Saturday, December 5, 2009

Second in a series: Vietnam vets wait years and fight skeptical agency to get disability

www.chicagotribune.com/health/agentorange/chi-agent-orange2-dec06,0,2356181.story

chicagotribune.com

For Vietnam War veterans, injustice follows injury

Second in a series: Vietnam vets wait years and fight skeptical agency to get disability

By Tim Jones, Tribune reporter, December 6, 2009

Also see map of Spray areas, Vietnam, Laos, Cambodia at:

http://www.chicagotribune.com/health/agentorange/chi-091204-agentorange-map,0,1959438.htmlpage

http://www.chicagotribune.com/health/agentorange/chi-agent-orange2-dec06,0,5115651,print.story

Jack Cooley delivered his final argument in a long, distinguished legal career from a hospital bed.

Four months before succumbing to multiple myeloma, the Chicago-area Vietnam veteran and federal magistrate judge wrote a 140-page claim for justice and filed it with the U.S. Department of Veterans Affairs. Cooley's message to the government was personal and direct: Agent Orange is killing me, and you need to take responsibility.

Cooley didn't know it last spring, but when the former Army artillery captain filed his disability claim, he was just entering a maddening bureaucratic maze many veterans know well. The VA would kick back Cooley's claim after a month, saying he lacked the required proof he'd served in Vietnam.

Cooley could have spent months navigating this convoluted path. But with Cooley's life fading, his family reached out to an old friend, a member of his West Point class of 1965. It was former Army Chief of Staff Eric Shinseki, recently appointed secretary of the Department of Veterans Affairs.

In short order the obstacles to Cooley's claim disappeared. The VA delivered three monthly disability checks for $2,700 before Cooley died July 21, at 65, in Evanston.

"This was insult to injury," said his daughter Christina. "If Gen. Shinseki was not ... a family friend and a West Point classmate, we would have never seen a dime. It makes me think about everybody else out there struggling without resources."

The Vietnam War ended almost 35 years ago, but for many veterans, battles with cancer, diabetes, Parkinson's disease and other maladies associated with defoliants used in the war are only now beginning. Until 2007, Jack Cooley had been in good health.

For many veterans, this is the unexpected new war, long after the old one ended.

The government has been slow to recognize the connection between wartime service and debilitating diseases that strike Vietnam veterans decades later. Even when they suffer from conditions officially linked to Agent Orange, veterans can wait years for their requests for disability compensation to run through the VA system.

Jack Cooley's death from multiple myeloma, a form of blood cancer associated with exposure to Agent Orange, opens a window into the clogged workings of the VA, the final arbiter on war-related disability claims.

"The truth is, veterans who went to Vietnam returned much sicker than their (civilian) peers. Something happened over there. Why arm wrestle over it?" said Linda Schwartz, commissioner of veterans affairs in Connecticut and the author of early studies on the health of female veterans.

The VA declined requests to interview Shinseki, who has said he wants to change the culture at the agency and make it more of an advocate for those who serve the country.

As long-dormant effects of Agent Orange begin to surface in many Vietnam War veterans, the backlog of disability claims has been growing fast, despite the VA's adding more than 3,000 employees to handle the traffic jam.

"They're overwhelmed," said Joe Moore, a former VA attorney who now represents veterans in cases against the agency. "They simply can't do the decision-making fast enough."

In response to a December 2008 lawsuit filed in U.S. District Court in Washington seeking to force the VA to decide claims in 90 days, the government acknowledged that "certain diseases for Vietnam-era veterans" are contributing to the backup.

The lawsuit, filed by the Vietnam Veterans of America and Veterans of Modern Warfare, argues that "thousands of veterans die each year" before the VA acts on their disability claims. The lawsuit alleges the VA takes at least six months to consider an initial request, and appeals can drag on for years.

"In the face of such delays, many veterans simply give up, choosing to accept less than they deserve rather than to endure years of delay and frustration," it said.

Or they just die early. According to data from the VA, 58 percent of the 490,135 Vietnam veterans who died from 2000 to 2007 were younger than 60.

A 3-act tragedyFor Vietnam veterans, the ongoing drama over Agent Orange can be broken into three acts. In the first, soldiers are totally unaware of the dangers posed by dioxin-laced defoliants sprayed in Vietnam. With the second comes outrage at the belated discovery of harm. And the third act is frustration with the bureaucracy set up to help veterans.

James Sprandel, a retired truck driver for the Chicago Department of Streets and Sanitation, has lived through all three.

Sprandel left South Vietnam almost 41 years ago, relieved to have survived his one-year tour as a combat medic at Tan An Airfield, about 20 miles south of Saigon. Today Sprandel, 64, uses a wheelchair because of diabetes and neuropathy, a nerve disorder that has drained the strength from his legs. The VA took 14 months to approve his disability claim.

Although he has little desire to revisit the war, Sprandel said he clearly recalls being assured that nothing was wrong with the water from rivers and streams around the air base. "There was a huge tank for bathing. ... We bathed in it, we drank it. They told us it was potable water," Sprandel said.

Never informed of the health risks, soldiers commonly reused Agent Orange barrels as barbecue pits, toilets and holding tanks for shower water. Studies show that as much as five gallons of residue often remained in 55-gallon barrels.

Not long after the war, it appeared the government would respond to the emerging realization that veterans faced a health threat from their exposure. Upon learning about Agent Orange's risks, Congress ordered a full epidemiological study in 1979 with the intent of determining and monitoring the health impact of exposure to the defoliants.

But the government balked at the directive and has yet to carry it out. Early studies on women who served in Vietnam suggested a higher risk of several types of cancer, as well as reproductive problems and birth defects in their children. But, as with male veterans, extensive studies still have not been completed.

Meanwhile, veterans joined a massive class-action lawsuit against Dow Chemical Co., Monsanto and other chemical companies that produced herbicides used in Vietnam. The case was settled out of court in 1984 for $180 million. The most common payment, distributed from 1988 to 1997, was for mental disorders -- which, ironically, research has never linked to Agent Orange.

Out-of-court settlements often suggest closure of a dispute, but the controversy has only grown in the last 25 years. At the time of the agreement scientists did not fully understand the long-term effects of dioxin, especially its connection to cancer and other slow-developing diseases, gradually documented in small studies.

In 1998, attorneys filed a new lawsuit against chemical companies that manufactured defoliants, contending that the settlement money had dried up by the time thousands of veterans developed illnesses linked to the defoliants. The 2nd U.S. Circuit Court of Appeals rejected the argument, and the Supreme Court declined to hear the case in March.

The most comprehensive study on the defoliants' health effects was conducted by the Air Force, which over 27 years took biological samples from and tracked the health of a small number of soldiers who personally handled and sprayed the chemicals during the war.

The Operation Ranch Hand study, named for the defoliation effort, has long been criticized for underestimating the impact of the chemicals. More recently, new information has emerged showing that some herbicides used in the war contained even more dioxin than was once thought.

Scientists who worked on the study say re-examining the rich data in this light could bring crucial new insights. "I believe the whole thing needs to be reconsidered," said Joel Michalek, an epidemiologist at the University of Texas Health Science Center at San Antonio.

Last year, Congress directed the VA to provide funding to do just that. So far the money has not been made available.

A war on 2 frontsMary Ann Dove's husband, a Vietnam veteran and former Marine, was diagnosed in 1989 with the same disease that killed Cooley, multiple myeloma, which the VA did not link to Agent Orange until five years later.

