TIME celebrities

The Military Absolutely Loved Robin Williams

The late comedian took multiple trips to war zones to entertain troops

Robin Williams was beloved by the U.S. military, perhaps even more so than by the American public. He carried Bob Hope’s mantle as a funny man far from home, often in inhospitable places. Throughout his career, Williams made six USO tours to Iraq, Afghanistan, and 11 other countries and performed for 90,000 troops by the time of his final tour in 2010.

He had the troops roaring in Baghdad in 2003, shortly after the capture of Saddam Hussein. “I love the fact that when he came out of that spider hole, he wanted to negotiate,” Williams said, before changing his voice into that of a bellowing soldier: “It’s a little late for that, bubsy! You’re at the point where you’re going to share a cell with a large man named Bubba. I’m gonna be yo’ new Baghdaddy.”

He also poked fun at the Army itself, including a change to uniforms that appeared to be computer-generated. “The new Army camouflage—it’s digital,” he told troops in Kabul in 2007. “So you can disappear in front of a computer.”

“Williams traveled around the world to lift the spirits of our troops and their families,” the USO posted on Facebook following the news of Williams’ passing. “He will always be a part of our USO family and will be sorely missed.” The post had attracted nearly 60,000 “likes” by midday Tuesday.

Defense Secretary Chuck Hagel made a statement of his own on Williams, saying that “from entertaining thousands of service men and women in war zones, to his philanthropy that helped veterans struggling with hidden wounds of war, he was a loyal and compassionate advocate for all who serve this nation in uniform. “He will be dearly missed by the men and women of DOD—so many of whom were personally touched by his humor and generosity.”

Jim Garamone, a writer for the Pentagon’s internal news service, wrote Tuesday of the comedian’s caring and compassion for those fighting the nation’s wars:

At the end of every performance—be it a combat outpost or a forward operating base—Robin was always the last entertainer to leave. In Iraq, a group of Marines came in from patrol and missed his show. He made it a point to meet with them and give them 20 minutes of fun, even as the chopper’s blades were turning to go to the next show.

In Afghanistan, the “clamshell” at Bagram Air Field was a favorite venue for him, and he performed there many times. In 2010, he started the show with “I love what you’ve done with the place.”

He was not a prima donna. One time a sandstorm grounded the party at an outpost near Baghdad. Robin along with everyone else crammed into a small “tin can” to spend the night. The next day his jokes about snoring and gaseous emissions pretty much convulsed everyone.

Rear Admiral John Kirby, the Pentagon’s top spokesman, recalled asking Williams, the father of three, for some fatherly guidance during that last 2010 tour. “I once asked Robin Williams to offer advice for my son, who would soon turn 18,” Kirby tweeted early Tuesday. “’Follow your heart,’ he said. ‘The head is sometimes wrong.'”

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DoD photo / Chad J. McNeeley Airman enjoy Robin Williams’ shtick during a 2007 show in Kuwait.
MONEY College

Why Veterans Will Soon Save Thousands on College

War veterans & co-eds taking notes during classroom lecture at crowded University of Iowa
Margaret Bourke-White/The LIFE P—Getty Images The latest change to the GI Bill will help fill college classrooms for less.

A bill heading to the president's desk grants veterans and their families automatic in-state status at all public colleges, potentially saving them time and money.

Great news for college-bound veterans and their families: Starting next year—the fall of 2015—veterans and their dependents will be able to pay low in-state tuition at any public university in the country.

A bill granting veterans automatic in-state status at the nation’s public colleges got final bipartisan approval by Congress last Thursday, and President Obama has said he will sign it into law.

While public colleges are concerned that the new bill will cost them money, veteran’s organizations are thrilled. “We’re really excited,” says William Hubbard, vice president of government affairs for the Student Veterans of America, which estimates there are 550,000 veterans currently in higher education.

Because members of the military often spend long periods overseas, many don’t maintain residency in any U.S. state. So servicemen and women often can’t find an affordable college when they return home to start civilian life, Hubbard says.

Twenty-four states have passed state laws giving vets in-state status at their public colleges, but many veterans live or want to live in states that haven’t done so, such as California or North Carolina, he says. At the University of North Carolina, for example, in-state residents are charged tuition and fees of about $6,400 this year; out-of-state students pay roughly $31,800.

The bill could save families tens of thousands of dollars, since the automatic in-state status will also be granted to veterans’ spouses and children.

