Veteran Affairs: 90 Years Military & Wellness

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

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VETERANS AFFAIRS 90 YEARS: MILITARY & WELLNESS

INSIDE

28

TRAUMA AFTER THE TRENCHES

54

THE POWER OF LOVE

70

VA HOME LOANS

6 Denis R. McDonough

Secretary of Veterans Affairs Dr. Carolyn Clancy 8 Acting Deputy of Veterans Affairs

82 110 WOMEN VETERANS

AMERICA’S BEST

54 The Power of Love

Service Dogs Help Veterans Make the Long Journey Home 70 The Inside Scoop on VA Loans

10 Tanya Bradsher 77 GI Bill History and Timeline Chief of Staff for the Department 82 Giving a Voice to Women Veterans of Veterans Affairs 94 A Guide to the Benefits of 12 Legacy of Service Veteran-Owned Businesses

Caring for Those Who Fought 104 Veterans and Military Business the Good Fight Owners Association 28 Trauma After the Trenches 110 America’s Best PTSD in Veterans The Medal of Honor 40 Armed with Awareness 130 America Salutes You Diabetic Neuropathy in Veterans

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

DENIS R.

MCDONOUGH Secretary of Veterans Affairs

T

he Honorable Denis Richard McDonough was nominated by President Biden

to lead the Department of Veterans Affairs. Mr. McDonough’s nomination was

confirmed by the United States Senate on 8 February 2021, and he was sworn in the following day as the 11th Secretary of Veterans Affairs.

On 27 January 2021, during his confirmation hearing, Secretary McDonough testified to Congress, “I will work tirelessly to build and restore VA's trust as the premier agency for

ensuring the well-being of America’s Veterans. After all, there is no more sacred obligation

nor noble undertaking than to uphold our promises to our Veterans, whether they came home decades ago or days ago.”

Secretary McDonough served in the Obama Administration as the 26th White House Chief

of Staff from February 2013 to January 2017. In that role, Mr. McDonough managed the White House staff and worked across the cabinet to advance the Obama-Biden agenda, confronted

management issues facing the federal government, and devised and enforced goals, plans, and performance standards to preserve the Obama-Biden Administration’s reputation for effective, ethical operations.

Prior to his role as Chief of Staff, Mr. McDonough was Principal Deputy National Security Advisor from October 2010 to January 2013. He also served as the Chief of Staff of the National Security Staff and

as the Deputy National Security Advisor for Strategic Communications. He chaired the National Security

Council’s Deputies Committee, leading the multiagency team to address complex challenges including crisis management and national security policymaking. And throughout his service in the White House, Secretary

McDonough helped lead the Obama-Biden administration’s work on behalf of military families and Veterans.

Before his eight-year tenure in the White House, Secretary McDonough served in senior leadership and

policymaking positions in the U.S. House of Representatives as a Professional Staff Member on the International Relations Committee and in the U.S. Senate for Majority Leader Tom Daschle and Senator Ken Salazar.

Since his White House tenure, Secretary McDonough was Professor of the Practice of Public Policy at the Keough School of Global Affairs at the University of Notre Dame, Senior Advisor and Senior Principal at the Markle

Foundation, and on the board of directors of the National Democratic Institute, the Tent Partnership for Refugees, and the SAFE Project, a national nonprofit working to end the nation’s catastrophic addiction epidemic.

Secretary McDonough grew up in Minnesota in a family of 11 children, graduated from St. Johns University in Collegeville, Minnesota, and earned his master's degree from Georgetown University. Secretary McDonough and his wife, Kari, have three children.

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

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DR. CAROLYN

CLANCY D Acting Deputy Secretary of Veterans Affairs

r. Carolyn Clancy has served as Acting Deputy Secretary of Veterans Affairs

since 20 January 2021. Previously she served as the Assistant Under Secretary

for Health for Discovery, Education and Affiliate Networks. She has also served

as the Veterans Health Administration (VHA) Executive in Charge. Dr. Clancy also

served as the Deputy Under Secretary for Health for Organizational Excellence overseeing VHA’s performance, quality, safety, risk management, systems engineering, auditing,

oversight, ethics and accreditation programs, as well as ten years as the Director, Agency for

Healthcare Research and Quality. In 2015, Dr. Clancy was selected as the Outstanding Federal Executive of the Year by Disabled American Veterans.

Dr. Clancy, a general internist and health services researcher, is a graduate of Boston College and the University of Massachusetts Medical School. She holds an academic appointment at

George Washington University School of Medicine and serves as Senior Associate Editor, Health Services Research. Dr. Clancy has contributed to eight academic textbooks and authored, co-

authored and provided invited commentary in more than 225 scholarly journal articles. She served as member of the National Quality Forum, Board of Directors, as the Chair of the AQA Alliance

and served on the Board of Governors, Patient-Centered Outcomes Research Institute. An elected

member of the National Academy of Medicine, Dr. Clancy was most recently presented with the 2014

Quality Champion Award, National Committee for Quality Assurance and was also named as Honorary Fellow, American Academy of Nursing.

CAREER CHRONOLOGY 2018 – present Deputy Under Secretary for Discovery, Education and Affiliate Networks Veterans

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Health Administration

2017 – 2018

Executive in Charge, Veterans Health Administration

2015 – 2017

Deputy Under Secretary for Health for Organizational Excellence, VHA, Washington, DC

2015

Chief Medical Officer, VHA, Washington, DC

2014 – 2015

Interim Under Secretary for Health, VHA, Washington, DC

2013 – 2014

Assistant Deputy Under Secretary for Health for Quality, Safety & Value, Washington, DC

2003 – 2013

Director, Agency for Healthcare Research and Quality (AHRQ), Washington, DC

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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TANYA

BRADSHER Chief of Staff for the Department of Veterans Affairs

A

s Chief of Staff, Ms. Bradsher is the senior advisor to the Secretary and Deputy Secretary in the federal government’s second-largest Cabinet department, with a budget of more than $246 billion and over 424,000 employees serving in VA medical centers, clinics, benefits offices, and national cemeteries.

Ms. Bradsher is a combat Veteran who served for 20 years in the United States Army. She enlisted in 1993 and was commissioned in 1994 from the Officer Candidate School at Fort Benning, Georgia. Her major assignments included Spokesperson on the White House National Security Council for the Department of Defense, Asia, Africa, Western Hemisphere, counter-terrorism, and detainee policies; Defense Press Officer in the Office of the Secretary of Defense for Public Affairs at the Pentagon; Brigade Public Affairs Officer during OPERATION IRAQI FREEDOM, Deputy Public Affairs officer, 8th US Army; Commander, Delta Company 516th Battalion, and Executive Officer, 1st Replacement Company, 8th Personnel Support Command.

Prior to being named VA’s Chief of Staff, Ms. Bradsher served as Special Assistant to the President and Senior Director for Partnerships and Global Engagement on the National Security Staff in the Executive Office of the President. She previously served as the Chief of Staff to Congressman Don Beyer in Virginia’s 8th District. Before working on the Hill, Ms. Bradsher was the Chief of Communications for the American Psychiatric Association (APA). Prior to joining APA, she served at the Defense Health Agency as the Chief for Communications Plans and Operation in the Office of Public Affairs.

During the Obama Administration, Ms. Bradsher served as the Assistant Secretary for Public Affairs at the Department of Homeland Security where she oversaw public outreach, media, and incident communications efforts and served as the principal communications advisor to the Secretary. Prior to joining DHS, she served at the White House as the Assistant Director, Office of Public Engagement, where she led Veteran, Wounded Warrior, and Military Family Outreach initiatives.

Ms. Bradsher earned her MA in Strategic Communications from George Washington University and her BA from the University of North Carolina at Chapel Hill. Her military awards include the Legion of Merit, Bronze Star, Defense Meritorious Service Medal, Meritorious Service Medal, Joint and Army Commendation Medals. She and her husband, Colonel (Retired) John Bradsher, have three children.

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

THANK YOU FOR YOUR SERVICE

Dear Veteran, I salute you.

Gun Owners of America exists to protect the constitutionallyrecognized right to keep and bear arms of all Americans.

Unfortunately, VA bureaucrats continue to follow the Clinton Administration “fiduciary rule” whereby veterans are wrongly reported to the FBI’s National Instant Criminal Background Check System, which is used to prevent criminals from purchasing firearms in commercial sales. Thus, veterans are being disarmed - all for not being able to balance their checkbook!

Gun Owners of America supports your right to keep and bear arms.

We will never cease demanding that the Department of Veterans Affairs reform its financial incompetence adjudication procedure and cease the extralegal reporting of veterans who cannot balance their checkbooks to the FBI database of prohibited gun owners.

In liberty, Colonel (Dr.) Val W. Finnell, USAF, Ret. Veterans Affairs Policy Advisor

DID YOU KNOW THAT OVER OF RECORDS SUBMITTED TO NICS BY THE FEDERAL GOVERNMENT FOR MENTAL-HEALTH REASONS BELONG TO VETERANS?

98%

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WITHOUT

LOSING YOUR RIGHTS

TODAY!

of LEGACY

Caring for Those who

“To care for him who shall

have borne the battle,

and for his widow, and his orphan.”

— President Abraham Lincoln

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

SERVICE

Fought the Good Fight

By Jim Lamb

A

s WORLD WAR II came to a close, General

Jennifer Sardam, a Veteran who served as an Army

Omar Bradley took over the reins of the

journalist during OPERATIONS IRAQI FREEDOM

Veterans Administration and launched

and NEW DAWN, says America’s legacy of caring

a major re-organization to help welcome home

has “roots traceable back to 1636 when the Pilgrims

millions of soldiers, sailors, and aviators.

of Plymouth Colony passed a law that provided

The legacy of caring for America’s warriors was a

support for disabled soldiers…”

seed planted early and nurtured often as the nation

Later, the Continental Congress provided

grew. President Abraham Lincoln expressed the

pensions for soldiers who were disabled during

vision this way: “To care for him who shall have

the AMERICAN REVOLUTIONARY WAR. In 1833

borne the battle, and for his widow, and his orphan.”

the Bureau of Pensions was established. In 1862

While there are have been many steps in America’s ongoing journey to care for its citizen-soldiers, the days after WORLD WAR II marked a major milestone. According to Katie Delacenserie,

Congress authorized the President to purchase “cemetery grounds” for those who died in the service of the country. After the CIVIL WAR, many state Veterans’ homes were established.

Veterans Health Administration historian,

By the 1920s, benefits were being administered

the modern era of today’s Veterans Health

by three separate federal agencies: the Veterans

Administration began when President Harry S.

Bureau, the Bureau of Pensions, and the National

Truman established the Department of Medicine

Home for Disabled Volunteer Soldiers.

and Surgery on 3 January 1946 as the nation helped 16 million Veterans transition back to civilian life.

President Herbert Hoover moved the nation closer to fulfilling Lincoln’s vision on 21 July 1930, when he signed Executive Order 5398 to “consolidate

So many men and women. So many needs.

and coordinate Government activities affecting war

Challenges were numerous and multi-faceted.

Veterans.” He called it “One of the most important steps

It wouldn’t be easy.

taken in reorganization of the Federal Government…” g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

The modern era of today’s Veterans Health Administration began when President Harry S. Truman established the Department of Medicine and Surgery on 3 January 1946 as the nation helped 16 million Veterans transition back to civilian life.

The man President Hoover selected as the first administrator of the Veterans Administration was Brigadier General Frank T. Hines, who was known as a “man of stern honesty.” He had directed the Veterans Bureau for the prior seven years and, during the first World War, he’d organized and managed the Army’s Embarkation Service his job: ship newly trained military personnel to fight in France. Hines held the VA post until 1945, when he was replaced by General Omar Bradley, who during WORLD WAR II was dubbed the “GI’s General.”

“I don’t think there’s any job in the country I’d sooner not have, nor any job in the world I’d like to do better,” Bradley said of his appointment. “Even though it is burdened with problems, it gives me the chance to do something for the men who did so much for us.”

Historian Katie Delacenserie adds context to Bradley’s comment: “…when Bradley took over, the GI Bill was over a year old,” she said. “This landmark piece of legislation mandated medical care for both service and non-service related injuries as well as rehabilitation for veterans.

There were nearly half a million veterans needing medical care. What awaited them were only 100 existing VA hospitals that were often located in rural areas, and were overcrowded and understaffed.”

General Bradley worked with Major General Paul Hawley, MD, the VA’s first medical director, to create the Department of Medicine and Surgery. Since 1991, it’s been known as the Veterans Health Administration (VHA).

Bradley and Hawley worked together to welcome home Veterans, many of whom returned with wounds not previously survivable thanks to improved battlefield medical care. To met the needs, the duo embarked on a reorganization of VA health care services. Their goals included: Establishing new Veterans’ hospitals to accommodate caring for Veterans of all eras and conflicts and converting former military hospitals into Veterans facilities. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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Locating VA hospitals alongside major medical schools to promote research and innovation, responding both to the US physician shortage and providing training for Veterans pursuing medical education after the war.

Incorporating mental health services and facilities into the design and operations of new VA hospitals for the first time, re-envisioning the concept of the modern general hospital.

Creating a pilot program known as the Michigan Plan to allow Veterans to be treated by local physicians, expanding access to care where VA care was not available.

Absorbing VA’s research and development capacity, committing to spend more than $1 million each year, beginning with a focus on improving prosthetics for Veterans with limb loss.

Establishing the VA Voluntary Service to augment and complement VA’s low-cost goods to Veterans, their families, and caregivers.

Hiring the first women doctors in VA history.

One of those doctors was Margaret Craighill who after the bombing of Pearl Harbor left her position as dean of the Woman’s Medical College of Pennsylvania to become the first woman doctor to receive a military commission. Following the war, she became one of the first consultants on female Veterans’ medical care at the VA. General Bradley, who appointed Dr. Craighill, served with the VA two years; he later became America’s first chairman of the Joint Chiefs of Staff. In recognition of his various achievements, the primary conference room at the Department of Veterans Affairs headquarters is named in his honor.

Readers Digest noted that, General Omar Bradley transformed the medical service of the Veterans Administration into “a model establishment.”

According to Jon M. Jensen, who serves as the Department of Veterans Affairs, Veterans Health Administration (VHA), Chief of Staff, the theme for the VA’s anniversary is “a legacy of service, the future of care.”

Jensen is an Army Veteran, having served 25 years, including the GULF WAR and OPERATION IRAQI FREEDOM. “The overarching objective of this (anniversary) campaign it is to amplify these efforts through the lens of VHA’s history,” Jensen said. g 18

VETERANS AFFAIRS 90 YEARS: Military & Wellness

SALUTING THOSE WHO HAVE SERVED AND THOSE WHO SERVE TODAY AM General was with you then, is with you now, and will be there in the future.

HERE IS A TIMELINE OF THAT HISTORY:

offices and 14 regional offices, and set up 721 contact offices,

1946: Public Law 79-636 established the Veteran’s Canteen

R. Gray Jr. who served from 1948 to 1953).

Service (VCS), which was “created to provide articles of merchandise and services at reasonable prices to Veterans enrolled in VA healthcare system, caregivers, and visitors.”

VA Department of Medicine & Surgery, created by Public Law 79-293 on 3 January. Originally to care for Veterans returning from WORLD WAR II, it “has evolved to meet the unique challenges and care needs of Veterans from every era and at every stage of their lives.”

and 29 new hospitals. (Stepping in for Bradley was General Carl

1948: Congress formally authorized a program of VA research in prosthetics, orthotics, and sensory devices.

1949: VA built 30 amputee clinics in the US. 1953: The first appointment of students for VA training in counseling psychology.

1954: Segregation ended in VA Hospitals after a year-long study ordered by Harvey Higley, a WORLD WAR I Veteran who served

Founding of the Veterans Administration Voluntary Service

as VA Administrator 1953-1957.

(VAVS) which has become “the largest volunteer program in

1958: The first definitive physical proof of the connection

the federal government,” performing a variety of duties at VA medical centers, national cemeteries, regional offices, and regional counsel offices.

1947: General Omar Bradley left his position as VA Administrator, reporting that the VA had established 13 branch

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

between cigarette smoking and lung cancer was made by Dr. Oscar Auerbuch, a pathologist at the VA hospital in East Orange, New Jersey.

1963: First successful liver transplant was performed at

the Denver VAMC, where techniques were developed g

for suppressing the body’s natural attempt to reject

VA’s national Suicide Prevention Hotline became operational.

transplanted tissue.

The number is 1-800-272-8255 Press 1. (It’s estimated that

1964: VA established the first two hemodialysis centers in

Hines, Illinois, and Los Angeles, California. (Hemodialysis is a process of purifying the blood of a person whose kidneys are

suicide deaths in the US).

2008: National expansion of an Alzheimer’s-caregiver

not working normally).

program begins.

1969: Visotactor B reading machines for the blind were

2011: The Million Veteran Program is launched. It’s one of the

developed and tested by the VA.

1970: Research begins on planning and developing the

Electronic Health Record (EHR). According to the Office of Information and Technology (OIT)… “An EHR is software used to securely document, store, retrieve, share, and analyze information about individual patient care. It enables a digital version of a patient’s health record.”

1971: Valerija B. Raulinaitis, MD, in Pittsburgh, Pennsylvania,

became the first woman appointed as director of a VA hospital.

Raulinaitis was born in Lithuania.

1984: Viola Johnson was the first African-American woman

to lead a VA hospital when she became director of the Battle Creek, Michigan, VAMC. 1988: The Women Veterans Health Program was established

for female veterans. Since that time, women have become the fastest growing group within the Veteran population.

1989: The VA was elevated to a Cabinet-level Executive

world’s largest databases of health and genetic information for use in preventing and treating illness among Veterans.

2012: VistA Evolution begins with a goal of providing essential

health information technology. (VistA stands for Veterans Health Information Systems and Technology Architecture).

2018: The tele-health program is instituted. It’s designed to serve Veterans living in rural areas who have post-traumatic stress disorder (PTSD).

2019: VA joined the PREVENTS initiative to prevent Veteran

suicides, in part through the development and implementation of a national research strategy. (The initiative is designed to elevate the national conversation around mental health and suicide).

2020: COVID-19 pandemic envelops the world. VHA quickly mobilizes to respond.

While each of the milestones in the VA’s history is significant, perhaps the most momentous was when the Veterans Administration became a cabinet-level post and was renamed

Department by President Ronald Reagan, making it the 14th

the Department of Veterans Affairs. Its first secretary was

Department in the Cabinet.

Edward Derwinski, who had served in the

1991: The Department of Medicine & Surgery was re-designated as the Veterans Health Services and Research Administration and called the Veterans Health Administration (VHA).

2003: VA launched MyHealtheVet (myhealth.va.gov) nationwide. The personal health record portal now has more than 2.5 million registered users.

The largest-ever clinical trial of psychotherapy to treat PostTraumatic Stress Disorder (PTSD) was initiated.

2007: The first powered anklefoot prosthesis, developed in

collaboration with researchers at MIT and Brown University, was unveiled.

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Veteran suicides represent approximately 22 percent of all

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Army in the PACIFIC THEATER during WORLD WAR II. g

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At the time of Derwinski’s appointment, the VA had 245,000

The VA’s mission is varied and complex. Its tasks include

employees, a budget of more than $25 billion, and control over

disability compensation, vocational rehabilitation, education

one of the largest health-care systems in the nation. According

assistance, home loans, and life insurance. According to its

to the Washington Post, one of Derwinski’s first decisions involved Vietnam veterans seeking disability benefits for exposure to the defoliant Agent Orange.

America’s second VA secretary was the first African-American in that office. Jesse Brown served from 22 January 1993, 13 July 1997. He was appointed by President Bill Clinton.

Brown was stationed by the Marine Corps in Da Nang, Vietnam, where he was wounded in combat. His right arm was shattered, leaving him partially paralyzed. He later got a job with Disabled American Veterans (DAV) an organization that helps disabled

largest integrated health care system, providing care at 1,293 health care facilities, including 171 medical centers and 1,112 outpatient sites of care of varying complexity … serving 9 million enrolled Veterans each year.”

Those statistics paint part of the VA’s picture, but there’s a vision undergirding the numbers: “To provide veterans the world-class benefits and services they have earned and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism,

military veterans and their families. Eventually he became DAV’s

integrity, accountability, and stewardship.”

first African-American executive director.

Denis McDonough, the current Secretary of Veterans Affairs,

As VA secretary, Brown extended disability payments to Veterans with post-traumatic stress disorder and veterans who were exposed to Agent Orange exposure. He also shined a spotlight on the plight of homeless Veterans, convening the first National Summit on Homelessness Among Veterans in 1994.

It was Brown’s belief that “the way we treat our Veterans is an indication of who we are as a nation.”

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website, “The Veterans Health Administration is America’s

VETERANS AFFAIRS 90 YEARS: Military & Wellness

put it this way: “Our department remains fully committed to fulfilling the sacred obligation that we have to those who serve in uniform.”

With such a large organization, spread across an entire nation, representing hundreds of thousands of workers, and millions of Veterans, can one person make a difference?

The answer is “Yes.” g

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“The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the Veterans of earlier wars were treated and appreciated by their nation.”

— President George Washington

Take the case, for example, of Thor Ringler, a Writer/Editor

It should be noted that volunteers are a key asset in the

at the William S. Middleton Memorial Veterans Hospital in

department’s operation.

Madison, Wisconsin. He’s the national program manager of “My Life, My Story.”

Ringler is at the forefront of the VA Department’s effort to use what is known as “narrative medicine.” Patients are asked to share their life story. That story after being read, reviewed, and

volunteers served more than 9.2 million volunteer hours.

Individuals and partnering organizations gave over $99 million in gifts and donations.”

approved by the Veteran is included in his or her medical record.

VHA Chief of Staff Jensen said this about the ongoing volunteer

This helps doctors, nurses, and other medical providers connect

effort: “Over the years, VA volunteers have represented an

with each patient as a person, rather than just as a collection of data like blood pressure, heart rate, weight, and height.

Since 2013, more than 5,000 Veterans have shared their stories.

With the Veteran’s permission, each story is added to his or her medical record.

Meeting the individual needs of each and every Veteran is a massive task.

Consider this: The Veterans Health Administration is America’s largest integrated health care system. Supporting its mission requires a multitude of administrative and business offices that include the Office of Academic Affiliations, VA Canteen, VA Careers, Center for Compassionate Innovation, Community Care, Office of Emergency Management, Health Benefits / Health Eligibility Center, Health Resource Center, Informatics / eHealth, Organizational Development, National Center for Organization Development (NCOD), Non-VA Care, Patient Advocate, Office of Policy & Planning, Office of Procurement and Logistics, Office of Research Oversight, Returning Service Members, VistA Imaging, and Voluntary Service.

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According to the VA, “In Fiscal Year 2019, over 61,000

VETERANS AFFAIRS 90 YEARS: Military & Wellness

unparalleled degree of dedication, commitment and unselfish service with only the care of veterans as their compensation.”

Engaging volunteers was part of General Bradley’s strategy from the start. He initiated the founding of the VA’s Voluntary Service with a coordinated and integrated plan to support VA facilities. To accomplish that nationwide effort, General Bradley invited representatives from key organizations, like the Veterans of Foreign Wars, American Legion, the Disabled American Veterans, USO, and the Red Cross.

Karen M. Sanders, MD, Deputy Chief Academic Affiliations Officer for the US Department of Veterans Affair, helps put the challenges faced Bradley into historical perspective: “WORLD WAR II had just ended and many veterans were coming home from the theaters of war,” she said, “… hundreds of thousands of veterans that were wounded or had illnesses of war and needed to be treated as soon as they came back.”

It was daunting.

