq in 2009 and Afghanistan in 2006, was released from active duty.

While cobbling together work in construction and at a call center — both of which severely reduced his National Guard pay — Ron filed a claim for post-traumatic stress disorder that resulted from his combat experience  during his deployments. The disability benefit would have helped the Sanquists afford their $3,000 in rent and monthly bills, but the backlog of claims meant the family would have to wait months for a decision.

---

Ron lost his position at the call center after requesting leave to fulfill his National Guard duties. Bills then began to pile up as the family of five missed rent, utility and insurance payments, among other expenses. The situation worsened in May when Ron, 39, was diagnosed with a heart murmur for which he'd need emergency surgery, guaranteeing that he'd be out of work and unable to job hunt for several weeks.

Desperate not to fall further behind, Karen turned to the patchwork safety net for veterans and their families experiencing financial hardship, an occurrence that happens more frequently than the public realizes, according to those who assist veterans and service members during hard times.

As of Aug. 25, there were 899,000 compensation and pension claims pending, two-thirds of which have been in the system for more than 125 days. In the Portland, Ore., area, where the Sanquists live, there are nearly 12,000 claims pending, far fewer than other major metropolitan areas in the West; Los Angeles, San Diego, Seattle, Oakland and Phoenix are seeing twice that figure. While two-thirds of the claims processed in Portland have taken more than 125 days, the percentage spikes to more than 90 percent in Los Angeles and Oakland.

In a statement to NBC News, the Department of Veterans Affairs said that 1 million claims had been completed in the previous two fiscal years, and that the agency is on target to finish an additional 1 million in 2012.

"Still, too many veterans and their families have to wait too long to get the benefits they have earned and deserve which is unacceptable," the statement said.

VA is aiming to complete claims within 125 days with 98 percent accuracy by 2015 as it transitions to a digital processing system. The technology will be implemented in 16 regional offices this year and reach an additional 56 regional offices by the end of 2013. VA called the technology a "lasting solution" that will eliminate the backlog.

Karen told NBC News that her experience with VA was very positive, but that the nearly yearlong delay in receiving a decision on Ron's disability benefit still took a toll. "The waiting period is scary because you don’t know if it’s going to be two months or if it’s going to be another year." 

To survive the wait, Karen used what was left of the couple's savings and applied for assistance from several nonprofit groups and veteran service organizations. Ron's unit gave the couple a month's rent, as did the American Legion. ReserveAid covered another month's rent as well as lapsed medical insurance payments. USA Cares paid a garbage bill and Operation Homefront sent a $250 Wal-Mart gift card.

In July, the Sanquists began receiving disability payments for Ron's PTSD as well as his heart surgery, which was deemed service-connected. The process was expedited since the Sanquists were experiencing hardship, and the first sum included back payment for the months required to award the claim.

As Ron looks for a position that will allow him time to finish his last semester of school in animation and graphics afforded by the GI Bill, the family's finances remain shaky. "It's definitely one month at a time," Karen said.

Some families aren't as lucky as the Sanquists.

Barry Walter, state director of veterans services for the Illinois Veterans of Foreign Wars, said that though the "backlog adds to an already desperate situation," many families don't seek help until it's too late and their home is already in foreclosure, for example. The stigma of needing financial aid, particularly for veterans, can prevent them from coming forward early in the process.

However, veterans often aren't aware that they are eligible to receive emergency financial assistance from the county or state as well as organizations like VFW. In Illinois, counties have veterans assistance commissions that provide aid for expenses like unexpected dental or medical bills and utility shut-off notices. Some states also offer emergency grants to veterans, but Walter said that many don't know of those resources.

VFW's national program, Unmet Needs, awards one-time grants of up to $2,500 to families in hardship. Since 2004, more than $4.4 million has been given out to 3,200 military families. Veterans are qualified to receive assistance up to 36 months after an honorable discharge. The Illinois VFW also runs its own assistance fund and spent $38,000 in 2011, the majority of it to help veterans with expenses like rent and groceries.

Walter said that he receives about one inquiry a day from veterans seeking aid. The calls come from young veterans who have just returned and can't find work, veterans nearing retirement age who have been laid off, and even the elderly who now need a pension increase for medical expenses or nursing home care. They are all affected by the backlog, Walter said. He'll tell them about the VFW's programs, but he'll also refer them to organizations like the Salvation Army, Lutheran Services, Easter Seals and Catholic Charities, which can provide help.