In fact, the Vietnam War had been over for 16 years before the VA acknowledged that Agent Orange exposure was associated with a higher risk of any postwar illnesses. The first three to be recognized, in 1991, were soft tissue sarcoma, non- Hodgkin's lymphoma and chloracne, a skin disorder that chemical companies had linked to dioxin decades earlier.

From 1991 to 1997, the VA accepted evidence that 10 diseases, including several cancers and neuropathy, were linked to Agent Orange. In the next six years, two diseases were added to its list.

Dove, a retired Army nurse who also served in Vietnam, recalls her husband saying early on: "You can fight the disease or you can fight the government -- you can't do both." He chose to fight the disease, which killed him within six years.

The government "is clueless about what it did in Vietnam and the damage that was done," Dove said.

The VA's slowness in evaluating claims may come down to sheer numbers. According to annual reports from the VA, the number of Vietnam veterans receiving disability benefits grew 20 percent from 2003 to 2008 to 1,015,410.

At the same time, the number of veterans receiving aid after fighting in the Persian Gulf, Afghanistan and Iraq jumped 88 percent, to 897,000.

"There's a lot of pressure to decide the cases from Iraq and Afghanistan quickly. What seems to be getting lost is those cases in the middle, where the veteran has already been denied and is now appealing," said Barton Stichman, joint executive director of the National Veterans Legal Service Program, a Washington-based advocacy group for veterans.

Stichman said the VA is generally tightfisted and "with Agent Orange, they are skeptical adjudicators."

Shinseki, a veteran wounded in Vietnam, proposed new rules in October for adding diseases to the expanding list of illnesses presumed to have been caused by the defoliant. The rules will undergo a period of public comment. He says he also wants to speed up the claims process.

"Since my confirmation as secretary, I've often asked why, 40 years after Agent Orange was last used in Vietnam, we're still trying to determine the health consequences to our veterans who served in the combat theater," Shinseki said in a statement at the time. "Veterans who endure a host of health problems deserve timely decisions."

Paul Sutton, the former chairman of Vietnam Veterans of America, called the announcement too little, too late.

"At this stage, about a million-and-a-half of us are already gone," Sutton said.

Feeling 'betrayed'Jack Cooley never expected to fight his government. He attended a military high school in St. Louis and, at West Point, developed a deep respect for Civil War Gen. Ulysses Grant. "Jack is not the type to 'take things by storm,' " his classmates said of him in the 1965 West Point yearbook, the Howitzer.

One July day in 1968, Cooley flew by helicopter to Quang Tri province's Landing Zone Jane, which he described in a letter to his wife, Maria, as "God-forsaken."

Cooley was traveling the area as an artillery officer based at Camp Carroll. In all, 168,000 gallons of Agent Orange and other defoliants were dumped on the province in the year he spent there, according to a Tribune analysis of spraying data.

"This is one of the better places to be at the present time," Cooley assured his mother in a tape recording he mailed home in early 1968.

After leaving the Army, Cooley would earn a law degree from the University of Notre Dame, clerk for a federal judge in Chicago and be appointed a federal magistrate. He earned a reputation as a skilled mediator who could bring people together. He wrote textbooks on problem-solving and taught at Northwestern and Loyola universities.

When he was diagnosed with multiple myeloma, Cooley quickly made the connection to Agent Orange.

"I then (in the summer of 2007) put 2 and 2 together and realized that I had been exposed to massive amounts of toxic chemicals in the air observer assignment and other job assignments I had while in Vietnam," Cooley wrote in his claim to the VA for disability compensation.

The Cooleys started work on his claim to the VA while he was in intensive care in an Evanston hospital, having earlier undergone a stem cell transplant that failed to stop the spread of the disease.

Christina Cooley said her father "felt very betrayed" by the government's failure to disclose the dangers of Agent Orange to the men and women serving in Vietnam.

"He strongly believed the government is there to watch out for us," she said.

At Cooley's memorial service in September, friends from the West Point class of '65 attended, including Shinseki. At the end of the service, a short prayer was recited for "families who have lost a member to Agent Orange."

Two weeks later a packet from the federal government was dropped in Cooley's mailbox in Evanston. Inside were documents requested nearly four months earlier, verifying that Cooley had served in the Vietnam War.

Tribune reporter Jason Grotto contributed to this story.

Coming Tuesday: Controversy over illnesses in Vietnam

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Friday, December 4, 2009

Agent Orange's lethal legacy Poisonous defoliants still exact a toll in U.S., Vietnam

http://www.chicagotribune.com/health/agentorange/



Coming Sunday: U.S. vets battle for compensation

www.chicagotribune.com/health/agentorange/chi-agent-orange1-dec04,0,1766354.story

chicagotribune.com
Agent Orange's lethal legacy
Poisonous defoliants still exact a toll in U.S., Vietnam
By Jason Grotto and Tim Jones

Tribune reporters

December 4, 2009

Part 1 of a Tribune investigation finds that U.S. officials have neglected a lasting problem even as the health fallout has spread.

In central Indiana, two sisters struggle through another day, afflicted by a painful condition in which their brains are wedged against their spinal cords. They are in their 30s, but their bodies are slowly shutting down.

Thousands of miles away, amid the rice paddies of Vietnam, a father holds down his 19-year-old daughter as she writhes in pain from a seizure brought on by fluid in her skull, which has been drained four times in the past four years.

"The doctors said that they were sorry, but they could not cure her," the father says. "They told me I should take her home and that she would pass away very soon."

These women come from different cultures, from nations separated by more than 8,300 miles. Their fathers fought on opposite sides of the Vietnam War, but they are linked by the stubborn legacy of Agent Orange and other defoliants sprayed by the U.S. military decades ago.

Contaminated with dioxin, a chemical now considered the most toxic ever created by man, the defoliants are linked to a higher risk of multiple cancers, birth defects and other conditions that are contributing to a dramatic increase in financial compensation for U.S. veterans and their families.

Service-related disability payments to Vietnam veterans have surged 60 percent since 2003, reaching $13.7 billion last year, and now account for more than half of such payments the U.S. Department of Veterans Affairs provides to veterans of all wars. The average compensation payment for Vietnam vets is 41 percent higher than that for World War II veterans and 35 percent higher than for those who served in Korea. Those disability checks do not include the billions spent on health care for Vietnam veterans.

The price tag is only expected to escalate as scientists learn more about the effects of dioxin, as veterans are stricken late in life and as the children of veterans discover they are sick. In September, three more diseases were added to the list of illnesses for which the VA provides compensation -- an expansion the agency estimates will affect roughly 200,000 veterans and cost billions of dollars annually.

Meanwhile, untold numbers of Vietnamese -- including many who weren't even alive during the war -- also suffer from maladies associated with the defoliants. Tens of thousands more are at risk today from dioxin that remains in the environment at dozens of former U.S. military bases.

Yet in the 30 years since Agent Orange was recognized publicly as a potential health threat, the federal government has established a record of neglect.

U.S. veterans seeking compensation for their illnesses face delays and a maddening bureaucracy. Adding to their frustration, the federal government never has gotten to the bottom of Agent Orange's full impact, failing to follow through on requests for large-scale studies on how defoliants may have affected veterans' health.

In Vietnam, children sing songs of the devastation caused by Agent Orange and government officials wonder how the U.S. can avoid fully addressing the health and environmental havoc wreaked by the chemicals, even as the two nations foster stronger trade and military ties.