“The VA wasn’t set up to care for this many veterans,” Sanders

To help facilitate connecting with veterans across the nation,

explained. “Some brilliant physicians decided to create a

the VA maintains a location tab on its website at https://www.

partnership between academic institutions and the VA system.

va.gov/directory/guide/home.asp — where it states: “This

This would bring senior clinicians from medical schools, with their

site is a storehouse of facility and key staff information within

trainees, over to the VA’s, and help care for veterans, immediately

1,956 VA facilities, maintained on a regular basis by editors

improving the quality of care and the staffing deficit, but also

and administrators nationwide throughout the VA network.

provide a learning experience for these trainees.”

Designed for ease-of-use, this site categorizes information for

But much has happed since those early days, according to Dr. John Prescott, Chief Academic Officer at the Association of American Medical Colleges (AAMC), who was a military physician in the Army for eight years.

“For the past 75 years, academic medicine and the VA have had a wonderful relationship, which really has impacted public health,” Prescott said. “The physician training that happens at VA is incredibly important and about 70 percent of all our physicians from the United States get part of their training at the VA. There’s 124,000 health care providers that were trained in the last year, at the VA, over 40 different healthcare professions, so the impact is huge.”

Dean Albert Reece, MD, PHD, MBA, Executive Vice President for Medical Affairs, University of Maryland School of Medicine, called it “an extraordinary symbiotic relationship, the combination of the VA and the university hospital…” while Marjorie A. Bowman, MD, MPA, Chief Academic Affiliation Officer, Office of Academic Affiliation Veterans of Health Administration, explained the relationship this way: “There are many words for different kinds of health professions working together. We emphasize the whole person and whole health.”

“I think we have a next 75 years that’s going to be incredibly bright,” said Dr. Prescott. “We are going to see enhanced clinical training for our students. The research is going to continue to expand. We’re going to hit on new areas that are particularly important to Veterans is post-traumatic stress disorder, traumatic brain injury, and neurological injuries.”

Even as it identifies new areas of focus, concern, and advancement, the VA continues to support its current population of Veterans and their families as it educates them about benefits, encourages healthy living, supports mental health, and discusses the tragedies of war, loss, grief and transition after trauma. That means reaching out to combat veterans, and their families, older veterans, and their caregivers, homeless vets, returning service members, women veterans and veterans who live in rural areas.

browsing by state and administration, as well as by viewing through an interactive map of the United States.”

Facilities can be located, based on street, city, state, or zip code.

The VA takes a multi-faceted approach when it comes to serving veterans, carrying out four specific missions: Veterans Health Care: “VA’s Veterans Health Administration is the largest integrated health care network in the United

States, with 1,255 health care facilities serving 9 million enrolled Veterans each year.”

Veterans Benefits: “Veterans can earn a range of benefits that

help them transition back to civilian life in the country they fought to defend. Through the Veterans Benefits Administration, VA helps service-members transition out of military service, and assists with education, home loans, life insurance and much more.”

National Cemeteries: “The job of the National Cemetery

Administration is to make sure those who served this nation are never forgotten. NCA provides dignified burial services for Veterans and eligible family members by maintaining 142 cemeteries as national shrines and providing lasting tributes that commemorate their service and sacrifice to our nation.”

The Fourth Mission: “VA’s ‘Fourth Mission’ is to improve the Nation’s preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to veterans, as well as to support national, state, and local emergency management, public health, safety and homeland security efforts.”

As Chief of Staff Jon M. Jensen mentioned earlier, the VA’s anniversary is “a legacy of service, the future of care.”

That legacy was on display when President Joe Biden honored the heroics of a 94-year-old KOREAN WAR vet.

Retired Army Colonel Ralph Jr. was awarded the Medal of Honor for what President Biden called "extraordinary heroism and selflessness" in the KOREAN WAR. g VETERANS AFFAIRS 90 YEARS: Military & Wellness

27

In addition to the Medal of Honor, Puckett had previously been

Honoring heroes of the past like Colonel Ralph Puckett Jr. sets

awarded two Distinguished Service Crosses, two Silver Stars

the tone for Veterans of the future. America’s first president,

for valor, two Bronze Stars for valor, and five Purple Hearts.

One of his Distinguished Service Crosses was upgraded to a Medal of Honor.

Attending the ceremony was South Korean President Moon Jae-in.

"Colonel Puckett is a true hero of the KOREAN WAR. With extraordinary valor and leadership, he completed missions until the very end, defending Hill 205 and fighting many more battles requiring equal valiance," Moon said. "Without the sacrifice of veterans including Colonel Puckett and the Eighth Army Rangers Company, the freedom and democracy we enjoy today couldn't have blossomed in Korea."

According to news reports, Puckett entered the room in a wheelchair but stood at attention as the citation was read about how he (as a First Lieutenant) drew enemy fire multiple times in order to allow his Rangers to find and destroy enemy positions during a multi-wave attack in which gravely injured.

Puckett had previously received a Distinguished Service Cross for his actions. He went on to serve in Vietnam as a member of the 101st Airborne Division.

28

VETERANS AFFAIRS 90 YEARS: Military & Wellness

General George Washington, made just such an observation, as true today as it was on the day, he said it: “The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the Veterans of earlier wars were treated and appreciated by their nation.”

John F. Kennedy, Navy Lieutenant, WORLD WAR II Veteran, American hero, and 35th President of the United States, put it this way: “As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”

The VA does both.

Jim Lamb is a retired journalist living in Florida. He served in the US Navy, including a brief stint in Vietnam. He went to college on the GI Bill.

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

TRAUMA After the TRENCHES PTSD IN VETERANS

At first, everything seems dark and muffled. Slowly, the sights

a few weeks. Others, like Lieutenant Sloane, experience these

stinging from the dust in the air, the deafening sound of artillery

persistent, occurring without warning and brought on by deep-

and sounds come into focus … the acrid smell of smoke, eyes

fire and the heart stopping bang of a grenade explosion. As the scene sharpened, Lieutenant Mark Sloane woke up screaming, with his pulse racing and ears ringing with the desperate cries of fallen comrades. He reached subconsciously for his service weapon, his hands clutching the cool wood of his bedside

table. He woke up, crashing back down to reality as he emerged from a recurring nightmare that left him shaken and on edge the morning after.

L

ieutenant Sloane returned from the war in Afghanistan

scarred with invisible wounds from his experiences on the battlefield. Once a calm, optimistic and patient man, he

was now a frightened, sleep deprived soldier with a short fuse,

who couldn’t handle being around his wife or his family. He did not know how many sleepless nights he could endure alone.

He just wanted it all to end, because in his opinion, a life this painful was not worth living.

It’s normal to have upsetting memories, feel on edge, or

have trouble sleeping after a traumatic event. At first, it may be hard to get through the day. Even regular activities like

going to work or spending time with family and friends are

overwhelming. However, most people start to feel better after

feelings months after the event. They are usually intense and

seated triggers. This condition is commonly referred to as PostTraumatic Stress Disorder and is, unfortunately, seen often in the veteran population.

PTSD (Post-Traumatic Stress Disorder) is a chronic and

debilitating mental condition that develops in response to

catastrophic life events, such as military combat, sexual assault,

and natural disasters. It was defined as an anxiety disorder until 2013 when the American Psychiatric Association categorised PTSD as a trauma and stressor-related disorder.

It affects 7-8% of the general US population at some point

during their lifetime; however, the prevalence is much higher among certain subgroups, including active-duty military personnel and veterans. Although estimates vary across studies, evidence suggests that the prevalence of PTSD

in deployed US military personnel may be as high as 14-

16%. Veterans Affairs defines PTSD as the development of

characteristic, long term symptoms after exposure to a lifethreatening experience or one that led to serious injury, to

themselves or others, which makes it difficult for the person to function in routine life. It is also commonly referred to as “shell shock” or “combat stress.” g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

31

PTSD affects 7-8% of the general US population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active-duty military personnel and veterans.

ILLUMINATING THE INCIDENCE

soldiers are surviving with very significant injuries who would not

number of patients suffering from the condition have increased

with both the physical and psychological trauma.”

While PTSD has been common among veterans for years, the exponentially over the last few decades.

The military strategies used in current wars are ever-changing

The diagnosis of PTSD was not adopted until the late 1970s,

and continuously getting more dangerous. From urban

Diagnostic and Statistical Manual of Mental Disorders, used by

attacks, blurred lines between safe zones and battle zones, the

and it became official in 1980 when it was included in the

territories being used as battle grounds, intermittent terrorist

doctors and psychiatrists.

use of guerrilla tactics to the ever-present threat of roadside

Studies conducted on soldiers who survived the VIETNAM

WAR, the GULF WAR and OPERATIONS IRAQI FREEDOM (OIF) and ENDURING FREEDOM (OEF), have estimated that 12-30%

bombs, have led to many civilian lives lost and served as

additional burdens to soldiers who were facing multiple, lengthy deployments abroad away from their families.

of veterans suffer from PTSD. The US Department of Veterans

Female soldiers have shown an increased risk of developing PTSD.

veterans, 20% of Iraqi war veterans and 11% of veterans from the

veterans reported Military Sexual Trauma (MST), which refers to

Affairs estimates 31% of Vietnam veterans, 10% of Gulf War

According to a study performed in 2003, 22% of screened female

war in Afghanistan live with PTSD.

sexual assault or recurrent, threatening sexual harassment that

The last few wars have seen an increase in the use of Improvised

occurs during the person’s time serving in the military.

Explosive Devices (IEDs) which produce traumatic brain injury and

SEEKING SIGNS

been improvements in battlefield medicine and protective gear,

times and in different ways, there are characteristic features that

morbid conditions like severe burns or amputations. There have

and survivability has increased, but these advances come at a price.

While veterans may present with symptoms of PTSD at varying are seen often. These include:

Paula P. Schnurr, PhD, Executive Director of the VA National

Intrusion – Reliving the Event: Many veterans deal with

the troops and responding to injuries on the ground, a lot of

event. These memories can be very realistic and frightening,

Center for PTSD said, “Between the way we’re protecting

32

necessarily have survived before. And they’re returning stateside

VETERANS AFFAIRS 90 YEARS: Military & Wellness

unwelcome memories that come up even years after the

transporting the person mentally to the original scene of

hard to enjoy time spent with loved ones and puts a strain on

or nightmares. They may come after coming across certain

be unprovoked. It makes it hard for the veteran to develop

the traumatic experience. These may occur as flashbacks

triggers like the sound of a car backfiring that may remind the

veteran about the sound of guns or bombs on the battlefield or

watching a war movie with terrifyingly familiar sights and sounds.

Avoidance: Most veterans suffering from PTSD find it easier

to avoid their family, friends or acquaintances as they are not sure when they may begin to experience their symptoms.

They prefer to avoid discussions about their military life and therefore stay away from public or social events and from

their familiar surroundings. They also tend to withdraw even

from close relationships as they feel like no one is capable of understanding what they are going through.

Negative Cognitions or Moods: Soldiers who survive and

are able to get home, while many of their brothers and sisters in arms could not, carry around feelings of overwhelming

fear and shame, including a distorted sense of self blame or

survivor’s guilt. This makes them retreat further away from wellmeaning friends and family as they are unable to experience positive emotions.

Hyperarousal or Feeling on Edge: Patients find it difficult to

relax, they experience insomnia or difficulty in sleeping and are unable to concentrate on work or daily activities. This makes it

relationships due to outbursts of anger or irritation that may

meaningful or intimate attachments with other people and they begin to feel more isolated and alone.

These feelings may lead to an overwhelmingly negative state

of mind, which in some severe cases result in acute depression with a tendency to resort to alcohol or drug abuse, suicidal tendencies and other self-destructive behaviors.

DEFINING A DIAGNOSIS

The current clinical or psychiatric diagnosis of PTSD includes: • Exposure to a traumatic stressor • The development of a characteristic symptom involving re-experiencing, avoidance and hyperarousal

• Experiencing symptoms for a duration of at least 1 month • Significant distress, impaired social interactions or ability to function at work

PTSD may be further classified into acute stage if the

symptoms last for less than three months; chronic stage if the symptoms last more than three months; and delayed onset if

the onset of the symptoms occurs at least six months after the traumatic event. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

33

Late-Onset Stress Symptomatology (LOSS): Older veterans can

develop PTSD symptoms even 50 or more years after their wartime experience. Without a multitude of tasks to distract them, retired

veterans find themselves with more time to reflect on past events.

A combination of free mind space and health issues from aging leave these veterans both physically and mentally vulnerable.

CASCADING COMPLICATIONS

PTSD often goes hand in hand with other anxiety disorders and

clinical depression. These mixed symptoms make the diagnosis and treatment more challenging. Results from a large national survey revealed that people with PTSD are three to five times

more likely to develop Major Depressive Disorder (MDD) than those without PTSD. The two conditions are known to occur

together in almost 52% of cases. Substance abuse is commonly

seen in veterans with PTSD. It is used as a coping mechanism or a way to numb their overwhelming feelings. A modern study of

recent veterans showed that 63% of the soldiers who were found to use and abuse alcohol or drugs had concurrent PTSD.

In addition, exposure to traumatic events increases the incidence of poor physical health. It is often observed that patients with

PTSD are more likely to have co-morbid conditions like diabetes, heart disease, obesity and osteoarthritis.

GAUGING THE GRAVITY

Several measures are available to help diagnose PTSD and assess its severity.

PTSD assessments were developed to be psychometrically sound; to collect information from multiple sources 34

VETERANS AFFAIRS 90 YEARS: Military & Wellness

across response channels; and to use across different

trauma populations, settings, genders, ethnic groups,

and cultures. These include structured interviews as well

as self-report measures.

STRUCTURED INTERVIEWS

Clinical interviews provide psychiatrists and treating

physicians an opportunity to ask follow-up questions,

to clarify items and responses, and to use their clinical

judgment in making an evaluation of the patient’s state

of mind. It also helps them to identify landmark moments

that may have led to the development of PTSD in soldiers

or veterans. These are also called Index Events, which are

extreme traumatic events that they may have been directly exposed to either by witnessing it, experiencing it or

hearing about it. The events trigger intense and emotional responses like fear, horror, or helplessness. Unfortunately,

some veterans may have been exposed to multiple traumatic events. The challenge will be in identifying the target trauma in these cases, which is the one that is causing the most severe or the most frequent symptoms of PTSD in the patient.

Some of the validated and frequently used assessment scales are: 1.) The Clinician-Administered PTSD Scale (CAPS), which

was developed in 1989 at the National Center for PTSD,

consists of 30 items that evaluate the onset, duration and

severity of the symptoms of PTSD in patients. In addition, the CAPS also uses a Life Events Checklist which screens for Index Events. g

(continued on page 36)

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2.) The comprehensive Structured Clinical Interview for DSMIV (SCID) is designed to diagnose all major disorders

identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

3.) The PTSD Symptom Scale–Interview (PSS-I) is a structured interview that evaluates the intensity and frequency of

symptoms and corelates well with self-evaluation tests.

SELF-REPORT TECHNIQUES

1.) The Post-Traumatic Stress Diagnostic Scale (PDS) is a

self-report questionnaire designed to assess the DSM-IV

diagnostic criteria for PTSD. It has been translated into many

languages and has been used successfully in many countries and cultures.

2.) The PTSD Checklist (PCL) was developed at the National

Center for PTSD in 1990 and uses a simple five-point scale to

analyze the severity of the symptoms as felt by the patients. It

has been widely adopted by Veterans Administration systems.

3.) The Davidson Trauma Scale (DTS) and the Mississippi Scale for Combat-Related PTSD (Mississippi Scale) also use a five point rating scale for symptoms. In addition, The Mississippi Scale

is commonly used to measure combat-related PTSD and was

selected as the primary method used to evaluate PTSD in the National Vietnam Veterans Readjustment Study (NVVRS).

• Improving symptoms

• Teaching patients skills to cope with it • Restoring self esteem These goals can be achieved through a variety of strategies

and treatment has shown remarkable improvements in patients.

According to the National Center for PTSD, 53% of patients who receive these therapies will be able to recover well.

COGNITIVE BEHAVIORAL THERAPY (CBT)

CBT aims to help patients to change the way they think, which in turn affects the way they behave. In patients with PTSD, it helps patients to develop alternative ways of thinking and behaving in order to reduce their psychological stress. They learn to

discriminate between their own thoughts and reality so that they are able to identify their own unhelpful beliefs and change their actions accordingly. Following are common types of CBT: Cognitive Processing Therapy (CPT)

Treatment begins with educating the patient about PTSD

and the relationship between thoughts and emotions. They

begin to identify “automatic thoughts” that may be leading to and worsening the symptoms of stress. The patient writes a

detailed account of the traumatic experience, including why it

occurred and the impact it has had on the patient’s beliefs about themselves, others, and the world. These thoughts are explored

THE ROAD TO RECOVERY

and questioned by the therapist who guides the patient in

deployment counseling, active and continuous screening, and

Prolonged Exposure Therapy (PE)

Given the prevalence and potential consequences of PTSD, premental health assessments made while debriefing may help in catching early warning signs of the condition.

38

PTSD therapy has these main goals:

VETERANS AFFAIRS 90 YEARS: Military & Wellness

developing the mental tools required to cope with the trauma.

Prolonged exposure teaches patients to slowly approach traumarelated memories, feelings, and situations, while working with g

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their therapist in a safe, graduated fashion to face their trauma instead of avoiding it and thereby reduce their fear.

1.) Eye Movement Desensitization and Reprocessing

Therapy (EMDR) In EMDR, the care provider guides patients

to make repetitive eye movements or follow hand taps, at the

same time they are recounting traumatic events. In doing so, the patient is made to focuss on other stimuli while revisiting the

experience, which in turn helps them to reprocess the traumatic information until it fails to be disruptive.

2.) Medications Some patients do not respond adequately to therapy treatment alone and may prefer a combination of

medication and psychotherapy. Antidepressants like sertraline and paroxetine are approved for treatment, while adjuvants

like SSRI fluoxetine and (SNRI) venlafaxine are also prescribed for mood modulation. Anticonvulsants and anti-epileptic

medications have also helped with the symptoms of PTSD. Although controversial, medical marijuana has proven to be

quite effective to deal with aggressive presentations of PTSD

with a recent study showing a 75% reduction in CAPS symptom scores for patients using cannabis.

3.) Holistic Healing There are many practices advocated for

the management of PTSD symptoms that are categorized

as complementary and alternative medicine or CAM. These

methods are gaining popularity with over 40% of PTSD patients reporting the beneficial effects of CAM based treatments on

their emotional and mental health. Mind-body treatments like

meditation, relaxation, acupuncture, and exercise therapy were commonly used.

In 2010 the Department of Veterans Affairs, Office of Research

and Development, requested a systematic review of CAM for PTSD to investigate the evidence of these methods and their

benefits. In 2012 the addition of mantram or mantra repetition found modest improvements in symptoms of depression and PTSD. Another study researched the effects of Mindfulness-

Based Stress Reduction (MBSR) as an adjunct to usual care in veterans with PTSD. This is a group-based intervention that

includes meditation and yoga which researchers observed had a beneficial effect on the participants in the trial.

SUPPORT SYSTEMS: IT TAKES A VILLAGE

While PTSD has detrimental effects on veterans’ emotional and

physical well-being, there is no doubt that these invariably affect the family members as well.

Family members caring for a veteran with PTSD symptoms may react in different ways: Some may exhibit sympathy, confusion and anger; others may feel unequipped to deal with the trauma and prefer to detach themselves and avoid the situation with guilt and shame 40

VETERANS AFFAIRS 90 YEARS: Military & Wellness

adding to a complicated mix of feelings. The caregiver burden can

CBT and narrative therapy using peer support groups along with

and financial load brought about by this condition.

and NLP analytics are used to analyze the interaction with patients

be heavy in these cases as they deal with the emotional, societal, Studies have found that partners of veterans with PTSD or any combat stress reactions are more likely to develop their own

mental health issues. These couples also experience a higher rate of marital or relationship discord.

While there can be challenges living with someone suffering from PTSD, it is important for families to take concrete steps to seek

human facilitated asynchronous online discussions as guides. AI

to provide insights and detect minor amounts of personal change

and post traumatic growth that may not be captured by traditional symptom measures.

“The great myth of war is that it can be left behind.”

help for themselves as well as their loved ones.

Patients can find comfort in spending time with a supportive circle of friends and well-wishers. Coping is easier with support from

extended family, friends, church, community groups or support groups. Maintaining family routines, such as dinner together,

church, or sports or recreational outings may also alleviate some of the symptoms of PTSD and help the veteran to acclimatize

– Catherine Whitney.

PTSD in the veteran population continues to be an ongoing struggle both for the soldiers and their families. Holistic

approaches and further studies are required to bring more

effective treatments and to raise awareness about the issue.

The brave men and women who protect their country deserve peace.

to life after combat. Family therapy sessions have also been

beneficial in helping both parties cope with difficult situations.

REFERENCES:

A large part of recovering from a mental illness is understanding

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.

Washington, D.C.: American Psychiatric Association; 2013.

observed every year on the 27th of June. It began in 2010 as a

Gates, M. A., Holowka, D. W., Vasterling, J. J., Keane, T. M., Marx, B. P., & Rosen, R. C. (2012).

Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychological Services, 9(4), 361–382.

it without misconceptions or bias. PTSD Awareness Day is

day marked to spread awareness about the condition in tribute to Staff Sergeant Joe Biel, a North Dakota National Guard member

Carlock D. A guide to resources for severely wounded Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans. Issues in Science and Technology Librarianship. 2007. [cited 2021 May 14]. Available from: http://www.istl.org/07-fall/internet2.html.

June is also PTSD Awareness Month and is intended to

Kimerling, R., Gima, K., Smith, M. W., Street, A., & Frayne, S. (2007). The Veterans Health Administration and military sexual trauma. American journal of public health, 97(12), 2160–2166. https://doi.org/10.2105/AJPH.2006.092999.

who committed suicide following two tours in Iraq.

destigmatize the condition, ensuring that those who do carry the

burden of these invisible wounds receive the treatment they need.

TRIALS WITH TECHNOLOGY

Vieweg, W. V. R., Julius, D. A., Fernandez, A., Beatty-Brooks, M., Hettema, J. M., & Pandurangi, A. K. (2006). Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. The American Journal of Medicine, 119(5), 383–390.

To manage a large number of patients presenting with PTSD,

National Center for PTSD. (2019). Understanding PTSD and Aging. Retrieved from https://www. ptsd.va.gov/publications/print/understandingptsd_aging_booklet.pdf.

receive the help they need.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of general psychiatry, 52(12), 1048–1060. https://doi.org/10.1001/archpsyc.1995.03950240066012.

technology has invariably been roped in to ensure that patients The Zeriscope system, Bio Ware, is a web-based mobile

technology program that leverages live interactive video

and streaming real-time physiological and environmental

data obtained from sensors and cameras to enable mobile

physiological monitoring and momentary awareness during

prolonged exposure therapy. It allows therapists and doctors

to see what the patient is seeing as they go through a stressful

situation, while communicating with them as well as monitoring

heart rate and skin responses like sweat gland activity. The system is being tested on veterans at the Medical University of South Carolina (MUSC).

Digital health company, Tiatros, was co-founded by a veteran

Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2013 Jun; 26(3):299-309.

Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2013 Jun; 26(3):299-309.

Seal, K. H., Cohen, G., Waldrop, A., Cohen, B. E., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug and alcohol dependence, 116(1-3), 93–101. https://doi. org/10.1016/j.drugalcdep.2010.11.027.

SCID-5. (2018, July 11). Retrieved May 10, 2021, from Columbiapsychiatry.org website: https:// www.columbiapsychiatry.org/research/research-labs/diagnostic-and-assessment-lab/structuredclinical-interview-dsm-disorders-11.