The American Legion, also a veterans service organization, operates a temporary financial assistance fund for military families with children at home. An average of a half million dollars is allocated each year for food, clothing, shelter and utilities. Requests can be granted in as little as 24 hours and the average claim takes less than a week to process, according to Jason Kees, family support network coordinator for the American Legion. 

Kees told NBC News that the fund is run through a separate endowment and that requests exceed the available aid. As a result, the organization dips into its own funding to make up the difference.

Kees said that the public's lack of awareness adds to the challenges of getting enough resources to families in need.

Once a community realizes a veteran is struggling, Kees said, "the outpouring of love and support is fabulous." But all too often, the public doesn't realize military families need help because of the perception that the war in Iraq is over and the fighting in Afghanistan is winding down.  

Karen Sanquist said that the emergency aid her family received was a "blessing," but that she wished more people knew about the available services.

"It was wonderful hearing these people say, 'There’s a light at the end of tunnel but until you get there, make sure you don’t get so far behind that you get in trouble."

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

More content from NBCNews.com:

• Isaac's storm surge overtops levee, floods some La. homes
• Teens charged after 5-year-old girl found dead in trash
• Israel court says US activist not unlawfully killed
• Jury seated for Amish beard-cutting trial
• Ga. murder case uncovers alleged terror plot
• Video: Grizzly kills hiker in Alaska

Follow US News from NBCNews.com on Twitter and Facebook

The Department of Veterans Affairs announced Monday that it has approved more than 36,000 applications for a training and education program designed for unemployed veterans.

Veterans Retraining Assistance Program (VRAP) was created as part of the Veterans Opportunity to Work (VOW) to Hire Heroes Act of 2011 and provides up to 12 months of training in more than 200 jobs skills.

---

Veterans who receive the benefit must enroll in a VA-approved program at a community college or technical school and train for a high-demand occupation. The Department of Labor has defined those fields to include positions like petroleum technician, paralegal, preschool teacher, radiation therapist and locomotive engineer.

VA has received 51,000 applications and approved 36,000; the program's goal is to train 99,000 veterans in the next two years.

Veterans who have been approved for VRAP are encouraged to enroll as soon as possible to start training full-time in a VA-approved program of study offered by a community college or technical school.  The program of study must lead to an associate degree, non-college degree, or certificate for a high-demand occupation as defined by DOL.

“The tremendous response illustrates how important this program is in providing veterans the opportunity to find employment in a high-demand field,” said Secretary of Veterans Affairs Eric K. Shinseki, in a statement released by the agency.

To be eligible for the program, a veteran must be between 35 and 60, unemployed and have received an honorable discharge, among other requirements.

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

More content from NBCNews.com:

• Mandatory evacuations outside New Orleans as Isaac nears
• Reports: 37 people shot in Chicago since Friday
• NTSB: Doomed plane topped speed limits in race
• Student shot at Md. high school on first day of class
• Video: Elvis festival brings out many 'Kings'

Follow US News from NBCNews.com on Twitter and Facebook

The military is seeing unprecedented mental illness and suicide in its ranks, and is funding research to treat depression and prevent the most tragic of outcomes.

In July, a report released by the military found that mental health disorders in active-duty troops increased 65 percent since 2000. Of the more than 900,000 diagnoses, about 85 percent included cases of adjustment disorders, depression, alcohol abuse and anxiety. This month, the Army reported 38 suspected suicides among active-duty and reserve soldiers in July, the highest monthly number of suicides since record-keeping began a few years ago. 

Col. Carl Castro, director of the Military Operational Medicine Research Program, told NBC News that the military is "leaving no stone unturned" in its hunt to find evidence-based treatments for depression and suicide. Included in its multimillion dollar research portfolio is a grant to evaluate whether a nasal spray using a fast-acting hormone could alleviate symptoms of both depression and suicidal behavior.

---

Related: Mental health disorders among troops increased 65 percent since 2000

The $2.9 million grant will support a three-year development and testing period that will ideally culminate in seeking Food and Drug Administration approval for the medication and delivery device. The grant was awarded in April to Dr. Michael Kubek, a professor of neurobiology at Indiana University. 

Kubek will research the use of Thyrotropin-Releasing hormone (TRH), which is known to act rapidly in relieving depression and suicidal behavior. However, its effects are short-term and the hormone has difficulty crossing the blood-brain barrier. Kubek is aiming to load up nanoparticles with TRH and then deliver them via the nasal spray, which could lengthen the drug's effectiveness and overcome the challenges of getting past the blood-brain barrier.

