War Comes Home: Helping Vets Cope

ALAN RAY (Host): Welcome to These Days on KPBS. I’m Alan Ray in for Maureen Cavanaugh. In one way or another, at one level or another, America has been at war for most of the past nine years. First in Afghanistan, then and now in Iraq, and now both. This wartime is twice a long as World War II, and dramatically, frightening, tragically different for the men and the women who are fighting this time. The fighting may be going on in foreign places, but every day some of the war comes home. This week, KPBS begins a series of features on Morning Edition. We’re looking at the effects of war on the homefront. Multiple deployments, families displaced, kids going into the fourth or fifth grade with no idea what it's like to have a mom or dad who’s not repeatedly going overseas to strange, dangerous places. We call the series "War Comes Home." It is a stationwide effort. We'll talk about it on These Days this week. You can watch for a special report Friday night on "San Diego Week," and you can back up the stories and go back and look at them again at KPBS.org. We’re joined on These Days today by the executive producer of the series “War Comes Home,” Alison St John. Good morning.

ALISON ST JOHN (KPBS Executive Series Producer): Good morning, Alan.

RAY: And we’re also joined by Laura Owen, who’s program manager for the Veterans Administration San Diego Care Management Team. Laura, good morning.

LAURA OWEN (Program Manager, Veterans Administration San Diego Care Management Team): Good morning.

RAY: Now, before we go too much further, I suppose it’s worth mentioning this is a serendipitous time for us to talk to you because you’re talking about this very thing right now.

OWEN: That’s right. I am calling you from Las Vegas, Nevada, where we are having the second annual Joint Department of Veterans Affairs and Department of Defense Evolving Paradigms. We are meeting right here as we speak to discuss new treatment methodologies, research and evolving care management strategies for our returning OEF, OIF vets.

RAY: Okay, we’d be pleased also if you’re listening and you’d like to join the conversation. Do you have a loved one who’s deployed and, if so, what’s the hardest thing about that? What kind of support do you get? Do you get enough support? Is it more difficult to get support off base or on? Just some of the questions you might have and we might have, or we might have answers to. Give us a call. We’d love it if you’d participate in the conversation. 1-888-895-5727, 1-888-895-KPBS. First of all, Alison, why – where did this – the idea for this series come from?

ST JOHN: Well, Alan, we have done quite a bit of coverage here on KPBS about the economic impact of the military on San Diego. And we’ve shown that, indeed, this county is the recipient of more Department of Defense dollars than any other county in the nation. And there are some pretty positive, you know, repercussions of this. We get about $15 billion, if not more, from the DOD every year, that’s not even counting defense contract dollars and more dollars for building more infrastructure on the bases. But what we hadn’t been really looking at so much until now was the other side of it, the personal side. It’s not all about money. It’s about what is the impact on this community of having such a large military contingent, and how is being a nation at war affecting those families and those individuals who are living right here in our midst. You know, we know that there’s about 240,000 – 250,000 vets, that’s a conservative estimate from the VA. Some people suggest it might be more like 300,000. We know that there’s more than 100,000 active duty and maybe about half of those are married so there’s – there are hundreds of thousands of people in this community who are living this war in one way or the other.

RAY: So if you figure an average – an average family is three or four. If we have 250,000 vets, there are effectively a million people who might, in one way or another, be directly affected with the military and deployments.

ST JOHN: Right. I haven’t found it easy to get specific statistics on San Diego, although there are statistic nationally. And nationally speaking, they’re saying that there’s about 20% of the population is linked to a veteran.

RAY: Okay, give us an overview over the week, if you would. What can we look forward to hearing in the next couple of days?