Advancing science and promoting understanding of traumatic stress [Internet]. Ptsd.va.gov. 2012 [cited 2021 May 20]. Available from: https://www.ptsd.va.gov/publications/rq_docs/v23n2.pdf.

and explored the ability of artificial intelligence (AI) tools like

Reisman M. (2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next.

P&T: a peer-reviewed journal for formulary management, 41(10), 623–634.

behavioral health initiatives. These teach mindfulness-based

Greer, G. R., Grob, C. S., & Halberstadt, A. L. (2014). PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. Journal of psychoactive drugs, 46(1), 73–77.

natural language processing (NLP) to introduce digitally based

VETERANS AFFAIRS 90 YEARS: Military & Wellness

41

ARMED

WITH

AWARENESS : Diabetic Neuropathy in Veterans

D

iabetes is increasing at an alarming rate in the United

in 1999 by an expert committee on behalf of the Department of

Prevention (CDC), there are 34.2 million cases of diabetes

found that there was suggestive evidence of an association

States. According to the Centers for Disease Control and

documented in the National Diabetes Statistics Report, 2020.

A chronic, non-communicable metabolic disease, diabetes

causes high blood sugar. The hormone insulin released from

the chemical dioxin used Agent Orange and the onset of Type

2 diabetes in soldiers exposed to this chemical, which then led to further complications like neuropathy.

the human pancreas is responsible for moving sugar from the

Advancing age coupled with low income and an increased risk of

stored as a source of energy. People with diabetes are unable

more susceptible to lifestyle diseases like hypertension, high

blood stream into the cells of the body, so that it can be used or to produce or effectively use insulin, leaving high levels of sugar in the blood which in turn causes damage to the blood vessels, nerves and organ systems, leading to severe complications.

DIABETIC NEUROPATHY

(neuro- means nerves; -pathy means disease or suffering) is the most common, long standing complication of diabetes according to the American Diabetes Association, with data

indicating that it occurs in nearly 28% of people with Type 1 and Type 2 diabetes.

Further research estimated that approximately 4% of diabetic

patients develop a neuropathy within 5 years of diagnosis and 15% do so within 20 years.

SOLDIER STATISTICS: THE INCIDENCE OF DIABETIC NEUROPATHY IN VETERANS

obesity without access to healthy foods, may also leave veterans cholesterol levels, prediabetes and Type 2 diabetes.

An interesting study conducted by the US Department of

Veteran Affairs in 2017 revealed a correlation between PostTraumatic Stress Disorder (PTSD) and gestational diabetes

in women veterans, along with disrupted neuro-endocrine

functions (disruption in hormone and nerve functions) as well as worsening cardiovascular health.

SPOTTING THE SYMPTOMS: PRESENTATIONS OF DIABETIC NEUROPATHY

Most patients suffering from uncontrolled or poorly controlled long term diabetes exhibit some general symptoms of the

disease, indicating high levels of sugar in the blood stream.

These include blurry vision, excessive thirst, fatigue, frequent urination, hunger, and weight loss.

Diabetes affects nearly 25% of the veteran population and is

In addition, patients with diabetic neuropathy may exhibit a

amputation. The prevalence of diabetes amongst veterans is far

on the nerves affected. These are categorised as:

the leading cause of blindness, end-stage renal disease, and more than the 8.3% incidence seen in the general public.

variety of symptoms that present in various forms, depending • Peripheral Neuropathy

When looking at incidence rates in veterans, diabetes has

• Autonomic Neuropathy

Orange, used during the VIETNAM WAR. This was determined

• Mononeuropathy (focal neuropathy) g

been associated with exposure to a herbicide called Agent

42

Veterans Affairs (DVA) and the Institute of Medicine (IOM), who

VETERANS AFFAIRS 90 YEARS: Military & Wellness

• Proximal neuropathy (diabetic polyradiculopathy) (continued on page 45)

Diabetes affects nearly 25 percent of the veteran

population and is the leading cause of blindness, end-stage renal disease, and amputation. The prevalence of diabetes

amongst veterans is far more than the 8.3% incidence seen in the general public.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

43

How NEW TREATMENTS for

PTSD

ARE HELPING AMERICAN VETERANS

By Dr. Keith Stuessi, MD U.S. Service members who return from war often bear wounds.

Some are visible and easy to recognize. We know them, we think we understand them, and we even expect them. But others are not visible, and those invisible wounds of war, which often accompany the physical wounds, are often much harder to treat.

Post-traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI) plague our troops. These are the invisible wounds of war, evading the eyes of other service members, family members, and society.

Since October 2001, approximately 2.7 million U.S. troops have been deployed to the war zones of Afghanistan and Iraq.

Early evidence suggests that the number suffering from psychological injuries from these deployments is far greater than the number suffering from the

physical injuries. Prolonged exposure to combat-related stress, often over multiple rotations, takes a serious toll. We may not see the damage, but it is there.

According to the Department of Veterans Affairs (VA), PTSD afflicts up to one in five veterans who deployed to Iraq and Afghanistan in a given year, and as many as one in three Vietnam veterans have had PTSD in their lifetimes.

As many as 500,000 U.S. troops who served in Afghanistan and Iraq over the past 13 years have been diagnosed with PTSD. These figures suggest that psychological trauma is a staggering burden on active-duty troops, veterans and society.

Because the medical community did not understand the science of PTSD until recently, past treatments varied from heavy drugs to hospitalization to simply telling patients to try to put their experiences behind them.

But today, clinicians increasingly rely on emerging therapies along with psychotherapy and medication in a holistic treatment approach.

In 2017, the VA and Department of Defense developed clinical practice guidelines for the treatment of PTSD. The guidelines recommend using individualized treatments called traumafocused psychotherapy. The most commonly used therapies in both combat veterans and non-veterans are:

PROLONGED EXPOSURE THERAPY (PE) Veterans suffering from PTSD often try to avoid anything that reminds them of their prior trauma because these stimuli cause an emotional and/or physical reaction. Unfortunately, this avoidance only reinforces their fear. In PE therapy, patients are repeatedly exposed to the stimuli in a safe way, and eventually modify or reduce their fear response. This helps veterans to manage their condition and lead a more normal life.

COGNITIVE PROCESSING THERAPY (CPT) After a

trauma, it’s common to have repeated negative thoughts and get “stuck”on the traumatic event. CPT helps the patient learn to identify and change these thought patterns. In CPT, the therapist helps the patient identify his or her “stuck points” and use cognitive restructuring to create a more accurate and balanced interpretation of the traumatic event. This therapy helps patients to get past recurring thoughts, such as selfblame, shame and hindsight.

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) People with PTSD react negatively

to the memory of their traumas because the brain has not adequately processed the experience. EMDR can help them process these upsetting memories and separate the memory from thoughts and feelings experienced at the time. The patient focuses on specific sounds or movements while they talk about the traumatic event with a therapist. This helps the brain work through the traumatic memories and resolve the associated distress. Over time, they change how they react to memories of their traumatic event.

Beyond these therapies, we have seen great success in some emerging treatments, including mindfulness and meditation and art-and-craft therapy.

MINDFULNESS AND MEDITATION Many therapists and

patients have found that adding mindfulness and meditation to traditional therapy can be beneficial for veterans with PTSD. Mindfulness means focusing attention on sensory perceptions and bodily sensations and includes meditation, yoga, breathing exercises and tai-chi. Mindfulness has been shown to decrease heart rate and blood pressure, and it has been an effective way for people in all walks of life to deal with stress. It can benefit veterans as well.

CRAFT THERAPY Craft therapy has been proven to be an

extremely effective PTSD treatment, and ample evidence suggests it has a positive overall impact on brain function. Craft therapy helps vets take their minds off events that may have led to their illness. Engaging in craft activities has been shown to address cognitive, neurological and sensory-motor needs by focusing the brain on performance skills. It has been shown to help promote the use of right- and left-brain functioning and help maintain cognitive functioning. An organization that is near and dear to my heart, Help Heal Veterans, has known this for quite some time. In fact, for 50 years Heal Vets has been providing craft therapy to active duty military and veterans.

What is truly impressive to me as a physician, however, is what the veterans who have used Help Heal Veterans’ craft kits have to say:

• 94% said the kits helped them have a more positive outlook on life • 81% said the kits helped improve their relationships with family and friends • 89% said our kits helped relieve their pain. On average, there was a 63% drop in pain scale when using HHV’s kits • 78% of respondents who had a physical injury or wound said our kits helped with their condition • 98% said the kits took their mind off of problems • 97% of respondents with behavioral health issues (PTSD, depression, anxiety) said the kits helped them feel better • 75% of respondents with history of TBI said our kits helped them Because PTSD is such a heterogeneous disease, any treatment plan should be individualized, and one must consider current life stressors and co-morbid conditions such as chronic pain, substance abuse and traumatic brain injury.

As a Naval Medical Officer who specializes in traumatic brain injury, I can attest that there is no one-size-fits-all approach, but using a combination of traditional and emerging therapies can provide much needed support for our troops and wounded veterans. We need to embrace these therapies.

For more information about the healing power of craft therapy visit healvets.org.

CAPT (Ret) Stuessi served in the U.S. Navy for 23 years as a Family Practice/Sports Medicine physician. His last tour was as Medical Director of the Concussion Care Clinic at Naval Hospital Camp Pendleton. He now serves on the Board of Directors of Help Heal Veterans, the nation’s largest provider of free therapeutic arts-and-craft kits to U.S. veterans and active duty military personnel.

Celebrating 50 Years

of Healing and Partnership with the Department of Veterans Affairs For 50 years, Help Heal Veterans has provided free therapeutic arts and crafts kits to veterans and active duty military suffering from the visible and invisible wounds of war. These craft kits help improve fine motor skills, cognitive functioning, manage stress and substance abuse, cope with symptoms of PTSD and TBI, while also improving their sense of self-esteem and overall physical and mental health. Most of these kits are developed, manufactured and packaged for delivery at our production center headquartered in Winchester, California.

Since its inception in 1971, Help Heal Veterans has delivered over 31 million of these arts and crafts kits to veterans and veteran facilities nationwide, along with active duty military overseas.

The Power of Crafting Maria-Eliza Cabarrus, Army Veteran, VA Employee Sculpture: But On The Inside

 Maywood, Illinois

“Even though my injury from the military has wreaked havoc and derailed my initial plans in life, I don’t regret a single thing. It was my honor to serve our country. The injury depicted in my art piece is what catapulted me to my true calling. It reminds me to savor this joy ride until the wheels fall off doing what makes me happy. All the while, making art that hopefully inspires and touches others. I strive to make something visually pleasing but even more important, I want it to mean something. Made in 2020, this piece is my first sculpture. I wanted it to embody the pain that I endure on a daily basis. Pain that isn’t visible to the naked eye. Invisible pain that many of my fellow veterans struggle with.”

Sherman Watkins, United States Air Force Veteran Paintings: Black History V-I-P and The Quilt

 Hampton, Virginia

“[The first painting] took me two years to complete, 72 portraits: oil on canvas. The painting illustrates some of the accomplishments of Black Americans. I am 79 years old and while looking up the information on these people, I learned something about the achievements of Black Americans.

I hope this painting brings some insight to schools and the American people on the accomplishments of Black Americans. The second piece, “The Quilt” tells what each person did, painted in acrylic.”

Ting Du, Navy Veteran Woodwork: Sailboat of Hope and Beacon of Light

 San Diego, California

“As a retired sailor, the boat reminds me of all those days and nights that I had spent underway among the deep blue ocean. Not only does it symbolize all the tumultuous hardships that I have successfully navigated through in life, it also symbolizes the ultimate inner soul journey that I am still sailing and navigating through, within the heart, searching for the ultimate truth, freedom, and the place of peace and harmony: harmony with the self, and harmony with all nature-beings on earth. The tower symbolizes the beacon of light and beacon of hope. Even during the darkest nights with the most difficult conditions in the ocean, as long as we can see the beacon of light within our own hearts, we will be able to find our own path back home.”

Support Help Heal Veterans Donate: support.healvets.org Visit our store: healvets.square.site

All items are handcrafted by a U.S. veteran.

100% of proceeds go to helping vets heal.

FOLLOW US ONLINE:  HELPHEALVETERANS

 HEALVETS

 HHVETS

CFC# 12251

PERIPHERAL NEUROPATHY

to as “silent” diabetic peripheral neuropathy and affects up

common type of diabetic nerve damage that affects one or more

cases, neuropathy can lead to complete paralysis, like foot drop

Also called distal symmetric peripheral neuropathy, it is the most

peripheral nerves in the body, making daily tasks very challenging.

While it is most commonly perceived as a complication of

diabetes, it may also be found in cases of alcoholism, poor

nutrition or vitamin deficiency, certain cancers or chemotherapy, overly aggressive immune reactions, medications, kidney or thyroid disease and in HIV or other infections.

It affects the feet and legs first, travelling upwards to the hands and arms. The symptoms of peripheral neuropathy are often worse at night, and may include:

• Numbness or reduced ability to feel pain or temperature changes • Tingling or burning sensation, also called dysesthesias • Sharp pain or cramps • Increased sensitivity to light touch • Ulcers

and infections in the feet followed by bone and joint pain In late stages, the area that the nerve supplies becomes numb,

due to progressive degeneration of the nerve fibres, which can

lead to muscle atrophy and difficulty with coordination. Patients frequently mention that their feet feel like they are wrapped

in wool or that they are walking on thick socks. It is the loss of

the “gift of pain” that permits patients with plantar neuropathic ulcers , that is ulcers found on the soles of the feet, to walk on the lesions, without experiencing pain. Patients are unlikely to notice these cuts, blisters or wounds. This makes the lesions

chronic and non-healing as they are frequently complicated by infection and develop into gangrenous wounds that lead to a

2.5 fold increased the risk of amputations. This is also referred

to 50% of the patients suffering with the condition. In severe occurring in the lower limbs.

AUTONOMIC NEUROPATHY

The autonomic nervous system, which involves both the

parasympathetic and sympathetic nervous systems, controls

the heart, bladder, stomach, intestines, sex organs and eyes.

Damage to these nerves due to increased blood sugar is known as diabetic autonomic neuropathy (DAN).

The symptoms and signs of autonomic dysfunction should

be elicited carefully while taking medical history and physical

examination. Once considered rare, researchers now say DAN

is more common in recent times affecting up to 90% of people suffering from Type 1 diabetes and 70% with Type 2 diabetes.

The clinical manifestations of the disease include: • Disorientation and confusion • Tachycardia or increased heart rate even at rest • Orthostatic hypotension: This is a drop in blood pressure with a change in body position, causing light-headedness, weakness, palpitations and fainting. It is diagnosed with a fall in systolic or diastolic blood pressure by >20 mmHg or >10 mmHg,

respectively, upon standing without an appropriate increase in heart rate

• Gastroparesis or slow gastric emptying • Constipation, diarrhea, fecal incontinence (inability to control

bowel evacuation) along with general symptoms like bloating, abdominal pain and nausea

• Erectile dysfunction g VETERANS AFFAIRS 90 YEARS: Military & Wellness

47

• Neurogenic bladder or lack of bladder control due to nerve damage

• Increased or decreased sweating • Patients may also present with heart attacks, and stroke, due to heart rate variability

• They may have trouble exercising and are unable to recognise the signs of low blood sugar – a dangerous condition called hypoglycaemic unawareness

PROXIMAL NEUROPATHY (DIABETIC POLYRADICULOPATHY) This type of neuropathy, also called diabetic amyotrophy, often affects nerves in the thighs, hips, buttocks or legs as well as the abdominal and chest area. Symptoms are usually on one side of the body (unilateral) but may spread to involve both sides (bilateral). The symptoms of the disease include: • Severe pain in a hip and thigh or buttock • Muscle atrophy or weak and shrinking thigh muscles • Difficulty rising from a sitting position • Severe stomach pain MONONEUROPATHY (FOCAL NEUROPATHY)

Mononeuropathy refers to damage to a single specific nerve

and is differentiated into two types depending on the location

of nerves that it affects, that is: the cranial and peripheral nerves.

Mononeuropathy results in:

• Difficulty focusing or double vision • Aching behind one eye • Paralysis on one side of the face, also called Bell's palsy • Numbness or tingling in the hand or fingers

48

VETERANS AFFAIRS 90 YEARS: Military & Wellness

• Weakness in the hand that may make it difficult to hold on to objects

CHALLENGING COMPLICATIONS: THE SEQUELAE OF DIABETIC NEUROPATHY

As the disease progresses, patients with diabetic neuropathy

also experience unsteadiness, recurrent minor injuries that do not heal well and increased risk of falls and fractures. As the

condition becomes chronic, recurrent, non-healing infections

increase the risk of amputation of the limbs, which in addition to driving up the economic costs of diabetic neuropathy, also

increase morbidity or disability rates, severely affecting quality of life and in some cases, even leading to death. Complications of diabetic neuropathy include: DIABETIC FOOT

It is estimated that as many as 15% of individuals with diabetic

neuropathy will experience a foot ulcer during their lifetime. In

addition, foot ulcers precede 85% of all nontraumatic lower limb amputations in the US along with nerve damage there is also

damage to the blood vessels that supply the injured areas in the periphery, like the foot. This combination further reduces the

blood and oxygen supply required for healing of the wounds,

leading to gangrene and then amputation of toes or limbs. Foot

care is therefore extremely important in cases of neuropathy and foot exams should be a mandatory part of physical examinations in primary care set ups.

In response to the need for more consistent evaluations, the American Diabetes Association (ADA) created the

Comprehensive Foot Examination and Risk Assessment, which

takes only three minutes to perform and is called the 3 Minute g

creating odd shapes, like a rocker bottom. This condition is known as Charcot’s joint or Charcot’s Neuroarthropathy.

MENTAL HEALTH EFFECTS

A recent study has shown that diabetic neuropathy is a risk

factor for depression and anxiety. The most prevalent causes of depression in these cases were the chronic pain and

unsteadiness that leads to fear, insecurity and loss of confidence due to the inability to perform social roles as well as increased dependency on their caregivers.

Several research tools have now been developed that focus

of the effect of conditions like diabetic neuropathy on overall quality of life, as opposed to just the physical effects, placing a renewed interest in mental health issues that are especially

prevalent in vulnerable populations like veterans. The Neuro-

QoL Index (Quality of Life in Neurological Disorders) and QOLDN (Norfolk Quality of Life-Diabetic Neuropathy) instruments

have been found to be dependable in determining the effects of DN on patient lives.

Diabetic Foot Exam. It involves taking history specific to lower

limbs and feet for 1 minute, with targeted questions about

peripheral nerve sensations and lifestyle habits like smoking that could lead to peripheral artery disease.

That is followed by a 1 minute physical examination that looks for, calluses, wounds, fissures, macerations or nail infections, ingrown or elongated nails. Skin discoloration or loss of hair growth are often the first signs of vascular insufficiency or

reduced blood supply to affected areas, followed by thickened skin areas like calluses. Areas between the toes are also

inspected properly as that is where deeper lesions may go

unnoticed. A simple touch test determines the responsiveness of the nerves. The Ipswich Touch Test (IpTT) is an alternative

neurologic test that requires only the physician’s index finger,

instead of any machines or instruments and is therefore a great

alternative for field hospitals or primary care centres. During the IpTT, the physician instructs the patient to close his or her eyes while the physician lightly rests his or her finger on each of the

patient’s first, third, and fifth toes for 1 to 2 seconds. Patients are

instructed to respond with a “yes” when they feel the physician’s

touch. The last one minute of the examination is spent educating the patient about foot care.

CHARCOT NEUROARTHROPATHY

Chronic nerve damage due to diabetes may destroy the joints and soft tissues in peripheral joints, most commonly the feet.

This changes the overall shape and structure of the affected foot.

Although it in initially starts with redness, warmth and swelling in the

soft tissues, the damage may progress to the bones in the toes, feet, and ankles, causing them to shift or in severe cases cause fractures,

50

VETERANS AFFAIRS 90 YEARS: Military & Wellness

SCREENING FOR SENSATIONS: INVESTIGATIONS DONE IN DIABETIC NEUROPATHY

Diabetic neuropathy is undiagnosed or misdiagnosed in veteran as

well as civilian populations. Often veterans in particular, fail to report symptoms because they may occur intermittently in the beginning, while most assume that the symptoms are the result of aging.

DN is largely a diagnosis of exclusion by narrowing down causes of the neuropathy with those other than diabetes. This is done

by using family and medication history and performing relevant investigations like serum B12, folic acid, thyroid function,

complete blood count, metabolic panel for enzyme levels and blood protein analysis.

Evaluations of patients with symptoms of neuropathy should also include general assessment like blood pressure, heart

rate and ECGs to diagnose orthostatic hypotension seen in autonomous neuropathy.

Clinical tests that are frequently used for the localised evaluation of the nerve functions include neurological examinations,

Electromyography (EMG) tests, Nerve Conduction Velocity (NCV) tests, and biopsies. Different tests are done in order to detect damage to the nerve fibres fibres. For example, pinprick and

temperature sensation tests are done to evaluate small nerve

fibres whereas vibration perception, proprioception, light touch perception with a 10-g monofilament, and muscle reflexes

checks the functioning of large nerve fibres or nerve bundles.

During the physical examination of the patient, there are

various symptom scores that are used to diagnose Diabetic

Neuropathy, including the Neurological Symptom Score (NSS), g

If this is a compass,

this is a GPS.

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Mission Critical

to help control diabetes.

The Dexcom G6 Continuous Glucose Monitoring (CGM) System helps you more easily navigate diabetes. See glucose readings on your smartphone* every 5 minutes – without fingersticks.† Trend arrows tell you where your glucose is heading.

Plus, it may be covered for qualified veterans.‡

Learn more at Dexcom.com/Veterans

For a list of compatible devices, visit dexcom.com/compatibility.

If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. ‡ For a complete description of Veterans Affairs coverage criteria and additional information, please see the Department of Veterans Affairs Criteria for Use Memorandum, January 31, 2019. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to be eligible to receive coverage. * †

BRIEF SAFETY STATEMENT Available by prescription only. Failure to use the Dexcom G6 Continuous Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. If your glucose alerts and readings from the G6 do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Seek medical advice and attention when appropriate, including for any medical emergency.

Dexcom is a registered trademark of Dexcom, Inc. in the U.S., and may be registered in other countries. ©2020 Dexcom, Inc. All rights reserved. This product is covered by U.S. patent. LBL019926 Rev002

Nuropathy Symptom Profile (NSP) and Diabetic Neuropathy Symptom Score (DNS).

The DNS is a simplified scoring system that evaluates the different factors and assigns scores, as seen in the table given below.

DNS ITEMS

RATE

Unsteadiness in walking

0 = absent, 1 = present

Numbness

0 = absent, 1 = present

Burning, aching pain or tenderness in legs or feet

0 = absent, 1 = present

Prickling sensations

0 = absent, 1 = present

The Revised Neuropathy Disability Score (NDS) took other

sensations into account like vibration, temperature and reflexes.

NDS ITEMS

DESCRIPTION

Vibration sensation (128 Hz tuning fork)

0 = present, 1 = reduced/absent

Temperature sensation (cold tuning fork)

0 = present, 1 = reduced/absent

Pin-prick sensations in index finger or big toe

0 = present, 1 = reduced/absent

Ankle reflex and muscle strength

0 = normal, 1 = present with reinforcement, 2 = absent per side

THE VANS SCALE (VETERANS AFFAIRS NEUROPATHY SCALE) The symptoms of DN prompt a neurological examination of

patients to determine the extent and severity of nerve damage.

52

VETERANS AFFAIRS 90 YEARS: Military & Wellness

While veterans with access to funded health systems may benefit from regular examinations, those who are dependent on distant community clinics, are often left without expert care. To improve the availability of neuropathy care in these areas, a telemedicine– based evaluation system was constructed for remote exams that could substitute in-clinic exams.