The military is hopeful that the spray will provide a treatment for the period between when a patient is first diagnosed for depression or suicidal thoughts and when typical anti-depressants become fully effective, which can take three to six weeks.

The clinical trial will compare a few hundred patients split into two groups: one receiving the nasal spray and another getting a similar drug used to treat suicidal behavior and depression. The idea, Castro said, is to determine not only if the spray works, but if it is more effective than current drug therapies. The study will look at whether or not the drug decreases depression and suicidal thoughts.

Should the drug prove effective, Castro said a realistic timeline for putting it in a soldier's hands would be five to eight years to account for possible setbacks and additional studies.

The research is part of a $100 million  effort to study psychological and mental illness in the Army. Half of that funding is for Army STARRS (Study To Assess Risk and Resilience in Servicemembers), an initiative done in partnership with the National Institute of Mental Health to gather details about the lives and mental health of 55,000 soldiers. The Army hopes that the epidemiological study may eventually identify groups of soldiers whose mental health is most fragile based on an algorithm or formula of factors.

Related: Army program aims to predict soldiers' resiliency

The Army has allocated $18 million for 12 studies looking at treatment for depression and suicidal thoughts. The nasal spray study is the only one in the Army's portfolio to test a drug. 

Despite the fact that suicide ranks in the top 10 leading causes of death in the U.S. — 36,909 people died by suicide in 2009 according to the latest available figures — clinicians still don't have a set of evidence-based standards for how to effectively treat suicidal patients. Instead, they rely often on a combination of medication and therapy that has shown promise, but has varying degrees of success.

The urgency to find a treatment has become critically important to the military as it searches for answers to its own suicide epidemic.

"We have no real explanation for why they're happening," Castro said of military suicides. The goal, he said, is to base treatment on science as opposed to "medical hunches."

The time it takes to design and execute a study can be frustrating to those waiting for an effective treatment, but Castro said, "at least at the end of the day, we'll know if something does work."

Rebecca Ruiz is a reporter at NBC News and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.

More content from NBCNews.com:

• Mandatory evacuations outside New Orleans as Isaac nears
• Reports: 37 people shot in Chicago since Friday
• NTSB: Doomed plane topped speed limits in race
• Ga. murder case uncovers alleged terror plot
• Student shot at Md. high school on first day of class
• Video: Elvis festival brings out many 'Kings'

Follow US News from NBCNews.com on Twitter and Facebook

A study conducted by the military has found that nearly 6 percent of soldiers experienced concussions during combat-training courses at Fort Hood, according to a report from ProPublica and NPR.

The study raises questions about the safety of standard training classes and whether or not soldiers had deployed to combat without realizing they suffered a mild traumatic brain injury.

The results are preliminary and rely on data gathered from hand-to-hand combat classes taken by nearly 2,000 soldiers at the Texas base. The post is one of the Army's main centers for basic training where soldiers spend more than 20 hours learning fighting techniques that include boxing, wrestling and Brazilian Jiu-Jitsu, according to the report.

---

Experts told ProPublica and NPR that they were concerned that brain injuries suffered prior to combat could have made soldiers more vulnerable to the long-term consequences of additional concussions, including frequent headaches and memory loss.

“Even 1 percent of soldiers would concern me,” Col. Carl Castro, the director of the Military Operational Medicine Research Program, told ProPublica and NPR. “I’d say we need to do something. We don’t want soldiers getting injured while training, if we can prevent it.”

There have been at least 244,000 traumatic brain injuries as a result of explosions and accidents since 2000, but previous reports from ProPublica and NPR found that number may be much higher due to underreporting and missed diagnoses.

Reporters who were permitted to observe advanced students learn how to teach combat-training classes in Fort Benning in Georgia witnessed one student get kicked in the head during a sparring match. That student appeared dazed, was evaluated by a medic and did not participate in the remainder of the class. He was later sent to a clinic for evaluation.

The ProPublica/NPR report said that hundreds of thousands of soldiers had taken the combat courses at bases nationwide in the past decade before deploying.

More content from NBCNews.com:

• 2 dead, 9 injured in shooting near Empire State Building
• Panel calls for better care, protections for wounded troops
• Report offers a roadmap for America's national parks
• Undocumented mom risks life in US to join immigration fight
• Video: Did ex-SEAL sell out with bin Laden tell-all?
• Video: Missing teen escapes from captor of two years

Follow US News from NBCNews.com on Twitter and Facebook

 

The Recovering Warrior Task Force, a panel appointed by Congress in 2010, issued an annual report (PDF) Thursday outlining how the Department of Defense can improve medical treatment and retirement for wounded service members.