ST JOHN: Well, tomorrow we’re going to be hearing from Kenny Goldberg about how some families in Camp Pendleton are dealing with the fact, as you mentioned in your intro, this is a different kind of war. There are these repeated deployments and that’s a huge strain on families because it’s not just losing someone and then getting them back. It’s like a sort of on-going cycle which has its own emotional rollercoaster effect on the wives and the children. The next day, we’ll be speaking to a veteran, a young vet who has symptoms of PTSD and also traumatic brain injury and is still struggling, really, to get back on his feet after being discharged almost two years ago now, marriage broken up. This whole issue of how many of the veterans’ marriages are not lasting, you know, once they get discharged from the military is a big, unanswered question. Then on Thursday, we’ll be talking about education and Ana Tintocalis, our education reporter, will be bringing us a family that is, you know, going to show us a little bit of the sort of everyday reality of what you have to deal with when your father or mother, who’s in the military, is constantly changing locations, so you may just sign up for a college, get in, and then, boom, you have to change and go to a different college. It could be affecting academic performance but at this point there’s very little statistics on that. So – And then on Friday, we’ll be hearing from Duane Brown about the number of women veterans that are now homeless. And according to the VA, about seven point – a little bit more than 7% of all veterans are women now. So I think one of the things we’ve discovered, Alan, over the whole week is that there is a lot that isn’t known yet. But this is really important. You mentioned how serendipitous to be talking about this and I think right now, as the nation is really trying to decide should we be going into Afghanistan in more force, you know, what is the implications of being a – continuing being a nation at war, and there are a lot of questions that haven’t been answered about the impact of war here at home.

RAY: Laura Owen, every war has, I suppose, its hallmark weapons and its hallmark sorts of injuries for the men and women in combat. Vietnam had Bouncing Bettys and Claymore mines and now, all of a sudden, we’re seeing IEDs and roadside bombs with I – it sounds like an entirely different kind of set of injuries more common.

OWEN: Absolutely. The hallmark, the signature injuries we are seeing from this war are traumatic brain injury, referred to as TBI, and post traumatic stress disorder, as well as amputations and burns and disfigurements, blindness, hearing loss, those are all very common. One of the reasons that we’re seeing such a high level of traumatic brain injury is that our protective armor and our – you know, the protection that we put around the physical space of our soldiers is improving and so, you know, maybe 30 years ago in other conflicts, our soldiers would have died from the blasts that they’re now coming back from. But, as a result, that doesn’t keep them injury free. That just keeps them alive, and so we’re seeing large numbers of traumatic brain injury, and that’s basically a blast that affects the brain’s movement inside the skull and causing physical damage to the brain. And we’re seeing – we are catching up with the high demand for that.

RAY: Now is that more than a simple concussion like I might get on the football field?

OWEN: Absolutely. This is, you know, ten years ago, we saw traumatic brain injury in motorcycle accidents or in motor vehicle accidents, people who were hit hard in the head but were still protected and were able to walk away. That was, by and large, who we saw suffering from these injuries, and it was in very, very small numbers. These days, we see a large number of traumatic brain injuries. It’s sort of the signa – again, it’s the signature injury of this conflict. And our research and our medicine is scrambling to catch up with the high number of patients with this illness. As well, we have seen a large number of co-morbidity, you know, the co-existence of post traumatic stress disorder and TBI. They seem to go hand in hand, and we are gradually learning why. In addition to that, we are learning that PTSD, which, you know, was previously called combat stress or, you know, other – gone under other names, PTSD we are learning is no longer just an emotional problem. We are seeing high numbers of headaches and reports of pain from our patients with PTSD. This is not just a psychological problem. PTSD has physical manifestations and we are learning how to best care for our patients with those.

RAY: Now, after World War I and World War II, we heard about something called shell shock. Is that something like this?

OWEN: Shell shock, combat stress, that’s all the same – that’s all just other names for post traumatic stress disorder, PTSD.

RAY: Okay. You’re listening to These Days on KPBS. I’m Alan Ray in for Maureen Cavanaugh. We’re talking with Laura Owen, who’s program manager for the Veterans Administration San Diego Care Management Team, and with KPBS reporter Alison St John, who’s executive producer of our series this week, “War Comes Home.” We would be pleased if you would join us in the conversation at 1-888-895-5727, 1-888-895-KPBS. Laura, I – Particularly with post traumatic stress disorder but I suspect also more than we realize with traumatic brain injury, the symptoms can be more subtle than we’d think?