The tele-neurology sessions included doctor-patient interactions using real-time videoconference technology and were sometimes conducted by technician under the guidance of a neurologist. They used exhaustive history taking along with neuro-muscular examination components that showed a high sensitivity and specificity to in diagnosing patients with DN and PN. The system was called the Veteran Affairs Neuropathy Scale (VANS). It evaluated balance, gait, ankle and knee reflexes, great toe extension, foot inspection looking for fissures or ulcers, response to vibration or light touch, temperature of the limb and pinprick sensation, with possible scores ranging from 0 (no abnormalities detected) to 50 (severe abnormalities detected).

A study conducted in 2019, using the VANS to evaluate veterans, showed that the method had a 98% sensitivity and 91% specificity rate for diagnosing PN, yielding similar scores when used with both neurologists or technicians and can be used effectively for remote as well as in-patient assessments.

The American Diabetes Association (ADA) has recommended that all patients should be assessed for distal symmetric polyneuropathy starting at diagnosis of Type 2 diabetes and 5 years after the diagnosis of Type 1 diabetes and at least annually thereafter. g

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CATCHING IT EARLY: PREVENTIVE MEASURES

FOR DIABETIC NEUROPATHY

In patients diagnosed and under treatment for diabetes, keeping

the management of orthostatic hypotension. Midodrine and

diabetic neuropathy.

should be encouraged to devote time for physical activity and

blood sugar levels in a healthy range slows the development of

Simple measures like having a comprehensive, annual foot exam

exercise, for long term benefits.

performed by a healthcare practitioner is a good way to check

The Department of Veterans Affairs provides health benefits

to catch nerve damage and related problems early, only happen

with a focus on primary care and intervention for a variety of

for peripheral neuropathy. Regular foot exams, recommended

at 12 to 30% of medical appointments for people with diabetes, according to the American Diabetes Association task force on

foot health. Improving these rates may lead to early detection and intervention in cases of diabetic foot.

Following a heart-healthy lifestyle has also shown benefits in

reducing the incidence of diabetic nerve damage. Studies show

that it reduces the risks associated with autonomic nerve damage of the heart for people with Type 1 and Type 2 diabetes. In

for around 6% of persons with diabetes in the United States, health conditions. While diabetic neuropathy is known to cause detrimental effects to both the physical and mental well-being

of the veteran population, early diagnosis and intervention can drastically improve disease outcomes.

References US Department of Health and Human Services. Centres for disease control and Prevention. National Diabetes Statistics Report 2020, Estimates of Diabetes and Its Burden in the United States [Internet]. 2020.

Available from: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

Hicks, C. W., & Selvin, E. (2019). Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Current diabetes reports, 19(10), 86. https://doi.org/10.1007/s11892-019-1212-8.

addition, aerobic and cardiovascular exercise has demonstrated

Institute of Medicine (US) Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Second Biennial Update). Veterans and Agent Orange: Update 1998. Washington (DC): National Academies Press (US); 1999. 10, Neurobehavioral Disorders.

demonstrated in a trial involving diabetic veterans.

Division of Health Promotion and Disease Prevention Institute of Medicine. Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes. Chapter: Executive Summary. Washington, D.C.; National Academy Press; 1999.

an improvement in sensory fibre functions in patients with DN, as COMPREHENSIVE CARE: THERAPEUTICS

Federal Practitioner - Data Trends 2017 - 20 [Internet]. Fedprac-digital.com. [cited 2021 May 22]. Available from: https://www.fedprac-digital.com/federalpractitioner/data_trends_2017?pg=2.

MANAGING NEUROPATHIC PAIN AND DISCOMFORT

Shaw, J. G., Asch, S. M., Katon, J. G., Shaw, K. A., Kimerling, R., Frayne, S. M., & Phibbs, C. S. (2017). Posttraumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia. Paediatric and perinatal epidemiology, 31(3), 185–194.

FOR DIABETIC NEUROPATHY

At present, pregabalin and duloxetine have received regulatory approval for the treatment of neuropathic pain in diabetes by the US Food and Drug Administration (FDA), Health Canada,

and the European Medicines Agency. The opioid, tapentadol,

has regulatory approval in the US and Canada. Other opiods like

tramadol or oxycodone are effective, however, there is a high risk of addiction, abuse, sedation, and other complications even with short-term opioid use. Anticonvulsants like Gabapentin and antidepressants like Amitriptyline may also be used in some cases, to decrease the sensation of pain.

MANAGING ORTHOSTATIC HYPOTENSION

Treatment for orthostatic hypotension is challenging and usually involves both pharmacological and nonpharmacological

interventions. Volume repletion with fluids and salt is central to 54

low-dose fludrocortisone are also used with caution. Patients

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Pop-Busui R et al: Diabetic Neuropathy: A Position Statement by the American Diabetes Association.

Diabetes Care 2017;40:136–154. http://care.diabetesjournals.org/content/diacare/40/1/136.full.pdf.

Verrotti A et al. Autonomic neuropathy in diabetes mellitus. Front. Endocrinol., 01 December 2014 | https:// doi.org/10.3389/fendo.2014.00205.

Vileikyte L, Peyrot M, Gonzalez JS, et al.Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia 2009;52:1265–1273pmid:19399473.

Vileikyte L, Peyrot M, Bundy C, et al.The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument. Diabetes Care 2003;26:2549–2555pmid:12941717.

Vinik EJ, Hayes RP, Oglesby A, et al.The development and validation of the Norfolk QOL-DN, a new measure of patients’ perception of the effects of diabetes and diabetic neuropathy. Diabetes Technol Ther 2005;7:497–508pmid:15929681.

Yang, Z., Chen, R., Zhang, Y., Huang, Y., Hong, T., Sun, F., Ji, L., & Zhan, S. (2018). Scoring systems to screen for diabetic peripheral neuropathy. The Cochrane Database of Systematic Reviews, 2018(7), CD010974. https://doi.org/10.1002/14651858.CD010974.pub2.

Wilson, A. M., Ong, M. K., Saliba, D., & Jamal, N. I. (2019). The Veterans Affairs Neuropathy Scale: A Reliable, Remote Polyneuropathy Exam. Frontiers in neurology, 10, 1050. https://doi.org/10.3389/fneur.2019.01050.

Miller: How to do a 3-minute diabetic foot exam. The Journal of Family Practice, November 2014, Vol 63, No 11. http://www.mdedge.com/jfponline/article/88218/diabetes/how-do-3-minute-diabetic-foot-exam/pdf.

Patil: Opioid Use in the Management of Diabetic Peripheral Neuropathy (DPN) in a Large Commercially Insured Population. Clin J Pain . 2015 May ; 31(5): 414–424. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4391274/pdf/nihms602471.pdf.

THE POWER OF SERVICE DOGS HELP VETERANS

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

L VE

MAKE THE LONG JOURNEY HOME VETERANS AFFAIRS 90 YEARS: Military & Wellness

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By Jim Lamb Canine caregivers can learn specific tasks like assisting a Veteran prone to getting dizzy or suffering from PTSD. Properly trained service dogs can even alert veterans with diabetes when their blood sugar reaches high or low levels.

In his poem “The Power of the Dog” Rudyard Kipling wrote, “Buy a

pup and your money will buy Love unflinching that cannot lie.” Josh Billings, a 19th-century American humorist, put it this way: “A dog is the only thing on earth that loves you more than he loves himself.”

Ronald Carney, a veteran living in Texas, can attest to what Kipling

and Billings wrote. In 2017 November, Carney’s dog went missing, perhaps even stolen. But Sampson wasn’t just a pet. Or even Carney’s “best friend.” He was a service dog.

responsible for the development, monitoring and evaluation of

the standards applied within all IGDF-member organizations, and

to which all Enquiring and Applicant organizations aspire, in order to ensure equity of high-quality service to guide dog users and Handlers around the world.”

Service dogs can be trained to do specific tasks. For example, they can pick things up, guide a person with vision problems, assist a person who has hearing impairments, or help people prone to

getting dizzy, losing their balance, and falling. One Veteran even

reported that his service dog (without being told) would fetch him his prosthetic leg each morning when he wakes up.

Other impairments that can substantially limit mobility include

anxiety, depression, bipolar/mood disorders, panic attacks, stress,

Eighteen months after he disappeared, Sampson was found, and

Post-traumatic stress disorder (PTSD), personality disorders, fear/

the two were re-united.

phobias, other emotional/psychological condition.

“After about 30 seconds or so, he just started jumping on me and

Specially trained service dogs can alert veterans with diabetes

him, it was him," Carney told KCEN-TV following the reunion. “… it

be trained to remind someone to take medication. Service dogs

walking in circles and whining, and I knew right away by seeing

when their blood sugar reaches high or low levels. Other dogs can

was pretty amazing that after 18 months, he remembered me.”

can even be trained to detect the start of a seizure and help keep

It should be noted that there’s a difference between service dogs

and emotional support animals, the former is formally trained and

the veteran safe until help arrives or the seizure stops.

The benefit of the relationship between veterans and dogs is

certified; the latter, not necessarily.

well-documented. For example, Christine Hassing in her book

According to the US Department of Veterans Affairs, service dogs

stories about veterans and their four-legged friends. Each chapter

are prescribed for Veterans diagnosed with having visual, hearing, or substantial mobility impairment. Specifically, 38 CFR 17.148 states that the “VA will provide to veterans with visual, hearing,

or mobility impairments, benefits to support the use of a service

dog as part of the management of such impairments. The benefits include assistance with veterinary care, travel benefits associated

with obtaining and training a dog, and the provision, maintenance, and replacement of hardware required for the dog to perform the tasks necessary to assist such veterans.”

That doesn’t mean the VA provides guide and/or service dogs.

They do not; however, “Veterans approved for guide or service dogs are referred to accredited agencies. Many of these

organizations do not charge for the dog or the dog's training.”

The VA does provide a veterinary health insurance benefit and other

benefits in support of service dogs. To qualify, the dog must be trained

and from an Assistance Dogs International (ADI) or International Guide Dog Federation (IGDF) accredited service dog organization.

According to its website, ADI is “a worldwide coalition of not-for-

“Hope Has a Cold Nose” has put together a collection of heart-felt is dedicated to a different dynamic human-canine duo: Jacob

and Tracer, Jennifer and Onyx, Kristopher and Shera, Desiree and Chunky, to name a few.

The idea of dogs helping people is not new.

According to IGDF, “The first special relationship between a dog and a blind person is lost in the mists of time, but perhaps the

earliest recorded example is depicted in a first-century AD mural in the buried ruins of Roman Herculaneum. There are other records from Asia and Europe up to the Middle Ages, of dogs leading blind men.”

Other citations include:

• A wall-painting (circa AD 79) of a blind man apparently being led by his dog was found during the excavations in Pompeii.

• A Chinese scroll in the Metropolitan Museum (dated 1200) reveals a blind man being led by a dog.

• An Irish reference from 1260 mentions a dog guiding a blind man.

profit programs that train and place Assistance Dogs. Founded in

The ballad "Blind Beggar of Bethnal Green" (1715) tells the tale of

leading authority in the Assistance Dog industry.”

ballad’s lyrics include: g

1986 from a group of seven small programs, ADI has become the

58

Meanwhile, IGDF describes itself as “the industry-elected body

VETERANS AFFAIRS 90 YEARS: Military & Wellness

a knight who becomes a beggar after losing his sight in battle. The

VETERANS AFFAIRS 90 YEARS: Military & Wellness

59

“It was of a blind beggar, long time he's been blind, He is called the blind beggar from Bethlehem Tyne, And his marks and his tokens unto you I will tell; He's continually led by a dog, chain and bell.”

With many soldiers blinded by mustard gas in WORLD WAR I,

the role of dogs as helpers was put in the spotlight when the first canine was assigned to a German veteran, Paul Feyen, in 1916.

Within three years, there were 539 trained guide dogs.

According to the Service Dogs Registration of America, most

service dog programs train Golden Retrievers and Labradors.

Other breeds suitable for service include (but are not limited to)

German Shepherds, Border Collies, and Bernese Mountain Dogs.

It should be noted, however, that the Americans with Disabilities Act (ADA) “does not restrict the type of dog breeds that can be service animals.”

impairment that substantially limits one or more major life activities.

The American Kennel Club (AKC) points out that, “The ADA

prohibits discrimination on the basis of disability in employment,

state and local government, public accommodations, commercial facilities, transportation, and telecommunications. A service dog is trained to take a specific action whenever required, to assist a

person with their disability. The task the dog performs is directly related to their person’s disability.”

The AKC also noted that “The ADA considers service dogs to be primarily working animals that are not considered pets.”

The US Department of Justice, Civil Rights Division, Disability

Rights Section, clarifies the distinction between service animals and animals that merely “provide comfort.”

“If the dog has been trained to sense that an anxiety attack is about to happen and take a specific action to help avoid the attack or

The ADA goes on to say that, “A service animal may not be

lessen its impact, that would qualify as a service animal. However,

breed or how the animal might behave. However, if a particular

considered a service animal under the ADA.”

excluded based on assumptions or stereotypes about the animal's service animal behaves in a way that poses a direct threat to the

health or safety of others, has a history of such behavior, or is not under the control of the handler, that animal may be excluded. If an animal is excluded for such reasons, staff must still offer their goods or services to the person without the animal present.”

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By the way, “Disability” is defined by the ADA as a physical or mental

VETERANS AFFAIRS 90 YEARS: Military & Wellness

if the dog’s mere presence provides comfort, that would not be Some people may wonder, “How long does it take to train a service dog?”

Great question. Here’s a great answer from Assistance Dogs International (ADI): g

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“There is no specific time frame for training a service dog once

VA medical team will perform a complete clinical evaluation to

training. Service dog programs will have very clear training plans

dog request is reviewed and evaluated on a case-by-case basis.”

they have completed their early socialization and basic obedience for every dog. In general, service dogs are placed with their

future owners around the age of 2. Each service dog undergoes specific training (obedience, task work, etc.) for 1-2 hours a day

for a period of 6 to 24 months before they are matched with their

future owner depending on the age of the dog when they start the training process.”

Little wonder, then, that the time and money invested in training

If the veteran is eligible, “VA will pay for veterinary care and the

equipment (e.g. harness and/or backpack) required for optimal use of the dog.”

Veterinary care includes: “Prescribed medications, office visits

for medical procedures, and dental procedures where the dog is

sedated (one sedated dental procedure will be covered annually).

certified service dogs are not inconsequential.

Vaccinations should be current when the dog is provided to the

“The cost of training a service dog can exceed $25,000,” says the

will be covered by VA. Prescribed food will be reviewed on a case-

AKC. “This may include training for the person with a disability

who receives the dog and periodic follow-up training for the dog to ensure working reliability. Some organizations provide service dogs to disabled individuals at no cost or may offer financial aid for people who need, but cannot afford, a service dog. Other organizations may charge fees for a trained dog.”

Veteran through an accredited agency. Subsequent vaccinations by-case basis.”

Veterinary care does not include over-the-counter medications, food, treats and non-sedated dental care.

It’s also important to know that “Flea and tick medications are considered over-the-counter and are the responsibility of the

The AKC offers this advice for choosing a service dog candidate.

Veteran along with over-the-counter dental care products.

• Be calm, especially in unfamiliar settings

Veterans with medically approved service dogs can be enrolled in

They should:

Grooming, boarding and other routine expenses are not covered.”

• Be alert, but not reactive

a contracted veterinary health insurance policy to cover:

• Have a willingness to please

• Comprehensive veterinary services for their service dog

• Be able to learn and retain information

• Annual visits for preventive and maintenance care (i.e.,

•B e capable of being socialized to many different situations and environments

• Be reliable in performing repetitive tasks Of course, veterans should make sure they are actually eligible

to receive medical services through the VA before they explore the possibility of obtaining a service dog. This can be done by

registering at the Health Administration/enrollment section of a VA Medical Center.

“Once registered, a referral to a specialist may be requested

through the assigned VA primary care provider. The Veteran's 62

determine how best to assist the Veteran. Each guide and service

VETERANS AFFAIRS 90 YEARS: Military & Wellness

immunizations, dental cleanings, screenings, etc)

• Urgent/emergent care • Prescription medications •C are for chronic illnesses and/or disorders to enable the dog to perform its duties in service to the Veteran

•E nrollment in VHIB (Veterinary Health Insurance Benefit) eliminates the need for VA pre-authorization

VA policy states that “Service dogs are allowed on VA owned or

leased property. Only dogs that are individually trained to do work

or perform tasks for the benefit of an individual with a disability are g

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considered service animals. There are no restrictions on the breeds of dogs that may be considered service animals.”

Rules and regulations are key to facilitate matching up each veteran

with an appropriate service animal and that means filling out the proper paperwork, getting involved in the selection process, and participating in the required training procedures. But, at the end of the day, it’s the

relationship between the dog and the Veteran (and their ability to work together) that determines success.

For example the case of Philip Bauer, who was interviewed for

Westchester Magazine, based in Rye, New York. Bauer benefited from

a program offered by East Coast Assistance Dogs (ECAD), a non-profit group that trains and provides service dogs.

“We found out there were a lot of veterans who had a hard time getting

out of their homes, being part of society,” says program director Barbara

Jenkel. “So far we’ve given 20 dogs to veterans from all over the country.

All of them have some form of PTSD, some have TBI (Traumatic brain Injury), loss of limbs, bad backs.”

Bauer is one of those Veterans. He lost a leg after the helicopter in which he was flying was shot down on a flight to Baghdad. Eighteen died; 15

survived. Bauer’s right leg was too burned and broken to save, and it was amputated below his knee.

“I became an amputee on Thanksgiving morning of 2003,” Bauer told

Dana White of Westchester Magazine. “I took my retirement, went home, and spent the next five and a half years trying to kill myself in one shape or form.”

Then, thanks to ECAD, Bauer met Reese, a Golden Retriever, who helped turned the Veteran’s life around, so much so that Bauer eventually joined ECAD’s staff.

“Reese helps me go into public, to not feel quite so awkward. In crowds

he blocks and covers for me,” Bauer told the magazine. “He picks things up for me, turns on the lights for me, brings me my leg if it’s across the room. He always looks like he actually cares.”

Kendra Meinert of the Green Bay Press-Gazette in Wisconsin spoke with Sylvia Bowersox, an Army Veteran who suffered from traumatic brain

injury and severe post-traumatic stress disorder, among other diagnoses.

“They had me on just bizarre, bizarre medications. I was a zombie. I was an absolute zombie. I wasn’t functioning,” Bowersox said. “I was just

beside myself, because I am not bipolar. They kept upping my doses, so I did not have a quality of life at all. I was desperate.”

Then Bowersox, thanks to Little Angels Service Dogs which trains canines on a ranch near San Diego, meet Timothy, a British Labrador.

“Timothy is my baby. He’s my fur baby. He’s my child,” Bowersox said to Meinert. “He tells me when I’ve had enough and I have to go walk around the building. He paws at me when I’m freaking out.” g 64

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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Brandon Lewis served in the Marines a dozen years, which

According to the National Veteran Suicide Prevention Annual

and PTSD forced him into a medical retirement.

including 6,435 US Veterans. Social Connection and Isolation are

included three deployments in Iraq, but a traumatic brain injury “I was a little upset about it because I loved the Marine Corps,”

two of the societal factors involved:

he told Margaret Myers of The Renewal Project, which shares

Isolation is a risk factor for suicide, which is a significant

their communities.

of COVID-19.

stories of individuals and organizations who solve problems in

concern given social-distancing practices to reduce the spread

Lewis said he suffered from migraines and dizziness; he tried

Among VHA patients, suicide rates are highest among those who

then he met a black Labrador named Boothe. Since pairing up

among those who are married.

counseling and medication, but was unhappy with the results, with his service dog, Lewis has been able to cut down on his

meds, and the number of his migraines have declined. He’s now

are divorced, widowed, or never married, and rates are lowest

Suicide rates are elevated among individuals residing in rural areas.

working as a liability claim adjuster.

But there’s a sliver of good news:

Army veteran Becca Stephens also has a story. She told it to Julia

“The data shows the rate of suicide among Veterans who

LeDoux. It was published on the Connecting Vets website.

“I had a lot of great experiences, but Iraq really took the wind out of my sails,” Stephens told LeDoux. “It was kind of like a whirlwind for me.”

The situation went from bad to grim but, eventually, there was a source of sunshine just around the corner. It came from a

little service dog named Bobbi, who ending up making all the difference in the world.

The stories of Stephens, Lewis, Bowersox, and Bauer are

encouraging, they faced substantial obstacles, but each became

an overcomer with the help of trained and certified service dogs: Bobbi, Boothe, Timothy, and Reece.

66

Report (2020) 46,510 American adults died from suicide in 2018,

VETERANS AFFAIRS 90 YEARS: Military & Wellness

recently used VA health services has decreased, an encouraging sign as the department continues its work and shares what

we learn with those who care for and about Veterans,” said VA Secretary Robert Wilkie.

The fact that there’s a positive connection between using VA

health service and declining suicide rates is a great reason for

Veterans in need to do their homework regarding service dogs.

Here is a key point to remember: Though VA does not provide service dogs, it does approve Veterans for referral to Assistance Dogs International accredited agencies or International Guide Dog Federation accredited agencies. g

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Once referred, dogs and veterans must successfully complete a training program offered by these accredited agencies. (VA will recognize these completions for the purpose of paying stipulated benefits).

Veterans with hearing, guide, and/or mobility issues should meet with their

VA Clinical Care Provider to begin the application process for VA Veterinary Health Benefits. Veterans with mental health mobility issues should meet

with a VA Mental Health Provider to begin the application process for VA Veterinary Health Benefits.

Regardless of the service for which it is trained, whether to aid the seeingimpaired, help the hearing-impaired, or steady those suffering from

dizziness or PTSD, properly trained and certified service dogs consistently under-promise and over-deliver.

People who love dogs seem able to grasp the ability of canines to connect and make a difference. Best-selling author and self-admitted dog lover Dean Koontz summarized it this way:

“No matter how close we are to another person, few human relationships are as free from strife, disagreement, and frustration as is the relationship you have with a good dog. Few human beings give of themselves to another as a dog gives of itself.”

That statement is even truer for service dogs.

Jim Lamb is a retired journalist living in Florida. He has four dogs.

VA HOM

THE INSIDE SCOOP ON VA LOANS

know what to expect pricewise. The more amenities and

look to achieve at some point in their life. Statistics show that

in how valuable a real estate purchase can be. Now with, when

The journey to becoming a homeowner is a dream most adults homeownership is a major difference in financial affluence and wealth generation. It is also true that most wealth is passed down through generations via a real estate transfer. These two facts indicate the importance for potential home buyers to educate themselves about the process and properly prepare themselves for the responsibility involved. The more you know about real estate the more likely you are to make sound decisions when you are ready to purchase. We have met many people who were simply unaware of the programs available to them. These programs expand far and wide, but particularly

conveniences available to the area can truly make a difference you are seeking a loan from the VA, through one of their loan programs knowing the details of the area will help you explain your purchase and could ultimately provide some insight that supports the loan being offered.

THE FUNDING PROCESS

Most new homeowners’ biggest concern during the purchasing process is usually if they will have the money to secure the purchase. When you are purchasing a home, in most cases you will be asked to make a down-payment, this

for veterans, the VA has a lot to offer.

can range anywhere from 5%-20% depending on your credit

Before we dive into the programs offered by the VA, it is

This is where the VA Loan program provides advantages to

important that we take into consideration some vital aspects of the home buying process. As a home seeker, it is your responsibility to do the necessary research to ensure you make the best investment possible. The best way to do that is by

score and other factors your financial institution will disclose. those who qualify.