Since the countries normalized relations in 1995, Congress has allocated just $6 million for herbicide-related issues in Vietnam, even though Vietnamese officials say addressing them will take tens of millions. The Ford Foundation, a philanthropic organization that has made Agent Orange a focus, has provided $11.7 million.

With assistance from the Fund for Investigative Journalism, the Tribune spent a month traveling to eight provinces throughout Vietnam, conducting nearly two dozen interviews with civilians and former soldiers who say they were exposed to the defoliants.

The newspaper used a database of every spraying mission, mapping software and a GPS device to help corroborate their stories. And in the U.S., the paper researched thousands of pages of government documents and traveled to the homes of veterans to gauge the impact and measure the cost in both dollars and human misery.

Some scientists remain skeptical that Agent Orange and other defoliants directly cause diseases. But with hundreds of independent studies completed in the years since the war ended, there is strong evidence that people exposed to the herbicides have a higher risk of contracting illnesses such as soft tissue sarcoma and non- Hodgkin's lymphoma. The number of medical conditions linked to the defoliants continues to grow.

The lingering controversy over the herbicides on both sides of the Pacific Ocean provides a sobering reminder of the often unforeseen consequences of war at a time when the country is fighting protracted conflicts in Iraq and Afghanistan.

"We do not know the answer to the question: What happened to Vietnam veterans?" said Jeanne Stellman, an epidemiologist who has spent decades studying Agent Orange for the American Legion and the National Academy of Sciences. "The government doesn't want to study this because of international liability and issues surrounding chemical warfare. And they're going to win because they're bigger and everybody's getting old and there are new wars to worry about."

A deadly defenseThe U.S. military began spraying herbicides in South Vietnam in 1961, as the Cold War raged and America seemed beset on all sides by the threat of communism. Vietnam, a sliver of a country hugging the South China Sea, was split in half, with communists controlling the north. Led by nationalist leader Ho Chi Minh, the communists sought to reunite the country by toppling the U.S.-backed Republic of Vietnam in the south.

The greatest asset of the armies fighting the U.S. may have been the landscape of South Vietnam. Triple-canopy jungles cascading down mountainsides, patchworks of rice paddies and dense forests covered a battlefield where the line between enemy and civilian was often blurred.

The verdure allowed North Vietnamese forces to harass, resupply and melt back into the thick vegetation while surviving on food grown by local supporters.

The U.S. countered with chemical defoliants aimed at destroying the natural fortresses protecting the enemy. Over 10 years, U.S. and South Vietnamese forces released nearly 20 million gallons of herbicides in Southeast Asia, enough to blanket Lake Michigan four times. The vast majority of the missions took place in South Vietnam, but border areas in Cambodia and Laos were also sprayed.

Though Agent Orange was the most widely used herbicide, there were actually a half-dozen "agents," including White, Blue, Purple, Pink and Green. About 65 percent of them were contaminated with TCDD, a highly toxic form of dioxin, while more than 1 million gallons of Agent Blue contained arsenic.

The U.S. military stopped using Agent Orange in 1970 after a study for the National Institutes of Health showed that a chemical found in some of the compounds caused birth defects in laboratory animals. Soon after, the U.S. surgeon general halted the domestic use of that chemical, a dioxin-tainted compound known as 2,4,5-T.

Some limited spraying continued in Vietnam for another year, but only with agents that did not contain dioxin. The herbicide program, known as Operation Ranch Hand, stopped in 1971, four years before the war officially ended.

'We're a mess'Nearly four decades later, on a quiet street in Brownsburg, Ind., Carrie Price-Nix and Amanda Price Palmer have resigned themselves to a life of prolonged fatigue and permanent disability. They've had 41 surgeries between them in the past 20 years, including five brain operations, two spinal cord surgeries and one hysterectomy.

Their father, Stephen Price, was an Air Force mechanic who served at the U.S. air base in Da Nang in 1967. Even today, the site is contaminated with levels of TCDD that are as much as 365 times higher than what the World Health Organization deems safe.

Price died in April 2008 after fighting leukemia, diabetes and chloracne, all of which are associated with the herbicides used in Vietnam. He began receiving full disability compensation from the VA in 2005, after waiting two years for his claim to be approved.

His daughters both have Chiari malformation, a structural defect in the base of the brain associated with spina bifida, which the VA recognizes as a defoliant-related birth defect in the offspring of male veterans.

Price filed a claim with the VA for Price-Nix in July 2002. Three and a half years later, she was approved for partial compensation. By that time, her bladder had shut down, and her father was dying.

Palmer, who has similar health problems, has spent six years seeking compensation from the VA. "They're waiting for you to die," her sister said. Last week, the agency denied Palmer's claim, ruling her illness is not related to spina bifida.

The deterioration of Palmer's abdominal muscles forces her to remove her feces manually. Price-Nix has a pacemaker-like device to regulate her bowels and must catheterize herself daily.

"We're a mess," Palmer said jokingly. Then the sisters began weeping as they pondered the reality that there is no recovery from their conditions.

Far away from Brownsburg, in central Vietnam's Quang Binh province, Do Thi Hang, 19, suffers from symptoms similar to the sisters'. She has regular seizures caused by the fluid that accumulates in her brain. She can't walk and has trouble controlling her bowels.

Her parents have never been given a specific diagnosis because of Vietnam's underdeveloped health care system, but Hang's ailments mirror those of people suffering from spina bifida.

As a soldier fighting the U.S., Hang's father, Do Duc Diu, 58, was stationed for four years at an abandoned U.S. air base called A So, located in a valley where parts of the Ho Chi Minh Trail wound along the Laotian border. U.S. and South Vietnamese forces sprayed more than 400,000 gallons of herbicides in the Aluoi Valley, formerly known as A Shau.

New studies show that areas where the U.S. military stored chemicals on the A So air base are still contaminated with dangerously high levels of TCDD.

Since the war ended, Diu and his wife, Pham Thi Nuc, have had 15 children. Twelve died before the age of 3, all from illnesses similar to Hang's, Diu said. Their small graves sit atop a sandy hill behind Diu's home where he goes nearly every day to burn incense.

"I can say that I have no future, no happiness," he said.

Invisible woundsThe compensation U.S. veterans now receive for herbicide-related illnesses was gained only after a long, hard-fought battle in which the lines between science and politics were often blurred.

Part of the problem was that veterans were returning home with invisible wounds. Their fight to receive recognition and compensation for their war-related illnesses, including post-traumatic stress disorder, opened the door for veterans of all wars.

"The better care that troops get now is owed to their Vietnam brothers," Stellman said.

New scientific studies, dogged investigations into political interference in government-sponsored studies and a $180 million settlement in a veterans' class action suit against chemical companies paved the way for the Agent Orange Act of 1991.

Among other provisions, the legislation created a list of "presumptive illnesses" for which Vietnam veterans could be compensated. It directed the National Academy of Sciences to review studies on the chemicals found in the herbicides and, every two years, recommend additions to the list. Diseases or birth defects are recommended if exposure to defoliants is more likely than not to increase a person's risk.

Since then, the VA has added 15 diseases as well as 17 birth defects in the children of female veterans.

But veterans groups say as many as a dozen more illnesses could be associated with the herbicides, as could numerous birth defects in the offspring of male vets.