Because veterans won’t have to wait to establish residency in a state to pay the lower tuition, the new law will also save time and speed the transition to civilian life, says Ryan Tomlinson, education program coordinator of the Iraq and Afghanistan Veterans of America. “I’m happy for the vets,” he says. “This increases their access to good colleges.”

Public colleges and universities, while sympathetic to the veterans’ plight, expressed concern that Congress was forcing them to take on extra expenses. Peter McPherson, president of the Association of Public Land-Grant Universities, notes that states have been cutting the budgets of public colleges for years. This new law, by reducing their tuition revenues, “would add further financial strain to these institutions,” he warned.

Learn more about Money’s Best Colleges 2014-2015

TIME Congress

As Time Runs Out, Congress Is Gridlocked on Immigration Reform

John Boehner
J. Scott Applewhite—AP House Speaker John Boehner, center, walks to the House chamber on Capitol Hill on July 31, 2014

The House of Representatives has consequently had to delay its recess by a day

On Thursday, Republicans in the Senate stymied the bill that would have allotted $2.7 billion to resolving the issue of Central American minors illegally crossing the border into the U.S., which many politicians have deemed a national crisis.

The bill received 50 yeas and 44 nays, falling short of the 60 it needed in order to end up on President Barack Obama’s desk. In July, Obama had asked legislators for a comprehensive emergency plan dedicated to resolving the immigration issue.

Republicans, according to a CNN report, took issue with the legislation’s dearth of provisions concerning the deportation of illegal immigrants. A bloc of far-right Congressmen within the party also managed to successfully suspend the vote on a bill in the House of Representatives intended to facilitate the deportation process, deeming the legislation too moderate.

The squabbling has forced the House to delay its August recess by one day.

Not all was gridlocked in Congress, though. The Senate voted almost unanimously in favor of a bill that will provide the Department of Veterans Affairs with over $16 billion to address some issues concerning health care services for veterans, including reduction of delays and the hiring of more doctors.

TIME Veterans

Congressional Negotiators Strike VA Reform Deal

From right: Senator Bernie Sanders and Senator Richard Blumenthal during a news conference on Capitol Hill in Washington, D.C., on July 24, 2014.
AP From right: Senator Bernie Sanders and Senator Richard Blumenthal during a news conference on Capitol Hill in Washington, D.C., on July 24, 2014.

In three days, Sen. Bernie Sanders and Rep. Jeff Miller have turned around the state of negotiations and come up with a $17 billion solution

Updated at 3:55 p.m.

The two chief congressional negotiators to reform the scandal-plagued Veteran Affairs Department have struck a $17 billion deal to address long patient wait times and dishonest government employees who doctored records to make their hospitals appear more efficient.

The bill includes $10 billion to allow veteran patients to receive non-VA health care and another $5 billion to hire more doctors and health care practitioners. The cost of the bill is offset by $5 billion in cuts to the department elsewhere, said Vermont Independent Sen. Bernie Sanders Monday.

The bill is a compromise between two proposals created last week by Florida Republican Rep. Jeff Miller and Sanders, which they said would have cost $10 and $25 billion, respectively. Interim Veterans Affairs Secretary Sloan Gibson requested $17.6 billion two weeks ago to hire 1,500 doctors and build new clinics, among other things.

Sanders, the Senate Veterans’ Affairs Committee Chairman, said that the bill was “far from what I would have written if I had to do it alone” and that “God knows” there is more work to be done. But both he and Miller, the House Veterans’ Affairs Committee Chairman, said they support the bill and expect it to pass this week before members leave for a five-week recess.

The deal uses a variety of methods to speed up patient service. If the VA doesn’t grant an appointment to a patient within the current wait time goal of 14 days, or if a patient resides more than 40 miles from a VA facility, the veteran can use non-VA care, including from private health care providers that participate in Medicare, and Department of Defense health centers.

The bill would also allow the VA Secretary greater authority to fire employees, who would have three weeks without pay before an appeals board would be required to make its verdict. The new power will aid former Procter & Gamble CEO Robert McDonald, whose confirmation to the position is pending.

Miller and Sanders noted that the cost of the Senate and House bills that passed overwhelmingly in June made negotiations difficult. Each of those would have cost at least $35 billion, according to the Congressional Budget Office.

The Veteran Affairs Department has been rocked by reports of patients dying while on months-long waiting lists. Secretary Eric Shinseki resigned in May after an inspector-general report signaled a widespread practice of employees falsifying records to hide slow response times.