BENEFITS OF A VA HOME LOAN

If you are an ex-soldier or family member to a veteran,

having a clear understanding of the market, in these uncertain

you should know everything you can about acquiring VA

times, not having a clear game plan and market analysis could

Home Loans. These can be used for various reasons but for

create unwanted complications.

purchasing loans. These kinds of loans help you purchase a home at a competitive interest rate, often, these loans can

70

You identify the market by taking a closer look at the area

be given with little to no down payment or mortgage

you desire to buy in, knowing this information will help you

insurance required.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

ME LOANS VA Home loans can also

be used as a “Cash-out Refinance” loan. These loans allow you to extract cash from your home's equity, this can be used specifically for redeveloping your home, paying off personal debt, or even funding higher education or a business for your family. These advantages highlight how important homeownership is to the fabric of a growing family. The VA Loan program touts itself as a true champion for equal access to homeownership in which prioritizing the men and women who fight for our country is first and foremost.

FINDING LENDERS

Depending on your location, finding a lender who provides the VA loan can be tricky. We will suggest some of the more popular organizations in this section. The more you learn about homeownership, the more you realize how important the lender is to the process. Once you have locked down a lender and an amount qualified for your loan you are now one giant step closer

If you are an ex-soldier or family

member to a veteran, you should know everything you can about acquiring VA Home Loans.

BEST LENDERS BEST BANK FOR VA LOANS: USAA

BEST CREDIT UNION FOR VA LOANS: Navy Federal Credit Union

BEST ONLINE MORTGAGE COMPANY FOR VA LOANS: Quicken Loans

BEST VA REFINANCE COMPANY: Freedom Mortgage

BEST VA LOAN LENDER OF 2019: Veterans United

to making the purchase. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

71

DETERMINING ELIGIBILITY

CREDIT REQUIREMENTS

The application process is not overly complicated when applying

be considered eligible. The lenders tend to require a score of

for a VA home loan. You may qualify by meeting one or more of

640 so homebuyers should take that into consideration prior

the following requirements:

to applying.

How do you qualify for a VA Home Loan?

The VA does not set a minimum credit score requirement to

• You have served 90 consecutive days of active service during wartime

In addition to credit score, the VA requires borrowers to maintain

• You have served 181 days of active service during peacetime

a certain amount of income left over each month after all

• You have 6 years of service in the National Guard or Reserves

major expenses are paid. Through the enforcement of these

• You are the spouse of a service member who has died in the

residual income requirements, the VA increases the chances

line of duty or because of a service-related disability

of its borrowers earning sufficient income to meet all financial obligations, and ensures borrowers have a cushion in the event of

These requirements set the table for your approval but are not the sole factors for you qualifying for a loan. You will also need to provide debt to income ratio that indicates your ability to afford the home. For active-duty officers, this is typically not a

an emergency.

AVOID GETTING DENIED FOR THE LOAN

Denied applications happen all the time, to avoid having to redo

concern but for non-active vets providing this can become a

the process repeatedly there are a few things you can do to

headache, so it is best you consult with your loan expert to iron

ensure your application is properly completed and submitted.

out the details.

You must remember the more details you can provide about your

WHAT IS THE DEBT-TO-INCOME RATIO?

This ratio is the determining factor if you qualify for VA Loans.

potential investment the more the lenders will be willing to work with you. We were able to gather the most notable reasons your application can be denied by a VA home loan lender.

The acceptable debt-to-income for a VA loan is 41%, according to the Veteran Affairs website. The debt-to-income ratio refers to

• Application errors. Double-check your loan paperwork

the percentage of your gross monthly income that goes toward

• Change in employment. Keep your employment consistent

debts. Simply put it is the ratio of your monthly debt compared

72

throughout the loan process. Change in credit

to your monthly income. This will show a lender you have the

• Borrower Delays

necessary funds available to sustain the investment.

• Factors beyond your control g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Your credit score can help you access more funds, so it is

and NGB Form 23 for National Guard and Reserves. However,

important to hold off on other credit applications during the

this isn’t always the case. See the required forms for each

purchasing process to be sure your score doesn’t change

service type below.

before the process is complete. Once your application is completed and submitted you can then move forward into

These are the documents your lender may require:

the next stages.

Veteran

WHAT DO YOU NEED TO BE ELIGIBLE

The first step is presenting your Certificate of Eligibility (COE) to provide confirmation that you have qualified for VA loan benefits. This is essential to the process; the majority of lenders will want to access your COE through the automated system.

You can obtain your COE by doing these: • Applying through a VA approved lender • Applying online through the VA’s eBenefits portal • Applying by mail with VA Form 26-1880

DD Form 214 (Report of Separation) Current or Former Activated National Guard or Reserves DD Form 214 (Report of Separation) Active Duty

Statement of Service Current National Guard or Reserves (Never Activated) Statement of Service

Discharged National Guard (Never Activated)

NGB Form 22 (Report of Separation and Record of Service) and NGB Form 23 (Retirement Points Accounting and proof of the character of service)

Once you have applied, a specialist can walk you through the next phase of the process. These work to ensure your

Discharged Reserves (Never Activated)

Army Reserve: DARP Form FM 249-2E or ARPC Form 606-E

information is found to be correct and enable the lender to

Navy Reserve: NRPC 1070-124. Air Force Reserve: AF 526

move forward with the home buying process without delays.

Marine Corps Reserve: NAVMC HQ509 or NAVMC 798 Coast Guard Reserve: CG 4174 or 4175

Each military branch may require different documents, but these are typically the most important to start the VA loan process.

UNDERSTANDING THE CLOSING COST

Once you have successfully qualified for your VA Home Loan your journey to finding your home begins. This is the best part

74

Proof of service to obtain your COE often comes in the form

of the process but there is always underlying cost that needs to

of the DD Form 214 for regular military, and the NGB Form 22,

be accounted for so you are not stretching yourself too thin. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

A unique benefit of the VA loan program is the ability for the homebuyer to add in the closing costs to the sellers. Although this is not a requirement of the seller, the ability to suggest provides leverage for homeowners to get all or even a portion of the cost covered. Every dollar counts especially if repairs and amenities are needed to make the home livable. Here are a few of the more common closing costs associated with the VA Loan.

Origination Charge: This is a charge the VA allows lenders to

initiate for origination, processing, and underwriting cost. This can be charged as a flat fee of 1% for origination or charge for any applicable fees if it adds up to no more than 1%. If the lender is not charging the flat 1% fee, then VA buyers can pay some fees that would otherwise be unallowable.

Appraisal Fee: An appraisal fee is a requirement for VA buyers.

Appraisals can cost around $525, but costs can vary significantly depending on where you're buying. These upfront costs are set by the VA, not the lender. You can get a look at the current appraisal fees for your state at the VA's website.

Title Charges: Title insurance protects lenders and homebuyers if liens, legal defects, or other title-related issues are discovered after closing. Lenders tend to require title insurance, which ensures the interest of the property is protected. This one-time fee should ensure your asset is covered.

Discount Points: This process means you are simply paying

more upfront money to decrease the interest rate. Also known as a “permanent buydown,” it is an option provided to VA buyers.

Credit Report: Some lenders have fees for accessing your credit

report that will be applied. This cost should not be more than $50 but it is out of pocket expense to consider during your process.

Well, Septic and Termite Inspection Fees: Inspection fees

are a major part of the process. You must inspect every area of your potential asset to ensure you aren't overpaying or setting yourself up for future financial obligations. VA buyers do not pay the termite inspection fee but may need to shell out cash for any repairs and stemming from a well, septic, or termite problems.

LATEST UPDATES TO THE VA HOME LOAN PROGRAM

The CARES Act was passed to help combat complications caused by the pandemic. The changes have affected the VA buyer just as it has everyone else. The CARES Act allows borrowers with 76

VETERANS AFFAIRS 90 YEARS: Military & Wellness

government-supported loans, including VA loans to request special forbearance. This is an agreement between you and your mortgage servicer, allowing delayed payments or partial payment for one or more months. This will all be determined by your lender.

SOME COMMON QUESTIONS ABOUT VA LOANS

The closer you get to your closing date the more questions you will have, for many VA buyers have little knowledge of real estate so they may miss key caveats that can ensure the stability of their investment.

Can I possess multiple VA loans simultaneously?

In some situations, two VA loans are allowed. Those eligible can qualify for a new VA loan even if they have previously defaulted on one. This is a wide misconception that VA buyers should be aware of.

What can I use my VA loan for?

VA housing assistance is tailored to veterans, service members, and their surviving spouses. This aids our servicemen and women by providing finances to buy or refinance your loan.

The VA program can also be applied to home repairs, moving expenses, and other distinct situations. Now your reasoning must be provided but there is always room to take advantage of the caveats in the VA loan program.

Most VA buyers lack the knowledge necessary to help them gain the funding they desire. Therefore the loan program is essential, it pairs the homebuyer with a professional and it allows veterans to come back home from their duties and live the life they were promised. Homeownership is a powerful aspect of life that every individual can take advantage of to grow wealth and secure their families for generations. The VA provides the ammunition you need to reach this goal with as little money needed as possible.

HISTORY & TIMELINE I t has been heralded as one of the most significant pieces of legislation ever produced

by the federal government—one that impacted the United States socially, economically, and politically. But it almost never came to pass.

The Servicemen’s Readjustment Act of 1944 commonly known as the GI Bill of Rights—

nearly stalled in Congress as members of the House and Senate debated provisions of the controversial bill.

Some shunned the idea of paying unemployed Veterans $20 a week because they thought it diminished their incentive to look for work. Others questioned the concept of sending battle-hardened Veterans to colleges and universities, a privilege then reserved for the rich.

Despite their differences, all agreed something must be done to help Veterans assimilate into civilian life.

Much of the urgency stemmed from a desire to avoid the missteps following WORLD WAR I, when discharged Veterans got little more than a $60 allowance and a train ticket home.

During the Great Depression, some Veterans found it difficult to make a living. Congress tried to intervene by passing the World War Adjusted Act of 1924, commonly known as the Bonus Act. The law provided a bonus based on the number of days served. But there was a catch: most Veterans would not see a dime for 20 years.

A group of Veterans marched on Washington, DC, in the summer of 1932 to demand full payment of their bonuses. When they did not get it, most went home. But some decided to stick around until they got paid. They were later kicked out of town following a bitter standoff with US troops. The incident marked one of the greatest periods of unrest our nation’s capital had ever known. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

77

The return of millions of Veterans from WORLD WAR II gave

instead opted for education. In the peak year of 1947, Veterans

Congress a chance at redemption. But the GI Bill had far greater

accounted for 49 percent of college admissions. By the time the

implications. It was seen as a genuine attempt to thwart a

original GI Bill ended on 25 July 1956, 7.8 million of 16 million

looming social and economic crisis. Some saw inaction as an

WORLD WAR II Veterans had participated in an education or

invitation to another depression.

training program.

Harry W Colmery, a former national commander of the American

Millions also took advantage of the GI Bill’s home loan guaranty.

Legion and former Republican National Chairman, is credited with drawing up the first draft of the GI Bill. It was introduced in the House on 10 January 1944, and in the Senate the following day. Both chambers approved their own versions of the bill.

But the struggle was just heating up. The bill almost died when Senate and House members came together to debate their versions. Both groups agreed on the education and home loan

WORLD WAR II Veterans.

While Veterans embraced the education and home loan benefits, few collected on one of the bill’s most controversial provisions—the unemployment pay. Less than 20 percent of funds set aside for this were used.

benefits but were deadlocked on the unemployment provision.

In 1984, former Mississippi Congressman Gillespie V "Sonny"

Ultimately, Rep. John Gibson of Georgia was rushed in to cast

the "Montgomery GI Bill" ever since, assuring that the legacy

the tie-breaking vote. The Senate approved the final form of the bill on 12 June, and the House followed on 13 June. President Franklin D Roosevelt signed it into law on 22 June 1944.

The Veterans Administration (VA) was responsible for carrying out the law’s key provisions education and training, loan guaranty for homes, farms or businesses, and unemployment pay.

78

From 1944 to 1952, VA backed nearly 2.4 million home loans for

Montgomery revamped the GI Bill, which has been known as of the original GI Bill lives on, as VA home loan guaranty and education programs continue to work for our newest generation of combat Veterans.

In 2008, the GI Bill was updated once again. The new law gives Veterans with active-duty service on, or after, 11 September 2001, enhanced educational benefits that cover more

Before the war, college and homeownership were, for the most

educational expenses, provide a living allowance, money for

part, unreachable dreams for the average American. Thanks

books and the ability to transfer unused educational benefits to

to the GI Bill, millions who would have flooded the job market

spouses or children. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Start Your Next

MISSION

At the #1 Choice of Veterans Using GI Bill® Benefits1

Maximize your GI Bill® benefits as you explore opportunities to turn your military service, professional training, or job experience into college credit at American Military University (AMU).

Finish What You Started Learn more at AMUonline.com/VAMag 1

Based on FY 2019 Department of Defense tuition assistance and Veterans Administration student enrollment data, as reported by Military Times, 2020.

GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official website http://www.benefits.va.gov/gibill.

American Military University is part of American Public University System, which is accredited by the Higher Learning Commission (hlcommission.org) and certified to operate by SCHEV. American Military University is not affiliated with the U.S. military. For more about our graduation rates, the median debt of students who complete a program, and other important information, visit www.apus.edu/disclosure.

President Franklin D Roosevelt signs the GI Bill into law.

President Franklin D Roosevelt’s Statement on Signing the GI Bill, 22 June 1944.

This bill, which I have signed today, substantially carries out most of the recommendations made by me in a speech on 28 July 1943, and more specifically in messages to the Congress dated 27 October 1943, and 23 November 1943: It gives servicemen and women the opportunity of resuming their education or technical training after discharge, or of taking a refresher or retrainer course, not only without tuition charge up to $500 per school year, but with the right to receive a monthly living allowance while pursuing their studies.

It makes provision for the guarantee by the Federal Government of not to exceed 50 percent of certain loans made to veterans for the purchase or construction of homes,

with promptness and efficiency.

With the signing of this bill a well-rounded program of special veterans’ benefits is nearly completed. It gives emphatic notice to the men and women in our armed forces that the American people do not intend to let them down.

By prior legislation, the Federal Government has already provided for the armed forces of this war: adequate dependency allowances; mustering-out pay; generous hospitalization, medical care, and vocational rehabilitation and training; liberal pensions in case of death or disability in military service; substantial war risk life insurance, and guaranty of premiums on commercial policies during service; protection of civil rights and suspension of enforcement of certain civil liabilities during service; emergency maternal care for wives of enlisted men; and reemployment rights for

farms, and business properties.

returning veterans.

It provides for reasonable unemployment allowances payable

This bill therefore and the former legislation provide the

each week up to a maximum period of one year, to those veterans who are unable to find a job.

It establishes improved machinery for effective job counseling for veterans and for finding jobs for returning soldiers and sailors.

It authorizes the construction of all necessary additional

80

enable it to discharge its existing and added responsibilities

special benefits which are due to the members of our armed forces – for they "have been compelled to make greater economic sacrifice and every other kind of sacrifice than the rest of us and are entitled to definite action to help take care of their special problems." While further study and experience may suggest some changes and improvements, the Congress

hospital facilities.

is to be congratulated on the prompt action it has taken.

It strengthens the authority of the Veterans Administration to

Article provide by https://www.benefits.va.gov/gibill/history.asp.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

R O N HO ES O R E H

OUR

FAMILY MEALS BENEFIT MILITARY FAMILIES

As the home of famous chicken, biscuits and Legendary Iced Tea®, Bojangles has been feeding families delicious Southern meals for more than 40 years. Now, we’re taking our meals to benefit families in a new way through a partnership with Folds of Honor, a nonprofit organization that provides educational scholarships to families of fallen or wounded soldiers. With every Camo-themed Big Bo Box® that includes an 8, 12 or 20-piece family meal sold, Bojangles will donate $1 to Folds of Honor, up to $750,000. It’s our way of showing thanks and appreciation to our military. For more information, go to www.bojangles.com/foh.

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

GIVING A VOICE TO

WOMEN

VETERANS

By Linda Maloney, CEO of Women Veteran Speakers

Ensign Linda Maloney in Navy flight training with her class, circa July 1987

THE EARLY YEARS

I knew as a child growing up that life held more for me than staying in my hometown, that I would do something. After high school, at 17 years old, I joined the Navy enlisted as an air traffic controller. My first duty station was Ford Island, Hawaii. Eight months into my tour, my supervisor, Senior Chief Dickinson, encouraged me to apply for an officer program, and I was accepted. I still wish to this day that I could thank him for seeing something in me that I didn’t see in myself and encouraging me to shoot for the stars. I left for an eighteen-month college preparatory program in San Diego, California, then received a Navy Reserve Officers’ Training Corps (ROTC) scholarship at the University of Idaho and started college in the fall of 1982.

Four and a half years later, I graduated with a degree in computer science and received my commission as a Navy ensign. Soon after, I started Naval Flight Officer (NFO) training in Pensacola, FL in the summer of 1988. NFOs handle an aircraft’s communications and navigation gear, the radar and weapon systems. In most of my flight school classes, I was the only woman. On one of my very first days of training, a flight instructor directed me to stand up and tell the class a joke. Not a jokester, I failed at this first test! Regardless, I enjoyed flight training and did well. Although I went through the same flight training as

my male contemporaries, I did not have many choices of where to go once I graduated, even though I graduated at the top of my class. This was due to the combat exclusion law, which prohibited women from flying in combat.

NUGGET

I was assigned to VAQ-33 in Key West, Florida, to fly the EA-7, a two-seat variant of the single-seat A-7, used to simulate enemy radars and enemy missiles to train Navy ships and combat aviators in electronic countermeasures. The squadron was one of two Navy squadrons that provided this type of training. It wasn’t frontline combat, and I was frustrated to be relegated to what I thought was a second-rate squadron. New aviators in a squadron are called “Nuggets” and even though I was flying in support squadrons, I was thrilled to be a “Nugget.” But I wanted to fly in combat, not a support squadron.

A year after flying the EA-7L, I requested a transition to the two-seater EA-6A, a vintage combat A-6 Intruder aircraft, also g VETERANS AFFAIRS 90 YEARS: Military & Wellness

83

LT Linda Maloney and her squadron mates (VAQ-135), USS Abraham Lincoln, circa June 1995

have control; EJECT!” I pulled the lower ejection handle and remember a flurry of yellow papers (from my kneeboard card) flying around, and then my ejection seat exploding through the canopy glass. The pilot ejected seconds later.

I lost consciousness briefly. When I came to, I was hanging in my parachute, descending toward the ocean. In the water, I climbed into my raft. About an hour later, I was rescued by a helicopter search-and-rescue swimmer, AT2 Steven Wishoff. In the helicopter, we traded name patches, and I still have his nametag preserved in a scrapbook with all of my military memorabilia.

I sustained no major injuries following the ejection and I was

utilized in an electronic training role with an expanded role for the naval flight officer. There were a handful of women aviators in my squadron. One of my favorites was LT Kara Hultgreen.

Kara was an A-6 pilot, tall, competitive and with an amazingly funny wit. A few months after training in the EA-6A, I went on a weekend cross-country flight with Kara. A couple of hours after leaving Key West, we stopped for fuel at a North Carolina Marine Corps base. I climbed down the aircraft steps toward the Marine Corps ground crew, comprised of all men. Every one of them stared when I removed my helmet and my long hair tumbled out. Because there were few women flying military aircraft at the time, I was accustomed to long stares and unusual questions.

One man asked, “You don’t fly this aircraft, do you?” I said, “No, but she does,” motioning toward Kara as she climbed down her side of the aircraft and took off her helmet. We laughed about our “unmanned flight,” went about our business of getting the jet refueled and serviced, and, shortly thereafter, climbed back in, waved goodbye to the ground crew, and continued on our flight.

THE EJECTION

In February 1991, I flew with a senior pilot, LCDR Stan Parsons, alongside another EA-6A, providing missile simulations training for the USS Forrestal about one hundred miles off the Florida coast. Afterward, we headed to a nearby Air Force base to refuel, but as we started our climb to 15,000 feet, the plane appeared sluggish, and the pilot grew concerned.

One of the hydraulic lights illuminated, indicating a hydraulic failure. I pulled out my pocket checklist, started the emergency procedures with the pilot, and, radioing the air traffic controller, declared an emergency. We changed course and headed to a Navy base, so we could make an arrested landing, because we potentially could not slow the aircraft down after landing, due to the hydraulic failure. However, before we could finish our emergency procedures, the aircraft started to slowly roll to the right, and more hydraulic lights illuminated. The pilot tried to steady the jet, but it continued to roll. The pilot said, “I don’t

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

back up flying a few weeks later and felt some trepidation climbing up into the cockpit. Unbeknownst to me, I was the first woman to eject from the Martin Baker Ejection Seat out of 6,000 previous ejections. Weeks later, I received a call from a Martin Baker representative congratulating me on a successful ejection.

He also asked me if I wanted the commemorative Martin Baker Tie that they bestowed upon all Martin Baker ejectees, or something else since I was their first woman ejectee. Not sure if I wanted a tie, I left it up to the company. Soon after, I received a letter in the mail inviting me to England to officially receive a Martin Baker Pewter Pin specially designed for the first woman ejectee, to be presented by Diana, Princess of Wales. The Navy denied my request to travel to England for the presentation, stating that military members couldn’t be perceived as endorsing a company or product.

FINALLY – THE TRANSITION TO A COMBAT SQUADRON Finally, in April 1993, I got my wish, the combat exclusion law was repealed. I joined a combat squadron, VAQ-135, “Black Ravens” at Naval Air Station Whidbey Island, WA the following year and flew in the EA-6B “Prowler.” My squadron was assigned to the USS Abraham Lincoln, the first west coast aircraft carrier, affectionately known as the “boat” with women aviators. We were part of Carrier Air Group Eleven which included several other aircraft squadrons.

My good friend, Kara, from my previous squadron in Key West, was assigned to the F-14 squadron on the Lincoln. Before

departing for a 6-month cruise to the Persian Gulf, we spent several short detachments on the Lincoln becoming carrierqualified and conducting training flights. One evening after flight ops, in July 1994, a few of the women aviators were

sitting together in Kara's room. This was the first time since we all joined our fleet squadrons and were on the boat together.

We sat in Kara's room in our flight suits sharing our flying

experiences during our first day on the boat. Kara was her

usual gregarious self, exclaiming, "this is so cool" moving her g

(continued on page 88)

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LASIK: LET’S TAKE A CLOSER

SO,

WHAT EXACTLY IS LASIK? LASIK is an advanced, safe and effective1 type of laser vision correction that uses the measurements of your eye and highly accurate light energy to reshape the cornea—improving your eyesight and freeing you from wearing glasses and contacts. 95% of patients reach 20/20 UCVA.2

Discover a brighter future and freedom from glasses and contacts with the technology of the WaveLight® Refractive Portfolio.

Important Patient Information about the WaveLight® Excimer Laser Systems Caution: Federal (U.S.) law restricts the WaveLight® Excimer Laser Systems to sale by or on the order of a physician.

Alternatives to LASIK: LASIK is just one option for correcting your vision. Alternative options include eyeglasses, contact lenses, photorefractive keratectomy surgery (PRK), and other refractive surgeries.

Be sure to talk to your doctor to find out if LASIK is appropriate for your condition.

Indications: FDA has approved the WaveLight® Excimer Laser Systems for use in laserassisted in situ keratomileusis (LASIK) treatments for nearsightedness (myopia), farsightedness (hyperopia), and astigmatism, including mixed astigmatism.