One reason for the slow pace in adding diseases is that the VA relies on outside research on workplace exposure and industrial accidents instead of conducting a broader epidemiological study on veterans, which Congress first asked for in 1979. For years the agency said it could not study the impact of the herbicides on veterans because it had no way of measuring their exposure.

But that excuse is no longer valid, according to Stellman, professor emeritus at Columbia University's school of public health.

With her husband, Steven, an epidemiology professor, she compiled a comprehensive database on spraying missions and used it to develop an exposure model that has twice been blessed by the Institute of Medicine, an independent panel of medical experts whose recommendations on health policy help guide the VA's decision-making.

The VA said in 2003 it would take the model under advisement. The agency is still evaluating it.

"I'm surprised that it hasn't been pursued more energetically," said Dr. David Savitz, a physician at Mount Sinai School of Medicine in New York City who chaired the institute's review panel.

In September, the VA announced a broad, three-year study on Vietnam veterans' health, but it won't look specifically at defoliants like Agent Orange. Coming more than three decades after the war ended, the plan has many veterans believing the government is simply waiting for them to disappear.

"The mantra of the VA is delay, delay, delay until they all die," charged Paul Sutton, a Vietnam veteran and former chairman of Vietnam Veterans of America.

Retired Army Gen. Eric Shinseki, now the secretary of veterans affairs, has acknowledged the adversarial relationship between the VA and former soldiers. A Vietnam veteran who was wounded in combat, Shinseki has vowed to be more of an advocate for those who serve the country.

Members of Congress say much of the foot-dragging on studying Agent Orange is tied to the bottom line.

"I don't think they really want to know the answer," said Rep. Bob Filner, D-Calif., chairman of the House Veterans Affairs Committee. "The (financial costs) would be so high that they'd scare the hell out of everybody."

Jason Grotto reported from Vietnam; Tim Jones reported from Indiana.

jgrotto@tribune.com

tmjones@tribune.com

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House Committee Examines How Federal Dollars Get to Local Veterans for Health Care

http://veterans.house.gov

House Committee Examines How Federal Dollars Get to Local Veterans for Health Care


Democratic Congress Provides Historic Budget Increases for Veterans and Vows Transparency and Accountability for Taxpayers


Washington, D.C. - On Wednesday, December 2, 2009, House Committee on Veterans’ Affairs Chairman Bob Filner conducted a hearing to explore how the Department of Veterans Affairs (VA) determines its resource needs and executes its spending plans for providing local medical care for veterans. The hearing specifically focused on how VA Central Office distributes and tracks the federal resources and how oversight is conducted to ensure that federal dollars reach the various programs and initiatives at the local VA medical centers.

Congress has provided a significant increase in resources for VA medical care in recent years. Appropriations for VA medical care have increased over 40 percent from $29 billion in FY 2006 to $40 billion in FY 2009. Despite the robust budget increases, concerns have been raised that allocations to some local VA medical centers have either remained stagnant or have not been proportional to the unprecedented increase in overall funding for VA medical care.

Committee members agreed to send a joint letter requesting a Government Accountability Office review of the budget planning and allocation process to determine the resources needed to provide proper medical care to veterans.

“Federal funds may not be flowing to the local VA facilities in the most efficient and effective manner and this hearing is intended to scrutinize VA’s decision making process in order to promote efficiency and best serve our veterans,” said Chairman Filner. “This Committee has worked to provide America’s veterans with a budget worthy of their service and sacrifice and it is essential that these resources are dedicated to keeping the promises that our country has made to our veterans.”

Following the enactment of the Military Construction and Veterans Affairs Appropriations bill, VA distributes approximately 75% of the funds to each of the 21 Veterans Integrated Service Networks (VISNs) using the Veterans Equitable Resource Allocation (VERA) system, which essentially allocates funds based on where the veterans go for their health care. VERA makes adjustments to address such factors as patient mix, high-cost patients, geographic costs (for example, labor), research and education support costs, equipment and non-recurring maintenance activities. VA then delegates to its health care networks the power to make decisions on health care financing and service delivery, including most budget and management responsibilities concerning medical center operations. There are 153 medical centers in the Veterans Health Administration system.

A number of reasons were cited that affect the manner in which federal funds are delivered to local medical centers. First, VA must ensure that local needs and demands are met, while maintaining a certain level of centralization to ensure that dollars are spent effectively. Additionally, Members raised concerns that methods to share best practices between local facilities were not effective. Budget and management responsibilities concerning medical center operations are not standardized and, therefore, more difficult to fully account for.

Currently, resource allocations are based on the number of veterans seen in the region in the previous years. Members were concerned that this process did not offer adequate flexibility to the changing demographics of today’s veterans or sufficient responsiveness to the wide range of health care needs. Because funding levels are dictated by those veterans that seek care rather than veterans that are eligible for care, veterans that are unable to access the system are not a part of the VA’s decision making process. Members raised concerns that some rural veterans are prevented from accessing VA health care because of the long distances they must travel, often in poor health. Additionally, low-income veterans may not have the means to access their entitled health care benefits and thus, are not counted.


Filner concluded: “Under Democratic leadership, Congress immediately addressed the stagnant budgets that plagued the VA for decades; stagnant budgets which resulted in reduced access for veterans and a department that could not afford to reach out to veterans in need. Although President Bush undertook two military operations during his Presidency, resources remained restricted for the VA, thus inhibiting the agency from adequately preparing to care for the wounded warriors of the current conflicts. Now with appropriate funding levels, VA faces the enormous task to improve health care delivery to veterans who need it. This includes veterans from past generations, rural veterans, veterans in need of mental health treatment, and of course, wounded veterans from the current conflicts. Although the consequences of funding neglect cannot be corrected overnight, this Committee is committed to rigorous oversight of all aspects of veterans spending and operations to ensure long term fiscal responsibility, but more importantly to keep the promises made to our brave veterans.”

WITNESS LIST

Panel 1

· Clyde L. Parkis, Former Director, VISN 10, VA Healthcare System of Ohio


Panel 2

· Rita A. Reed, Office of the Assistant Secretary for Management, U.S. Department of Veterans Affairs

· Michael S. Finegan, FACHE, Director, Veterans Integrated Service Network 11, Ann Arbor, Michigan, U.S. Department of Veterans Affairs

Accompanied by:

o William C. Schoenhard, Deputy Under Secretary for Health Operations and Management, Veterans Health Administration

o W. Paul Kearns III, FACHE, FHFMA, CPA, Chief Financial Officer, Veterans Health Administration

###

Prepared testimony and a link to the webcast of the hearing are available on the internet at this link: http://veterans.house.gov/hearings/hearing.aspx?newsid=504.

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Vietnam vets deserve better

Vietnam vets deserve better

Vietnam vets deserve better

By KIRSTEN GILLIBRAND

First published in print: Friday, December 4, 2009

Too many veterans who served our country decades ago still suffer from horrible medical problems stemming from their time in the military. Time and again, the federal government has failed to provide them with the quality care they have earned.


Sometimes, it is bureaucracy that stands in the way. Other times, it is red tape or cost-cutting measures that prevent vets from getting the care they deserve. But for hundreds of thousands of Vietnam veterans, it is a shameful technicality in the law.

During the Vietnam War, the U.S. military sprayed 20 million gallons of the defoliant Agent Orange. The chemical cleared the way for combat troops to see their enemies, but it also infected service members with serious, long-term illnesses.

It is time to face the consequences of Agent Orange.