The panel made 35 recommendations to DOD, among them ensuring that all behavioral health care providers are trained in evidence-based treatment for post-traumatic stress disorder; extending military medical coverage from six months to a year for reservists when they return home; and making it easier for families of the injured to receive counseling and logistical support.

---

It also suggested creating a bill of rights for recovering service members that would address the "adversarial dynamic" that can sometimes occur between the wounded and their chain of command.

 

Seven civilians and seven members of the military serve as task force members. DOD is required to provide Congress an assessment of the recommendations within three months and a plan for implementation at five months.

Related: Red tape entangles injured service members who can no longer deploy

Suzanne Crockett-Jones, co-chair of the task force whose husband was severely injured in 2004 in Iraq, told NBC News that the improvements made to the care and retirement of wounded service members have been significant in the past decade.

"When my husband was injured, there were no resources for families — that was not even on the map," she said. Now, there are systems in place to ensure that care is being closely monitored and that family members are included in the process.

Still, there have been 49,000 Iraq and Afghanistan casualties to test the quality of care, and as of late July, more than 26,000 service members in the Army, Air Force, Navy and Marine Corps were being processed in the disability evaluation system, which determines whether or not an injury is service-connected and meets the threshold for full military benefits upon retirement. In the Army, which accounts for two-thirds of the caseload, service members wait the longest at an average of 427 days; the goal set by the Departments of Defense and Veterans Affairs is to process active-duty cases in 295 days.

The task force offered a number of recommendations to improve efficiency and streamline the Integrated Disability Evaluation System, including creating electronic records for those cases and increasing staffing for liaisons who guide service members through the process.  

In focus groups, some service members and their families complained that the chain of command and support staff did not always support the recovery process. At times, service members said they felt "disrespected and inappropriately penalized" and that athletic reconditioning or formations were prioritized over getting medical or transition services. They were also concerned about violations of medical confidentiality as some staff members had discussed service members' cases in inappropriate settings.

Lt. Gen. Charles B. Green, surgeon general of the Air Force and co-chair of the task force, told NBC News that a bill of rights could help set expectations for commanders who may not have experience managing injured or ill service members likely to retire from the military.

Green said the task force wanted to see consistency in the respectful treatment of the wounded between the services and from one installation to the next. 

"A lot of people have done wonderful things for their country, and may not go back to active duty, and we want to treat them exceptionally well."

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

More content from NBCNews.com:

• Undocumented mom risks life in US to join immigration fight
• Ex-Navy SEAL in legal jeopardy for book on bin Laden raid
• Faith in Army's direction falls to all-time low, survey shows
• Video: Woman walks straight off train platform
• Embattled tanning industry fights back, taking cues from Big Tobacco
• California school district sued over abstinence-only sex ed

Follow US News from NBCNews.com on Twitter and Facebook

 

 

Daniel Kinberg had not planned on leaving the Navy. The second class petty officer was a reservist who enlisted in 1994 and eventually served as a Navy Corpsman to Marines deployed in Afghanistan's Helmand Province from October 2009 to June 2010.

Kinberg, a medical specialist, was constantly under fire. A suicide bomber struck in a bazaar, killing one of Kinberg's closest friends, and he was the first to respond. When the vehicle of his sergeant major was struck by an improvised explosive device, he could not attempt a rescue as it burned. He was often approached by Afghans who needed medical attention for their injured or dying children.

The deployment took a physical and mental toll on Kinberg, who is 40 and lives in San Diego. "We were always fearing for our lives every second and not knowing if the next step you take is going to be your last," he told NBC News.

---

He returned from the deployment with terrible back pain, which he attributes to frequent dives for cover and daylong foot patrols in rugged terrain with a full combat load. He was soon diagnosed with ankylosing spondylitis, a disease characterized by inflammation in the spinal and pelvic joints. The disease can be hereditary, but Kinberg did not experience symptoms until during combat. 

When a doctor said in June 2010 that he could not be deployed again as a result, it was a "tough blow." A few months later, after having trouble reintegrating, Kinberg was diagnosed with post-traumatic stress disorder.

The yearlong battle that followed, however, as Kinberg attempted to retire from the Navy with disability and medical benefits, was more difficult than he could have imagined. At first, the military denied him a retirement with full benefits, arguing that the PTSD and ankylosing spondylitis pre-existed his service.

