On The Edge: Doctors over prescribe opioid painkillers to young veterans, leading to addictions and accidental overdoses

By Ken Olsen

(Copyright 2014, All Rights Reserved)

By the time Justin Minyard discovered the video of himself stoned, drooling and unable to help his daughter unwrap her Christmas presents, he was taking enough OxyContin, oxycodone and Valium every day to deaden the pain of several terminally ill cancer patients.

“Heroin addicts call it the nod,” the former Special Forces soldier says of his demeanor in that video. “My head went back. My eyes rolled back in my head. I started drooling on myself. My daughter was asking why I wasn’t helping her, why I wasn’t listening to her.”

Seeing that video jolted Minyard out of a two-year opiate stupor. He asked a Fort Bragg pain specialist to help him get off the painkillers his primary care physician had prescribed. “I was extremely disappointed in myself,” he says. “I knew I couldn’t do that to my family again.”

There are thousands of post-9/11 veterans like Minyard – men and women whose bodies were broken by roadside bombs, bullets or jumping out of helicopters and Humvees day after day, deployment after deployment, wearing 80 pounds of body armor and battle gear. Some have traumatic brain injuries. Some have PTSD. Some have deteriorating knees, shoulders or spines. All have pain.

Overwhelmed primary care physicians have responded with ever-increasing doses of prescription opioids. There has been a 270-percent increase in VA prescriptions for four key opiates since 9/11, according to an analysis by the Center for Investigative Reporting. VA patients are twice as likely to die from accidental drug overdoses as civilians, according to a VA study published in the journal Medical Care in 2011. Yet opioid painkillers provide “only modest medical benefits in treating chronic non-cancer pain,” a separate VA study found.

In Minyard’s case, as in so many others, “the treatment regimen was as bad as the disease,” says Dr. Tony Dragovich, an Army pain specialist now in private practice in Virginia who helped get Minyard off opioids.

MULTIPLE INJURIES

A series of debilitating injuries led to Minyard’s massive painkiller habit. The first occurred when he and other members of the 3rd Infantry Regiment spent six weeks moving piles of rubble at the Pentagon following the 9/11 attacks. He then volunteered for language school, and by the time he deployed to Afghanistan in 2004 as an interrogator he was already taking aspirin, ibuprofen, Vicodin and muscle relaxants, and was being administered epidurals for his back pain. “I was only 25,” he says. “And if you looked at an MRI, I had the spine of a 60-year-old.”

The injuries mounted. Minyard fell two stories during a combat operation in Afghanistan, on top of the wear and tear that comes from riding in a helicopter – the vibration in a Black Hawk is particularly hard on the spine, Dragovich says  – and running around in full combat gear. He had surgery to replace two discs after he returned from that deployment. By then he was alternating between Percocet and Vicodin and should have stayed home. But because the Army was short of soldiers fluent in Arabic, he volunteered to go to Iraq in 2007.

“Looking back, that was probably one of the worst decisions I made,” Minyard says. “It had a lot of ripple effects beyond my health. I left when my daughter was three weeks old.”

His pre-deployment physical was a quick conversation with a physician sitting behind a desk, who asked if he “needed any meds.” Minyard doesn’t blame the doctor. “Probably half of the people coming to his office every day are trying to get out of deployment,” he says. “And he has to deal with 500 guys who are in line behind me. He probably doesn’t care about Justin and his back problems.”

The op tempo in Iraq was as furious as the strain on Minyard’s body. Before his unit rolled out on missions, he gave himself injections of a super-strength anti-inflammatory called Toradol. Between them, he visited the medical tent for epidurals and additional pain medications. “That was a double-edged sword,” he says. It eased his pain while enabling him to continue harming his back.

Minyard’s pain was severe enough, however, that he went to the doctor while home on R&R. Fort Bragg physicians told him the damage to his spine was so significant that he shouldn’t return to Iraq. For him, that would have meant abandoning his platoon. “I chose my military family over my real family,” he says. “I chose the military over my personal health.”

The accumulated damage caught up to him. Minyard collapsed as he climbed out of a Humvee in August 2008. He was airlifted to Balad, where he sustained a concussion and additional back injuries after a nurse dumped him on the floor during a mortar attack, he says. Once home, surgeons at Duke University installed eight titanium rods to hold his spine in place – a procedure called an “anterior-posterior interbody fusion.”

Before doctors could operate, however, Duke had to bring in an outside team to figure out how to treat Minyard’s post-surgical pain given his high tolerance to opioids. They settled on ketamine in combination with other drugs that allowed Minyard to disengage from reality, he says. It worked. But by that time he was confined to a wheelchair and weighed 280 pounds.

For the next two years, Minyard struggled with PTSD, depression, severe cognitive challenges, the loss of his military career and anger over his injuries. He took ever larger doses of “big league opioids,” as he puts it. “No one said, ‘This is a problem.’ This was offered to me.”

Somewhere in that haze he came close to killing himself.

“To go from a very successful career as a soldier to hiding out in our guest bedroom with the shades closed for weeks at a time, taking pain pills and being ashamed … I considered taking the whole 30-day supply in one shot,” he says. “It would have been incredibly selfish on my part.” Though not unusual. Seven of his friends died in combat. Fifteen have killed themselves since coming back.

Minyard attempted to kick opioids three different times. “It was the most unpleasant, horrible, excruciating time of my life,” he says. In the middle of moving to a different home, he came across an unlabeled video, popped it in the VCR, and watched in horror as his near-comatose self couldn’t even help his daughter unwrap her Christmas presents. He asked his primary care physician at Fort Bragg to refer him to a pain specialist.

ACCIDENTAL DEATH

An untold number of other veterans don’t get the sort of help that saved Minyard. A 43-year-old retired Army veteran died four days after back surgery in the fall of 2011. The Arkansas State Crime Lab ruled the cause of death as “mixed drug intoxication” complicated by back surgery. His widow, Kimberly Stowe Green, told the House Veterans’ Affairs Committee, “My husband – Ricky Green – died as a result of VA’s skyrocketing use of prescription painkillers.” Ricky’s medication list included oxycodone, hydrocodone, Valium, Ambien, Zoloft, Gabapentin and Tramadol. This despite her husband’s repeated requests that VA doctors treat the root cause of his medical problems – knee, back and ankle injuries acquired over his 23-year career as a paratrooper and military policeman – and reduce his prescription opiate painkillers, she said.

VA declined to answer questions regarding Green’s case, noting that it does not comment on specific patients. Overall, the agency says it has “worked aggressively to promote the safe and effective use of opioid therapy.” VA clinicians discuss benefits and side effects of medications with patients. Opting for opioids is “a collective decision between the veteran and their health-care team,” VA says. In addition, VA connects patients and families to “pain schools,” support groups and other resources.

VA has also adopted regulations aimed at reducing the risks of prescription painkiller use – a strategy it emphasized during that same congressional hearing. But VA hospitals and clinics are not adopting those changes, Green says. “They were repeatedly violated in my husband’s case – and he had to pay with his life.”

There are several other factors fueling the prescription painkiller epidemic, according to congressional testimony from The American Legion. Veterans can receive overlapping prescriptions from DoD, VA and TRICARE, and Medicaid or Medicare providers. Physicians often have difficulty distinguishing between TBI, PTSD and pain issues. The result is over-reliance on painkiller prescriptions. In addition, there is a significant need for prescription painkiller oversight among VA providers, the Legion says.

Meanwhile, Iraq and Afghanistan veterans who are at the greatest risk of addiction and accidental overdoses are the most likely to receive opioid painkillers from VA, according to a VA study published in 2012. This was particularly true if the veteran also had PTSD.

“People at the greatest risk of addiction and overdose are the people who are going to have the most distress from their pain,” Dragovich says. “If a patient comes to you with a lot of psychological distress and a lot of pain-related distress, most physicians are going to give them opioids.”

STANDARD PROCEDURE

High doses of opioids became standard protocol for pain treatment in the late 1990s and early 2000s, Dragovich says. When that protocol is applied to a military base with 1 million primary care visits a year, the result is a lot of opioid prescriptions. Because young soldiers build tolerance to opioids quickly, he adds, doctors escalate the doses quickly.

Severely injured servicemembers also often come out of the hospital receiving high doses of opioids for traumatic battle injuries such as the loss of an arm or leg. Then they are faced with the excruciating work of getting off opioids for good. That’s not an easy sell no matter the patient.