OWEN: Absolutely. There is a spectrum of both PTSD and TBI and we are learning to discern the spectrum, you know, and there are patients who go overseas and fight in conflicts and they actually have what you referred to as the concussion. They black out after, you know, after an IED goes off, and they have been affected some way. They, you know, their Humvee has been, you know, hit and they walk away from the attack with a concussion. Or there are people who just sort of are dazed and walk away not knowing quite what happened to them. And so there is mild, moderate and severe traumatic brain injury and a lot of it doesn’t get diagnosed in the field but what we, at the VA with our partners at the Department of Defense, are learning to do and what – one of the innovations that we’ve learned as a result of this war and the unique injuries that our patients are suffering is that we do what’s called a TBI screen almost immediately after a deployment. So patients, for the first time in VA history, are meeting with VA health representatives, mostly social workers, psychologists, mental health experts, after they get off the plane. Almost literally after they get off the plane, we are meeting with them to do a comprehensive TBI screen, asking questions and, you know, evaluating for TBI, evaluating for post traumatic stress, and, of course, it’s a lot easier to see the physical injuries of the war so we see our patients who have been amputated or who have been physically hurt in some way, you know, maybe burns or scarring in some way, and those are easier to sort of flag for potential TBI or PTSD, but we are screening everyone. And this is kind of an exciting time to be with the VA because we’ve never done this before so we are – we’re quickly catching up with identifying TBI patients and we are scrambling to catch up with how we treat those patients. And we’ve got some exciting research and we’ve got some exciting new methods for treating that.

ST JOHN: Laura, I understand that about 8% or so of the people who are enrolled at the VA Medical Center are diagnosed with traumatic brain injury but not everybody enrolls, do they? So do you think that there are people out in the community who’ve slipped through the net and have not come for help but who are suffering from those symptoms?

OWEN: That’s a great question. We know in the VA San Diego, there are about 18,000 – a little bit over 18,000 that’s who are eligible for care through OEF and OIF. And another exciting thing that the VA is doing is that we have extended medical coverage for any veteran of those two conflicts, of Operation Enduring Freedom, of course that’s the war in Afghanistan and the theatre that surrounds it, so you don’t actually have to go to Afghanistan to be an OEF vet, and Operation Iraqui Freedom and, again, you don’t actually have to go to Iraq to have served as an OIF vet. And what we’re doing is, we’re offering five years post-deployment medical care, and we have never done that before. And it – again, it shows the nation’s commitment to our veterans in a whole new way. So of those 18,000 that are eligible for care we have a little over 9,000 who are enrolled in one way or another. You know, maybe they’ve just gone through the process of enrolling but they haven’t done much with that. After the 9,000 plus vets that we have enrolled in our system, then each of those vets is offered a comprehensive intake screen and we do a number of things. We screen for suicidality, for chemical dependence, for, of course, traumatic brain injury and PTSD and a host of other things, what we call bio-psycho-social problems. Those are family problems, difficulty readjusting into, you know, the civilian world. And when our patients are flagged for certain problems then they receive care from my candidate care management team. And of those 9,000 who are enrolled, about nine – excuse me, about 500 to 600 patients are being seen on a comprehensive, intensive care management level, and that means that they have help applying for disability benefits, they have help with family counseling, with readjustment problems, with their GI Bill benefits. Pretty much we help them get reintegrated into society. But you’re right, a lot of patients are not seeking care and that could be because they have private health insurance elsewhere, because they’re concerned about the stigma of having mental health, and we’re teasing that out. And one way that we are teasing that out again is by meeting our service members before they even become vets. When they step off of the plane after a deployment, we are there with their DOD hosts, welcoming them back and letting them know what their benefits are. We call those demobilizations. And, I mean, literally when they get off the plane, and sometimes that’s not good because they want to see their families and they have other things on their minds rather than hearing about their VA benefits, but it’s a good chance for them to see somebody from the Department of Veterans Affairs and hear exactly what they are eligible for. We don’t expect them to remember it all because, of course, they’ve got many other things on their minds when they first come home from a deployment but it’s the first seed that we plant in their heads to let them know, hey, when you get out – when you get off of active duty, and for some of our service members, these are reservists so they get off of active duty fairly quickly after they come home, say, don’t forget to check in with the VA. You are eligible for – These are your services. You are entitled to these services. Don’t forget about us.