A deal had seemed unlikely Thursday, when Sanders said on the Senate floor that he wouldn’t be shoehorned to pass the Republican’s $10 billion proposal. “Any sixth-grader in a school of the United States understands, this is not negotiation,” he said. Miller then released a statement saying that it would be “impossible” to forge a bill if Senate Democrats refused to participate in conference meetings. With only a week left before the August recess, media outlets proclaimed that negotiations had “imploded,” “ground to a halt” and were “on the verge of collapse.”

But these squabbles may have actually pushed the negotiations further along, a congressional aide with inside knowledge told TIME. Asked Friday if the previous day’s press coverage was overblown, the aide said, “Maybe a little, but we all gave everyone plenty of fodder and it could be that some of the drama, intentionally or not, helps move things along.”

TIME Military

Quadruple Threat: Soldier, Sailor, Airman and Marine, All Rolled Into One

Branched out: From Marine, Soldier, Sailor to U.S. Air Force Airman
Staff Sgt. Evelyn Chavez / Department of Defense Now-Air Force Staff Sgt. Jesus Yanez has also served in the Army, Navy and Marines since 1993.

Staff sergeant has served in all four branches of the U.S. military

Despite the Pentagon’s nonstop jawboning about joint operations—where the military’s four sister services cooperate to prevail on the battlefield—those with time in uniform will tell you that each service is like a foreign land to the other three.

That makes Staff Sergeant Jesus Yanez, currently manning checkpoints at the biggest U.S. base in Afghanistan, a genuine world traveler.

Since 1993, he has served in the Army, Navy, Air Force and Marines.

His skills pay dividends when he’s spending his day off getting pizza or walking around with military colleagues at Bagram air base, just outside Kabul. After his buddies spy an American sailor wearing foreign-looking insignia they don’t understand, the questions begin:

“They ask me, `What rank is that?’ And I’ll say `He’s a petty officer,’ and they ask: `What’s a petty officer?’” referring to the Navy’s non-commissioned officers. “They’ll ask me, `Do you salute warrant officers?’”—those in the Army between enlisted and officers—“and I’m like, `Yes, Army warrant officers get a salute.’”

But military life’s not all about rank. “The food in the Air Force is much better than in the Army, Navy or Marine Corps,” says Yanez, who is in the middle of a five-month tour in Afghanistan with the Air Force—and enjoying every bite. Marine chow, not so much: “You could throw a biscuit into the wall and make a hole through it.” But the Marines, he concedes, score high elsewhere: “Their uniforms are probably the best in the military.”

Yet he says he has learned from each of the services. “In the military, you’re like a family,” Yanez says. “It doesn’t matter what branch you’re in, if something happens to you, everybody’s going to be there for you. And the military gave me an education—I have an associate’s, bachelor’s and a master’s.”

USMCYanez as a Marine 20 years ago.

Yanez, 39, hails from El Paso, Texas. He served as an active-duty Marine from 1993-97. “They always say the Marine Corps’ boot camp is the hardest one to go through,” he remembers thinking. “In my mind, when I was in high school, I’d think if I could be a Marine, I could do anything.”

He left the corps and spent a couple of years in the civilian world. “After awhile, I missed the military, just in general,” Yanez recalls. The single father of two wanted to stay in El Paso. He was looking for a reserve slot, and checked out, but rejected, the El Paso Marine Reserve unit. “I didn’t want to do artillery,” he says of their specialty.

So he ended up in a nearby Navy Reserve unit. “The Navy Reserve had a master of arms program, which is almost like an MP [military police], and that when I enlisted,” he says. “I wanted to pursue a career in law enforcement.” But Yanez says he found the Navy too informal—“I wasn’t used to the first-name basis at the reserve unit”—especially following his Marine service.

He traded the Navy for the Army in late 2001. “After September 11, I just felt that I needed to go back and do my part for my country,” he says. But he spent time stateside after his new reserve unit already had deployed to Iraq, which Yanez found disappointing. “The opportunity for me to deploy with the Army wasn’t there,” he says. In his reserve service, Yanez generally has drilled one weekend a month, with a two-week block of training annually.

But while working as a civilian Army police officer at El Paso’s Fort Bliss, he heard from Air Force reservists there that they routinely deployed overseas. So in 2006, he joined the Air Force as a member of the Texas Air National Guard’s 204th Security Forces Squadron, and spent part of 2010 in Iraq.