It took Minyard six months from his first meeting with Dragovich to agree to try the doctor’s plan for helping him kick opioids. Dragovich used a drug called Suboxone to ease Minyard’s transition off the painkillers. He also arranged for him to get a spinal-cord stimulator that uses electrical impulses to short-circuit pain messages before they reach the brain. He calls it a pacemaker for pain.

“(It) was like a lightning bolt,” Minyard says.

“I felt like this was going to be the one thing that helps turn me around.” It did. Today he’s out of his wheelchair, has lost 100 pounds and regularly bicycles.

The Army supports the use of spinal-cord stimulation, but there are few specialists to guide soldiers to such alternatives. Fort Bragg had two board-certified, fellowship-trained pain specialists while Dragovich was stationed there. As a result, it may take three or four years of other treatments before injured troops see someone with Dragovich’s expertise.

It’s also difficult to get a referral to a pain specialist in VA, says Minyard. And it’s quite difficult to receive spinal-cord stimulation at VA. “You have to fail at all other treatment plans,” he says. “Is failure an overdose? Or is failure when you are a full-blown addict?”

VA says it has expanded its alternative medicine offerings, and provided spinal cord stimulation to 36 patients from fiscal 2011 to fiscal 2013. Beyond that, its treatment includes “timely access to secondary consultations from pain medicine, behavioral health, physical medicine and rehabilitation,” VA says.

Minyard, who is 90-percent service-connected for his injuries through VA, has charted his own recovery. He took his last opioid painkiller in October 2011. At his Army retirement ceremony in March 2012, he thanked Dragovich for saving his life. He feels so passionately about staying off opioids that he has a medical directive prohibiting the use of narcotics without his consent. And if he’s unable to provide that consent, his wife has to agree to it. He tested that directive when he was struck by a truck while bicycling at Fort Bragg – an unsolved hit-and-run. But he has no second thoughts about opioids.

“I consider myself extremely lucky,” he says. “I was able to push through the maze of providers … and find the doctor who knew the secret. Many soldiers aren’t so lucky, and are left to the crushing reality of lifelong opioid dependency. Or worse.”

 

Group sees spinal-cord stimulation, other alternatives as better way to treat veterans’ pain.

By Ken Olsen

(Copyright 2014, All Rights Reserved)

When veterans seek help for pain problems, their first treatment option usually involves the most potent and highly addictive opioid medications, Justin Minyard says. Alternative treatments – without any of the destructive side effects – are last on the list.

“That’s insane to me,” says the former soldier, who fought his own painkiller addiction after a series of back injuries during his military career. “Why isn’t the first step an alternative like spinal-cord stimulation? You can take it for a test drive. It’s not addictive. It’s not damaging to your body.”

Spinal-cord stimulation helped Minyard stop using opioids and manage his pain. He started Operation Shifting Gears in 2013 to help combat-injured veterans quickly access alternative treatment, find jobs and deal with other hurdles in the transition to civilian life. The all-volunteer group includes a physician who looks at veterans’ medical challenges holistically. “If you have PTSD, he looks at what’s exacerbating your symptoms,” Minyard says. “He might work with you on diet and exercise or getting enough sleep.”

Helping veterans access nonnarcotic pain treatment, find a job or deal with other problems can be a life-and-death matter, says Minyard, who has lost many colleagues to suicide.

When a veteran turns to Operation Shifting Gears for help, the organization has a plan in place to address that individual’s needs in five days, including working with other nonprofits to help veterans find jobs. Minyard values that sort of collaborative approach over building a large organization. “Because we’re small, we’re able to react very quickly,” he says. “We fill in a lot of gaps where VA provides a lot of bureaucracy.”

Funded solely by donor dollars, Operation Shifting Gears helps veterans with pain issues get spinal-cord stimulation. Once the group identifies a candidate for the therapy, Minyard works with the manufacturer of the stimulator – Boston Scientific – and surgeons near where the veteran lives to get the stimulator implanted at a dramatically reduced rate. When possible, the group helps offset some of the cost.

Operation Shifting Gears has made it possible for about a dozen veterans who were denied spinal-cord stimulation to receive the therapy. Another 30 are on the waiting list.

“You’d be hard-pressed to find someone who’s served in the last 10 years who is not dealing with chronic back pain or knee pain,” Minyard says. “This issue is going to get worse – and it’s going to be with us a long time.”

These stories originally appeared in the April 2014 issue of The American Legion Magazine.

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Veterans and widows are bewildered by VA’s unpredictable — and seemingly unfair — approach to Agent Orange claims

By Ken Olsen

(Copyright 2014, All Rights Reserved)

When Mary Warner’s husband became too sick to care for himself, she took early retirement and a reduced pension to attend to his needs. It was a significant financial risk. The Warners thought they could squeak by, given Philip’s Agent Orange stipend and the promise that Mary could count on VA survivor benefits if something happened to her husband.

They were wrong.

Philip Warner in 1964

Philip Warner in 1964

Soon after Philip died of kidney failure in September 2011, VA decided the Vietnam War Navy veteran shouldn’t have received a decade’s worth of compensation for diesases the agency acknowledges are caused by Agent Orange exposure. In fact, VA now questions whether Philip was in Vietnam at all, despite service records he provided when he filed his first claim in 2001.

“I think it’s unethical for them to come back and say he was erroneously awarded Agent Orange benefits when he’s not here to speak for himself,” Mary says. “Why didn’t they ask these questions when he was living?”

Although VA trumpets its efforts to resolve 230,000 new  Agent Orange claims in recent years, its track record remains contradictory and confusing, particularly for servicemembers who cannot prove they set foot in Vietnam. In 2012, for example, one Blue Water Navy veteran’s leukemia claim was approved while an identical claim from another sailor who served on the same ship at the same time was denied. Widows like Warner find themselves in a fight for survivor benefits after their husbands die of Agent Orange-related causes. Thousands of Brown Water veterans who served on Vietnam’s rivers and inland waterways have been waiting almost four years for VA to review their cases after a U.S. senator discovered their claims had been denied without checking records of where they served.

“Thousands of veterans exposed to the toxin are left behind when it comes to vital treatment and benefits,” American Legion National Commander Dan Dellinger told a joint hearing of the U.S. House and Senate Veterans’ Affairs committees in
September. “Studies indicate that Blue Water Navy veterans may have experienced higher exposure rates to Agent Orange than those who were on the ground, due to water-desalination systems on the ships. This has never been satisfactorily addressed by VA.”

Frustration with VA’s treatment of Vietnam War Navy veterans continues to grow. Groups including Blue Water Sailors of the Vietnam War are pushing for federal legislation restoring benefits to all Vietnam War veterans suffering from Agent Orange-inflicted illnesses. H.R. 543 would reverse a 2002 rule change by the Bush administration that excluded veterans who couldn’t prove they had “boots on the ground” in Vietnam. Prior to that, all Vietnam War veterans who contracted certain diseases had qualified for benefits under the Agent Orange Act of 1991.

Two other veterans advocacy groups filed suit in August to force VA to provide Agent Orange benefits to Navy veterans who served off the coast of Vietnam during the war and are now suffering the consequences.

Mike Hodge is one of those sailors. He served with the gunnery crew on USS Diamond Head, which delivered ammunition to other ships along the Vietnam coast from March to December 1967. Hodge developed Type 2 diabetes in the 1970s, despite being in his 30s and having no family history of the illness. That was followed by neuropathy, ischemic heart disease, blood clots in his lungs, a stroke and an abdominal aortic aneurysm. He’s been unable to work since 2008.

“I felt like my body was giving out,” says Hodge, who lives with his wife, Sharon, in an apartment in Sarasota, Florida.

Hodge has filed four Agent Orange claims since 2001. All were denied. “This is so absurd it’s ridiculous,” Hodge says. “Here I am stuck at home. I have to put my wife to work to pay the bills.” Sharon works as a nursing assistant six days a week – including a 16-hour shift on Mondays – to help support the couple.

“It’s hard, really hard,” says Sharon, who has spent countless hours working on her husband’s claim. That includes unsuccessful attempts to reach members of Florida’s congressional delegation for help. “If you were in the Blue Water Navy, nobody wants to talk to you.”

Hodge, meanwhile, says the dozen-year claims ordeal makes him bitter. “I did my duty,” Hodge says. “Now they are telling us our service wasn’t worth a s**t.”