Attention: Ask your doctor for a copy of the current Patient Information Booklet for your procedure for a complete listing of the indications, contraindications, complications, warnings, precautions, side effects, and clinical study summaries

In addition, the WaveLight® Excimer Laser Systems, when used with the WaveLight® TOPOLYZER® Devices are approved for topography-guided LASIK treatments for the reduction or elimination of up to -9.00 diopters of nearsightedness, or for the reduction of elimination of nearsightedness with astigmatism with up to -8.00 diopters of nearsightedness and up to -3.00 diopters of astigmatism.

Adverse Events and Complications: Common risks of LASIK procedures include: • Developing dry eye syndrome, which can be severe; • The possible need for glasses or contact lenses after surgery; • Visual symptoms including halos, glare, starbursts, and double vision, which can be debilitating; and • The loss of vision.

The WaveLight® Excimer Laser Systems are only indicated for use in patients who are 18 years of age or older (21 years of age or older for mixed astigmatism), who have documented References: evidence that their refraction did not change by more than 0.50 diopters during the year before 1. Alcon data on file, 2018. their preoperative examination.

2. Alcon data on file, 2014.

Getting to 20/20 – can LASIK correct your vision?

With advanced LASIK technologies like Contoura® Vision, people can achieve better vision than they could with contact lenses or glasses.*1 You’ve probably heard about LASIK surgery but what is it and who can get it? In the Q&A below, two military doctors – Dr. Mark C. Lobanoff, MD and Dr. Karl G. Stonecipher, MD – answer common questions about LASIK and how it benefits tens of thousands of service men and women each year.

Dr. Mark C. Lobanoff, MD

of North Suburban Eye Specialists

What is LASIK surgery?

Dr. Lobanoff: LASIK surgery is a painless, rapid-healing, life-changing procedure that improves vision and provides freedom from glasses and contact lenses. This simple procedure involves two lasers. First, a femtosecond laser creates a thin flap on the front surface of the eye. Then an excimer laser reshapes the deeper cornea, making it the correct shape for that eye. The treatment is designed to allow light entering the eye to be perfectly focused on the retina for excellent vision without the need for glasses and contact lenses.

Even higher levels of precision and personalization can be achieved with the latest technology. One such treatment is called Contoura® Vision, which uses a topography-guided correction. This treatment has the potential to increase your ability to see fine detail and in many patients can give better vision than even contact lenses or glasses.*1,2

What is the procedure like?

Dr. Stonecipher: With nearly hundreds of thousands LASIK procedures performed annually, it is extremely safe and predictable.3 Personally, I have performed over 79000 laser vision correction procedures and I have had LASIK myself. LASIK surgery can help our nation’s servicemen and women to be less encumbered by glasses and contacts during their duties in all conditions.

The treatment takes only minutes from start to finish; however, the eye exam and other highly advanced diagnostic tests might last a few hours to create your personalized plan.

LASIK is typically not painful with minimal postoperative discomfort and recovery is rapid with little downtime. In fact, many patients return to work the next day.

How much does it cost?

Dr. Lobanoff: LASIK in the civilian world is approximately $2000 to $3000 per eye depending on the amount of tests needed to determine your candidacy and to create your surgical plan.4 Military benefits may allow this treatment for active duty with command authorization free of charge.

Who is a good candidate for LASIK?

Dr. Stonecipher: Patients 18 years of age and older can receive LASIK

Dr. Karl G. Stonecipher, MD of Laser Defined Vision Clinical Associate Professor of Ophthalmology, UNC

surgery. The best candidates for treatment are those with healthy eyes and bodies, free from eye disease and free from systemic bodily diseases that can slow proper healing. Patients with signs of cataracts or other ocular conditions are often provided other alternatives for their specific condition.

Who should not get LASIK?

Dr. Lobanoff: Your eye surgeon and medical professionals can provide great guidance in this area. Those with glaucoma, rare corneal dystrophies and other eye conditions can be assessed by the surgeon for best options of vision correction. Diseases such as autoimmune disorders and other systemic diseases will be evaluated for the progression of their specific condition prior to undergoing consideration for a LASIK treatment.

Fortunately, most patients are good candidates for the surgery.

What feedback do you get from vets that are active service members after LASIK surgery?

Dr. Stonecipher: When speaking with veterans, I hear positive reports and stories from their LASIK experience that range from being free from contact lenses in dusty training to the freedom they experience while using night-vision goggles. Pilots feel that LASIK vision has been life changing. I have operated on many of our special forces with comments like: “Now I am more confident in performing my duties.”

What should a patient expect after LASIK surgery?

Dr. Lobanoff: One of the most amazing things about LASIK is that you see instant results. After surgery, when a patient looks around and can see without their glasses, they know their vision has improved. A majority of the healing takes place the first night – and by the morning after LASIK the patient can typically drive, work, and can go back to regular daily routines.

If they have been treated with the latest technology, Contoura® Vision, studies show that the eyes will continue to improve for up to a year after the surgery.5 For more information please visit www.YourLASIKSolution.com. With any surgical procedure, there may be risks involved. As your doctor about the risks and benefits of vision correcting surgeries and read the Important Patient Information on the opposite page.

References *Study description: Prospective, nonrandomized, multicenter study of 249 eyes with myopia (up to -9D) or myopic astigmatism of 6.0 D or less. Outcome measures included manifest refraction, UDVA, CDVA and visual symptoms up to 12 months.

1. Stulting RD, Fant BS; T-CAT Study Group. Results of topography-guided laser in situ keratomileusis custom ablation treatment with a refractive excimer laser. J Cataract Refract Surg. 2016;42(1):11–18.

2. WaveLight® ALLEGRETTO WAVE® Excimer Laser System and the ALLEGRO Analyzer. Summary of Safety and Effectiveness Data. P020050S004b.

3. American Academy of Ophthalmology. Is LASIK for Me? A Patient’s Guide to Refractive Surgery. October 2008. http://www.geteyesmart.org/eyesmart/glasses-contacts-lasik/upload/LASIK-patient-guide. pdf. Accessed Dec. 17, 2018.

4. Market Scope. Refractive 2020.

5. Durrie DS, Potvin R, Petznick A. More eyes with 20/10 visual acuity at 12 months versus 3 months in a topography-guided excimer laser trial: Possible contributing factors. Paper presented at: ASCRS; March 14, 2018; Chicago, IL.

© 2021 Alcon Inc. 05/21 US-WLO-CEI-2100012

hands to show where her jet was at a certain point during her flight and talking about her trap (landing) aboard the boat.

We talked about how lucky we were to have transitioned to fleet squadrons. Had any of us been more senior in rank, we would not have been able to transition to a fleet combat squadron. I was so excited to finally be assigned to a combat squadron, it was a dream come true. Flying on and off the carrier was both exciting and dangerous. I frequently walked up on the flight deck in pitch-black conditions to preflight the aircraft before a flight. With other aircraft engines turning and the waves splashing high alongside the ship, those nights seemed surreal and dangerous, but were equally exciting and challenging.

Our next time on the Lincoln was the following October (1994). The boat pulled out from port in San Diego ready to carrier qualify its airwing's aviators. I had walked on board the ship instead of flying on because I had the Squadron Duty Officer (SDO) duty that day. It was my responsibility to sit in my squadron's ready room and monitor my squadron's airplanes coming aboard the aircraft carrier on the special television in our squadron ready room.

I was in the ready room, coordinating the Prowler flight schedule, answering the phone, and documenting the squadron pilots’ carrier qualifications. Via the ready-room television, I could see all the aircraft conducting their approaches. When my aviator girlfriends approached the carrier in their aircraft, I paid particular attention. I looked up from my SDO desk to monitor flight ops on the ready

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

room television wondering if the F-14 on final was Kara.

The first F-14 trapped and taxied out of the landing area. As the second F-14 Tomcat made its approach to the boat, the aircraft inexplicably rolled off to the left. Within seconds, I knew something was dreadfully wrong. Horrified, I watched the aircraft lose altitude and start rolling to the left. The landing signal officers screamed, “Power, power, power!” and then yelled for the crew to eject. Both aircrew ejected. The announcement over the announcement system blared “plane in the water, plane in the water!” Some of my squadron's officers and maintenance chiefs ran into the ready room to monitor the situation on the Shipboard TV awaiting word on the pilot and Radar Intercept Officer (RIO). I waited anxiously for the carrier’s loudspeaker to announce that both aviators were safe. There are several channels on the ship's TV that provide different type of information on flight ops. One channel will list all aircraft airborne with the pilots' names. I immediately switched to that channel to see who was in the downed aircraft and saw that it was Kara. Within minutes after the accident, we watched the ship's helicopter pick up one of the aircrew from the water. I hoped it was Kara but after closer observation, I realized it was the back seater, the RIO, and I expected Kara to be right behind him. It was finally announced that there was a search going on for the pilot.

About two hours later, a few women aviators met in one of our staterooms, looking at each other in disbelief, fearing the worst. We kept hoping Kara would be found, until it was obvious, she had not survived. They searched for Kara through the night and finally called off the search efforts the next day. g

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decide if I would return to flying, a decision I believed would impact my plans to marry and have a family. I was on track to become a commanding officer of a squadron and as much as I loved my career, my desire to have a family was a higher priority. I knew that if I decided not to return to flying Prowlers, my Navy career would potentially be negatively impacted. I knew I would regret my decision if I had returned to flying. It was as if God whispered to me to trust Him in this decision, and, as scary as it was, I transitioned to a different career path involved in the Navy’s aviation acquisition community.

The next year, I met my future husband, Dan, and immediately knew he was the man I would marry. He was living in Boston at the time, a single dad of a nineteen-year-old daughter, worked in the telecommunications field and also was a civilian instructor pilot. We dated for a year and married in 2001. We had our son, Ethan, in 2003, and then, three years later, had our LCDR Linda Maloney and her first born son, Ethan, Jan 200

LT Kara Hultgreen was listed as "missing at sea" and presumed dead. My heart hurt for her family because I knew they must have been contacted. I also wondered what my own parents must be thinking as I was sure the media was reporting the accident. My mom always worried so much about me flying especially after I had ejected a few years earlier. There was no way to contact anyone, and we were going to be on the ship for two more weeks. Kara’s memorial service was planned for a few days later and I was asked to give a eulogy. After giving the eulogy in the USS Abraham Lincoln's foc'sle for Kara, the first woman Navy fighter pilot lost at sea, I listened to the playing of taps with tears rolling down my face wondering if this were all a bad dream.

For months, an umbrella of sadness clouded the exhilaration the women aviators had initially felt about our combat assignments. Weeks and months after the F-14 crash, publicity and controversy surrounded Kara's death and many questioned her ability to fly the F-14 and questioned the Navy’s

our lives!

MILITARY FLY MOMS

I hung up my flight suit officially in 2004 when I retired from the Navy. As I packed away my flight gear in the basement in hopes to pass it down one day to my son, Ethan, who I just had a few months earlier, I thought about the legacy I would pass down to him, and now his brother, Aron, too. I wanted him someday to proudly tell his friends that his mom flew jets in the Navy and even ejected out of one over the Atlantic Ocean.

I didn’t want my aviation experience to be a far-off memory, and I wanted him to have a piece of it even though he didn’t experience it with me. Most of all I wanted to pass down a legacy to him of dreaming big dreams and achieving great things and service to our country.

I also thought about the unique group of military women aviators that I was a part of and wondered about the stories they would tell their children about their few years or careers in military aviation. This led me to my first book, Military Fly

efforts to train women to fly tactical aircraft. Kara had been the

Moms ~ Sharing Memories, Building Legacies, Inspiring Hope.

first woman to complete training to fly the F-14, following the

It was published in 2012 and is a biographical collection of the

decision to repeal the combat exclusion law. Needless to say,

inspiring true stories and photographs of seventy women who

it was a long and difficult 6-month deployment.

The flying and mission of patrolling the Iraq no-fly zone during cruise was interesting and intense and I enjoyed the flying around the boat, earning an air medal for combat operations.

DECISIONS

After my squadron tour was up, I transferred to Washington, DC, to a non-flying job, and I spent the next few years trying to

90

second son, Aron. What incredible joy they have brought to

VETERANS AFFAIRS 90 YEARS: Military & Wellness

shared the same two dreams: becoming aviators in the military and being moms. All of the women’s stories and experiences are different from each other but all have a common thread that weaves itself throughout the book creating a beautiful tapestry of amazing and inspirational collection of stories. My hope for the book is to tell the stories of these amazing women, inspire and encourage others to believe they can do anything, and also pass down a legacy to our future generations. g

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Jas Boothe (Army) Veteran and member of Women Veteran Speakers

WOMEN VETERAN SPEAKERS

courage, strength, and selfless service, everyday heroes who have

the first speakers and marketing agency of its kind offering

the generations following in their footsteps. The project includes

I started my own business in 2015, Women Veteran Speakers, exclusively exceptional women military veterans as event speakers, trainers, coaches, and facilitators, from emerging upand-comers to polished experts. Women Veteran Speakers connects clients with our members for speaking engagements, training events, conferences, webinars, panels, and forums. We also highlight and market our members via social media, email marketing and through event proposals. Our members are accomplished leaders, authors, entrepreneurs and speakers, coaches, trainers and facilitators with an array of business, corporate, military and defense expertise, and more importantly offer valuable leadership insights, experiences and compelling perspectives not available elsewhere covering a diverse selection of topics and expertise. Our members range from emerging up-and-comers to polished experts.

PROUDLY SHE SERVED

made an impact through their service to our country and inspire a series of twelve 36x30 inch oil paintings and captivating stories highlighted in a beautiful coffee table book. Through its beautiful portraits and captivating stories, the portrait series offers a glimpse into why these women chose to serve in the military and why they are proud of their military service. The mission of Proudly She Served is to highlight women who served or who have served in the US military, their service and sacrifice, raise awareness of the challenges many face when transitioning to life outside of the military, and to offer transition support and a helping hand as they define their post military career goals and next steps.

LIFE NOW

My husband and I both work in the telecommunications industry in Hunterdon County, New Jersey and have a grown daughter and two sons, ages 14 and 17.

I also volunteer as the Project Director for the Proudly She Served project, which offers a beautiful and powerful testimony and celebration of military and veteran women, who exemplify

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

Linda Maloney is an Award-Winning Author, Business Owner, Speaker & Former Military Aviator and Officer. For more information, please visit https:// womenveteranspeakers.com/ and https://www.proudlysheserved.com/

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A Guide to

VETER

BUS Veterans are twice as common to be entrepreneurs than other individuals.

Their experience serving taught them tenacity and grit you cannot learn anywhere else.

94

VETERANS AFFAIRS 90 YEARS: Military & Wellness

the Benefits of

RAN-OWNED

SINESSES V

eteran-owned businesses have access to a variety of

Business-startup does not have to be complicated.

benefits not available to other business owners.

Still, the SBA has tremendous resources to help smooth

Every person defines the American dream differently.

For many, owning a home or property embodies the American dream. For others, creating wealth and starting a business is their American dream.

One thing most Americans dream of is becoming their own boss. Owning a business is one of the best ways to achieve that goal. However, not everyone can handle the responsibilities of business ownership.

Veterans are twice as common to be entrepreneurs than other individuals. Their experience serving taught them tenacity and grit you cannot learn anywhere else. Overcoming

your transition.

This article provides an overview of veteran-owned business resources, the advantages veterans have as entrepreneurs and other veteran-owned businesses' success stories.

VETERAN-OWNED BUSINESS

While serving in the military, many members leave service and start their own businesses.

Often, they identify a need during service that was not met by the military or private company. Other times, veterans start businesses to serve their community's needs, such as bakeries, lawn management, or construction.

obstacles and staying on course are necessary ingredients for

The federal government is famous for its acronyms. Here are 2

a successful business owner. According to the SBA, veterans

you should know:

own 2.52 million out of the 27.9 million businesses in the

• VOSB - veteran-owned small business

United States. Vets employ nearly 6 million employees and

• SDVOSB - service-disabled veteran-owned small business

generate over $1.2 trillion in sales. Clearly, veteran-owned businesses are critical to the US economy.

VETERANS MAKE GREAT BUSINESS OWNERS

Veterans are equipped with a toolbox spanning technical skills

So, how do you get started earning your share? As a veteran,

to interpersonal skills. They have a depth of knowledge the

you have two primary resources with benefits unique to you:

average civilian does not have access to until they have been

the VA and the SBA.

in business for many years. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

95

Leadership – All veterans have seen effective leadership at

work, and many have participated in it.

Veteran-owned businesses can lean on their military role models and apply similar techniques to their business development.

Veterans with leadership experience obtained it through

VA OSDBU – Office of Small & Disadvantaged Business

Utilization guides you in starting your veteran-owned business.

VR&E – Veterans Benefits Administrations Vocational

Rehabilitation and Employment offer training for new careers

formal training in the service. Effectively leading and motivating

or starting businesses regardless of disability. VR&E can also

employees is a critical factor in successful business models.

help you write a business plan, learn about marketing and

Risk Management – Veterans had experienced situations when they had to take a risk to be successful. Or they

determined action was too risky to move forward. Every military plan involves risk assessment, so analyzing risks becomes automatic to veterans. This advantage prepares them for business decision-making. Every business venture involves risk, particularly financial risk. Veterans are equipped to analyze them and find ways to minimize exposure.

Veterans' Benefits – the VA offers excellent resources to help

veterans be successful in civilian and business life. The VA helps service members transition to civilian life by making plans and providing health care, mental health, career, and business support.

GI Bill - helps veterans pay for college to learn new skills.

DoD SkillBridge – learn skills and get experience in new industries where you plan to start your business.

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A Solid Start – provides resources to get started after separation.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

business management.

WHAT ADVANTAGES DO VETERAN-OWNED BUSINESSES HAVE?

Veteran-owned businesses can receive advantages and help that civilian-owned enterprises do not have.

Skillset – Veterans separate from service with skillsets key to

running successful businesses: leadership, creative thinking, resourcefulness, and often, technical abilities.

Access to Government Contracts – The federal government

budgets money for contracting with veteran-owned businesses with veteran status, disabled status, or women-owned status.

Search Engine Badges – Google helps veteran-owned

businesses with a "Veteran Led" badge on your business profile.

Loans – The Small Business Administration offers favorable

borrowing terms in the 7(a) Veteran's Advantage Loan program. g

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Franchising – Veteran franchising entrepreneurs are preferred in some organizations because of the training and skills they learn serving their country.

Tax Benefits – Businesses that hire veterans may receive up to $1,500 income tax credits through the Work Opportunity Tax Credit Program.

Veteran-focused Workshops – Many organizations like the

SBA or Boots to Business offer specialized workshops to assist veterans in starting their own businesses.

To qualify for Vets First Verification, you must register your VOSB with the OSDBU and meet all their requirements.

They identify you as a veteran if you meet all requirements: Served active duty for any amount of time for the Air Force, Army, Coast Guard, Marine Corps, or Navy, and did not receive a dishonorable discharge or you served as a member of the National Guard or Reserves, and you were called to federal active duty and disabled in the line of duty or in training status.

You or another veteran at your company must maintain control of the daily operation, decision-making, and management

Veteran-owned Business Week – In November of each

of the business. Own 51% or more of the business or work

year, the SBA celebrates veteran-owned businesses and their

full time at the business. You hold the highest position in the

accomplishments. They also provide resources, webinars, and

company and/or possess leadership ability to manage the

other assistance to guide veterans to success.

business. Be the highest-paid person in the company (or affirm

SBA Office of Veterans Business Development – The SBA dedicates a portion of its work to providing business and

personal resources, grants, loans, and education. Veterans, service-disabled veterans, reserve members, dependents, and survivors can all access the SBA OVBD. Surplus Equipment – The Veterans Small Business

Enhancement Act opens the door for veteran-owned businesses to acquire unused federal surplus supplies and equipment for free.

ARE GOVERNMENT BENEFITS AVAILABLE?

Veterans can open millions of dollars’ worth of new business through government contracting. However, it is not an easy process.

As a veteran, particularly a disabled veteran, your business could be preferred for eligible federal contracts and subcontracts.

To qualify, you must register the business through Vets First Verification, certifying you are a veteran-owned business.

VETS FIRST VERIFICATION (VFV)

VFV opens access to government contracts. Veteran-owned businesses complete a verification process through the VA's Office of Small and Disadvantaged Business Utilization.

The OSDBU maintains a directory of veteran-owned businesses. Their role is to help veteran-owned businesses network and gain government contracts.

98

WHO IS ELIGIBLE FOR VFV?

VETERANS AFFAIRS 90 YEARS: Military & Wellness

why your lower pay helps the business). Because government contracting can be a convoluted exercise, many vets are not interested in pursuing this avenue. Conversely, advertising your Veteran-owned business status on your social media, website, and storefront is sufficient to bring in business. As such, you do not need to waste time getting a VFV certification.

SBA The Small Business Administration is a government

organization dedicated to helping small businesses succeed.g

They offer a variety of programs from coaching to loans that give companies a boost upward. They can guide you from the concept phase into scaling a thriving business.

Veterans have access to more extraordinary services through the SBA. After your VOSB is registered with the SBA, doors open, making it easier for you to bid on government contracts.

Office of Veterans Business Development (OVBD) The OVBD is

devoted to promoting veteran entrepreneurship. This office provides access to capital and business planning, such as supply chains or federal procurement.

Veteran Business Outreach Centers (VBOC) All over the country to

guide veteran business owners. Their services include a mentorship with other successful business owners, training, business plan workshops, and concept assessments.

Lender Match SBA's website tool that helps veterans find capital

lenders. In some cases, veterans can receive lower interest rates than civilians.

Military Reservist Economic Injury Disaster Loan (MREIDL) This program offers loans if an essential employee is called to active duty (Reserves or National Guard) and causes a loss in operating costs.

Boots to Business DoD-sponsored entrepreneurial training program.

Women Veteran Entrepreneurship Training

Program (WVETP) Offers entrepreneurial training

for women service members, veterans, and spouses who start or grow a business.

Service-Disabled Veteran Entrepreneurship

Training Program (SDVETP) Entrepreneurship

training for service-disabled veterans wanting to start or grow a business.

Veteran Federal Procurement

Entrepreneurship Training Program

(VFPETP) This training program guides VOSBs and SDVOSBs in attaining federal contract procurement. Veterans can increase their eligibility for government contracts if they have a service-connected disability.

100

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Surplus Personal Property for Veteran-Owned Small Business Programs

Helps VOSBs receive federal property and supplies no longer needed.

8(a) Business Development Program Helps disadvantaged get the

opportunity to bid on federal contracts when they otherwise would not.

SBA Mentor-Protégé Program - Matches business mentors with protégés, where they work on business development with a mentor including:

BUSINESS MANAGEMENT: accounting, manufacturing, marketing, and strategic planning.

FINANCIAL ASSISTANCE: Capital investments and loans.

FEDERAL CONTRACT ADVICE: Guidance on bidding, acquiring, and how the federal procurement process works.

BUSINESS EDUCATION: Strategic planning, international trade, and finding markets.

BUSINESS DEVELOPMENT: Including strategy and identifying contracting and partnership opportunities.

PARTNERSHIP: Mentors may offer human resource sharing or security clearance support.

SUCCESS STORIES

Veteran-owned businesses are thriving all over the country in a variety of industries: clothing, home furnishings, food and restaurants, jewelry, personal care, and gifts, to name a few.

Grunt Style: An Army veteran founded this t-shirt company with its signature rifle logo. They have grown into a popular apparel store for patriotic gear and clothing. To date, they have over 1.1 million Instagram followers.

She Swank: This is a "community-building" marketplace that supports local, independent, and military makers.

Focusing on women and moms, this boutique curates apparel, stationery, home, baby, bath, and body goods.

Order online to support military entrepreneurs and small business owners.