“It sort of just happened, being in all four branches,” Yanez, with the 455th Expeditionary Base Defense Squadron at Bagram, recently told an Air Force public-affairs officer. “I didn’t even think about it until one of my friends mentioned it.” Pentagon officials said Thursday that Yanez’s quad-service heritage is “highly unusual,” but don’t have data detailing just how rare it is.

Yanez doesn’t boast of his unusual military background. “I don’t have any stickers on my vehicle—I don’t even have any tattoos,” he says. But something betrays his past, at least to keen observers. “People always ask me, even though I’m in an Air Force uniform, if I was a Marine,” he says. “Because I still have a high and tight flattop” haircut. “Saves me a lot of money.”

One more thing. Yanez doesn’t want those in the Coast Guard thinking he’s slighting them. Coasties always feel dissed when people talk about the nation’s four military services, because Coast Guard personnel insist they’re the fifth. The Coast Guard is part of the Department of Homeland Security, but can be commanded by the Department of Defense in times of war. “Maybe I’ll get a job with the Coast Guard,” he says, “when I retire.”

TIME animals

Ohio Man’s Therapy Ducks Fall Foul of Local Ordinances

Iraq war veteran Darin Welker holds one of his ducks at his home in West Lafayette, Ohio on July 10, 2014.
Trevor Jones—AP Iraq war veteran Darin Welker holds one of his ducks at his home in West Lafayette, Ohio on July 10, 2014.

Veteran Darin Welker says raising the birds helps him overcome PTSD from the Iraq War

Darin Welker loves his ducks. He feeds them, looks after them, and sometimes the Iraq War veteran from West Lafayette, Ohio just watches them interact. But Welker’s community doesn’t share the same affection for his feathered friends.

On Wednesday, the Associated Press reports, Welker will appear in a local municipal court facing a minor misdemeanor charge for raising 14 ducks in violation of local village rules. He could face a fine of up to $150.

Welker, an Iraq War veteran, says he’s been raising the ducks as a form of therapy for a back injury and post-traumatic stress disorder. Welker told the AP that although the Department of Veterans Affairs paid for his back surgery in 2012, they did not provide mental or physical therapy.

In March, he got the ducks to help fill that void, after hearing raising them could be therapeutic.

“Taking care of them is both mental and physical therapy,” Welker told the AP. “[Watching them] keeps you entertained for hours at a time.”

In West Lafayette, however, raising ducks or any farm animal violates a 2010 ban on housing “chickens, turkeys, ducks, live poultry or fowl of any kind, horses, ponies, cows, calves, goats, sheep, or live animals of any kind except dogs, cats, gerbils, hamsters, guinea pigs, birds or mice.”

But there is hope for Welker and his ducks. A local woman fought to keep the pot-bellied pig she and her daughter use for therapy in 2013. Mary Smith, the pig’s owner, told the Coshocton Tribune at the time that she would rather move than give up her pig. “He’s part of our family,” Smith said.

Smith obtained a letter from her doctor confirming her pig was for therapy. According to the AP, Welker has already gotten a letter from the mental health department of the U.S. Department of Veteran Affairs recommending he keep the ducks.

[AP]

TIME Veterans

Obama to Tap Soap Salesman to Clean Up VA

Former Procter & Gamble boss is a West Point grad

President Obama will announce he is replacing the retired Army general who was running the VA with a former Army captain—swapping four-star salutes for business smarts. The pick suggests just how tough the VA assignment is, and an acknowledges that the sprawling bureaucracy of 300,000 doesn’t always salute when it’s given orders.

Bob McDonald, a former chief executive of soap giant Procter & Gamble, is replacing Eric Shinseki, who stepped down May 30 after it became clear many officials at the Department of Veterans Affairs were hiding how long it took veterans to get their promised medical care.

Obama picked the right guy to clean an agency tarnished by accusations that its managers repeatedly gamed VA records—potentially leading to the deaths of some veterans—to help VA officials win annual cash bonuses. Early in his career at P&G, McDonald managed the company’s Tide detergent business, before heading to Canada and then Asia to run the company’s laundry and cleaning operations. The White House leaked news of McDonald’s nomination, expected Monday, and said his business skills and military background make him the right choice.

Paul Rieckhoff, chief of the Iraq and Afghanistan Veterans of America, suggested McDonald’s corporate background could be an asset. “His branding background may prove helpful,” he said. “There are few organizations in America with a worse reputation with its customers than the VA right now.”