VA, however, hasn’t treated all Diamond Head crewmembers equally. Bob Webb was granted Agent Orange benefits for chronic lymphocytic leukemia in August 2012 after pursuing his claim for more than two years. He succeeded only after thorough research and persistence, he says. That included hand-carrying information to his local VA office in Wichita, Kan., more than two dozen times. “They hope you give up,” says Webb, who was a gunner’s mate on Diamond Head in 1967. “You have to stay on it.”

In the last packet of supporting material Webb delivered to VA, he included a note that said, “I didn’t ask to get chronic lymphocytic leukemia. I hope you find in my favor.” He and his wife cried when they received notice that VA had approved his claim.

But the chronic lymphocytic leukemia claim of another sailor who served with Webb on Diamond Head during that same Vietnam tour was denied. Steve Voloshin was diagnosed with the cancer in 2004. He filed his Agent Orange claim with the VA office in Denver in 2011. That included a letter from his oncologist stating that his leukemia was likely caused by Agent Orange exposure – to no avail.

“VA said each case is different,” says Voloshin, who lives in Loveland, Colorado. “But we were on the same ship at the same time and we have the same diagnosis.”
Voloshin is appealing his case and searching for additional evidence to back his claim, including deck logs that will show Diamond Head serving in Vietnam’s territorial waters. “I’m glad they granted Bob’s claim,” Voloshin says. “But I feel slighted.”

Veterans advocates say such disparities are common. “The whole claims system is a
mishmash, with each VA regional office doing whatever it wants to do,” says Bill Miltenberger, founder of Blue Water Sailors of the Vietnam War. But there’s a larger problem as well: “(VA) ignores common sense, science, facts and maritime law when denying the majority of those Agent Orange claims.”

VA said it could not answer questions for this article because its funding had been interrupted by the government shutdown last fall.

Meanwhile, Agent Orange claim disparities play out in other ways. VA rejected Pat Rankin’s initial claims after doctors found a tumor at the back of his mouth more than two years ago. Agent Orange benefits are granted to Vietnam War veterans with cancers of the lower respiratory system – the larynx, trachea, lungs and bronchus – but not the upper respiratory system, says Rankin, who served on USS Lloyd Thomas. So he gathered information from the nation’s top medical schools to demonstrate what should have been obvious: Agent Orange-contaminated air passed through a person’s nose and mouth on its way to the lungs and other areas VA considers the respiratory system.

“How can they say this isn’t a respiratory cancer? The tumor was in a sinus cavity in my mouth,” says Rankin, who lives in Moorhead, Minnesota. In addition, Lloyd Thomas has been added to VA’s official list of Brown Water ships – vessels that entered rivers and inland waterways in Vietnam and were contaminated with the drift from Agent Orange spraying.

After appealing his case with the help of American Legion service officers, Rankin now has a 30 percent Agent Orange disability. But his claims for heart disease, high blood pressure and other issues are still pending.

Thousands of other Brown Water veterans aren’t getting any answers. In September 2010, then-Sen. Daniel Akaka asked VA to review nearly 17,000 Brown Water cases after learning it had rejected the claims without reviewing the veterans’ service records. In April 2011, VA said it had examined 6,700 cases. In the ensuing two and a half years, VA has repeatedly been unable to provide the status of the remaining 10,000 claims.

This offers little hope of a timely resolution for a widow like Mary Warner, who is on a tight budget while she works with a Legion service officer in Grand Rapids, Michigan, to appeal the denial of her survivor benefits. Her husband served on USS Constellation during the Vietnam War. He was diagnosed with Type 2 diabetes in 1984 even though he was not overweight, regularly exercised and did not have a family history of diabetes. “It’s not the typical diabetic scenario,” Warner says.

Philip was granted a 50 percent disability rating in late 2002 for diabetes and neuritis. That was upgraded to a 100 percent rating in 2007 after he developed kidney disease. “I’m so thankful he had VA benefits because our medical bills would have been astronomical without them,” Warner says.

But Philip was diagnosed with oral cancer in 2009 and died of kidney failure two years later, Warner says. When she contacted VA, she was told she wouldn’t receive survivor benefits, currently worth about $1,200 a month. Among other things, VA claims her husband’s death wasn’t connected to Agent Orange exposure.

Warner is left worrying about her financial future, given that she left her job as a postal clerk when she was 58. “I wouldn’t have retired early to take care of Philip if I had known,” she says. She was already looking at a reduced pension because she was hired by the U.S. Postal Service after it trimmed its retirement benefits. And at 63, she says it won’t be easy to find another job.

“I wonder,” Warner says, “how many other veterans and families are left behind.”

 

A version of this story originally appeared in the January 2014 issue of The American Legion MagazineFor more about U.S. veterans and Agent Orange exposure see these other Veterans Voices stories: Rare Victory: Vietnam Navy veterans struggle to prove, and keep, Agent Orange benefits Brown Water Bungle: Paperwork error excluded hundreds of Vietnam Navy veterans from receiving Agent Orange Benefits;  Sailors Adrift: The Lingering Tragedy of Agent Orange  and Still Adrift as well as Toxic Legacy: A Brief History of Agent Orange Exposure in Vietnam,  and Brown Water Update: VA Partially Addresses Bungle that kept Vietnam Navy Veterans from Receiving Benefits

 

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Quiet Crisis: In the shadow of a record number of military suicides, spouses and children are also taking their own lives

By Ken Olsen

(Copyright 2013, All Rights Reserved)

Her husband suffered a skull-shattering bullet wound in Iraq. She lost her job. Her car was repossessed. A psychiatrist misdiagnosed her then threatened to commit her if she didn’t take medication that made her feel crazy.

These are some of the reasons Torrey Shannon tried to kill herself. Twice.

“It piles on and piles on and you wake up one day and say, ‘I can’t take it anymore,’” Shannon says.

Shannon is part of a quiet crisis sweeping military families. In the shadow of a marked increase in military suicides, spouses and children are also taking their own lives. The crisis is rooted in the strain of 12 years of war, an overwhelmed mental health care system, financial woes, relationship problems and a code of silence dictated by the stigma associated with seeking help. It’s a problem military families expect to get worse as the wars wind down and they no longer have the distraction of the next deployment to postpone dealing with difficult issues.

“The trend is increasing and I would say in the last two years it has close to doubled,” says Brannan Vines, founder of Family of a Vet, whose network receives dozens of messages a week from spouses who are contemplating suicide. “At some point, we’re going to get past the tipping point.”

Military family suicide is a significant public health problem, adds psychologist Craig Bryan, associate director of the National Center for Veterans Studies at the University of Utah. He treated military families in a primary care clinic during his Air Force tenure. “If you don’t pay attention to suicide and suicide risk in family members,” he says, “you are not going to be able to address suicide in the military and society as a whole.”

But the civilian sector is going to have to step up and help.

“We can’t expect DoD and VA to do all of this — they simply don’t have the resources, and in many respects, the cultural competency,” says Kristina Kaufmann, executive director of Code of Support Foundation, which works to bridge the military-civilian divide. “This is not DoD’s Army. This is America’s military.”

Kaufmann has been raising the issues of military spouse suicides for years. She has lost three military spouse friends to suicide and knows of many others who have taken their own lives. They include Kaufmann’s first mentor – “a real practical, strong, get-it-done kind of person who was very involved in her church” – as well a neighbor who was four months pregnant. Both killed themselves the summer of 2009.

But Kaufmann is most troubled by the suicide of a fellow commander’s wife. Faye lived around the corner from Kaufmann and her husband at Fort Bragg. “She looked like the picture of a perfect Army wife – always put together, two great kids,” Kaufman says. Faye locked herself and her children in the garage and started the car during her husband’s deployment in 2006.

“To this day, it haunts me that I didn’t take that opportunity as a commander’s spouse to speak to our battalion about deployment, depression, stress, suicide and asking for help,” Kaufmann says. “But I had no idea how to have that conversation. I couldn’t have done it effectively at that point.”

Part of the problem is the stigma attached to seeking mental health care. That stigma is just as bad if not worse for spouses than it is for servicemembers, Kaufmann says. That’s not a military issue. It’s a societal problem. “The conversation I was too afraid to have in 2006 is a conversation our entire country needs to have,” she says.

Even when military families seek help, it’s often either hard to find or inadequate because the military and veteran’s mental health care systems are understaffed and overwhelmed. Jamie Johnston found no support after her husband, a pilot, was killed in a training accident in the mid-1990s. Her husband’s squadron walked her through life insurance documents and other paperwork then cut her loose. The sole military counselor she connected with was transferred three weeks after her husband’s death. In addition, she had a miscarriage just before her husband’s plane when down.