Mason Chix: Taking a different approach, two military spouses founded this custom apparel company with Southern, state pride, or inspirational designs. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

101

They donate a portion of their proceeds to organizations

Discuss the market need, do research, and make sure it is

that support military families.

a viable plan. The SBA mentors are a great place to start.

Spousely: Spousely is an Etsy-style marketplace for active military and veteran-owned sellers. Military families can support each other by buying products that range from

hard questions that make you think about your business in different ways.

jewelry, art, sweet treats, baby gear, and more. They also

Second, investigate funding. Will you start the business

have a platform to sell businesses and creative services

using your own money? Can someone loan you seed

such as marketing management, writing, taxes, and

money? How much do you need to spend upfront to launch

photography.

the business?

K-9 Salute: Veteran-owned company that sells all-natural

If your business is online, you may not need to invest more

dog treats. Their proceeds are donated to military and

than a few thousand dollars on a website, product photos,

police K-9 units for vests and other animal supplies. They

and some ads marketing your product. Alternatively, if your

also help disabled military veterans receive service dogs.

business requires big up-front purchases like equipment,

MilSO Box: Military Significant Other Box lets you choose a three-, six-, or twelve-month subscription of carefully curated gifts to send a loved one during deployment.

As you start your business, you may still be an active-duty member or separated from service.

First, find out if your business idea is going to work.

102

Have a conversation with your mentor, and they can ask

VETERANS AFFAIRS 90 YEARS: Military & Wellness

consider if you could partner with someone before committing to it.

Finally, tell everyone you know. Let your friends, family, social media followers, everyone know about your new business. Chances are, they will want to do business with you, particularly if you position your business as a veteranowned business.

S N A R E T V E AND Y R A T I L I M T

s s e n i Bus

s A s r Owne

he Veterans and Military Business Owners Association

achieve results. They

(VAMBOA) is known as the “go to” association and

are excellent team

website for military veteran entrepreneurs. This non-profit

501(c)6 was founded by Debbie Gregory in 2012 to address the needs of veterans and former military going into business.

VAMBOA is one of the most popular and fastest growing associations of its kind.

Debbie Gregory previously was the CEO of MilitaryConnection.com, a popular online destination directory of resources and information for military, veterans, and their families with employment being a major focus area. Debbie, being an entrepreneur and small business owner herself, recognized that those who served and began their own businesses needed vital resources, information, and connections.

VAMBOA also understands that those who have worn our nation’s uniform have the skills, tenacity, and dedication to be successful in operating a viable business. Some of these skills include a laser sharp focus with the goal of success whether a project, a successful quarter, or the viability of a business.

Veteran and Military Business Owners are dedicated to the

members but are also capable of working independently as well.

Without a doubt, Veteran Business Owners, ServiceDisabled Veteran Business Owners and Military Business Owners are the engine that runs our nation’s economy to a major extent. They are forty-five percent more likely to be self-employed than their civilian counterparts.

Since Veterans and former military include minorities, disabled and women, they hit all the boxes for corporations seeking a diverse network of suppliers.

VAMBOA is committed to connecting our Veteran and Military Business Owners with corporations dedicated to a diverse Supplier Network. We value these companies and appreciate their commitment and support to VAMBOA.

successful completion of the mission and each and every project.

Many Veteran Business owners and other associations focus on

Veteran and Military Business Owners also have a work ethic

the government contracting ball and sometimes overlook working

second to none. They understand how to work effectively to 104

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

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include an emphasis on corporations seeking a diverse network of suppliers.

Often, to obtain government contracts, it involves a very long

and involved process. Additionally, government contracts have inherent risks and can be complicated. The competition is also very tough.

Corporations want to do business with this group of

message of a corporation trying to reach Veteran, ServiceDisabled and Military Business Owners. We have a national database of over 14,000 business owners in these groups and more than 200,000 fans and followers on social media. We understand how to engage this audience and let them know about your corporate needs and Diversity Supply programs.

entrepreneurs and dedicate major resources, staff, and funds to

If you are a corporation that wants to explore corporate

do so. Many corporations that provide products and/or services

sponsorship, please contact Debbie Gregory at

to the government have stringent diversity supply needs.

dgregory@vamboa.org.

It is interesting that the Small Business Administration (SBA)

VAMBOA is unique and has been ahead of the curve even

the major customers of Veteran Owned Small Businesses.

Gregory, has been a small business owner herself, we realize

representing 37.9 percent. This is compared to governments

assets and at a premium.

statistics below support our focus when we look at who are

before the pandemic. Because VAMBOA’s founder, Debbie

Consumers account for 67.6 percent with corporations

that the time of a business owner is one of their most valuable

that represent only 8.3 percent with 5.1 percent of them being state and local governments and the remaining 3.2 percent

Many small business owners do not have the time nor the

being the federal government.

resources to attend numerous conferences to make connections

VAMBOA accomplishes this by facilitating win/win collaborations

person conferences in partnership with Amgen in earlier years

and partnerships with corporations.

VAMBOA does not charge its members any fees or dues. We are funded by corporate sponsorships and are incredibly grateful to the wonderful companies that value Veteran Owned Businesses

and Service-Disabled Veteran Owned Businesses supporting us.

and gain important information. VAMBOA has had a few in but moved its focus to online a number of years ago. Online on our “go to” website makes it easy.

VAMBOA provides two to three articles each week with a multitude of valuable information on its website blog. We have a small team of excellent writers and researchers that are

If you are a Veteran, Military or Military Spouse Owned Business,

dedicated to covering those topics that are most important and

member-registration/.

Small Businesses. g

please consider joining VAMBOA at https://vamboa.org/

106

VAMBO has the skill and reach to effectively put forth the

VETERANS AFFAIRS 90 YEARS: Military & Wellness

timely to Veteran, Service-Disabled, Military and Spouse Owned

Our blog contains hundreds of articles of value to our members.

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VETERAN OWNED BUSINESSES BY THE NUMBERS These statistics related to United States military veterans

who own businesses were issued by the US Small Business Association (SBA) Office of Advocacy in April of 2017.

2.52 Million – This is how many businesses in the United States that are majority-owned by Veterans.

442,485 – This is the number of Veteran owned Businesses with employees.

9.1 percent – This is overall percentage of United States businesses that are owned by Veterans and is a significant number.

1.14 Trillion – This is the annual revenues that are generated by Veteran Owned businesses and is also a significant number.

5.03 Million – This is the total number of people employed by Veteran Owned Businesses.

195 Billion – This is the annual payroll of Veteran Owned Businesses.

TOP INDUSTRIES FOR VETERAN-OWNED BUSINESSES 16.6 % - Professional, Scientific, and Technical Services 12.2% - Construction

11.8% - Other Services 8.6% - Real Estate

8.1% - Retail Trade

8.0 % - Administrative and Support THE PERCENTAGE OF VETERAN-OWNED BUSINESSES VARIES BY INDUSTRY

12.8% - Finance and Insurance 12.1% - Transportation 11.4% - Construction

11.3% - Agriculture, Forestry, and Fishing 10.9% - Utilities

10.8% - Professional, Scientific, and Technical Services 10.2% - Manufacturing

Veteran Owned Businesses are owned by men over women by

a huge majority with 84.3 percent being male owned compared

to only 15.2 percent being female owned. The trend is that more women veterans are opening their own businesses.

Veteran Owned Businesses by race or ethnicity are with the majority

VAMBOA, the Veterans and Military Business Owners Association

or 85.1 percent being White, 10.7 percent being African American,

Business, Owners, Service-Disabled Veteran Owned Businesses

percent being American Indian or Alaska Native and less than 0.3

ensures the development, growth and prosperity of Veteran

7 percent being Hispanic, 2.1 percent being Asian American, 1.3

(SDVOB) and Military Business Owners of all sizes nationwide.

percent being Native Hawaiian or Pacific Islander.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Many of VAMBOA’s membership characteristics are closely aligned with the SBA statistics above.

For example, the states with the most Veteran Owned Businesses also reflect the states with the most VAMBOA members. According to

the SBA, the top states include California with the most or 252,377 veteran businesses. The next largest state for Veteran is Texas with 213,590 followed by Florida with 185,756, then New York with 137,532 and Pennsylvania with 97,969.

The states with the highest percentage of all businesses are veteran-owned in order are South Carolina, New Hampshire, Virginia, Alaska, and Mississippi.

The States with the largest number of VAMBOA members include California, Pennsylvania, Texas, Colorado, Florida,

Michigan, Georgia, New York, Maryland, and New Jersey.

The top industries of VAMBOA members include

Construction, Information Technology, Consulting,

Manufacturing, Consumer, Security, Energy, Service, Engineering, Telecommunications, Healthcare and Transportation.

VAMBOA has members of all sizes from sole proprietors to companies with thousands of

employees. Annual revenues range from under $100,000 to over $50 million. The majority of

our members have at least one employee and others have hundreds of employees.

Some of the issues that are most important to our

members include; Raising Working Capital including Loans and Financing; Becoming a Diversity Supplier

to Private Corporations; Certification and Verification; Collaboration including Member to Member

Exchanges, Strategic Alliances, and Joint Ventures;

Training including Employee Training; Government Contracts, Insurance & Bonding; Keeping Up with

Technology including Establishing an Online Presence by coming up in the Search Engines and Generating Online Revenues as well as Blogging and Social Media; Legal,

Tax and Accounting Challenges; Legislative Advocacy; and Recruiting and Retaining Qualified Employees.

For many former military and Veterans, the next tour of duty is owning their own business. We

encourage consumers and corporations to choose “Veterans First” when selecting a business to

patronize. They have made huge sacrifices so that the rest of us can live safely and prosper. It is time to return the favor.

VETERANS AFFAIRS 90 YEARS: Military & Wellness

109

America’s Best

I WILL ALWAYS PLACE THE MISSION FIRST I WILL NEVER ACCEPT DEFEAT I WILL NEAVER QUIT I WILL NEVER LEAVE A FALLEN COMRADE

110

VETERANS AFFAIRS 90 YEARS: Military & Wellness

MEDAL of

HONOR F

ormer US President Harry S Truman said he would rather

Here are some of the most recently awarded recipients.

have the Medal of Honor than be president of the United

UNITED STATES ARMY

States. No wonder. The Medal of Honor (MOH) is the most

prestigious and highest ranked US military award bestowed for bravery on the battlefield. It is also the hardest to earn. There have been only 3,525 MOHs awarded since its establishment.

Sadly, 624 of them have been awarded posthumously. The number of awards pales in comparison to the plethora of stories that compose the medal’s glorious history.

SERGEANT

MATTHEW O WILLIAMS Sergeant Matthew O Williams distinguished himself by acts of gallantry and intrepidity above and beyond the call of duty on 6 April 2008, while serving as a

The Medal of Honor dates to 1861. The Army and Navy needed

Weapons Sergeant, Special Forces

a medal for bravery for US Warfighters during the AMERICAN

Operational Detachment Alpha

CIVIL WAR. Traditionally, awards for battlefield bravery had never

3336, Special Operations Task

been a priority for either service. The few available prior to the

Force-33, in support of OPERATION ENDURING FREEDOM.

CIVIL WAR were temporary in nature and not always associated

Sergeant Williams was part of an assault element inserted by

with honor or bravery.

helicopter into a location in Afghanistan. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

111

The Medal of Honor (MOH) is the most prestigious and highest ranked US military

award bestowed for bravery

on the battlefield. It is also the hardest to earn.

critical satellite radio communications. He then assisted with moving the wounded down the near-vertical mountainside to the casualty collection point. Noting that the collection point was about to be overrun by enemy fighters, Sergeant Williams led the Afghan commandos in a counterattack that lasted for several hours. When helicopters arrived to evacuate the wounded, Sergeant Williams again exposed himself to enemy fire, carrying and loading casualties onto the helicopters while continuing to direct commando firepower to suppress numerous insurgent positions. His actions enabled the patrol to evacuate wounded and dead comrades without further casualties. Sergeant Williams’

As the assault element was moving up a mountain toward

complete disregard for his own safety and his concern for

its objective, it was engaged by intense enemy machine

the safety of his teammates ensured the survival of four

gun, sniper, and rocket-propelled grenade fire. The lead

critically wounded soldiers and prevented the lead element

portion of the assault element, which included the ground

of the assault force from being overrun by the enemy.

commander, sustained several casualties, and became

Sergeant Williams' actions are in keeping with the finest

pinned down on the sheer mountainside. Sergeant Williams,

traditions of military service and reflect great credit upon

upon hearing that the lead element had sustained casualties

himself, Combined Joint Special Operations Task Force-

and was in danger of being overrun, braved intense enemy

Afghanistan, Special Operations Command Central, and the

fire to lead a counterattack across a valley of ice-covered

United States Army.

boulders and a fast-moving, ice cold, and waist-deep river.

Under withering fire, Sergeant Williams and his local national

112

commandos fought up the terraced mountainside to the

STAFF SERGEANT

besieged element. Arriving at the lead element’s position,

DAVID G BELLAVIA

Sergeant Williams arrayed his Afghan commandos to

Staff Sergeant David G Bellavia

provide suppressive fire, which kept the insurgent fighters

distinguished himself by acts of

from overrunning the position. When the Team Sergeant was

gallantry and intrepidity above

wounded, Sergeant Williams braved enemy fire once again

and beyond the call of duty on

to provide buddy-aid and to move the Team Sergeant down

10 November 2004, while serving

the sheer mountainside to the casualty collection point.

as a squad leader in support of

Sergeant Williams then fought and climbed his way back up

OPERATION PHANTOM FURY in

the mountainside to help defend the lead assault element

Fallujah, Iraq. While clearing a

that still had several serious casualties in need of evacuation.

house, a squad from Staff Sergeant

Sergeant Williams directed suppressive fire and exposed

Bellavia's platoon became trapped

himself to enemy fire in order to reestablish the team’s

within a room by intense g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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enemy fire coming from a fortified position under the stairs

an entire enemy-filled house, destroyed four insurgents, and

leading to the second floor. Recognizing the immediate

gravely wounded a fifth. Staff Sergeant Bellavia's bravery,

severity of the situation, and with disregard for his own

complete disregard for his own safety, and unselfish and

safety, Staff Sergeant Bellavia retrieved an automatic

courageous actions are in keeping with the finest traditions

weapon and entered the doorway of the house to engage

of military service and reflect great credit upon himself and

the insurgents. With enemy rounds impacting around him,

the United States Army.

Staff Sergeant Bellavia fired at the enemy position at a cyclic rate, providing covering fire that allowed the squad to break

114

contact and exit the house. A Bradley Fighting Vehicle was

STAFF SERGEANT

brought forward to suppress the enemy; however, due to

TRAVIS W ATKINS

high walls surrounding the house, it could not fire directly

Staff Sergeant Travis W Atkins

at the enemy position. Staff Sergeant Bellavia then re-

distinguished himself by acts of

entered the house and again came under intense enemy

gallantry and intrepidity above

fire. He observed an enemy insurgent preparing to launch

and beyond the call of duty on

a rocket-propelled grenade at his platoon. Recognizing

1 June 2007, while serving in

the grave danger, the grenade posed to his fellow soldiers,

the position of Squad Leader

Staff Sergeant Bellavia assaulted the enemy position, killing

with Company D, 2nd Battalion,

one insurgent and wounding another who ran to a different

14th Infantry Regiment, 2nd

part of the house. Staff Sergeant Bellavia, realizing he had

Brigade Combat Team, 10th

an un-cleared, darkened room to his back, moved to clear

Mountain Division, in support

it. As he entered, an insurgent came down the stairs firing

of OPERATION IRAQI FREEDOM. While manning a static

at him. Simultaneously, the previously wounded insurgent

observation post in the town of Abu Samak, Iraq, Staff

reemerged and engaged Staff Sergeant Bellavia. Staff

Sergeant Atkins was notified that four suspicious individuals,

Sergeant Bellavia, entering further into the darkened room,

walking in two pairs, were crossing an intersection not far

returned fire and eliminated both insurgents. Staff Sergeant

from his position. Staff Sergeant Atkins immediately moved

Bellavia then received enemy fire from another insurgent

his squad to interdict the individuals. One of the individuals

emerging from a closet in the darkened room. Exchanging

began behaving erratically, prompting Staff Sergeant Atkins

gunfire, Staff Sergeant Bellavia pursued the enemy up the

to disembark from his patrol vehicle and approach to

stairs and eliminated him. Now on the second floor, Staff

conduct a search. Both individuals responded belligerently

Sergeant Bellavia moved to a door that opened onto the

toward Staff Sergeant Atkins, who then engaged the

roof. At this point, a fifth insurgent leapt from the third-floor

individual he had intended to search in hand-to-hand

roof onto the second-floor roof. Staff Sergeant Bellavia

combat. Staff Sergeant Atkins tried to wrestle the insurgent’s

engaged the insurgent through a window, wounding him

arms behind his back. When he noticed the insurgent was

in the back and legs, and caused him to fall off the roof.

reaching for something under his clothes, Staff Sergeant

Acting on instinct to save the members of his platoon from

Atkins immediately wrapped him in a bear hug and threw

an imminent threat, Staff Sergeant Bellavia ultimately cleared

him to the ground, away from his fellow soldiers. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Staff Sergeant Atkins maintained his hold on the insurgent,

by enemy machine gun, sniper, and rocket-propelled grenade

placing his body on top of him, further sheltering his patrol.

fire. As the attack intensified, Staff Sergeant Shurer braved

With Staff Sergeant Atkins on top of him, the insurgent

enemy fire to move to an injured Soldier and treat his wounds.

detonated a bomb strapped to his body, killing Staff Sergeant

Having stabilized the injured Soldier, Staff Sergeant Shurer

Atkins. Staff Sergeant Atkins acted with complete disregard

then learned of the casualties among the lead element. Staff

for his own safety. In this critical and selfless act of valor, Staff

Sergeant Shurer fought his way up the mountainside, under

Sergeant Atkins saved the lives of the three other soldiers

intense enemy fire, to the lead element’s location. Upon

who were with him and gallantly gave his life for his country.

reaching the lead element, he treated and stabilized two more

Staff Sergeant Atkins' undaunted courage, warrior spirit, and

Soldiers. Finishing those lifesaving efforts, Staff Sergeant

steadfast devotion to duty are in keeping with the highest

Shurer noticed two additional severely wounded Soldiers

traditions of military service and reflect great credit upon

under intense enemy fire. The bullet that had wounded one

himself, the 2nd Brigade Combat Team, and the United

of these Soldiers had also impacted Staff Sergeant Shurer’s

States Army.

helmet. With complete disregard for his own life, Staff Sergeant Shurer again moved through enemy fire to treat and stabilize one Soldier’s severely wounded arm. Shortly

STAFF SERGEANT

thereafter, Staff Sergeant Shurer continued to brave withering

RONALD J SHURER II

enemy fire to get to the other Soldier’s location in order to

Staff Sergeant Ronald J Shurer

treat his lower leg, which had been almost completely severed

II distinguished himself by acts

by a high-caliber sniper round. After treating the Soldier, Staff

of gallantry and intrepidity

Sergeant Shurer began to evacuate the wounded, carrying

above and beyond the call of

and lowering them down the sheer mountainside. While

duty on 6 April 2008, while

moving down the mountain, Staff Sergeant Shurer used his

serving as a Senior Medical

own body to shield the wounded from enemy fire and debris

Sergeant, Special Forces

caused by danger-close air strikes. Reaching the base of the

Operational Detachment Alpha

mountain, Staff Sergeant Shurer set up a casualty collection

3336, Special Operations Task

point and continued to treat the wounded. With the arrival of

Force-33, in support of OPERATION ENDURING FREEDOM.

the medical evacuation helicopter, Staff Sergeant g

Staff Sergeant Shurer was part of an assault element inserted

Former US President Harry S

by helicopter into a location in Afghanistan. As the assault element moved up a near vertical mountain toward its objective, it was engaged by fierce enemy machine gun, sniper, and rocket-propelled grenade fire. The lead portion of the assault element, which included the ground commander, sustained several casualties, and became pinned down on the mountainside. Staff Sergeant Shurer and the rest of the trailing portion of the assault element were likewise engaged

116

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Truman said he would rather have the Medal of Honor than be president of the United States.

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Sharer, again under enemy fire, helped load the wounded into

direct friendly artillery on the advancing enemy forces. With

the helicopter. Having ensured the safety of the wounded,

complete disregard for his own safety, Lieutenant Conner

Staff Sergeant Shurer then regained control of his commando

maneuvered 400 yards through enemy artillery fire that

squad and rejoined the fight. He continued to lead his troops

destroyed trees in his path and rained shrapnel all around

and emplace security elements until it was time to move to

him, while unrolling telephone wire needed to communicate

the evacuation landing zone for the helicopter. Staff Sergeant

with the Battalion command post. Upon reaching the

Shurer’s actions are in keeping with the finest traditions

Battalion’s front line, he continued to move forward under

of military service and reflect great credit upon himself,

the enemy assault to a position 30 yards in front of the

Combined Joint Special Operations Task Force-Afghanistan,

defending United States forces, where he plunged into a

Special Operations Command Central, and the United States

shallow ditch that provided minimal protection from the

Army. In 2020 Staff Sergeant Ronald J Shurer II died due to

advancing enemy’s heavy machine gun and small arms fire.

lung cancer.

With rounds impacting all around him, Lieutenant Conner calmly directed multiple fire missions, adjusting round after round of artillery from his prone position, until the enemy was

118

FIRST LIEUTENANT

forced to halt its advance and seek cover behind a nearby

GARLIN M CONNER

dike. For three hours, Lieutenant Conner remained in this

First Lieutenant

compromised position, enduring the repeated onslaught

Garlin M Conner

of German infantry which, at one point, advanced to within

distinguished himself

five yards of his position. As German infantry regrouped

by acts of gallantry

and began to mass in an overwhelming assault, Lieutenant

and intrepidity

Conner ordered friendly artillery to concentrate directly

while serving

on his own position, having resolved to die if necessary, to

with Company K, 3rd Battalion, 7th Infantry Regiment, 3rd

destroy the enemy advance. Ignoring the friendly artillery

Infantry Division. On the morning of 24 January 1945, near

shells blanketing his position and exploding mere feet from

the town of Houssen, France, German forces ferociously

him, Lieutenant Conner continued to direct artillery fire on

counterattacked the front left flank of the 7th Infantry

the enemy assault swarming around him until the German

Regiment with 600 infantry troops, six Mark VI tanks, and

attack was finally broken. By his heroism and disregard for his

tank destroyers. Lieutenant Conner, having recently returned

own life, Lieutenant Conner stopped the enemy advance. The

to his unit after recovering from a wound received in an

artillery he expertly directed, while under constant enemy fire,

earlier battle, was working as the Intelligence Officer in

killed approximately fifty German soldiers and wounded an

the 3rd Battalion Command Post at the time of the attack.

estimated one hundred more, preventing what would have

Understanding the devastating effect that the advancing

undoubtedly been heavy friendly casualties. His actions are

enemy armor could have on the Battalion, Lieutenant Conner

in keeping with the highest traditions of military service and

immediately volunteered to run straight into the heart of

reflect great credit upon himself, the 3d Infantry Division, and

the enemy assault to get to a position from which he could

the United States Army. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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SERGEANT GARY M ROSE

Rose carried him through the bullet-ridden combat zone

Sergeant Gary M Rose

to protective cover. As the enemy accelerated the attack,

distinguished himself

Sergeant Rose continuously exposed himself to intense

by acts of gallantry and

fire as he fearlessly moved from casualty to casualty,

intrepidity while serving as a

administering life-saving aid. A B-40 rocket impacted just

Special Forces Medic with a

meters from Sergeant Rose, knocking him from his feet

company-sized exploitation

and injuring his head, hand, and foot. Ignoring his wounds,

force, Special Operations

Sergeant Rose struggled to his feet and continued to render

Augmentation, Command

aid to the other injured soldiers. During an attempted

and Control Central, 5th

medevac, Sergeant Rose again exposed himself to enemy

Special Forces Group

fire as he attempted to hoist wounded personnel up to

(Airborne), 1st Special Forces, Republic of Vietnam. Between

the hovering helicopter, which was unable to land due to

11 and 14 September 1970, Sergeant Rose’s company was

unsuitable terrain. The medevac mission was aborted due

continuously engaged by a well-armed and numerically

to intense enemy fire and the helicopter crashed a few miles

superior hostile force deep in enemy-controlled territory.

away due to the enemy fire sustained during the attempted

Enemy B-40 rockets and mortar rounds rained down while

extraction. Over the next two days, Sergeant Rose continued

the adversary sprayed the area with small arms and machine

to expose himself to enemy fire in order to treat the

gun fire, wounding many and forcing everyone to seek

wounded, estimated to be half of the company’s personnel.

cover. Sergeant Rose, braving the hail of bullets, sprinted

On 14 September, during the company’s eventual helicopter

fifty meters to a wounded soldier’s side. He then used his

extraction, the enemy launched a full-scale offensive.

own body to protect the casualty from further injury while

Sergeant Rose, after loading wounded personnel on the first

treating his wounds. After stabilizing the casualty, Sergeant

set of extraction helicopters, returned to the outer perimeter

The Medal of Honor dates

wounded personnel to more secure positions until they

to 1861. The Army and Navy

could be evacuated. He then returned to the perimeter to

needed a medal for bravery

arrived. As the final helicopter was loaded, the enemy began

for US Warfighters during the

Marine door gunner was shot in the neck. Sergeant Rose

American Civil War. Traditionally, awards for battlefield bravery had never been a priority for either service.