A native of Gary, Ind., McDonald spent five years in the Army, primarily with the 82nd Airborne Division, after his graduation from the U.S. Military Academy at West Point in 1975. He joined P&G—and its lengthy roster of brands, which now includes Gillette, Crest and Febreze—in 1980. He ran the company for four years before retiring in 2013, after pressure from investors that he wasn’t cutting spending sufficiently.

Congressional reaction was muted. Senator Bernie Saunders, I-Vt., who chairs the veterans committee that will hold McDonald’s confirmation hearing, said simply that he looks forward to meeting McDonald “in order to ascertain his views” on the VA’s problems. His Republican House counterpart was even less welcoming. “The only way McDonald can set the department up for long term success is to take the opposite approach of some other VA senior leaders,” said Rep. Jeff Miller of Florida, chairman of the House Committee on Veterans Affairs. “That means focusing on solving problems instead of downplaying or hiding them, holding employees accountable for mismanagement and negligence that harms veterans, and understanding that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them.”

McDonald spoke about such fudging as P&G’s chief operating officer. “We don’t lie, cheat, or steal,” he said in remarks he would make to new P&G employees in 2008 and 2009, “and we don’t tolerate people who do.”

McDonald has his work cut out for him, as detailed in a report by White House deputy chief of staff Rob Nabors, who Obama dispatched to the VA’s Veterans Health Administration to determine how bad things are. “The VHA leadership team is not prepared to deliver effective day-to-day management or crisis management,” Nabors report, released Friday, concluded. “Instead, VHA is marked by an inherent lack of responsiveness and a belief many issues raised by the public, the VA Leadership, or oversight entities are exaggerated, unimportant, or `will pass.'”

McDonald will be the first VA chief of the last four who didn’t retire from the service after an Army career. The prior four VA secretaries—since it became a Cabinet-level agency in 1989—served, like McDonald, in uniform early in their careers. He qualified for many badges during his five years in uniform: Airborne, Ranger, Jungle, Arctic and Desert Warfare, Jumpmaster, Expert Infantry, and Senior Parachutist.

He brought that same approach to P&G. When he took control of the Tide account in 1984, “Tide only came in one form, which was powder Tide regular scent,” he told a Yale audience last year. “Today…you can get liquid Tide, you can get Tide with bleach, and you can get Tide with Febreze. We just launched a Tide for fitness clothes.”

Knowing consumers—and what they want—is key, he explained: “You’re going to create better loyalty, more indispensability, and as a result of that you will have a higher market share.”

He’s going to need all the business savvy he can muster, assuming Senate approval, in his new job. When McDonald left P&G, it had annual sales of about $84 billion, half of the VA’s annual budget. The Congressional Budget Office estimated earlier this month that the reforms the Senate wants to make in providing veterans with better access to health care could double the VA’s annual $44 billion health-care budget.

TIME Veterans

2 Veterans Affairs Officials Resign in Scandal’s Wake

Following Eric Shinseki's resignation

The Department of Veterans Affairs said Wednesday that two senior officials are stepping down next week as the agency looks to rebound from a scandal over concealing long wait times for veterans to get care.

The VA said the resignation of Will A. Gunn, the current General Counsel, and the replacement of Dr. Robert Jesse, the acting Under Secretary for Health, are “aimed at accelerating Veterans’ access to quality health care and rebuilding the trust of America’s Veterans.”

Jesse served as principal deputy under secretary for health beginning in 2010. In May, he assumed the new position amid reports veterans weren’t receiving adequate care. On July 2, Dr. Carolyn Clancy, who has been at the VA since 2013, will replace him.

“Dr. Carolyn Clancy is a leader and a real innovator when it comes to Veterans’ health care quality and safety,” Acting VA Secretary Sloan Gibson in a statement. “As we conduct our search for an Under Secretary for Health, there’s no one better to take on the issues we face. Dr. Clancy will be charged with the Department’s top priority – getting Veterans off of wait lists and in to see their doctors.”

Gunn’s resignation goes into effect July 3 when he will be replaced by the current principal deputy general counsel Tammy Kennedy. Gibson also announced that Dr. Jonathan Perlin, who served as the undersecretary for health under President George W. Bush, would be returning as a senior advisor to the Acting Secretary.