Johnson was forced to sell their house, find a new place to live and deal with the disappearance of her social circle.  “I had friends tell me, ‘You’re too depressing to be around,” Johnston says. About a month after her husband’s death, she tried to overdose on sleeping pills. “He was my rock and my rock disappeared,” she says. “I just wanted to be able to see him and I needed to die to do that.”

Johnston’s brother discovered her suicide note and she was hospitalized. She found help through the Tragedy Assistance Program for Survivors – which tracked her down and offered its support – then spent years rebuilding. “I was completely broken,” says Johnston, who requested that her real name not be published because she has since remarried and had children.

Shannon sought treatment while her husband, Dan, was hospitalized at Walter Reed Army Medical Center. He was shot in the head in Ramadi in November 2004 and arrived when Walter Reed was at its worst. Dan became part of the front-page story in The Washington Post that revealed despicable conditions at the Army medical center. Meanwhile, Shannon’s family was worried that Dan’s PTS diagnosis meant he was a danger to their children and initiated multiple frivolous Child Protective Services’ investigations, she says.

That pressure, along with financial issues and other family problems, prompted Shannon to seek help. She was assigned to a psychiatrist named Major. Nidal Hasan, who now is on trial for shooting fellow servicemembers at Fort Hood. Hasan misdiagnosed her with bipolar disorder. “I was prescribed a cocktail of medications,” Shannon says. “I went crazy.” Shannon says she told Hasan the drugs made her feel worse. He threatened to have her committed if she stopped taking the medications.

Shannon tried to overdose in November 2006 and April 2007. “In my skewed thinking, I thought I was doing my children a favor,” she says. After getting out of the hospital following her second suicide attempt, Shannon stopped taking the drugs. While medications are helpful for some, “Since I’ve been medication-free, I’ve been fine,” she says.

Military children also are falling through the cracks in the mental health system, sometimes with tragic consequences.

Twelve-year-old Daniel Radenz killed himself just days after convincing doctors at Darnall Army Medical Center in Texas that he didn’t need to be hospitalized despite a litany of warnings including drawing graphic suicide pictures and writing on the walls of a school bathroom with his own blood.

The youngest of three boys, Daniel was a good student with perfect attendance and lots of neighborhood friends, says his mother, Tricia Radenz. A “funny little prankster,” Daniel was close to his father. He postponed his ninth birthday celebration until his father returned from his first deployment.

Soon after Daniel’s father deployed the second time, however, he started having nightmares. He became withdrawn and didn’t want to go to school. “He was just telling me he was so sad and worried about his dad and he didn’t know if his dad was coming home,” Tricia says. She found Daniel an appointment with a civilian counselor – the first opening was about 10 days later – then rushed Daniel to Darnall after his teacher called and told her he needed immediate help. He was seen by both a psychologist and psychiatrist, started on a low dose of medication and set up with a counselor.

Daniel’s mood never improved except when his father came home on R&R in March 2009. “After his dad left, he plummeted,” Tricia says. “He started having hallucinations at school, and writing in blood on the walls of the school.” Meanwhile, it was very difficult to reach his doctor.

Throughout the school year, Tricia had cut back on her hours as an emergency room nurse at a civilian hospital so she was available to help her son whenever he needed her. She and Daniel’s teachers corresponded by email throughout the day. Daniel’s former football coaches took him fishing. “Everybody was trying so hard to help him,” Tricia says. “Nothing was working.” Tricia finally told her husband what was happening. The Army sent him home from Iraq immediately.

While Daniel was happy to see his father, Tricia also believes he felt guilty. “I think he may have wondered, ‘Is dad in trouble because he came home early because I was having problems?’”

After Daniel drew detailed pictures of people shooting themselves in the head, his parents took him to Darnall. “We were very uneasy,” Tricia says. “We thought he needed hospitalization with the pictures and the things happening at school.”

Daniel convinced doctors he was OK and they sent him home. He hung himself within a week. Today, Tricia wishes she wouldn’t have let Daniel out of her sight for even a second. “I thought he went into the kitchen to get a sandwich with his dad. His dad thought he was outside with me. He was out of sight five or 10 minutes. That’s all it took.”

Tricia also wishes she had asked Daniel if he was contemplating suicide. “I think of all of the times I could have opened up the dialogue and prevented it,” she says. “I was afraid of putting the idea in his head. I know now that you don’t put the idea of suicide in someone’s head anymore than you cause a brain tumor.”

Darnall told Daniel’s family it has made changes in the way it treats patients as a result of Daniel’s death, but refused to provide details. “Pointing fingers at this point is counter productive,” Tricia says. “We have to find out where he fell through the cracks and have it not happen again.”

One of those cracks is the strain on the mental health system. “I know (Darnall) is overwhelmed. I know they couldn’t see him as much as they needed to given his situation,” Tricia says. “There were probably a hundred Daniels.”

She also believes parents need more education about the medication their children are given. Tricia read the pharmaceutical company’s warnings about anti-depressant increasing the risk of suicide. Still, “I had no idea of the seriousness of it,” she says. “And his doctor told me he had a lot of success with children taking this medication.”

Tricia now speaks about suicide prevention at places like Fort Hood and Fort Benning. She corresponds with children who need a listening ear on Facebook. She worries about the other children who are in despair.

“You have an increase in suicides when hopelessness exceeds the resources,” Tricia says, “and that’s where we were.”

Andrew Patrin’s family was there was well. Andrew went to an Army primary care clinic in search of help soon after returning to San Antonio to attend college. He felt medications he was given three months earlier were making him more depressed and wanted to be referred to a mental health specialist or inpatient treatment, says his father, George Patrin, then an Army pediatrician commanding a clinic in California. Instead, the physician changed Andrew’s medications and told him to come back in two to three weeks if he wasn’t better. Mental health appointments, he was told, only were available to active duty patients.

After that appointment, Andrew told his best friend he had answered yes to every question about being depressed and suicidal on a survey he was given during that clinic visit and still couldn’t get help. Ten days later, Andrew sent each of his family members a goodbye email from a motel room, turned off his computer and phone and shot himself. “I’m really sorry Dad,” Andrew wrote. “I’m giving up. I’m stuck at 5 percent all the time because of these stupid human limitations.”

Since Andrew died, George retired and he and his wife Pam started the Serendipity Alliance to work on ending suicide and improving health care. They realize, after speaking with hundreds of other grieving families over the past four years, that the same steps that would have saved Andrew will save servicemembers who are completing suicide, George says. That includes referring patients like Andrew to a mental health specialist that same day they ask for help and following up with in a few days to see if patients have improved. It means listening to family members when they say a patient is struggling and including them in a treatment plan when there is a risk of depression or suicide. It means screening for mental health issues every time patients visit a clinic.

Bryan, of the National Center for Veterans Studies, also advocates training mental health professionals in the military and civilian communities to provide the most effective care to servicemembers and their families.

The consequences of not taking these steps are evident in the suicides rates and homelessness of veterans and families who didn’t receive the care they needed 40 years ago. “We have a model of what not to do here – the Vietnam generation,” says Kaufmann of Code of Support. “Are we really going to do that again?”

This story originally appeared in the September 2013 issue of The American Legion Magazine

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Stealth Soldiers of the Vietnam War: The Little Known Legacy of the U.S. Army’s Combat Tracker Teams

By Ken Olsen

(Copyright 2013, All Rights Reserved)

Pete Peterson was recruited for the combat trackers while recovering at a U.S. military hospital in Japan during the fall of 1968. It wasn’t a hard sell for the two trackers who shared his hospital ward. Peterson had lost several friends in a firefight with the North Vietnamese while he was sidelined with an ankle injury. “The tracker’s job was to hunt down the enemy,” says Peterson, who had been serving with an infantry company. “I liked the idea of that. I wanted some payback.”

When he returned to Vietnam, Peterson joined one of the elite Army teams charged with finding an enemy known for melting into the jungle, gathering intelligence, and searching for missing U.S. soldiers and pilots. Although the secrecy surrounding the combat trackers has meant their accomplishments were all but lost to history, they were so successful that the North Vietnamese army put a bounty on the five-man teams and their Labrador retrievers. That bounty was a point of pride with the trackers, part of what made the work both arduous and gratifying.

Ready to head out (Photo courtesy of David Herbert. Reproduction prohibited without express permission)

David Herbert (far left) and Steve Krause (far right) with other members of a Tracker team. (Photo courtesy of David Herbert. Reproduction prohibited without express permission)

“It was easier than being in a line company, plowing through the jungle, waiting for something to happen,” Peterson says. “At least with the trackers, you knew something could very well happen. It kept you on your toes.”