120

under enemy fire, carrying friendly casualties and moving

VETERANS AFFAIRS 90 YEARS: Military & Wellness

help repel the enemy until the final extraction helicopter to overrun the company’s position, and the helicopter’s instantly administered critical medical treatment onboard the helicopter, saving the Marine’s life. The helicopter carrying Sergeant Rose crashed several hundred meters from the evacuation point, further injuring Sergeant Rose and the personnel on board. Despite his numerous g

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wounds from the past three days, Sergeant Rose continued

zone” on four more occasions to extract wounded comrades.

to pull and carry unconscious and wounded personnel out of

He treated the injured, prepared the evacuation, and though

the burning wreckage and continued to administer aid to the

bleeding heavily from shrapnel wounds on his head and

wounded until another extraction helicopter arrived. Sergeant

body, refused evacuation to safety in order to remain at

Rose’s extraordinary heroism and selflessness above and

the battle site with his fellow Soldiers who were heavily

beyond the call of duty were critical to saving numerous

outnumbered by North Vietnamese Army forces. On 14 May,

lives over that four-day time period. His actions are in keeping

the platoon was again ordered to move out towards Nui Yon

with the highest traditions of military service and reflect great

Hill. Private First-Class McCloughan was wounded a second

credit upon himself, the 1st Special Forces, and the United

time by small arms fire and shrapnel from a rocket propelled

States Army.

grenade while rendering aid to two Soldiers in an open rice paddy. In the final phases of the attack, two companies from the 2nd North Vietnamese Army Division and an element of

PRIVATE FIRST-CLASS

700 soldiers from a Viet Cong regiment descended upon

JAMES C MCCLOUGHAN

Company C’s position on three sides. Private First-Class

Private First-Class James C

McCloughan, again with complete disregard for his life, went

McCloughan distinguished

into the crossfire numerous times throughout the battle to

himself by acts of gallantry

extract wounded Soldiers, while also fighting the enemy. His

and intrepidity at the risk of

relentless and courageous actions inspired and motivated

his life above and beyond

his comrades to fight for their survival. When supplies ran

the call of duty from 13 -15

low, Private First-Class McCloughan volunteered to hold

May 1969, while serving as

122

a

a blinking strobe light in an open area as a marker for a

combat medic with Company

nighttime resupply drop. He remained steadfast while bullets

C, 3rd Battalion, 21st Infantry,

landed all around him and rocket propelled grenades flew

196th Light Infantry Brigade, Americal Division. The company

over his prone, exposed body. During the morning darkness

air assaulted into an area near Tam Ky and Nui Yon Hill. On 13

of 15 May, Private First-Class McCloughan knocked out a

May, with complete disregard for his life, he ran 100 meters

rocket propelled grenade position with a grenade, fought

in an open field through heavy fire to rescue a comrade

and eliminated enemy soldiers, treated numerous casualties,

too injured to move and carried him to safety. That same

kept two critically wounded Soldiers alive during the night,

day, 2nd Platoon was ordered to search the area near Nui

and organized the dead and wounded for evacuation

Yon Hill when the platoon was ambushed by a large North

at daylight. His timely and courageous actions were

Vietnamese Army force and sustained heavy casualties. With

instrumental in saving the lives of his fellow Soldiers. Private

complete disregard for his life and personal safety, Private

First-Class McCloughan’s personal heroism, professional

First-Class McCloughan led two Americans into the safety

competence, and devotion to duty are in keeping with the

of a trench while being wounded by shrapnel from a rocket

highest traditions of the military service and reflect great

propelled grenade. He ignored a direct order to stay back

credit upon himself, the America l Division, and the United

and braved an enemy assault while moving into the “kill

States Army. g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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Medals of Honor are awarded sparingly and are bestowed

Here are just a few examples of Soldiers who were awarded

only to the bravest of the brave; and that courage must

the Medal of Honor from three wars. Their actions, like the

be well documented. Other recent Army Medal of Honor

other recipients of the medal, were far and above the call

Recipients are:

of duty.

Lieutenant Colonel Charles Kettles Captain Florent Groberg Sergeant Henry Johnson Sergeant William Shemin 1st Lieutenant Alonzo H Cushing Command Sergeant Major Bennie G Adkins Specialist 4 Donald Sloat Staff Sergeant Ryan M Pitts Sergeant Kyle J White Captain William D Swenson Staff Sergeant Ty Michael Carter Staff Sergeant Clinton L Romesha Sergeant 1st Class Leroy A Petry Staff Sergeant Salvatore A Giunta Staff Sergeant Robert J Miller Sergeant 1st Class Jared C Monti Private 1st Class Ross McGinnis Sergeant 1st Class Paul R Smith

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During the CIVIL WAR, the job of color bearer was one of the most hazardous as well as important duties in the Army.

Soldiers looked to the flag for direction and inspiration in battle and the bearer was usually out in front, drawing heavy enemy fire while holding the flag high. On 16 November 1863, regimental color bearer Private Joseph E. Brandle, from the 17th Michigan Infantry, participated in a battle near Lenoire, Tennessee. "Having been twice wounded and the sight of one eye destroyed, he still held to the colors until ordered to the rear by his regimental commander."

Corporal Alvin C York, from the 82nd Division, fearlessly engaged the numerically superior German force at ChatelChehery, France, on 8 October 1918 – just a month before the armistice was signed. His citation reads: "...After his platoon had suffered heavy casualties and three other noncommissioned officers had become casualties, Corporal York assumed command. Fearlessly leading seven men, he charged with great daring toward a machine gun nest, which was pouring deadly and incessant fire upon his platoon. In this heroic feat the machine gun nest was taken, together with four officers and 128 men and several guns."

Valor is found across the times as well as across the ranks, as WORLD WAR II 2nd Lieutenant Robert Craig, from the 3rd Infantry Division, demonstrated. According to his citation, 2nd Lieutenant Craig volunteered to defeat an enemy machine gun that three other officers before him could not.

Since 1998 at least 15 other Medals of Honor have been

He quickly located the gun outside of Favoratta, Sicily, but

awarded to correct past administrative errors, oversights,

without cover, he and his men found themselves vulnerable

and follow-up on lost recommendations or because of

to approximately 100 enemies. "Electing to sacrifice himself

new evidence.

so that his platoon might carry on the battle, he ordered g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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his men to withdraw... while he drew the enemy fire to

enemy to aid wounded Marines and carry them to safety.

himself. With no hope of survival, he charged toward the

Then-Gunnery Sergeant Canley's heroic actions saved the

enemy until he was within 25 yards of them. Assuming a

lives of his teammates.

kneeling position, he killed five and wounded three enemy soldiers. While the hostile force concentrated fire on him, his platoon reached the cover of the crest. 2nd Lieutenant Craig was killed by enemy fire, but his intrepid action so inspired his men that they drove the enemy from the area, inflicting heavy casualties on the hostile force."

UNITED STATES NAVY MASTER CHIEF

SPECIAL WARFARE

OPERATION BRITT K SLABINSKI As a Team Leader assigned

UNITED STATES MARINE CORPS MAJOR JOHN L CANLEY Sergeant Major John L Canley will receive the Medal of Honor for his actions from 31 January to 6 February 1968, while assigned to Company A, First Battalion, First Marines in the Republic of Vietnam.

While serving as Company Gunnery Sergeant, he fought off multiple enemy attacks as his company moved along a highway toward Hue City to relieve friendly forces who were surrounded. On several occasions, despite his own wounds, he rushed across fire-swept terrain to

126

to a Joint Task Force, in the early morning hours of 4 March 2002, thenSenior Chief Slabinski led a reconnaissance team to its assigned observation area on a snow covered, 10,000foot mountaintop in support of a major coalition offensive against Al-Qaida forces in the valley below. Rocketpropelled grenades and small arms fired from enemy fighters hidden and entrenched in the tree lines and rocks riddled the team’s insertion helicopter. One teammate was ejected from the aircraft, and the crippled helicopter crash landed on the valley floor below. Then-Senior Chief Slabinski boldly rallied his remaining team and organized supporting assets for a daring assault back to the mountain peak in an attempt to rescue their stranded teammate.

carry wounded Marines to safety. When his commanding

Later, after a second enemy-opposed insertion, then-Senior

officer was severely wounded, he took command and

Chief Slabinski led his six-man joint team up a snow-

led his company into Hue City. While in command of the

covered hill, in a frontal assault against two bunkers under

company for three days, he led attacks against multiple

withering enemy fire from three directions. He repeatedly

enemy-fortified positions while exposing himself to enemy

exposed himself to enemy fire as he engaged in a pitched,

fire to carry wounded Marines to safety. On 6 February, at a

close-quarters firefight against the tenacious and more

hospital compound, he twice scaled a wall in full view of the

heavily armed enemy forces. Proximity made air support g

VETERANS AFFAIRS 90 YEARS: Military & Wellness

impossible, and after several teammates became casualties, the situation became untenable.

Senior Chief Slabinski maneuvered his team to a more defensible position, directed air strikes in very close proximity to his team’s position, and requested reinforcements. As daylight approached, the accurate enemy mortar fire forced the team further down the sheer mountainside. Carrying a seriously wounded teammate down a sheer cliff face, he led an arduous trek across one kilometer of precipitous terrain, through waist-deep snow while continuing to call fire on the enemy who was engaging the team from the surrounding ridges. During the subsequent 14 hours, he stabilized casualties on his team and continued the fight against the enemy until the mountaintop was secured by the quick reaction force and his team was extracted.

UNITED STATES AIR FORCE

TECHNICAL SERGEANT JOHN A CHAPMAN Sergeant Chapman’s spouse, Valerie Nessel, and family will join the President at the White House to commemorate his example of selfless service and sacrifice.

Sergeant John A Chapman will receive the Medal of Honor posthumously for his actions on 4 March 2002, on Takur Ghar mountain in Afghanistan. During a helicopter insertion, Sergeant Chapman’s aircraft came under heavy enemy fire and was hit by a rocket-propelled grenade. One teammate was ejected from the aircraft, and the crippled helicopter crash landed in the valley below. Sergeant Chapman and the remaining joint special operations team members voluntarily returned to the snow-capped mountain, into the heart of a known enemy stronghold, in an attempt to rescue their stranded teammate.

Sergeant Chapman charged into enemy fire through harrowing conditions, seized an enemy bunker, and killed its enemy occupants. He then moved from cover to engage a machine gun firing on his team from a second bunker. While engaging this position, he was severely wounded by enemy gunfire. Despite severe wounds, he continued to fight relentlessly, sustaining a violent engagement with multiple enemy personnel before paying the ultimate sacrifice. Sergeant Chapman’s heroic actions, at the cost of his life, are credited with saving the lives of his teammates.

Article provided in part by army.mil/medalofhonor, whitehouse.gov and navy.mil.

Photos provided by the Congressional Medal of Honor Society cmohs.org.

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VETERANS AFFAIRS 90 YEARS: Military & Wellness

A

merica Salutes You is a national non-profit (501 c3)

charitable organization dedicated to raising awareness

and funds for best-in-class charities supporting veterans,

active-duty military, first responders and their families through a series of nationally broadcast benefit concerts. America Salutes

You mobilizes support through music and is now in its sixth year.

Our mission is to honor and raise awareness of brain and mental wellness with a particular focus on suicide prevention for those who currently serve, veterans and their loved ones. We have expanded to include first responders too.

MOTIVATION

Less than one percent of our population serve to make the

world safe for the rest of us. They make sacrifices, the most

important being that they literally write a blank check, payable to the United States for an amount up to and including their

lives so that the rest of us are safe and can live peacefully and

prosper. We owe them a huge debt and they have many needs when they return including healthcare, mental health services, housing, education, jobs, legal, financial readiness and more

enabling those who served the ability to find a career to support their families.

GOAL

Donations are raised via online fundraising during the broadcasts with all funds raised going to the America Salutes You Campaign.

Our production costs at America Salutes You have been paid for

by ticket sales, sponsorships and directly by America Salutes You. Everyone on the America Salutes You team donates their time as well as our artists. No donations are used for concert expenses 130

VETERANS AFFAIRS 90 YEARS: Military & Wellness

and overhead. One hundred percent of all monies raised are granted to nonprofit organizations with programs serving

veterans, service members, first responders and their families.

Those wishing to make donations can do so via PayPal here: https://bit.ly/3dVwFmw.

THIS YEAR’S CONCERT AT THE GRAND OLE OPRY IN NASHVILLE

Since our inception in 2016, we have produced one nationally broadcast concert each year. This year will be exciting

and ambitious with multiple concerts so that we can support more worthy charities during these trying times. g

This year America Salutes You will be honoring the legendary

Our returning sponsors for this benefit concert for 2021 include

blues musical entertainment and philanthropy. Billy has been a

Discovery, Davis Elkins Foundation and VAMBOA. Additional

Billy F. Gibbons of ZZ Top for 50 plus years of southern rock and longtime supporter of ASY. This year’s concert will take place on 16 May 2021 on “country’s most famous stage,” the Grand Ole Opry House in Nashville.

Walgreens, Medstar Health, KLOVE Media, The Center for sponsors are joining.

In addition to this amazing concert on 16 May in Nashville,

Tennessee, America Salutes You is planning a second benefit

The concert will be filmed live to tape for subsequent broadcast

concert to be filmed live to tape at the site of the original 1969

Live distribution to drive in theaters, YouTube, Circle TV and AXS

Woods Center for the Arts on 4 July 2021.

on Fox television stations, Fox Nation streaming service, Encore TV on cable and others.

infamous Woodstock rock concert with performances at The Bethel Other concerts planned in 2021 include Maui, Hawaii and a 9-11

Billy Gibbons will be joined by music royalty including Vince Gill,

tribute in NYC to the surviving first responder families on this 20th

Vaughn, Travis Twitt, Sturgill Simpson, and other surprise guests.

Some of our teams at America Salutes You includes our leadership

Brad Paisley, Ronnie Milsap, Eric Church, Lucinda Williams, Jimmy America Salutes You is so incredibly grateful to Billy and all of the artists who donate their services.

One hundred percent of public donations will go to deserving charities including ThanksUSA, the USO, CreatiVets, and First Responders Childrens' Foundation, among others.

Each year we also host a Mental Health Policy Roundtable with

the nation's leading experts. It is moderated by Marie Gallo Dyak, President and CEO of the Entertainment Industries Council,

Inc., and Bob Okun, CEO of America Salutes You. Here is a link to the last Mental Health Roundtable. They all can be found on

the America Salutes You website: https://americasalutesyou.org/ past-concerts/2019-brain-mental-wellness-policy-roundtable/.

anniversary of the attacks.

and production team, our Board of Directors includes Bob Okun, CEO; John Harrington III, CFO; Debbie Gregory, COO; Evan Haiman, Vice-President; and Martin Guigui, Secretary.

Bob Okun is the founder of America Salutes You. He served as the Executive Producer of the past four nationally televised concerts

“America Salutes You” and “America Salutes You – Guitar Legends” as well as our 2020 virtual concert due to the global pandemic.

Bob is a former US Assistant Secretary of Education. He headed up NBC Universal’s Washington, DC office for 17 years. Bob is currently CEO of The O Team, LLC.

Bob and his family have been long time supporters of those who

serve and their loved ones. He and his two daughters founded g

g 132

VETERANS AFFAIRS 90 YEARS: Military & Wellness

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ThanksUSA in 2005, a national, non-profit awarding post-secondary

Superbowl Champ (ret), CEO Matt Birks & Co., Marc Montoya, CRO,

military personnel. ThanksUSA has contributed more than $16

Spyridon, President & CEO of Nashville Convention & Visitors Corp

school scholarships to the children and spouses of active-duty

million to military dependents for education over the past 15 years.

Martin Guigui is our board Secretary and Music Director. He is an

award-winning producer, filmmaker, and music director. Guigui has

recorded, produced, shared the stage, and worked with iconic Rock ‘n’ Roll Hall of Famers and Hollywood’s biggest stars. Guigui was

the Music Director for the “One America” concert which featured

five living United States President and raised $42 million dollars for hurricane relief.

Evan Haiman is our Vice President and part of the Production team.

Evan served as Executive Producer of “America Salutes You Guitar

Legends Specials.” Evan is presently Senior Vice President, Content, Circle Media and responsible for the network’s content strategy,

development, programming, and operations for the linear AVOD,

and streaming services. Haiman brings over 25 years of experience in production, development, and programming sphere with a career spanning stops at MLB, HBO Warner Bros. and AXSTV.

Debbie Gregory is our COO and has been part of the America Salutes You team since the beginning with Bob Okun. Debbie

ShareRocket, Formerly Senior Executive AXS-TV, Nextstar, and Butch (NCVC).

OUR PAST CONCERTS America Salutes You, 2016, Rosemont Theater in Chicago. Performers included pop legend Cyndi Lauper, singer/songwriter extraordinaire Gavin McGraw, Andra Day, country music legend Wanda Jackson, Gospel Grammy winner CeCe Winans, worldrenowned tenor Anthony Kearns, and bluegrass legend Ricky Skaggs.

Our Sponsors included Walgreens, AT&T, VAMBOA, Production Glue and KLOVE. Our Beneficiaries nonprofits included TAPS, Bob Woodruff Foundation, Easter Seals Disability Services, Give an Hour, Dixon Center and Snowball Express.

America Salutes You presents Guitar Legends, 2017, New York City, New York. Cohosted by Trace Adkins and Eddie Trunk, the benefit concert featured Billy Gibbons, Dave Navarro, Sam Moore, Lindsay Ell, Robert Randolph, Nancy Wilson, Liv Warfield, Orianthi, Richie Sambora and Joe Don Rooney. This star-studded concert was the highest-rated Multi-Artist Benefit Concert for Veterans and aired nationally across all U.S. network affiliated tv stations.

Our Sponsors included Walgreens, AT&T, NFL, Johnson & Johnson, FedEx, Production Glue and VAMBOA. Our Beneficiaries nonprofits included Elizabeth Dole Foundation, Headstrong and Psych Armor Institute.

communities for almost 20 years and is known for supporting

America Salutes You presents Guitar Legends II, 2018, Novo Theater, Los Angeles, California. The concert featured Billy Gibbons, Sammy Hagar, Dave Navarro, Joe Bonamassa, Orianthi, Don Felder, Robbie Kreiger, Stephen Stills, and Vernon Reid. This star-studded concert was the highest-rated Multi-Artist Benefit Concert for Veterans and aired nationally across all U.S. Network affiliated stations.

to promote their missions. Debbie is the founder and CEO of

Our Sponsors included Walgreens, AT&T, NFL, Johnson & Johnson, FedEx and VAMBOA.

with over 8,000 members nationwide. She previously was the

Our Beneficiaries nonprofits included Elizabeth Dole Foundation, Headstrong and Psych Armor Institute.

is dedicated to the wellbeing of veterans, active-duty military,

and their loved ones. She has worked in the military and veteran military and veteran non-profits and facilitating win/win partnerships VAMBOA, the Veterans and Military Business Owners Association founder and CEO of MilitaryConnection.com, one of the most

popular and comprehensive online directories. Debbie also serves in the Department of Defense volunteer position as the Director of Employer Engagement for ESGR in California.

America Salutes You Advisory Board includes: James Nicholson, Former Secretary, US Dept of Veteran Affairs, Brownstein, Hyatt, Farbert Schreck, David Shulkin, Former Secretary of US Dept of

Veteran Affairs, Shulkin Solutions, Dr. Matt Miller, Director of Suicide

Guitar Legends III – America Salutes You presents Guitar Legends III as part of the 3-day inaugural Wonder front Music Festival – 2019 in San Diego, CA. Our Talent included Billy Gibbons, George Thorogood, Warren Haynes, Steve Luthaker, Nancy Wilson, Charlie Starr, and Ellis Hall.

Our Sponsors included Walgreens, AT&T, United, KLOVE, VAMBOA, The Center for Discovery, and Production Glue.

Our Beneficiaries nonprofits included Entertainment Industries Council, Los Angeles Fire Department Foundation, Leadership Foundation of National Association of Broadcasters, No Greater Sacrifice and Patriotic Dog Foundation.

Rod Essig, Vice President CAA, Nashville, Wendy Lakso, US Dept of

America Salutes You, 2020 was a virtual event produced in conjunction with the US Dept of Veterans Affairs. Our talent included Billy Gibbons, Kenny Loggins, Mike Love, The Bacon Brothers, Big and Rich, Ashley McBryde, Lindsay Ell, and Larkin Poe.

Ed Wilson, NBC, FOX, Senior Executive (ret), Larry Went, Tribune

Our sponsors included Walgreens, KLOVE, VAMBOA, The Center for Discovery, Verizon, Amazon, MedStar Health and USO.

Prevention, Office of Mental Health and Suicide Prevention, VHA,

Veteran Affairs (ret), Val Nichols, US Army (ret), Summit Media Corp.

Media (ret), Catherine Ann Stevens, Mayer Brown, LLP, Fred Graefe, US Marine Corps (ret), Grafe Law, Carla Endy, The McCain Institute

Foundation, Col. David Sutherland, US Army (ret), Special Assistant to the Chairman of the Joint Chiefs Warrior & Family Support,

Chairman Dixon Center, Dr. Albert “Skip” Rizzo, Executive Director USC Creative Technology Center, Matt Birk, NFL Bowl and All Pro

134

VETERANS AFFAIRS 90 YEARS: Military & Wellness

Our Beneficiaries nonprofits included McCain Institute Arizona State University, Patriotic Dog Foundation, Heart and Armor, TAPS, Veterans Support Foundation, CreatiVets, Operation Stand Down and Bridging The Gap. America Salutes You encourages readers to make a difference to those who place their lives on the line for the rest of us. Mental wellness and suicide prevention are two of the most important challenges facing veterans, military, first responders and their loved ones. Please consider making donations at https://bit.ly/3dVwFmw.

VET ER AN S

YEARS: MILITAR Y&

W E

SS NE LL

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