“We’re pleased to welcome this exceptional leader back to VA,” Gibson added. “I look forward to the contributions of Dr. Perlin who is recognized for his national healthcare leadership roles, as part of the VA team as we continue our work towards accelerating access to care and rebuilding trust with Veterans.”

Secretary of Veterans Affairs Eric Shinseki under fire in May.

“The only way today’s VA personnel actions can be viewed as positive developments is if the department fills the vacancies with leaders who put veterans first—not the VA bureaucracy—focus on solving problems instead of downplaying or hiding them, and understand that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them,” Florida Republican Rep. Jeff Miller, who chairs the House Committee on Veterans Affairs, said in a statement.

TIME

On Iraq, Leaders Should Listen to Ghosts of Dead Soldiers

The leaders who will decide how American will handle instability in Iraq would do well to look around their own haunted city

Iraq is not my war. But I spent 14 months in Afghanistan, and am one of the only combat veterans known by my circle of DC friends. I receive many questions of what I think about ISIS steamrolling their way towards Baghdad.

The next time one of them raises the prospect of America involving itself in a third conflict in Iraq, I’m going to tell them about Dan Whitten.

Last week, I was headed to my air-conditioned office building in downtown Washington in the already scalding 9am heat. The humidity was so thick I practically waded through it.

Just before my sweat forced me into a foul mood, I spotted him in the crosswalk. I hadn’t seen Captain Daniel Whitten since we were in Afghanistan in 2008. He had been an officer in my company, but got called up to be an aide to one of the 82nd Airborne Division’s Generals. We weren’t close, but we were friendly. We shared a cigar together at Musa Qala. Just before the deployment, we ran into each other at a Fayetteville CarMax, each there with our wife, trying to sell the vehicles we wouldn’t need for the next fifteen months. We spent a couple hours talking baseball, and discussing a mutual friend from West Point who had washed out and now worked as an enlisted man in the same office I did.

The corners of my mouth lifted as I prepared to ask Cpt. Whitten—whom I could now just call “Dan”—what he was doing in a suit in DC, still wearing a pair of sporty Oakleys like he had back then.

Then I remembered it couldn’t be Dan Whitten. Because Dan Whitten is dead. He was killed by an IED when he came back to our battalion to take a company command for the next deployment. I passed shoulders with this man who looked like Dan and went on my way.

I’ve had a handful of these moments since 2008. I’ve seen Drak and Frazier and Cleaver at various times in different parts of the country. No matter the distance between me and my time in Afghanistan, their ghosts drag me back.

Washington, D.C., is more haunted than most places. When I first moved inside the Beltway to a one-bedroom apartment in Arlington that I shared with my daughter, my bus took me by Arlington National Cemetery every morning. If I strained, I could see section 60, where Charlie and Slip and Frazier rest.

And there are the monuments to Korea, Vietnam, and World War II. From in front of the Capitol building that was burnt by British troops in 1812, General Grant gazes at General Washington, and beyond him the Commander-in-Chief of the War of the Rebellion. Admiral Farragut looks over the square where my bus arrives each morning. The African-American Civil War veterans keep watch on the street where I drink. More heroes and remembrances and former installations dot the District than I know.

For all those ghosts that haunt This Town, the city that sends American men and women into harm’s way never seems to heed—forget remember—their warnings. We cast the specters in bronze and put their spirits on our lapels and car bumpers. We neglect to consider why they haunt us in the first place. These walls and figures and marble temples are placed for the deliberate purpose of remembering the awful brutality of war. How many tourists or even residents can point to Peace Circle on a map? Or can tell you what FDR says about war in his monument (he hates it)? Or know that the MLK, Jr., monument engraves opposition to war in stone?

Every day, those of us who live and work here walk by these ghosts without a second thought. We come home and turn on our televisions and watch other (usually) men who work in This Town argue over whether we’re leaving a war too fast, or if the third time would be a charm for Iraq. If we paused for a moment and listened to our ghosts, even those of the just wars, they would tell us that war is horrible, and that no matter how righteous the justification many will die needlessly. And yet, men and women who now wear the same uniform I did and took the same oath have pledged to go anywhere in the world in the name of their county, and are willing to die for it. They pledged, as Dan and Charlie and Drak and Slip and Frazier did, to do this without asking whether such a sacrifice would be worth it.

The least we can do, as a nation, is ask that question for them.

 

Richard Allen Smith is a former Army sergeant. He served five years on active duty, including a deployment to Afghanistan with the 82nd Airborne Division from February of 2007 to April of 2008. Smith is currently a graduate student in writing at Johns Hopkins University.