But that constant tension was also exhausting. “We were busier than any other infantry operation,” says Perry Taitano, who was a dog handler with Peterson’s team. “We were always on the front line.”

British Legacy

Peterson learned the tracking trade on the job - but that was the exception. The British military secretly trained the first wave of U.S. tracker teams deployed in Vietnam. The U.S. Army later established its own training school at Fort Gordon, Ga.

The British had developed jungle-savvy combat tracker teams to deal with communist insurgents in Malaysia in the 1950s. Each included a visual tracker, a dog handler and Labrador retriever, a cover man, a radioman and a team leader. Their success depended on an ability to move quickly and avoid detection. That often meant running for miles to catch the enemy and maintain the element of surprise.

“The British had figured out how to out-guerrilla the guerrillas,” says Susan Merritt, wife of combat tracker Frank Merritt, and author of “Seek On!“, a history of U.S. combat trackers in Vietnam.

The Army contracted with the New Zealand Special Air Service (SAS) to train American trackers, and with the British to supply tracking dogs, beginning in 1966. Soldiers were shipped to British Jungle Warfare School in Malaysia for an intensive eight-week field course. They traveled from Vietnam to Malaysia in civilian clothes on temporary U.S. State Department passports – all part of the secrecy that surrounded the program.

A beloved tracking dog named Moose (Photo Courtesy of David Herbert. Reproduction prohibited without express written permission)

A beloved tracking dog named Moose (Photo Courtesy of David Herbert. Reproduction prohibited without express written permission)

Dog handlers were paired up with a dog and trained separately for most of the course. The other soldiers learned visual tracking, no matter what role they would assume once the team was in combat. The two groups came together for their final two weeks in Malaysia.

Jungle Warfare School was brutal. Each trainee had to run up a hill with someone on his back, then kick a latrine hard enough for the SAS instructors to hear it. “That latrine was made of ribbed metal, and you could hear it for miles, yet the instructors would always say, ‘I did not hear you hit it,’ and you found yourself running up the hill again,” says Charles Steward, who went through the school in 1968. Soldiers, working in groups of six, were also required to run through a field carrying a telephone pole. And that was only part of the endurance test.

“The philosophy was if you weren’t physically fit, you couldn’t follow that dog through the jungle,” Steward says. “Probably half the NCOs flunked out and went back to Vietnam. They couldn’t take it.” Trainees also washed out if they didn’t quickly learn visual tracking. Overall, 12 of the 40 men Steward went to Malaysia with failed.

That rigorous preparation paid off. “We were probably the best-trained U.S. Army soldiers in the field at the time,” says John Dupla, who trained in Malaysia in 1967. “We knew what we were doing and we had the confidence to do it.”

The jungle belonged to them

Combat trackers take a break (Photo courtesy of David Herbert. Reproduction prohibited without express permission)

Combat trackers including David Herbert, left, take a break (Photo courtesy of David Herbert. Reproduction prohibited without express permission)

Tracking teams were assigned to combat divisions and brigades but were dispatched wherever they were needed. Combat trackers were summoned when U.S. forces were ambushed or engaged and then lost contact with the enemy.

The teams traveled by helicopter and were often greeted by hostile gunfire. “From the time the helicopter started to land, I was waiting for a bullet to hit me,” says cover man David Herbert, who, ironically, was dispatched to tracker training after washing out of NCO school. “We didn’t wear flak jackets or steel pots. They were too heavy and hindered you more than helped you.”

Unlike scout dogs and their handlers, combat tracker teams worked well ahead of infantry units. The visual tracker or the dog and handler led the team, depending on tracking conditions and whether there was clear evidence – such as a trail of blood – indicating the direction the enemy had gone. The cover man was always second in line, protecting whoever was leading the team. “If you got into something, you shot your way out,” Herbert says. “The level of constant stress was unreal. I walked out after one firefight, and I couldn’t feel my feet touch the ground.”

Ideally, the tracker team located the enemy and then called the regular troops. “If things worked out OK, the dog alerted, we stopped, called the infantry forward, they re-engaged and the fight was on,” Steward says. “More times than not, we would take a few rounds before the infantry got up there. Fortunately, my team never lost anybody. A lot of times we got lucky. Very lucky.”

Although records are incomplete, it appears that 43 of the approximately 750 combat trackers deployed in Vietnam were killed in action, Susan Merritt says. That casualty rate would have been much higher if not for their superior training. “The jungle,” she says, “belonged to them.”

Incredible dogs

The trackers also credit the dogs for repeatedly saving their lives – alerting them to enemy soldiers and to the booby traps that the North Vietnamese were known for leaving behind. The British developed Labrador retrievers as jungle trackers in part because the easygoing dogs could adapt to different handlers as soldiers rotated out of teams at the ends of their combat tours, Merritt says.

Tracker Perry Taitano at work in Vietnam. (Photo Courtesy of David Herbert. Reproduction is prohibited without  permission from David Herbert)

Tracker Perry Taitano at work in Vietnam. (Photo Courtesy of David Herbert. Reproduction is prohibited without permission from David Herbert)

“There’s something about a Lab that makes it a great tracker,” says Taitano, who was the least likely dog handler. He grew up in Guam, where dogs are considered a nuisance, not pets or working animals. “When we see a dog in Guam, we kill it,” he says.

But a black Lab named Moose captured Taitano’s heart. “I had a best friend,” he says. “It’s a privilege to work with a dog who gives you unconditional love.” He tried to buy Moose at the end of his tour so he could take his tracking companion home. But the Army wouldn’t allow the dogs to leave Vietnam because of the risk of spreading diseases they acquired in Southeast Asia. That still bothers the trackers.

“The terrible thing is, the dogs were left behind - and the Vietnamese eat dog,” Peterson says. “That was always gut-wrenching.”

Once the North Vietnamese caught on to the tracker teams, they tried to develop ways to confuse them. A withdrawing enemy unit would have a couple of soldiers go off in a completely different direction, even dropping articles of clothing and leaving other obvious signs, Dupla says. His team lost a visual tracker and a cover man to enemy snipers as they checked out one of those false trails – the only men from his team who were killed during his tour.

The North Vietnamese also placed a bounty on the trackers rumored to be the equivalent of three or four years’ pay for an enemy soldier.

“It made you feel good at the time,” Peterson says. “But it caught up with you afterward.”

Sometimes the greater risk was friendly fire. One evening, Dupla’s team found itself between the North Vietnamese contingent it had been tracking and an American unit it didn’t realize was in the area.

“We stopped to call for a helicopter,” Dupla says. “And all hell broke loose.” He ended up with a piece of shrapnel in his shoulder from a grenade that could have come from either an American or a North Vietnamese soldier. “That was close,” he says. “A couple of inches’ difference, and it would have hit my head.”

The infantry units also often misunderstood the trackers’ role. In many cases, commanders wanted to use the team to walk point, not chase down the enemy. “I think it was just that a lot of companies and platoons had never heard of us, so they had no idea how we operated,” Peterson says.

Forgotten Legacy

The U.S. contract with the British Jungle Warfare School ended in 1969, and the tracker training program at Fort Gordon opened. Steward taught at the school for a year, then returned to Vietnam for a disappointing second tour with the trackers from 1970 to 1971.

“Vietnam was a different place,” Steward says. “The Americans were trying to turn more responsibility over to the South Vietnamese army to lessen U.S. casualties.” There was less follow-through when the trackers engaged the enemy, he adds. “It was not a good experience.”

The Army discontinued the program in late 1971, and the quiet legacy of the combat trackers faded. “We saved lives by not letting the enemy get away,” says Peterson, who started as a cover man and became a team leader. But the secrecy of the program cost the trackers recognition.

“We had a lot of kills, but the credit always went to the infantry unit we were with,” adds Steward, who went on to make a career in the Army and retired as a sergeant major. “And we’re so small, we’ll never get the notoriety the Special Forces did.”

But the combat trackers are leaving a trail. The U.S. Army Combat Tracker Team Memorial was erected at Fort Benning, Ga., in the early 2000s. The Merritts also created a website for the Vietnam combat tracker teams, combattrackerteam.org, more than a decade ago. That helped a couple of military gear collectors reunite Herbert with his M65 field jacket, with its rare combat-tracker shoulder patch intact, after it turned up in a North Carolina thrift store in 2009. Herbert had loaned it to a friend for a hunting trip in the late 1970s and never saw it again.