Experts who appeal cases like Kinberg's say his is one of many in which the military may wrongly try to separate an injured service member without benefits. Even if a service member is given a favorable decision, the average wait in each of the services is a year or longer, and most are left trying to navigate in a bureaucratic system that is not always kind to those who will never deploy again.

Last month, the disability system was criticized in a Congressional hearing for the long waits. As of late July, there were more than 26,000 open cases across the Army, Air Force, Navy and Marine Corps. In the Army, which accounts for two-thirds of the caseload, service members wait the longest at an average of 427 days; the goal set by the Departments of Defense and Veterans Affairs is to process active-duty cases in 295 days.

Medical retirement has been under Congressional scrutiny since 2007, when several commissions revealed that service members were frequently denied legitimate disability benefits and that an outdated processing system resulted in waits as long as 540 days. Since then, policies issued by DOD as well as Congressional legislation have resulted in significant improvements, primarily the streamlined process known as the Integrated Disability Evaluation System (IDES), which allows DOD and VA to jointly assess medical conditions and disability ratings.

Veterans advocate Michael Parker, a former lieutenant colonel in the Army who estimates assisting on hundreds of disability cases in the past seven years, said that while the changes have led to better outcomes, many service members like Kinberg continue to be denied legitimate but costly benefits.

Service members often approach Parker, who is not a lawyer and does not charge a fee, after they're found fit to serve despite severe injuries, or if the military or VA has ruled the condition in question does not deserve a disability rating high enough to qualify for benefits; the threshold is 30 percent.

"Somebody will come to me and say, 'My case is broken, can you help me?' " Parker told NBC News. "Every day there is a new situation that is counter to taking care of wounded people."

Parker has seen cases in which the military "cherry picked" from a number of injuries, selecting the least aggravated one and assigning it a disability rating that did not qualify for full benefits upon retirement. 

He has also seen a range of perplexing cases, including a combat Marine who in 2010 was first found unfit due to service-related disabilities, but not at a 30 percent rating. The decision was then reversed and he was found fit for duty, but he was subsequently separated without benefits. When he tried to re-enlist, the Marine was denied on the grounds that his conditions disqualified him for service.

Congress soon passed laws prohibiting the military from discharging a service member due to a condition for which he or she had been previously evaluated and found fit for duty. Parker said the legislation is important, but that the military has found different ways to withhold disability benefits; he has handled cases where service members are administratively discharged for a service-connected disability before they even enter or complete IDES.

Daniel Kinberg was prepared for a difficult process. “I never heard a good thing about it,” he said. “Everyone says this is a nightmare.”

Kinberg's medical conditions were assessed by a three-person physical evaluation board (PEB), which found him unfit for duty as a result of the ankylosing spondylitis and PTSD, but said that both conditions were pre-existing. Specifically, the board indicated that the PTSD may have been tied to his ankylosing spondylitis, not combat. His case was sent to VA to receive a disability rating, and it returned a different decision: the PTSD was service-connected and received a 100 percent rating, which would have allowed him to retire with full benefits.

The Navy, however, disagreed, and enforced its original finding that the conditions pre-existed service — without providing evidence to prove its case as required by law. Kinberg would be separated from the military with no DOD medical or disability benefits, though he would receive VA care and benefits.

"It’s a slap in the face," Kinberg said of the decision. "I know I’ll never be the same as I was before ... I used to be this happy guy and I don’t see me ever getting there." 

With Parker's representation, Kinberg appealed the decision. First, Parker convincingly argued that neither condition was pre-existing, but then the PEB reversed its original decision and found that the PTSD did not make Kinberg unfit for duty, which again prevented him from receiving a rating high enough for DOD benefits.

In May, Parker successfully appealed that decision before the Navy's physical evaluation board in Washington, D.C. In the end, the board agreed that both conditions were service-connected and made Kinberg unfit for duty, awarding him a 100 percent rating for PTSD, and as a result, a full DOD medical retirement.

In very rare cases, DOD told NBC News, the military can "depart" from a VA rating when approved at a high level. DOD said it did not know of cases in which the military did not follow the VA finding, but there is also no requirement to report those incidences.

Jason Perry, a former Army captain in the Judge Advocate General Corps who now assists service members with disability retirement cases, told NBC News that despite improvements to the medical retirement process, the system still seems "arbitrary." 

Often, Perry will see two cases with the same underlying facts, but different decisions. One service member will receive a high disability rating while another gets a substantially lower one.

DOD told NBC News that criteria for judgments differ across the services depending on the type of missions and fitness required of the service member.