TIME Military

The PTSD Epidemic: Many Suffering, Few Solutions

Soldiers with the U.S. Army's  Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afgan National Police compound before going on patrol near Command Outpost AJK (short for Azim-Jan-Kariz - a near-by village) in Maiwand District
Andrew Burton—Reuters Soldiers with the U.S. Army's Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afghan National Police compound before going on patrol near Command Outpost AJK in Maiwand District, Kandahar Province, Afghanistan on Jan. 24, 2013.

The scourge of wars in Afghanistan and Iraq is worse than we thought

Now that Iraq is falling apart, it seems only fitting that the U.S. government issues a fresh accounting revealing that neither the Pentagon nor the Department of Veterans Affairs has any idea if the billions they’re spending on PTSD treatments are doing any good.

A congressionally mandated Institute of Medicine panel reported Friday that neither agency assesses the success of their PTSD care. “Without tracking outcomes, neither DOD nor VA knows whether it is providing effective or adequate PTSD care, for which they spent $294 million and more than $3 billion, respectively, in 2012,” the 300-page study concludes.

Roughly 5% of all troops have been diagnosed with PTSD, the report says, but it’s nearly double—8%—for the 2.5 million who served in Afghanistan and Iraq. Post traumatic stress disorder is also increasing among older veterans. In 2013, the VA diagnosed 62,536 new cases in veterans who did not serve in the Iraq and Afghanistan wars. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran. All told, the number of veterans seeking PTSD care jumped from 190,000 in 2003 to more than 500,000 in 2012.

“Although these numbers are likely to underestimate the incidence and prevalence of PTSD, they demonstrate that action is needed to respond to this growing problem,” the study says. “Demands for post traumatic stress disorder services among service members and veterans are at unprecedented levels and are climbing.”

The IOM report is crammed with data about the extent of the problem, and figures to back them up (you can see more of them here):

  • Total Pentagon spending on PTSD treatment jumped from $29.6 million in 2004 to $294.1 million in 2012.
  • Outside PTSD care funded under the Pentagon’s TRICARE program climbed from $22.4 million in 2007 to $131 million in 2012.
  • Between 2006 and 2012, the number of hospitalizations of service members for PTSD increased by 192%.
  • The total annual cost for health care for a veteran who had PTSD was estimated to be $11,342, which was more than double the annual VA health care cost of a veteran without PTSD.

Even those who have dealt with the issue for years are surprised. “The acceleration of PTSD among service members and veterans is staggering,” says Elspeth Ritchie, a retired Army colonel and the service’s one-time top psychiatrist.

The Pentagon’s PTSD treatments “appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes,” the IOM report says. While the VA’s programs are “more unified,” they both lack records of what treatments work, meaning they “have no way of knowing whether the care they are providing is effective.”

IOMThe Pentagon PTSD bill grew 10-fold between 2004 and 2012.

“Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” says committee chair Sandro Galea of Columbia University’s Mailman School of Public Health. The report is a follow-up to an initial IOM assessment of PTSD treatment released in 2012 that only surveyed what was available; Friday’s study was to find out if they work.

The number of veterans of all eras who sought care for PTSD from the VA more than doubled from 2003 to 2012—from approximately 190,000 veterans (4.3% of all VA users) in 2003 to more than a half million veterans (9.2% of all VA users) in 2012. For those treated for PTSD in the VA system in 2012, 23.6 percent (119,500) were veterans of the Iraq and Afghanistan wars.

PTSD can happen when someone experiences a traumatic event, on the battlefield or elsewhere. It can lead to anxiety, depression, sleeplessness and other symptoms that can interfere with life, sometimes contributing to domestic violence, divorce and suicide. The multiple deployments required by a force too small to support the wars fought has played a major role in the PTSD increase among recent vets.

Unfortunately, even if the government begins tracking outcomes, the results may be what the IOM calls “modest,” at best. The only program that routinely conducts such assessments is the VA’s small specialized intensive PTSD program (SIPP). “In 2012, the 39 SIPPs had 3,792 entrants for a total cost of $88,572,953, or $23,578 per patient,” the study found. “The average PTSD Checklist (PCL) scores for veterans at admission to the programs and 4 months after discharge were 65.9 and 60.2, respectively. That indicates that most program graduates met the criteria for clinically significant PTSD after discharge on the basis of a PCL cutoff score of 50.”

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