The trackers have also been holding annual reunions since 2000. They will dedicate a stone bench, engraved with the names of trackers and dogs killed in action, at the Ohio Veterans Memorial Park in Clinton in June, thanks to the efforts of tracker John Carroll.

Beyond these clues, however, the trackers remain as mysterious to the American public and many of their fellow soldiers as to the North Vietnamese they surprised.

“There’s so many people who have no idea about the trackers and what we did,” Steward says. “Our legacy will never be known.”

This story first appeared in the May 2013 issue of The American Legion Magazine.

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The Gift of Arms: After years of waiting Iraq veteran Brendan Marrocco is celebrating a successful bilateral transplant

By Ken Olsen

(Copyright 2013/All Rights Reserved)

Brendan Marrocco has new arms.

Nearly four years after an armor‑piercing roadside bomb claimed all four of his limbs, Brendan became the first person in the United States to receive such an extensive bilateral arm transplant. Now he sees the day when he’s driving himself to the store or racing his Dodge Charger.

“It makes me feel more human,” Brendan says. “It’s given me more confidence about myself. It’s something

I was waiting for a long time.”

His family is astounded and grateful.

“It just blows my mind,” says his mother, Michelle, who is a nurse. “I look at his arms, and I think, ‘How can it be? You have two sets of DNA here but it heals like any cut.’”

“It’s been a very emotional time,” adds Brendan’s father, Alex. “We owe it all to a family who, in the midst of their sorrow and the midst of their loss, made a selfless decision to be a part of Brendan’s life.”The arm transplants, which took place at The Johns Hopkins Hospital just before Christmas last year, also give hope to others who have lost hands and arms. “This is groundbreaking work,” says Col. John Scherer of the Armed Forces Institute of Regenerative Medicine (AFIRM), which is helping fund limb transplants and other clinical trials for wounded warriors. “This will allow us to understand how the body will adapt to new arms.”

Brendan was injured on Easter Sunday 2009 when a roadside bomb ripped open the armored truck he was driving during a night mission 130 miles north of Baghdad. The bomb cost him his arms and legs, burned his body and damaged his left eye. When Alex and Michelle first walked into Landstuhl Regional Medical Center in Germany, they did not recognize their son. “We wouldn’t have known it was him if someone hadn’t told us,” Alex says.

Brendan was the first surviving quadruple amputee from the wars in Iraq and Afghanistan. Soon after he arrived at Walter Reed Army Medical Center, he told his medical team that he wanted to be standing on the tarmac in Hawaii to greet his unit when they returned in about six months.

And he was.

Brendan’s recovery continued to defy expectations. He mastered his first set of prosthetic legs in five weeks with the help of Walter Reed’s rehabilitation team and his brother Mike, who quit his job on Wall Street to become his primary caregiver. He caught the attention of Gen. James Amos, then assistant Marine Corps commandant, who asked Brendan if he was interested in arm transplants.

A few weeks later, Brendan met with pioneering surgeon Dr. W.P. Andrew Lee, then at the University of Pittsburgh, who developed a limb transplant regimen using a fraction of the immunosuppression drugs required for organ transplants, which have serious side effects.

Brendan had no second thoughts. “Pretty much from the get-go, I thought it was great,” he says.

Michelle, though, was angry, feeling that someone was giving her son false hope. That turned to worry when she learned that arm and hand transplants were really possible. “My greatest fear was that he would die on the operating table,” she says. “This is major elective surgery. Anything can happen. But it wasn’t my decision to make.”

Michelle also tried to persuade Brendan to have just a right-arm transplant to reduce his reliance on people post-surgery, given that he was doing well with the myoelectric prosthesis on his left side. “He doesn’t want to be dependent,” she says.

But prosthetic arms “were never the endpoint for me,” Brendan says. And Michelle says that she admires his courage, considering that he faced an additional three years of rehabilitation and a lifetime medication regimen as a result of the transplants.

Getting the arms alone proved a long and frustrating journey. Finding the right donor is difficult. Donor limbs have to be the same size, build and skin tone as well as matching the recipient’s blood and tissue types. After waiting for a donor for a year, Brendan contracted a bone infection and had to drop off the transplant list for 10 months.

“He was very discouraged,” Michelle says.

Brendan left Walter Reed in July 2011 and moved into a specialized home on Staten Island, N.Y., near where he grew up. The house was built with funds raised by the Stephen Siller Tunnel to Towers Foundation, Building Homes for Heroes and the Brendan Marrocco Road to Recovery Trust.

Lee, meanwhile, moved to Johns Hopkins University School of Medicine to become chairman of the plastic and reconstructive surgery department, and continued to prepare for the operation. Brendan would require the most complicated transplant surgery Lee’s team had ever performed. “It is really the first time in the country two arms were transplanted – the left arm to the elbow joint and the right arm above the elbow,” he says.

The left-arm transplant was especially challenging because Brendan didn’t have enough remaining muscle to operate a wrist or hand. Yet Lee wanted to preserve Brendan’s left elbow so that in the unlikely event that the transplant wasn’t successful, he would retain use of the joint.

Surgeons, nurses, anesthesiologists and other members of the team began meeting two years before the actual operation. They practiced the surgery on cadavers four times, right down to detaching and attaching the bones, nerves, tendons and skin. Each of the 16 surgeons had a specific task. One was responsible for preparing the bone on the right recipient arm, another for the muscle on the left donor arm.

“Going in,” Lee says, “everyone knew what he or she was going to do.”

Brendan was at his father’s house when he received a call from Lee on Dec. 16 telling him that they might finally have a donor. “I got a text from Brendan saying something like, ‘I think you’ll want to get home early,’” Alex says. “That meant one of two things. Either the roof is leaking again, or he got the arms phone call.”

Michelle and Mike were having lunch at a Staten Island restaurant when they got the word from Brendan. “I started to shake,” says Michelle, who had kept her suitcase packed the entire first year Brendan was on the transplant list.

The family traveled to Baltimore together on Dec. 17. Brendan’s transplant surgery began at

1:30 the next morning in an operating room crowded with medical staff, microscopes, a portable X-ray machine and other equipment. “Operating rooms are not designed for bilateral arm transplants,” Lee says.

Thanks in large part to the teamwork among doctors and nurses, however, it worked. Brendan had new arms after 13 hours of surgery – his 22nd operation since he was wounded.

He woke from the surgery excited, but confused from the anesthesia. “I was looking around for my arms,” he says. “It was weird because I couldn’t find them at first.”

Two weeks after the surgery, Brendan received an infusion of the donor’s bone marrow, part of the protocol Lee developed to help trick the immune system into accepting the new limbs. So far, Brendan hasn’t experienced any rejection.

“That’s the biggest hurdle of all transplants,” says Scherer, who is director of the Army’s Clinical and Rehabilitative Medicine Research Program in addition to his work with AFIRM. “We’ll revolutionize the transplant world if we can dramatically reduce or eliminate immunosuppression.”

Brendan’s success is good news for other wounded warriors contemplating limb transplants. More servicemembers have lost multiple limbs as insurgents develop more powerful IEDs, Lee says. About 300 have had major upper-extremity amputations as a result of combat in Iraq and Afghanistan. A number of them are going through the screening process for transplants.

Brendan spends four to six hours a day in hand therapy, six days a week. “I should be getting decent function in the coming year,” he says. “It will be a couple of years before I get feeling.” The nerves regrow a maximum of an inch a month.

He credits his family as the single most important element in his recovery and looks forward to giving them a break. “Being independent is definitely my main goal – being able to do what I want and not having to worry about someone being around the whole time,” he says.

In a few months, Brendan will move to Walter Reed National Military Medical Center, where he will get back on his prosthetic legs as well as work to strengthen his new arms and hands. He hasn’t used his legs in about 18 months. “Not having arms, you aren’t able to keep your balance. Once you lose your balance, you can’t grab anything.”

In the long term, Brendan will continue working on the 2006 Dodge Charger that he plans to race one day. People who know him aren’t surprised.

“I thoroughly expect him to scare the hell out of me,” Michelle says, although she isn’t sure she’s up for watching Brendan race. “I’ll support him in any way I can, but that might be pushing it.”

____     _____     ______

Rebuilding Brendan’s storm-damaged home

Superstorm Sandy flooded part of the specially designed home built for Brendan Marrocco with funds raised by the Tunnel to Towers Foundation, Building Homes for Heroes and The Brendan Marrocco Road to Recovery Trust. Donations are needed to repair the home, which is uninhabitable because of the storm damage. Alex, who lost his pickup while checking on the house during the hurricane, also plans to revamp the house so it is not vulnerable to flood damage from future storms. He also is establishing a foundation to help other soldiers and other organizations.