Right now, 800,000 Vietnam veterans, who were exposed to Agent Orange and need medical care, are being ignored. More than 13,500 of them live in New York.

Federal law requires the Department of Veterans Affairs to cover all illnesses directly linked to Agent Orange exposure. But in 2002, the VA determined that the government would only cover veterans who were "boots on the ground." That excluded those known as Blue Water veterans -- those who were on duty in the air and sea around Vietnam.

But Agent Orange didn't discriminate among those on land or water or in the air. When this toxin spread through wind and water, it infected millions of our troops stationed on ships and aircraft miles away from Agent Orange drop sites.

Just like those who were "boots on the ground," hundreds of thousands of Blue Water vets are chronically ill as a result of Agent Orange exposure.

From Type II diabetes to Parkinson's, to several blood and respiratory cancers and higher rates of non-Hodgkin's lymphoma, Agent Orange has been proven to cause a broad range of serious illnesses. But not one single Blue Water veteran's Agent Orange-related illness is covered by the VA.

These courageous veterans risked everything to fight for us. And now, because of their service and sacrifice, they are sick and need care. Serving as seamen or airmen should not deny them the needed benefits they've earned.

Even Dr. Mark Brown, former director of the VA's environmental agents service, has publicly acknowledged that there is no scientific basis for excluding Blue Water Navy veterans from coverage. But the VA continues to deny them care.

It's an outrageous injustice, and it must be changed.

Last month, I introduced the Agent Orange Act of 2009. It would fix the existing law so that Blue Water veterans and every service member awarded the Vietnam Service medal, or who was deployed on air, land and sea in Vietnam would be fully covered by the VA.

It would also streamline the VA's processing of Vietnam War veterans' claims for service-connected conditions by extending the VA's presumptive coverage of Agent Orange benefits to all Vietnam veterans.

Agent Orange is a very difficult chapter in our nation's history. It is time that we correct the errors of the past.

We have a solemn responsibility to those who answer our nation's call to service. They fulfilled their duty.

Now, it is our duty to make sure they have access to every benefit they have earned -- from health care to education and affordable loans to buy a house.

Let's make sure we never stop fighting for those who fought for us.

Kirsten Gillibrand represents New York in the U.S. Senate.


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I want to applaud Senator Gillibrand for sponsoring this legislation, however I wish she would add a few groups of veterans to this piece of law, or she might want to consider a new law for the veterans that were used in this nations secret testing of nuclear weapons, chemical weapons, drugs and biological weapons, these tests were mostly performed from the end of WW2 thru 1975 when Congress learned of the human testing thru the 1975 Department of the Army report on Human Experimentation. President Ford issued a Presidential Proclamation in 1976 that banned all government agencies, the military services, the CIA and anyone else from clandestine testing programs.

This was in response to the disclosure of the nuclear tests, the LSD experiments known as MKULTRA, the biological weapons tests at Fort Detrick that had been stopped after President Nixon signed the 1972 Bio-Weapons Treaty, the drug and chemical weapons had been tested on 7120 veterans of the Army and Air Force personnel at Edgewood Arsenal, Md, from 55-75, about 6,000 men had been used in Operation SHAD/112bioweapons experiments at Fort Greeley Alaska, and open sea trials off Hawaii, in the Cheasapeke Bay off Edgewood Arsenal, and other still not disclosed locations.

These veterans have largely been ignored by Congress, lied to by DOD and the VA, we have been told these experiments never happened, if we were there then we were NOT harmed by any toxic substances, we personnaly were NOT used in any hazardous experiments etc.

A Institute of Medicine Report published in March 2003 based on a FY 2000 survey of the 7120 Edgewood veterans, was used to placate veterans of the first gulf war that Sarin had not harmed them. The Edgewood veterans were the only known group of people that DOD had access to that had been exposed to Sarin. We were the control group used for this study.

One problem with this, they could only find 4022 surviving veterans of the experiments, even though they had access to VA, IRS and Social Security databases, they could not locate the other 3098 veterans. All of these men would have been between the ages of 45-65 in 2000, men of this age are either paying taxes, or in receipt of benefits checks from the VA or SS or SSD. I will grant a few men may have moved overseas and do not have any current data in the US, but not all 3098 of them. One can presume that the majority of them were already deceased. 40% of the test group, an extremely high number. Considering to be selected for the test program they only took the highest IQ's a soldier had to have GT score over 100, this score was also the cutoff score to be accepted into OCS. They were in good health or they would not have been in the military, and the majority of them were between 18-21 when selected for the 60 day Temporary duty assignment.

They also gave us extensive physicals when we arrived at Edgewood. Mental health tests, etc, it was the most extensive exam I had ever been given, before or since. We were told the program was so safe that they would not be doing any follow up studies afer we left. The real purpose behind no follow up studies is the fact none were programmed or funded for long term follow up. The only reason they found us in early 1980's was a report titled Veterans at Risk 1993 by the IOM, and then we were used as the control group to show Gulf War veterans that Sarin was safe, BS. The IOM ignored previous studies from the National Instiute of Health, and from SIPRI that show the known medical problems of Sarin exposure, and they wrote a very narrow report, that showed 25 per 100,000 developed brain tumors (cancer) and a higher than normal percentage of Sarin exposed veterans had sleep disorders, which is not a very high disability rating by the VA. It seems apparent the symptoms were financially acceptable to DOD that the IOM showed in the 2003 study, the NIH report showed links to pulmonary problems, cardiovascular problems, gastrointestinal problems, in other words, some medical issues that might end up in veterans being totally disabled or deceased by and would cost the DOD and or the VA billions of dollars.

Senator Gillibrand could do a lot very many veterans and their wives and children if they would look at all of these "forgotten veterans" not just the Agent Orange veterans of Vietnam, the government had not kept their PROMISE to these veterans, WHY?

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Veterans get special gifts for family thanks to free shopping

Veterans get special gifts for family thanks to free shopping

By Katie Boer KPIC News Video ROSEBURG, Ore. -- The Christmas season is always about giving, and thanks to the American Legion Auxiliary (ALA), during Christmas Veterans shop for free.

The annual Christmas Gift Shop is put on by the American Legion at the VA auditorium every year to provide assistance to veterans during the holidays.

The shop features a wide assortment of gifts like homemade quilts and afghans, along with clothing and toys that vets can chose from for their families.

For some, it makes all the difference. "So many of them are homeless and so many of them can't afford to buy gifts, let alone mail them, you know, so this is our contribution every year to help them out," said Evelyn Welch of the ALA.

American Legion Representative Jack Skold said, "It gives them something to look forward to, they're going to send gifts home to their family, I think this is what they look forward to."

Each vet gets to choose a gift for each dependent they have, including one for themselves.

American Legion works together for over a year collecting items and soliciting donations before the shop opens every December.

World War II veteran Gerald Devey said, "I think its very nice of them, I couldn't believe it. I was told about this out in the parking lot out there, and I couldn't believe it. I mean, I've been coming here for quite a few years really."

The gift shop has been a holiday tradition through the ALA, and has been going on for 57 years.

Denny Costello, also a veteran, said, "Things are tight you know, and it makes it a little easier, it expands my ability to give gifts. Since Christmas is about giving, its the spirit of Christmas and it helps out on the pocketbook, it really does."

The shop is open Wednesday, and outpatients or inpatients that haven't attended can shop for gifts from 9:00 a.m. to 4:00 p.m.

