The battle for benefits

A surge of veterans war with PTSD

By MELISSA JELTSEN

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When Lance Corporal James Crosby returned home to Boston paralyzed from a rocket attack in Iraq, stacks of paperwork stood between him and his benefits. His father, an ex-Marine who "doesn't take no for an answer," helped Crosby conquer the maze of bureaucracy.

But many veterans don't have this support. Those with severe injuries or mental health problems are especially susceptible to falling through the cracks, says Crosby. He's the director of Statewide Advocacy for Veterans' Empowerment (SAVE), a new outreach program launched by the Massachusetts Department of Veterans' Services.

Since 2001, 28,000 new veterans have returned to the Bay State. Although the federal government funds healthcare through the Veterans Affairs (VA) system, the Massachusetts Department of Veterans' Services offers additional aid. Dr. Roberta White, a professor at the Boston University School of Public Health, says the VA may need the help of state programs. "I think the VA has the bureaucracy, the setting and the scientific knowledge," she says. "But it's whether there's adequate funding; that's the critical question."

Last year, 121 service members committed suicide nationally—more than any other year on record. A recent Institute of Medicine report found that a quarter of all returning Iraq and Afghanistan combat veterans face mental health problems like Post Traumatic Stress Disorder (PTSD), depression and anxiety. PTSD is a condition that occurs after exposure to extreme mental or physical stress, characterized by re-experiencing traumatic events, numbing of general responsiveness (or, alternatively, hyper-vigilance), sleeplessness and irritability.

Dr. White suggests many returning Iraq veterans have suffered mild brain injuries from explosions, which can make their PTSD more severe than typical cases. "You might have a mild head injury superimposed on an emotional reaction to wartime stress," she says.

Crosby says SAVE's outreach workers are trained to recognize the warning signs of suicide and the symptoms of PTSD. They are all veterans themselves. "There's automatically a bond of trust. You can really empathize," Crosby says. "If you haven't been there, you can't even understand what its like." They travel around the state in their mobile outreach center (a van with wireless internet, a printer and a scanner), functioning as a one-stop shop for veterans' needs. They can print forms, have them signed and completed on the spot. "We're the ultimate referral service," says Crosby.

SAVE Family Outreach Coordinator Cayenne Isaksen says this is a form of early intervention, which is why the program receives funding from the Massachusetts Department of Public Health. "If they can get jobs and healthcare, they're less likely to commit suicide," she says.

Under Chapter 115 of Massachusetts law, qualifying veterans and their dependents can receive necessary financial assistance for food, shelter, clothing, fuel and medical care. The amount of cases per month where Chapter 115 provides assistance almost doubled from January 2004 to December 2007.

Legislators are also proposing bills to identify and treat a new wave of veterans. Gov. Deval Patrick proposed an $8 million increase in the 2009 budget for veterans and military spending. Rep. Anthony Verga, D-Gloucester, sponsored a bill creating a new special commission to study the "hidden wounds of war." The proposed 11-member commission would consider a proposed mandatory mental health treatment program for returning National Guard members, in the hopes that screening all veterans would help identify those with mental health problems and reduce the stigma of seeking professional help. The commission would also consider a statewide program educating law enforcement and other first responders about the symptoms of post-traumatic stress disorder.

Isaksen says both public programs and private organizations (health providers in particular) want to help veterans. She sees this as proof of increased cultural sensitivity to the struggles they face. "We don't want them to go through what Vietnam veterans went through," Isaken says. "I hope it translates to the veterans that this is a different generation, a different era."