Contributions may be mailed to:

The Brendan Marrocco Road to Recovery Trust

P.O. Box 120197

Staten Island, NY  10312

This story first appeared in the May 2013 issue of The American Legion Magazine.

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Veterans potentially exposed to toxic waste at nearly 140 military bases

By Ken Olsen

(Copyright 2013/ All Rights Reserved) 

From Marine Corps Air Station El Toro in California to Fort McClellan, Ala., there are nearly 140 U.S. military bases on the federal government’s roster of toxic waste sites.

This is a significant issue for veterans, says Jim Deremo, The American Legion’s department service officer in North Dakota. The drinking water was polluted at many of these bases. “I think a huge number may be suffering from health problems because of their exposure to these chemicals,” he says. “The whole issue has been and continues to be a well-kept secret, so not many veterans know about it.”

In 2010, a county veterans service officer asked for Deremo’s help with the case of a Marine stationed at El Toro in the early 1950s. Ray Alkofer was suffering from a nervous system disease called multiple system atrophy. “Essentially, his body shut down and he was bedridden for quite some time before he passed,” Deremo says. “There’s no question Ray’s illness was caused by his exposure to all of the chemicals at El Toro.”

Ray Alkofer as a young Marine

Ray Alkofer as a young Marine

The Navy identified more than two dozen potentially contaminated areas, including landfills, underground storage tanks, pits where jet fuel and paint thinner were burned for firefighting practice, and aircraft hangars where solvents such as trichloroethylene (TCE) were dumped.

Alkofer served at El Toro from 1951 to 1953, says his widow, Laura. Although his official job was in communications, he also cleaned airplanes and did other work around El Toro’s hangars. After his discharge, he came home to North Dakota and worked for the railroad and the telephone company.

Alkofer started experiencing medical problems in 2000, and went from being active in his community to bedridden. “You name it, he did it,” Laura says. “Community theater – he was in every musical. He was an EMT and a member of the fire department for 25 years. He was active in American Legion Post 147, Lions Club and Knights of Columbus.”

Laura and Ray Alkofer in 2004

Laura and Ray Alkofer in 2004

With Deremo’s help, Alkofer filed a VA claim based on his exposure to toxins, but it was denied. “I was ready to give up,” Laura says. “Jim said, ‘No, we’re not going to stop.’” They appealed, and Alkofer received a 100 percent disability rating in March 2011. He died seven months later.

“The last year of his life was sad for him,” Laura says. “It bothered him that he’d been exposed by the Marine Corps.”

A few months later, Deremo was helping file a claim for Richard Bounds, who served at El Toro from 1974 to 1976. Bounds says he became so ill while building a fence around a vehicle dry dock that he requested barracks duty.

Bounds first developed serious organ failure about a decade after he left El Toro, even though he has no family history of such medical problems. That led to kidney and liver transplants in 2007. Bounds’ VA claim was approved late last year, thanks to Deremo and Steele County veterans service officer Dennis Kubischta. Bounds also now has a 100 percent service-connected disability for toxic exposure.

Veterans who served at other contaminated bases haven’t fared as well. Sue Frasier has been unsuccessful in her fight for a national health registry for veterans who served at Fort McClellan between 1935 and 1999. Frasier went through basic training in 1970, when the base was home to the Army Chemical Corps and the Women’s Army Corps. Nearby Anniston had a chemical plant that manufactured PCBs.

“Nobody told us about the contamination level,” Frasier says. “There were factories all over America in those days – it was hard to get a sense of the danger.”

Frasier developed respiratory and gastrointestinal problems as well as chloracne while on active duty. Chloracne would later be one of several diseases tied to Agent Orange exposure.

Frasier’s health problems continued after her discharge in 1972 and forced her to retire from her civilian job at 41. VA rejected Frasier’s disability claim several times. She sold her car, her house and her furniture to pay her bills, she says.

Today Frasier runs the Fort McClellan Veterans Stakeholder Group. At her urging, Rep. Paul Tonko, D-N.Y., has introduced legislation to create a national health registry for veterans whose medical problems may be related to chemical exposure during their service at Fort McClellan.

“We want a universal notification form, sent out on Army or VA letterhead, telling veterans the truth about where they were stationed,” she says. “Something with substance, that includes a detailed account of what they were exposed to. Veterans should not have to rely on public rumors, Internet activists and storytelling to find out what happened at Anniston, Ala.”

This story first appeared in the February 2013 issue of The American Legion Magazine along with stories about decades of toxic exposure at Camp Lejeune, N.C.  

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Camp Lejeune’s Toxic Legacy: Marine Corps families who were exposed to decades of contamination search for answers

By Ken Olsen

(Copyright 2013/All Rights Reserved)

Jerry Ensminger’s 9-year-old daughter died of a rare form of leukemia he believes was caused by solvent-laced drinking water at Camp Lejeune, N.C. Her death could have been prevented, he says, if the Marine Corps had followed its own testing regulations.

“I have never been so disillusioned in my life,” says Ensminger, who served 11 of his 25 years in the Marine Corps at the base. “I want the truth. I want accountability. And I fully recognize they will probably pat me in the face with a shovel and blow Taps over me before I get that.”

Ensminger can claim partial victory in his 15-year battle over contamination at Camp Lejeune, where drinking water was tainted with five times as much trichloroethylene (TCE) as the Woburn, Mass., drinking water system made famous in the book and movie “A Civil Action.” Congress recently mandated that VA provide health care for Marines and family members stationed at Camp Lejeune between 1957 and 1987 who are suffering from certain cancers and neurological diseases.

“This bill is confirmation by the president of the United States and Congress that we were harmed by our leaders,” he says.

But the plainspoken former drill instructor and father of four is not standing down. “This is not the end of the issue – this is the end of the first act,” Ensminger says. “They are still withholding information from Congress and the public. There has been no accountability for the people who perpetrated this on us and our families.”

Record Exposure

The Marine Corps acknowledges that as many as 800,000 Marines, family members and civilians drank, swam and showered in Camp Lejeune’s toxin-laden water, the largest exposure of its kind in the nation.

Established as an advanced training base in 1941, the 246-square-mile complex relied on dozens of shallow wells, averaging 40 feet deep, for drinking water. These wells were contaminated by leaking fuel-storage tanks, a chemical dump and discarded industrial solvents. One well was even installed in a corner of a Camp Lejeune landfill where solvents, DDT and other waste was discarded. A civilian dry cleaner near the Camp Lejeune family housing complex where Ensminger lived also polluted the drinking water.

The Marine Corps says the contamination was the unintentional byproduct of an era when federal law didn’t limit the amount of toxic substances – including tetrachloroethylene (PCE), TCE, benzene and vinyl chloride – in drinking water.

“In the early 1980s, standards and regulations for the treatment and disposal of solvents were just starting to be put into place,” the Corps said in an email response to questions about Camp Lejeune. “The understanding of health effects of these chemicals has evolved. For example, up until 1977, TCE was allowed for use as a general anesthetic, skin wound and surgical disinfectant.”

Health experts call the Marine Corps’ response disingenuous.

“Hiding behind the lack of an official regulation doesn’t fulfill its moral obligation to the Marines and their families,” says Richard Clapp, an epidemiologist at the Boston University School of Public Health, who specializes in causes of cancer in workers, community residents and veterans. Massachusetts voluntarily closed two Woburn wells in 1979 after tests revealed a far lower TCE contamination level than that at Camp Lejeune, even though the Environmental Protection Agency (EPA) hadn’t yet set drinking water limits on the carcinogen.

“That was based on guidance from EPA and not a formal regulation, but it was done to protect the public health based on evidence available at the time,” Clapp says. “I see no reason why the Department of the Navy could not have done the same thing to protect its people.”

The medical community, meanwhile, abandoned TCE as an anesthetic because it was lethal. “It was causing people to go into heart failure on the operating table,” Clapp says. “That should have sent up a red flag about TCE exposure in the late 1970s as well.”