RAY: That’s Laura Owen. She’s program manager for the Veterans Administration San Diego Care Management Team. We’re talking to her on These Days, and with executive producer of our series, “War Comes Home,” KPBS reporter Alison St John. We would be pleased if you’d join the conversation. Do you have a loved one who’s returned from Iraq or Afghanistan? Do you need advice or wanted help about how to get that loved one help when they come home? Have you gotten the help you need? Do you need more? Do you want to know where to go to get it? 1-888-895-5727, 1-888-895-KPBS. You’re listening to These Days on KPBS.

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RAY: You’re listening to These Days on KPBS. I’m Alan Ray in for Maureen Cavanaugh. And we’re joined by the executive producer of our series, “War Comes Home,” KPBS reporter Alison St John. She’s with us in the studio. And we’re joined from Las Vegas, where she’s not gaming but working, by Laura Owen, program manager for the Veterans Administration San Diego Care Management Team. We had a caller who didn’t stay on the line, couldn’t stay long enough, but wanted to know are there any ways, either Laura or Alison, that you can think of that ordinary San Diegans can be of help or value or benefit to veterans?

ST JOHN: Laura, I think you would probably have much more to say about this than I would but from what I’ve heard from families, military families, a lot of it has to do with just the fact that if they’re not living on base and they’re living out in the community, the neighborhood is kind of important and even if neighbors are aware of the fact that they have a spouse who’s away, who’s deployed and that they’re basically a single parent, and is just willing to show that kind of support and sympathy and, you know, the little things that count, helping to take out the trash, you know, making sure that if you see the kid out in the street, you tell them. Just that feeling of support from the neighborhood was one of the things that I did hear a military mom talking about.

OWEN: That’s absolutely true. I also want to mention, I just moved here recently from Washington, D.C., and I have to say that of all the cities that I’ve visited in the United States, San Diego tends to be one of the most supportive environments for military families. San Diego takes particular pride in hosting so many military members and it seems to be part of the community culture in San Diego to support our troops, and in – not just in, you know, sort of – not just in sort of words but also in actions. And by that, I can give many examples. We have a tremendous number of volunteers in our hospital who come in and just, you know, sometimes they bring their pets for animal therapy or they come and they bring hobby kits for our veterans to keep busy while they’re rehabilitating from injuries, and so San Diego’s doing a very good job of taking care of our veterans. And there are a number of service organizations that are always looking for volunteers. You could certainly do that, or make a donation, if you’re able. But this is a pretty good community for our veterans and I think it shows, and I think that veterans in San Diego enjoy a higher level of support than maybe other parts of the country.

RAY: A cool personal story from yesterday. I flew back down from the Bay area on a Southwest plane and the flight attendant had made her final announcements and, you know, seat back in the upright position, all that sort of thing. Oh, there was one other thing, she forgot to mention on the passenger manifest, there were indications that there were members of the military who were coming back to San Diego and might be ready to be deployed and could we give them a round of applause? And if the ‘fasten your seatbelt’ sign hadn’t been on, it would have been a standing ovation. It was very cool.

OWEN: Absolutely. And that’s typical. I am, myself, an OEF vet and I was surprised the first time I took my kids to Sea World that I was asked to stand up in front of the Shamu Show and received, not just me but certainly all the veterans and members of the military, and we received a standing ovation. And I think that’s just part of the unique culture of San Diego.

RAY: You’re listening to These Days on KPBS. We’d be pleased if you’d join the conversation. If you have a friend or family member or loved one who is suffering from the effects of deployment or if you want to know how to prepare for the next deployment, give us a call, 1-888-895-5727, 1-888-895-KPBS. Joe in San Diego, good morning. You’re on These Days.

JOE (Caller, San Diego): Yes, hello. I was just calling, I have a friend who just came back and she was over there in the Air Force and I think she’s suffering from minor post traumatic stress and I – but when – because of something that happened on a convoy with her, she ended up getting out with a ‘other than general’ I think what it – a general under honorable conditions or honorable under general conditions. And we’re just wondering what she qualifies for, if anything?