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What a GREAT thing for this community to do, and to have been doing it for the past 57 years is awesome................my hat is off to these people

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Tuesday, December 1, 2009

Supreme Court throws out Korean war veteran's death sentence

Supreme Court throws out Korean war veteran's death sentence

By David G. Savage

December 1, 2009


PTSD must be considered by a jury, the justices rule for the first time in a Florida case in which murderer George Porter's own lawyer didn't know he served in the Army, earning two Purple Hearts.


Reporting from Washington - The Supreme Court on Monday threw out a death sentence for a decorated Korean War veteran, ruling for the first time that combat stress must be considered by a jury before it hands down the harshest punishment.

"Our nation has a long tradition of according leniency to veterans in recognition of their service, especially for those who fought on the front lines as [George] Porter did," the justices said in a unanimous, unsigned opinion. "Moreover, the relevance of Porter's extensive combat experience is not only that he served honorably . . . but also that the jury might find mitigating the intense stress and mental and emotional toll that combat took on Porter." George Porter Jr. was convicted in the 1986 shooting deaths of his ex-girlfriend and her then-boyfriend in Florida during a drunken rage. But the jury that sentenced him was never told -- and his appointed lawyer did not know -- of his military service more than three decades earlier.

In the past, the high court has set aside a handful of death sentences because a defense lawyer failed to tell jurors of crucial "mitigating evidence" that probably would have persuaded them to spare his life.

Monday's decision appears to be the first in which the court has said post-traumatic stress disorder was the type of circumstance that called for leniency. It comes as thousands of U.S. soldiers are being treated for PTSD suffered as a result of the wars in Iraq and Afghanistan.

Both the Florida Supreme Court and the U.S. 11th Circuit Court of Appeals in Atlanta had upheld Porter's death sentence, despite his overlooked military record. But the high court said those decisions were mistaken.

"George Porter is a veteran who was both wounded and decorated for his active participation in two major engagements during the Korean War; his combat service unfortunately left him a traumatized, changed man," the justices said.

The opinion put defense lawyers in capital cases on notice that they have a duty to look into their client's background and to tell jurors about any mitigating evidence that would call for leniency. In Porter's case, his lawyer testified later that he had only one short meeting with his client before the trial and that he did not meet with Porter's family and was unaware of his military record.

That information came to light only after Porter's conviction in the Florida state courts. When Porter's case was appealed in the federal courts, a new lawyer contacted his family, looked into his background and found new witnesses to testify for him, including his company commander from Korea.

To escape what the court called a "horrible family life" -- which included his father beating him and trying to shoot him -- Porter enlisted in the Army at 17. He was sent to fight on the front lines in Korea. Twice his division was left to hold back charging Chinese troops while the U.S. 8th Army retreated to the south. Porter's unit fought hand-to-hand combat over five days and nights at Kunu-ri.

Less than three months later, Porter's unit was cut off again from the 8th Army and forced to fight alone against a Chinese unit at Chip'yong-ni. Porter was wounded in both battles, and half of his comrades were killed or wounded. Lt. Col. Sherman Pratt testified in a post-conviction hearing that these were "very trying, horrifying experiences." Porter was awarded two Purple Hearts and a Combat Infantryman Badge, along with other decorations.

Porter went AWOL after he returned to the United States. He was imprisoned but later honorably discharged, according to court documents, and never adjusted to civilian life. He suffered from nightmares, drank heavily and was prone to violent and impulsive behavior.

More than 30 years after his combat experience, Porter was charged with shooting and killing Evelyn Williams and Walter Burrows. There was little doubt of his guilt. Porter first decided to represent to himself, and then asked to plead guilty halfway through the trial. That evening, he tried to commit suicide in jail.

The Supreme Court focused only on whether Porter deserved to die or serve a life term in prison. Had the defense lawyer told jurors of Porter's life history, they would likely have spared him the death penalty, the court said.

By today's standards, Porter would have been diagnosed as suffering from PTSD, the court said. It cited recent testimony before Congress from Veterans Affairs Secretary Eric K. Shinseki, who reported that 23% of those who have served in Iraq and Afghanistan and sought treatment through the VA had been "preliminarily diagnosed with PTSD."

The court noted that two states -- California and Minnesota -- provide a special sentencing hearing for veterans who are convicted of crimes and may be suffering from post-traumatic stress disorder.

Among the justices, only John Paul Stevens served in the armed forces during wartime. He was a Navy intelligence officer in the Pacific during World War II. Several others, including Justices Anthony M. Kennedy, Stephen G. Breyer and Samuel A. Alito Jr., also served in the military.

david.savage@latimes.com
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I am torn on this one, I also suffer from PTSD, is it an excuse to break laws, I don't think so, but as a mtigating factor, yes it should be something the jury considers when deciding if a defendant should live the rest of their life in prison or be sentenced to death. To have a jury make that decision without this information was a dis-service to them and to the person on trial, to the community as a whole. People with mental health issues should have the benefit of the full story about them being told, not just the bad, but the full scope of all of their problems with society, WAR and other factors that develop PTSD like the mans father trying to kill him before he ever went to war, he was already damaged before he ever went to Korea, but the fighting with the North Koreans and the Chinese was the icing on the cake.

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Soldier in suit over chemical is dead

Soldier in suit over chemical is dead

Guard commander said exposure to carcinogen in Iraq caused his cancer
By Jason Thomas
Posted: December 1, 2009

A funeral is set today for a retired Indiana National Guard commander who testified in October that exposure to a lethal carcinogen in Iraq caused his cancer.

Lt. Col. James C. Gentry, 52, Williams, Ind., died of lung cancer Wednesday. His death is a poignant marker in a pending federal lawsuit; his life inspired a federal bill working its way through Congress.

Maj. Gen. R. Martin Umbarger, Indiana's top National Guard general, will attend the service at noon at Kraft Funeral Service in New Albany in Southern Indiana.

"He was a very good person who cared for his soldiers and his family," Lt. Col. Deedra Thombleson, the Indiana National Guard's public affairs officer, said of Gentry, who retired in February 2008 after 22 years of service. "He came forth and talked about the issues, hoping it would draw attention to what he and his soldiers had gone through."

Gentry, who was diagnosed with cancer in 2006, last spring joined a federal lawsuit filed in December 2008. It accuses Texas-based KBR and several related companies of concealing the risks faced by 136 Indiana National Guard soldiers potentially exposed to a cancer-causing agent, according to the Department of Veterans Affairs.

The suit originally was filed on behalf of 16 Indiana soldiers but has grown to 47 plaintiffs, including the family of a soldier, David Moore, Dubois, Ind., who died of a lung disease in 2008.

Most of the plaintiffs served with a Tell City unit sent to Iraq with the Indiana National Guard's 1st Battalion, 152nd Infantry Regiment, based in Jasper. For three months beginning in May 2003, the unit provided security for KBR employees charged with rebuilding the Qarmat Ali water-pumping plant near Basra.

The lawsuit says sodium dichromate, an industrial chemical normally used to remove pipe corrosion, contained heavy doses of the toxin and had been spread around the site, possibly by fleeing loyalists of ousted President Saddam Hussein.

The carcinogen, hexavalent chromium, is known to heighten the risk for cancer of the lungs and respiratory tract and is one of the most dangerous carcinogens rated by the U.S. Environmental Protection Agency, said Mike Doyle, the Houston-based lead attorney on the lawsuit.