“I Had to Be Strong”

Ensminger first went to Camp Lejeune after he graduated from boot camp in 1970. He and his wife lived in a Marine Corps family housing complex called Tarawa Terrace from 1973 to 1975. One of their daughters, Janey, was conceived and carried through most of her first trimester at Camp Lejeune. That timing is key. A developing fetus is so sensitive to the chemicals that were present in Camp Lejeune’s water, Clapp says, that a few hours or days of exposure at the wrong time could cause birth defects, cancers or neurological diseases. There was an eightfold increase in the risk of childhood leukemia among Woburn, Mass., babies whose mothers were exposed to the TCE-contaminated water during pregnancy.

Ensminger and his family returned to Camp Lejeune in 1982, and lived in nearby Jacksonville, N.C. The town had little in the way of community recreation facilities, so his daughters regularly swam in the base swimming pools. Because TCE and the other contaminants can be absorbed through the skin, the pools were just one more source of potential exposure.

Janey Ensminger was diagnosed with childhood leukemia in July 1983. She was 6.

“At first I went into shock,” Ensminger says. “Then it was the hustle and bustle of getting her to a treatment facility.”

They took Janey to Penn State University Medical Center and Duke Children’s Hospital, searching for a cure and answers. No one in his or his wife’s family had ever had cancer. Janey’s illness didn’t make sense.

“After I had a chance to sit down and think about it, the question was why,” Ensminger says. “But these doctors couldn’t – or wouldn’t – answer my nagging question.”

Ensminger told Janey they would fight her cancer together. He told himself that he wouldn’t cry in front of his daughter. “I had to be strong,” he says.

“Every time that child went into a treatment room, she was screaming, ‘Daddy, Daddy, don’t let them hurt me,’” Ensminger says. He finally broke down in front of his daughter in late September 1985. Janey told him she loved him, lapsed into a coma and died 30 minutes later.

“I didn’t just lose my daughter. I feel like I lost my entire life,” Ensminger says.

Mystifying Response

Why didn’t the Marine Corps begin testing drinking water for total organic pollutants – a class of chemicals including TCE, PCE, benzene and other toxic substances – in 1963, as Navy regulations required?

The Corps says such testing wouldn’t have made a difference because those early regulations didn’t require specific analysis for TCE, PCE and other toxic substances. Indeed, the appropriate analytical tools weren’t readily available or commonly used by water utilities in the early 1960s.

But even if the Marine Corps hadn’t identified the specific contaminants, those early tests would have alerted officials to a significant pollution problem and prevented decades of human exposure to solvents and other dangerous chemicals, Ensminger says. At a minimum, the Corps would have discovered that Camp Lejeune’s Hadnot Point Fuel Farm was leaking, eventually allowing as much as 1 million gallons of petroleum to seep into the soil and groundwater.

There is other evidence to suggest that camp commanders were slow to act. Congress passed the Safe Drinking Water Act in 1974 after a national outcry over water pollution. Even the magazine Civil Engineering – hardly a staple of the environmental movement – published a cover story in September 1977 headlined, “Are U.S. cities doing enough to remove cancer-causing chemicals from drinking water?” By then, Camp Lejeune had the third-largest municipal water system in North Carolina and was obligated to meet federal drinking water standards.

An Army analytical lab was finally tapped to test Camp Lejeune’s water in 1980, as required under the Safe Drinking Water Act. It alerted the base several times to high levels of drinking water pollution that were interfering with its analysis, although the lab didn’t identify specific contaminants. Two years later, a private lab also found dangerously high levels of toxic substances while conducting similar water sampling. In fact, the water was so contaminated that Grainger Labs assumed it had gotten bad samples. It repeated the tests several times in May 1982 and discovered dangerously high levels of TCE and other solvents.

“I was alarmed,” says Mike Hargett, then co-owner of the lab. “By 1982, the toxicological impact of TCE and PCE exposure was well‑established. They should not have been drinking that water.”

Hargett took his concerns to Camp Lejeune officials, and even met with the officer in charge of the water utility – an individual whose name he no longer recalls. “I said, ‘This is not something you want to expose the population to,’” Hargett says. “He dismissed me, saying, ‘This is something we will turn over to the Navy.’”

Camp Lejeune continued to use the contaminated wells for another two and a half years. As a result, water supplied to parts of the base by the Hadnot Point treatment plant contained as much as 1,400 parts per billion of TCE. That’s the highest level of the solvent recorded in a municipal drinking water system in the United States, and 280 times today’s TCE limit.

But the Marine Corps says the source of the pollution was unknown. It also cites the lack of limits on solvents in drinking water as a reason it didn’t take immediate action. In addition, it’s difficult to second-guess decisions made decades ago. “Although it is impossible to know why a discretionary action was or was not taken more than 25 years ago, one must view the situation in the context of the relevant time period,” the Marine Corps says.

Camp Lejeune finally began closing its highly contaminated wells in late 1984. Even then, the base newspaper mentioned only “trace contamination” and did not warn of any potential health effects. A letter the Marine Corps sent to Tarawa Terrace residents in April 1985 mentioned “minute (trace) amounts of several organic chemicals in the drinking water,” but most of the letter focused on water conservation required by the well closures.

This lackluster response is puzzling for other reasons. The Navy shuttered contaminated water wells at other bases well before Camp Lejeune finally took action. Naval Air Station Willow Grove and Naval Air Warfare Center Warminster – both in Pennsylvania – closed contaminated wells in 1979, according to records Ensminger unearthed.

Hargett’s firm found lower concentrations of contamination in the drinking water at Marine Corps Air Station Cherry Point in North Carolina in the early 1980s. Hargett notified Cherry Point’s water system manager, who immediately shut down the offending well because the person in charge of the utility “understood the severity of the problem,” he says.

The difference, Hargett believes, is that the problem didn’t come to the attention of the right person at Camp Lejeune until late 1984. “I don’t think they had the right information or understanding of the problem,” he says. A field commander is concerned about having enough water for his troops to bathe, drink and do the work he needs to do. “The details of what was in that water were a secondary concern.” That mentality carried over to the water utility at Camp Lejeune.

Haunted By Questions

In the summer of 1997, almost 12 years after his daughter died, Jerry Ensminger heard a TV news report that said Camp Lejeune’s drinking water had been

contaminated with solvents potentially linked to childhood leukemia. “It was like God had opened up the sky and said, ‘Jerry, here is a possible answer to the nagging question that has plagued you,’” he says.

By then, Ensminger had retired from the Marines as a master sergeant and was raising corn and soybeans not far from Camp Lejeune. He started a group called The Few, The Proud, The Forgotten and began digging for answers. Tom Townsend, a former Marine whose son mysteriously died six weeks after his birth at Camp Lejeune, joined Ensminger. Townsend filed more than a thousand requests for Marine Corps and Navy records under the federal Freedom of Information Act.

Townsend’s health later forced him to step aside. But Mike Partain, the son of a Camp Lejeune Marine, heard about Ensminger’s work and stepped up. Partain was born at Camp Lejeune in 1968, had just undergone a radical mastectomy for a rare case of male breast cancer and was likewise searching for answers. He dedicated nine months to sorting the records Townsend and Ensminger had obtained and constructing a detailed timeline of Camp Lejeune’s contamination.

Ensminger and his volunteers pored through hundreds of documents, including copies of emails that showed that the Marine Corps considered postponing the release of information about drinking water contamination at Camp Lejeune, as well as a health survey, because the movie version of “A Civil Action” was about to hit theaters. Such timing would bring unwanted attention to the problems at the base, one Camp Lejeune official worried.

Ensminger, meanwhile, made countless trips to Capitol Hill. He’s testified before the House and Senate five times. In 2008, he successfully lobbied Congress to order the Marine Corps to formally notify former Marines, family members and civilians about the Camp Lejeune water contamination. Ensminger scored another victory last August when President Barack Obama signed legislation mandating VA health care for former Camp Lejeune residents. However, there are concerns about how long it will take VA to begin providing care to families.

Ensminger continues his fight for comprehensive epidemiological studies of the people who lived and worked at Camp Lejeune, and is worried about ongoing delays in the release of the results. The Agency for Toxic Substances and Disease Registry was expected to publish two studies in July: an analysis of birth defects among Camp Lejeune residents and a historical reconstruction of their exposure to contaminated drinking water. The historical reconstruction is particularly important, he says, since it’s the foundation for future Camp Lejeune health studies.

Most of all, Ensminger tries to make sense of the profound betrayal he and others feel from an institution he served and revered – and to answer the questions that still haunt them, such as how and why.

“We still don’t have the whole truth about what happened to us and our families,” Ensminger says. “Janey’s dead. Nothing’s going to help her. But there are other people out there who are still suffering.”

The story originally appeared in the February 2013 issue of The American Legion Magazine.

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