OWEN: That’s a great question. There are two things that I can say about that. You would have to go to – or, you would have to have your friend go to our member services enrollment at any VA hospital or clinic and discuss what she is eligible for. But at the same time, there are a number of excellent veterans advocacy groups. There is the Disabled American Vets, there’s Amvets, and I don’t want to name too many because I’m afraid I’m going to leave somebody out but there’s so many good ones out there. And they have effectively advocated for our veterans to have their discharge changed. And I don’t know the specifics of your friend, but sometimes a post traumatic stress disorder or a traumatic brain injury causes our patients to lose inhibitions and maybe make decisions that they wouldn’t normally make. And we are seeing some, not—and I don’t have statistics on how many—but we are seeing some discharges overturned and changed because we recognize that there’s a loss of inhibition, there is a loss of sort of cognitive ability sometime with some of these injuries and we are certainly seeing that after the deployments and so with our understanding of the effects of these illnesses, we are able to sort of take a second look at how people are being discharged.

RAY: Joe, can you talk about what symptoms or behaviors your friend might be manifesting? How’s she coping with this?

JOE: Well, I think she’s having a lot of problems sleeping at night. I think when she was getting out, they had given her medications for sleeping at night and stuff like that. So, other than that, I think she’s doing pretty good but she’s, you know, depressed a little bit and stuff but she gets back and, you know, she finds out that she – I guess she can get some things but she can’t get her education benefits.

OWEN: Got it. Got it. And, again, some of that is just worth talking to a veterans service organization to see what you’re eligible for. Those folks are your best advocates if you are a veteran. They know the system better than anyone. And a lot of these folks have been doing this for years. They are – They have – Some of them are Vietnam era, some of them are before Vietnam era, and they are outstanding advocates on behalf of our veterans. And we rely, we as a care management team, rely heavily on outside veteran support groups because we can’t do everything alone and, again, that’s one of the unique things about San Diego is that there is so much support, not just individual members of the community supporting individual veterans but also large organizations helping our vets.

RAY: Joe, thank you. Good luck to your friend, and thank you for taking care of her.

JOE: Thank you.

RAY: You’re list…

ST JOHN: It’s interesting, Alan, because on the one hand, there are numerous support services for vets out there but I went, for example, to a welcome home event put on by the VA Medical Center in La Jolla, and there were dozens of support groups there but very, when you consider the size of the population, not a lot of veterans coming to look for services. I mean, you know, a few dozen perhaps. They did say that they had several hundred people show up altogether but I only bumped into a few dozen when I was there. And I think that’s one of the big issues, is this issue of people out there who feel like where do I go to get help and they feel like the VA is just a fortress and it’s really hard to get any benefits out of it, and then the people providing services who feel, oh, where are the people who are looking for help, and are trying to do more outreach. And one question I wanted to ask you, Laura, was this business about the stigma, whether you feel that the stigma of asking for help is one of the things that is actually even stronger among active duty but should become less when you’re a vet because your career is not being affected by it. But does that prevent a lot of people from coming for help do you think?

OWEN: I think there are those who would stay away because they don’t want the stigma of having a mental health diagnosis or certainly the label of being, you know, the mili – the VA system is about percentage of disability and for some people to be told that they are 100% disabled because of post traumatic stress disorder, that sends a message to some people that they’ve got a mental health condition that makes them 100% disabled when, in fact, that’s not the case. That’s a ratings system for our benefits side of the house and not necessarily a judgment about somebody’s ability to cope in life. But I can say this, that we have a new generation of vets that is more savvy about their rights, that’s more savvy about technology and about social networking and social media, and we have a new generation of civilians, so in previous conflicts, I think our veterans came home not knowing where to get help, not knowing how to look up the help that they were eligible for, and not having a lot of support from the community directing them to the service organizations that were available to them. These are – You know, our Generation Y veterans are incredibly savvy and they are outstanding self-advocates. And they are coming home to a community, again particular to San Diego, where the community wants to help. And so if a neighbor or a friend or a colleague has information about a veterans service organization, they might say something to a young vet and plant the seed that it’s okay. It’s okay to seek help for mental illness, for traumatic brain injury, for PTSD. So I think the stigma might still exist but it’s certainly lessening and it is far less than it was in previous conflicts.

