War may be hellbut home aint exactly heaven, either. When a Soldier comes home from war, he finds it

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VA Healthcare for Returning Combat Veterans

• Jennifer Audette LMSW
• OIF/OEF Program Manager
• Stratton VA Medical Center
• Albany, New York

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QUIZ???
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• Operation Iraqi Freedom (OIF)
• Includes service members deployed on/after
  3/19/03 in the Arabian Sea, Bahrain, Gulf of
  Aden, Gulf of Oman, Iraq, Kuwait, Orman, Persian
  Gulf, Qatar, Red Sea, Saudi Arabia, United Arab
  Emirates

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• Operation Enduring Freedom (OEF)
• Includes service members deployed in Afghanistan,
  Pakistan, Uzbekistan, Cuba, Djibouti, Eritrea,
  Ethiopia, Jordan, Kenya, Kyrgyzstan, Philippines,
  Seychelles, Sudan, Tajikistan, Turkey, Yemen and
  sites listed above if deployed prior to 3/19/03.

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Service Members deployed as of 6/30/06
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U.S Casualty Status (as of 9/12/07)
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Department of Defense Data

• as of July 2006
• 1,339,210 service members deployed
• 19,994 service members have been wounded in
  action
• 712 persons with amputations (3.5)
• 1299 (6.4) persons with traumatic brain injury

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• Woman make 20 of the current force
• Increase from 13 in 1995
• Less traditional roles
• DOD reports over 20,000 serving in Iraq in 2005

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United States Military

• Active Duty -refers to military members who are
  currently serving full time in their military
  capacity generally stationed at a military base.
• Reserve Component are not generally considered
  active duty, although some will work full time
  occasionally, e.g. during periods of training.
  Reserve units may be "activated".

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National Guard and Reserve Components

• National Guard units available in times of
  national crisis or war. In times other than
  Congressional or Presidential call-up, the
  National Guard falls under the Governor of the
  State to which it is assigned with the Adjutant
  General acting as the Commander. Neither active
  nor reserve component service members may serve
  within the National Guard.

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Service BranchesThe U.S. Military includes the
Army, Marine Corps, Navy, Air Force, and Coast
Guard.
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Conditions of Deployments

• Heat Exposure
• Sand Storms
• Industrial waste and chemical exposure
• Poisonous insects and animals
• Long hours
• High altitude
• Dietary changes

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VA Healthcare

• Basic Eligibility
• 2 years on active duty
• Reservist served the full period
• National Guard mobilized under federal orders
• Must be discharged under conditions other than
  dishonorable

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Services for Families

• Limited from the VA
• Tricare

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Important to Remember

• Veterans should enroll with in 2 years of their
  discharge date !!!!!!!!

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Comprehensive Medical Care

• Preventive Care
• Inpatient and Outpatient Diagnostic and treatment
  services
• Prescriptions
• Prosthetics and Rehabilitative Devices
• Dental (limited) 90 days from discharge

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Combat Veteran Screenings

• Depression
• Substance Abuse
• PTSD
• TBI
• Post Deployment

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TBI Screening

• Exposure to blast, fall, vehicle accident ,
  fragment or blow to head
• LOC, confusion, difficulty recalling the event,
  concussion or head injury
• Memory problems, dizziness, balance issues,
  sensitivity to light , irritability, headaches or
  sleep problems
• Have they persisted

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Post Deployment

• Includes PTSD, Depression and Substance Abuse
  screenings
• Persistent Rashes
• Unexplained Fevers
• Fatigue
• Muscle Weakness
• Headaches
• GI issues

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Common Issues

• Dental
• Orthopedic Issues
• Rashes
• Allergies
• Gastrointestinal issues
• Hearing loss

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Complicated Care

• Mild Brain Injury and PTSD
• Substance Abuse and Brain Injury
• All three?

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Additional Services

• Gulf War Registry
• VA War Related Illness and Injury Study Centers
• Depleted Uranium

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Woman Veterans
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Womans Health

• gynecology services
• breast exams
• mammography
• reproductive health care
• menopause treatment

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Military Sexual Trauma

• The law defines sexual trauma as sexual
  harassment, sexual assault, rape and other acts
  of violence of a sexual or sexually biased
  nature. It further defines sexual harassment as
  repeated unsolicited, verbal or physical contact
  of a sexual nature toward a male or female which
  becomes threatening and impedes functioning

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MST Services

• Individual counseling
• Gender specific counselors
• Group counseling
• Information and education

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Vet Centers

• Vet Centers provide readjustment counseling and
  outreach services to all veterans who served in
  any combat zone. Services are also available for
  their family members for military related issues.
  Veterans have earned these benefits through their
  service and all are provided at no cost to the
  veteran or family.

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Care for the Severely Injured
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Polytrauma

• 2 or more injuries to physical regions or organ
  systems, one of which may be life threatening
• Traumatic brain injury (TBI)
• Limb Amputation
• Spinal Cord Injury (SCI)
• Visual or Hearing Impairments
• Burns/wounds
• Psychological trauma (PTSD)
• Fractures

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Typical Care

• Rehab Medicine
• Neurology
• Neuropsychology
• Psychiatry
• Physical Therapy
• Occupational Therapy
• Case Management

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OIF/OEF Program

• Seamless Transition
• Case Management
• Screening / Assessment
• Crisis Intervention
• Referrals
• Education
• Outreach
• Focus Groups

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Screening

• Type and length of service
• Remaining commitment to the military
• Combat Experience
• Blast Exposure
• MST
• PTSD
• Injuries

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Outreach

• Pre-Deployment
• Family Groups
• Post Deployment
• PDHRA
• Welcome Home Events

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Focus Groups

• Sensitivity of Healthcare providers
• Assistance with return to work and school
• Expanding hours and services
• Expanded web based services

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Case Examples
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• Questions