A funeral is set today for a retired Indiana National Guard commander who testified in October that exposure to a lethal carcinogen in Iraq caused his cancer.

Lt. Col. James C. Gentry, 52, Williams, Ind., died of lung cancer Wednesday. His death is a poignant marker in a pending federal lawsuit; his life inspired a federal bill working its way through Congress.





Maj. Gen. R. Martin Umbarger, Indiana's top National Guard general, will attend the service at noon at Kraft Funeral Service in New Albany in Southern Indiana.

"He was a very good person who cared for his soldiers and his family," Lt. Col. Deedra Thombleson, the Indiana National Guard's public affairs officer, said of Gentry, who retired in February 2008 after 22 years of service. "He came forth and talked about the issues, hoping it would draw attention to what he and his soldiers had gone through."

Gentry, who was diagnosed with cancer in 2006, last spring joined a federal lawsuit filed in December 2008. It accuses Texas-based KBR and several related companies of concealing the risks faced by 136 Indiana National Guard soldiers potentially exposed to a cancer-causing agent, according to the Department of Veterans Affairs.

The suit originally was filed on behalf of 16 Indiana soldiers but has grown to 47 plaintiffs, including the family of a soldier, David Moore, Dubois, Ind., who died of a lung disease in 2008.

Most of the plaintiffs served with a Tell City unit sent to Iraq with the Indiana National Guard's 1st Battalion, 152nd Infantry Regiment, based in Jasper. For three months beginning in May 2003, the unit provided security for KBR employees charged with rebuilding the Qarmat Ali water-pumping plant near Basra.

The lawsuit says sodium dichromate, an industrial chemical normally used to remove pipe corrosion, contained heavy doses of the toxin and had been spread around the site, possibly by fleeing loyalists of ousted President Saddam Hussein.

The carcinogen, hexavalent chromium, is known to heighten the risk for cancer of the lungs and respiratory tract and is one of the most dangerous carcinogens rated by the U.S. Environmental Protection Agency, said Mike Doyle, the Houston-based lead attorney on the lawsuit.
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Gentry, who commanded more than 600 soldiers, did not smoke.

The Indiana lawsuit is one of five across the country involving several hundred soldiers potentially exposed to the carcinogen, according to Doyle. Lawsuits have been filed in Oregon, West Virginia and Pittsburgh. In all, more than 600 troops from Indiana and three other states could have been exposed, according to the U.S. Department of Veterans Affairs.

The Indiana suit claims many soldiers who served at the plant are developing rashes and other health problems.

"I don't know what kind of impact it will have on the lawsuit, but it's a terrible loss for his family and Indiana and the soldiers who served with him," Doyle said of Gentry's death.

The original complaint claims KBR had early indications of a chemical risk before the soldiers arrived.

"KBR's commitment to the safety and security of all employees, the troops and those we serve is the company's top priority," Heather L. Browne, the company's communications director, said in a statement. "KBR did not knowingly harm troops."

The last of Gentry's two depositions in the case came in October at his Southern Indiana home, where he had hoped to live out his retirement with his wife, LouAnn.

"His wife," Thombleson added, "does not want his death to be in vain."

A few weeks after the deposition, U.S. Sen. Evan Bayh, D-Ind., spoke with Gentry on the phone. His story and that of his fellow soldiers stirred Bayh to write the Health Care for Veterans Exposed to Chemical Hazards Act of 2009, which is now with the Senate Veterans Affairs Committee.

The legislation would make affected soldiers eligible for medical examinations, laboratory tests, hospital care and nursing services. It also would recognize a veteran's own report of exposure and include it in a Department of Defense registry.

Passage of the legislation would be a fitting tribute to a soldier who gave all, those who knew Gentry say.

"He was just a great people person and cared about his soldiers," Thombleson said. "His loyalty to his soldiers, even when he passed away, was still there."

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SC WWII vet's battle ends in gunshot at VA clinic

SC WWII vet's battle ends in gunshot at VA clinic

By JEFFREY COLLINS, The Associated Press Sunday, November 29, 2009 12:29 AM

SC WWII vet's battle ends in gunshot at VA clinic

GREENVILLE, S.C. -- On the last day of his long, troubled life, Grover Cleveland Chapman packed a black duffel bag, washed out his coffee cup, put it in the dish rack and fetched his Smith & Wesson.

He threw away his favorite slippers and left his house key on his bedside table in the two-bedroom yellow bungalow he shared with his daughter, tucked in an aging neighborhood full of 1950s starter homes a few miles from downtown Greenville.

Harriett Chapman called as she always did on her morning break at the Walmart deli, checking on her 89-year-old dad. Everything is fine, he told her.

As he shuffled down the steps that spring morning in 2008, Grover Chapman carried the latest letter denying him treatment at the Veterans Affairs clinic in Greenville, directing him instead to take a 200-mile round trip to the VA hospital in Columbia. This time it was about his prostate cancer, though Chapman had received plenty of notices just like it turning him down for help with his jumpiness and frayed nerves. He folded this letter neatly into the bag beside his bottles of medicine and settled into a taxi.

In a few weeks, candidate Barack Obama would take note of what Chapman would do upon arriving at the clinic this last time, calling it an indictment of society's treatment of disabled veterans.

And maybe that's what it was. Or maybe Chapman just didn't want his daughter to have to come home and find him.

Perhaps this was simply an old man choosing when, where and how to close a life that had turned out, like so many, a good bit messier than he would have liked.

Before heading to the clinic, Chapman had one stop to make. He directed the cabbie to Dewey's Pawn Shop.

His .38-caliber revolver was out of bullets.

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The Army made Chapman a sharpshooter in the late 1930s and sent him to the Panama Canal. He spent another two years in the Navy at the end of World War II, manning machine guns on Liberty Ships, merchant marine vessels that moved supplies and men around the world. More than 200 of the 2,700 Liberty Ships were sunk by the Japanese and Germans.

Long into his old age, Chapman spent hours telling military psychiatrists about seeing men buried at sea and how he couldn't stand the thought of having to kill another person. He reported frequent nightmares and flashbacks, according to his military psychiatry records given to The Associated Press by his family.

Yet it's unclear how much action Chapman really saw or whether he ever took a life.

Other military records show most of Chapman's half-dozen trips across the Atlantic were uneventful, with ships' logs indicating no deaths or enemy attacks. On Jan. 3, 1945, a ship in his convoy was torpedoed. Machine gunners like Chapman were sent to their posts, while others helped rescue sailors in lifeboats. No one died, and the submarine responsible was never found.

Only the eldest of Chapman's seven children heard their father's more troubling stories.

"He saw injured soldiers, and I think that really took a toll on my dad," said Diane Perkins, who lives just a couple of blocks from where her dad last lived. "He used to tell me when they came in from port, the guys were blind and couldn't see and when they got to the Statue of Liberty, they'd say, 'Just turn me toward her. I know I can't see her, but turn me toward her.' My dad was a very sensitive person."

Chapman's military service left him intense and organized and a strict disciplinarian, spooked by loud laughter or talking, Perkins said. Psychiatrists didn't have a formal diagnosis for post-traumatic stress disorder for another 30 years, but plenty of World War II vets suffered from it silently, said Richard Cohen, the executive director of the National Organization of Veterans' Advocates.

"These guys came home, they would be anxious. They would be squirrelly or have no emotions. They would drink, they wouldn't talk about what happened," Cohen said. "They had all these symptoms of PTSD, but they would never be diagnosed."