RAY: You’re listening to These Days on KPBS. We’re talking with Laura Owen, who’s program manager for the Veterans Administration San Diego Care Management Team, and with KPBS reporter Alison St John, the executive producer of our series “War Comes Home,” a series that airs all week on KPBS. And we’d like it if you’d join the conversation, 1-888-895-5727, 1-888-895-KPBS. Cory in Pacific Beach, good morning. You’re on These Days.

CORY (Caller, Pacific Beach): Hi. I would like to thank San Diegans. I’m a Lieutenant Colonel in the reserves and San Diego has a great amount of programs and people supporting you all over the place when you’re on active duty and going through all the challenges of deployments. What I deal with is veterans on the tail end where they really need help and that’s in their transition back to community. And a primary concern being finding them good jobs when they’ve been out of industry for 4 to 20 years.

RAY: Laura, does the VA offer any help in that regard or is there someplace you could point them?

OWEN: Oh, yeah. This is a great time to talk about some of the really, really exciting things the VA is doing to support our service members transitioning back into civilian life. Let me give you a few examples. For our patients with traumatic brain injury, you know, some of the symptoms of traumatic brain injury is a disorganization of thought, the inability to sort of keep record of your time, of your tasks. And so our veterans might come back a little bit less organized and a little bit less cognitively able when they suffer from TBI. So our Center for Excellence for Stress and Mental Health, CESAM, is part of the VA Hospital in La Jolla, has a really exciting study right now that we’re doing research on supportive employment. We are taking veterans suffering from TBI and we are putting them in the community with a number of support systems in place. And those are both physical and cognitive support systems. It might be giving a veteran a Palm Pilot, something that, you know, beeps when it’s time to take your medicine. Or using a calendar or to-do lists, and these are electronic as well as physical tools that our veterans are using to help them readjust to the special demands of having TBI. So we are teaching them to rely on their Blackberry or their Palm to tell them when to take their medicine or to tell them when to go to work or to tell them when it’s time to see their doctor. And those are physical tools but we’re also using cognitive strategies, self-talk, so that when things get confusing or overwhelming for our TBI patients, they are being taught a way to self-talk to themselves to work through the anxiety of a lot of the stressors that they never had to face before. And we are seeing a lot of really good results early on in this supportive employment research study that we’re doing.

RAY: Cory, I have to ask, you’re seeing people on the way out, on the way toward being veterans after deployments in service, do you see some people from time to time that you think, given the damage they have psychologically, mentally, emotionally, that maybe they’re just not employable?

CORY: There’s a rare percentage of that, and I think that also there’s that stigma that a lot of veterans are out there. I mean, when we’re talking about TBI, PTSD type stuff, we’re talking about less than 5% of the veterans that are actually departing each year. I – Each year, I help hundreds if not thousands of veterans in their employment search and the – I think the challenge is sometimes we don’t have enough resources dedicated to helping all the healthy veterans make that successful transition and reaching out to employers in the community to say hire a veteran. He may not have all the – or she, may not have all the industry experience but they’re trained, they’re leaders, they’ve accomplished a great deal of things, they’ve experienced a great deal of things, and just take that chance. They will perform.

RAY: Okay, thank you, Cory. Alison, I know in the past you’ve done stories and features on programs to help veterans reengage in the workforce. And I believe one of the series you did was some special training where basically that you go out to employers and point out the fact that these are people who are used to working in a hierarchy, they’re used to organizing thought, they’re used to working cooperatively in groups with a really specific goal.

ST JOHN: That’s right. Yes, it was – The particular piece I did was about an initiative to bring very successful business owners, business founders, people who had – who were generating millions a year, to Camp Pendleton, put them through boot camp, and show them, you know, what kind of training the marines are having because it is a little bit difficult to put it down on a form. You know, if you fill out a form and you say what’s your experience? Sometimes you have to have actually been through it to know what the – that training inspires in terms of initiative, creative thinking, leadership skills, that kind of thing, you know, stick-to-itiveness, you know, conscientiousness, being supportive in a team. And so that, I think, is one of the things, is making the point that even if somebody has on their resume, you know, served in the military that there are a lot of qualities that they’ve learned which actually translate very well into the business environment.