Perry said, however, that the discrepancies are partly due to the subjectivity of individual doctors as well as the three-person panel that evaluates the merits of each medical retirement case.

Complaints like these are common on PEBforum.com, a website Perry founded that allows service members to glean intricacies of the process, ask other posters about their cases and learn how to avoid common pitfalls or mistakes.

Perry, who has handled 400 cases as a former Army captain and a for-hire lawyer over the past six-and-a-half years, doesn't believe those who serve on PEBs set out to "low ball" or deny benefits to service members. Instead, he thinks they're attempting to follow the rules, but often make errors in judging whether an injury is service-connected and is worthy of a full medical retirement.

Though designed to keep malingerers from taking advantage of the system, stringency for disability claims can prevent worthy cases of getting a proper ruling.

In Kinberg's case, he felt under constant scrutiny. While on medical hold, he was tasked with driving a shuttle for patients, a duty that too often triggered his PTSD symptoms of hyper-vigilance and irritability.

Instead, he signed up for vocational rehabilitation, a skills-based training program for those with service-connected disabilities, but that was cited as evidence by the PEB that his PTSD was not severe enough to make him unfit for duty. Yet, in Kinberg's opinion, it was the vocational rehabilitation that gave him a crucial "sense of fulfillment" to endure the yearlong wait for a decision on his case.

He also worried about taking advantage of community events and activities held for wounded warriors, fearing his participation might undermine his diagnosis in the eyes of the PEB.

"I didn’t do any of that stuff because I was already warned," he said, referencing advice given to him by other service members.

"It’s a long, drawn out process," Kinberg said of IDES and remaining on medical hold. "Unless you do something with your time there, it’s a very miserable existence. I know people who are suicidal because they don’t have anything going on in their life and they're just sitting in their room and going to doctor’s appointments." 

In the July Congressional hearing, VA Secretary Eric Shinseki defended the length of the decision process, explaining that much of that time was necessary for wounded service members to convalesce and receive appropriate medical attention.

However, a report on IDES published by the Government Accountability Office in May found significant delays in completing medical examinations; in 2011, only 31 percent of active-duty cases met the 45-day goal. Officials told GAO that case loads were large and that there were not enough doctors to complete paperwork in a timely manner. The report noted that the Army was in the midst of doubling its staffing for medical evaluations to address the delays.

Neither Parker nor Perry want the timeline goals achieved at the detriment of getting the process right. However, Perry said, long waits can lead to frustration for service members who have no ability to plan for the future, whether it be lining up civilian employment, enrolling in college, or knowing where their children will attend school in a year.

While the delays receive the most attention, there also appears to be a dangerous disconnect between the wounded and their command in some cases.

The Recovering Warrior Task Force, a panel that gives DOD recommendations on policies related to the treatment of the injured, found in the course of conducting focus groups with wounded service members that they often encountered an "adversarial dynamic ... which distracts them from focusing on healing." 

The task force wrote in a draft report earlier this year that the Army and Marine Corps might consider how to prevent transition staff from behaving in counter-productive ways, including acting or speaking to injured service members "in a demeaning or hostile way, accusing (them) of malingering in the course of their recovery, breeching privacy by discussing medical and personal matters ..."

Kinberg, who was among a handful of combat-wounded sailors in his medical hold unit of 50 people, witnessed that dynamic. Kinberg said his chain of command included activated reservists who had never been deployed and acted at times as though members of the unit were faking injuries.

Despite these troubling experiences, Kinberg is preparing to move on. The internship he secured through vocational rehabilitation has led to a job, which he will begin after being discharged from the Navy this month. Still, he can't quite fathom his experience in the disability retirement system.

"I thought some people weren’t doing something right," he said. "I did everything by the books, by the numbers and still they come back and say, 'Well you’re zero.' " 

"I was somewhat prepared, but I didn’t think it would happen to me." 

Jason Strachman Miller contributed to this report.

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

More content from NBCNews.com:

• Sioux tribes race to raise money to buy ceremonial land at auction
• Tropical Storm Isaac could threaten GOP convention in Tampa
• Satirical website The Duffel Blog dupes news sites with bogus stories
• Immigrant detainees land in limbo in Alabama jail
• Lesbian who alleged Nebraska hate crime to be charged with lying about attack
• Ruled innocent by judge 2 years ago, Los Angeles man remains in jail
• Video: Day care workers staged, taped tots fighting, cops say
• School vouchers make a comeback amid concerns about quality

Follow US News from NBCNews.com on Twitter and Facebook