The VA turned down Chapman's PTSD claims a half-dozen times, even though psychiatrists mentioned he had elements of PTSD as early as 1990. For the rest of his life, his records make frequent reference to PTSD, but the VA kept denying his claim for extra disability without a great deal of explanation.

Even if Chapman didn't witness everything he would later say that he saw, troops don't have to dodge bullets and bombs to suffer mental problems. The stress of spending night after night staring at the horizon for enemies could trigger PTSD, as well as seeing buddies hurt in training accidents or in storms, said Cohen, who never met Chapman. Even taking care of others traumatized by battle could cause emotional scars that never heal.

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Chapman dropped out of school to support his family at 13, and when he left the Navy, he went back to work in the textile mills in Ware Shoals. After he was laid off in the 1950s, he moved the family to Greenville, saying he never wanted them to work in the mills. He became a machinist helping to make lawn mowers and similar equipment at Homelite until he had a nervous breakdown in the late 1960s. He never worked regularly again.

Chapman blamed his military service for the breakdown and asked the VA to pay him 100 percent disability. The military denied the problems were service-related, instead blaming the stress from dealing with his youngest daughter, Caroline, who had to be institutionalized with Down syndrome. The VA would eventually consider him 60 percent disabled from prostate problems he suffered during his service.

Chapman depended on the VA, Social Security and his family for the rest of his life. The amount of disability and the amount of money he got from the VA fluctuated. The agency said it stands by its decisions in Chapman's case.

The mental problems became too much for his marriage, and Chapman and his wife divorced in 1975 after 34 years together. Chapman lived alone for most of the rest of his life, remarrying twice for short stints. He saved his money and traveled. He tried not to miss "The Price Is Right" and "Wild Kingdom." He went fishing. He visited with his World War II buddies and swapped stories.

A heart attack in November 2006 left Chapman with a pacemaker and tens of thousands of dollars of debt. With his health slowly declining, Chapman started to plan for the future.

He got on a waiting list for a VA nursing home because he did not want to have to wait a year once he got too feeble to take of himself. He was going to need treatment for prostate cancer, so he asked for a waiver to have the tests and procedures done in Greenville, instead of the 100-mile ride to the big VA hospital in Columbia.

By April 2008, the nursing home decision was dragging. Then came a letter denying him extra money to have someone take care of him at home or pay more of any nursing home bill and a phone call telling him he would have to take care of his prostate problems in Columbia.

The VA reversed its decision on treatment less than six hours later after receiving additional information, but Chapman's daughter said she never received a letter or a phone call.

Harriet Chapman made hamburgers for her father the night of April 23, 2008. They talked about the denials. She told him not to get down.

"Every time I ask the VA for something, they just turn me down," she remembered him saying, a line Obama repeated in recounting the story less than three weeks later at a campaign appearance in West Virginia.

"How can we let this happen? How is that acceptable in the United States of America?" the future president said. "The answer is, it's not. It's an outrage. And it's a betrayal - a betrayal - of the ideals that we ask our troops to risk their lives for."

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The taxi took Chapman to the pawn shop. After he bought bullets, he went on to the VA clinic. The driver passed the main entrance and dropped him off at the ambulance bay on the side of the building. Chapman tipped the cabbie $4.

There are no surveillance cameras and no one saw everything that happened next, but Greenville County Deputy Coroner Mike Ellis has pieced together a scenario based on evidence:

Chapman loaded all six bullets in the chamber, sat down, put the gun to the right side of his head and pulled the trigger. Doctors and nurses, some who took care of Chapman for years, heard a pop and rushed out to see what happened.

Harriet Chapman figures her father wanted to make one last stand against the VA.

"If he just wanted to kill himself, he would have done it behind the shed in the back yard," Harriet Chapman said. "He wanted to bring attention to what the VA had done to him and how they treated veterans."

But Grover Chapman left no suicide note. He appears to have spoken to no one at the VA that day and decided to take his life by the side door, where mostly doctors and nurses come and go, instead of the clinic's bustling front entrance or lobby. His bag contained all the items needed to identify him. And he almost guaranteed it would be medical professionals used to dealing with death who found him, sparing his family the shock of seeing the kind of things that haunted him since those days on the Liberty Ships, far out in the Atlantic.

Suicide was never far from Chapman's mind when he talked to his psychiatrists. Sometimes he expressed his suicidal thoughts so urgently he ended up in a VA mental hospital, like in 1998, when a psychiatrist noted the veteran told him "he is taking up space and damn tired of living." A note from a visit in November 1985 is especially chilling: "When I attempt to kill myself, I will succeed," Chapman told a doctor.

The doctors and nurses at the clinic received counseling after Chapman killed himself. The counselors stressed that they had done all they could by regularly checking his mental state. "People that truly want to commit suicide do not tell anyone beforehand because they want to be successful," VA spokeswoman Priscilla Creamer said.

---

The coroner's office released Grover Chapman's body to his family that Friday afternoon, a day after he died. They buried him Saturday morning and six of his children were there. The only one missing was Caroline, whom Chapman used to visit at a group home in Clinton a couple of times a month until his health began to decline.

Chapman had already planned his funeral and demanded it be kept simple. He was buried in his pajamas because he said it made no sense to dress him up after he died. No obituary ran in the local paper. There was no chapel service, just a preacher saying a few words to the 30 or so gathered at the graveside and reading a note written by the young grandson he lived with.

The family did one thing that wasn't on Chapman's list. The funeral home noted he served in the Army and Navy and asked if they wanted an American flag to drape his casket. The family agreed.
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I am a disabled veteran that lives in South Carolina, when I moved here from Georgia back in 2003 I attempted to transfer my healthcare from Augusta VAMC to Dorn VAMC, the experience was less than enjoyable. They spent many visits to the Emergency room showing me that I did not want health care from Dorn VA, one nurse spent one visit, complaining about vacationing veterans that come into Dorn wanting expensive refills of medication they receive from their VAMC back home and they have either run out, or lost of left the medications at home. How expensive it was, despite the fact that Dorn VA had expensive paintings every 4 feet along their hallways.

I was 5 minutes late to a mental health appt at Dorn, the receptionist treated me like a dog, I had a very bad night and didn't fall asleep until around 5 am, the appt was at 9, we got there at 9:05 they would have to rechedule a new appointment a month away.

I was never treated at Augusta VAMC like this, I have an excellent primary care doc, a excellent cardiac doc, and a fantastic psychiatrist, who has been treating me since I started treatment at the VA, I am 100% P&T for PTSD, and 60% CAD and 10% hypertension despite the fact my SSD was approved based on my VA medical records, I should also have a 100% rating for my cardiac problems, but I am SMC S and it's not going to change if I am 60% or 100% for CAD, so it's not worth fighting with the VARO over.

But until I am ready to die, I will never seek treatment again at Dorn, Augusta VAMC dental clinic made me a new set of dentures this year, the dentist that did the impressions and made the plate was fantastic, when he learned that lived more than 70miles away he made both the upper and lower impression on the same visit, normally the conic has it set up due to time constraints to only making one impression each visit, he took the extra time to save my wife and I another 140 mile roundtrip, and the dentures were the quality of the 1000 dollar set, most denture clinics have three version 300, 600 and the 1000 dollars, so the VA has treated me right in Augusta, well Columbia SC not so much....................

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