RAY: You’re listening to These Days on KPBS. I’m Alan Ray in for Maureen Cavanaugh. We’re talking with KPBS reporter Alison St. John, the executive producer of our series “War Comes Home,” airing this week on KPBS. And we’re talking with Laura Owen, the program manager for the Veterans Administration San Diego Care Management Team. You can join the conversation at 1-888-895-5727, 1-888-895-KPBS. And we’ll talk more about vets coming home after this.

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RAY: You’re listening to These Days on KPBS where news matters. We’re talking about veterans coming home, the problems they face. We’d love to talk to you. We’re joined on the program by Laura Owen, the program manager for the Veteran’s Administration San Diego Care Management Team, and by KPBS reporter Alison St John, who is the executive producer of our series this week, “War Comes Home.” Lalo in San Marcos, good morning. You’re on These Days.

LALO (Caller, San Marcos): Hello. I’m a Vietnam veteran and I – my original question was what are you doing different than during the Vietnam era and you just spent the last 15 minutes explaining wonderful services that are being offered to these young veterans, so my second part of my question is are the Vietnam era veterans—and I run across some out there who have not yet accessed VA Services, they had bad experiences in the seventies—are they able to access this same level of care that’s being offered the young returning veterans? I’ll take my answer off the air.

RAY: Laura.

OWEN: Great question. Before I answer that question, I wanted to go back to the previous caller, Cory, and he had made the – he made the comment that only about 5% of returning vets suffer from TBI, what are we doing for the remaining veterans who don’t suffer from PTSD or TBI? And I just wanted to make a mention of Chapter 33, the new – the post-9/11 new GI Bill. And I have to say that we are, as a team but also VA wide, we are promoting vocational education and return to college or entrance into college in a large scale way and in a way that has never been done before. And so our veterans are going to school and they are taking advantage of our – the benefits that – the extensive benefits and the extension of benefits that the government makes as entitlement to our veterans. So we are seeing a large number of our vets go to school as vocational training and as training to enter the workforce, not just with their military experience but others. And as for the question about Vietnam era vets, it is never too late to apply for benefits. It – Of course, it is easier to apply for benefits and to get service connected disability recognition the sooner you are out of the military but I have certainly seen examples of veterans coming back years later, decades later, and have been deemed qualified for services. So it never hurts to ask but, again, I just wanted to mention all of the very wonderful veterans services organizations out there, and there’s so many I hesitate to mention any because I don’t want to leave anyone out, but there’s the American Legion, there’s the Amvets, there’s Vets for Vets, and there is the DAV. And you could go to any one of those and, again, there’s many more and I’m forgetting at the moment, and you can ask for advocacy and you can explain your case and they are wonderful organizations, wonderful organizations of people, who make it their job to help veterans get the benefits that they deserve.

ST JOHN: One thing I just wanted to ask, Laura, is whether you’d heard anything from some of the people who just started in the last month with the new GI Bill at college? I’ve spoken to somebody who said that he and many of his colleagues haven’t seen any money yet and so they’re pretty much having to pay for, like, their housing allowance off their own credit cards because even though they’re promised quite good amounts of money in order to pursue their education, none of that has come through yet. It seems to be held up. Have you heard anything about that?

OWEN: Well, no, I haven’t heard that. You know, with every new program, especially with new government programs that are – that overhaul on this large of a scale, there are going to be problems. We help our veterans, and some of our veterans are having difficulty accessing money but I have to say that I’m a beneficiary of the GI Bill and I, you know, there – I had a few initial glitches but I eventually got my money and was able to use it to go to school. And that’s part of what my team does, one of the many things that my team does for our veterans, that they know that they’re not alone in their struggle to navigate the system because the system can be overwhelming and so we have Care Management professionals, social workers with advanced degrees, who meet with our veterans and they come in and they say I’m having trouble applying for disability or I’m having trouble applying for the GI Bill or I haven’t heard back from the benefits side of the VA about my disability or my rating or my compensation. And that’s where our social workers work best. They get on the phone, they use the contacts that they have, they use the relationships that they have, and just the extensive amount of knowledge that we have to make things easier for our veterans, to advocate for themselves. Because, of course, our goal is to have our veterans be able to function independently and function at their highest ability, and so we are not a crutch for life, we are a transitional service, or a lifetime service if necessary, for our veterans to come in, get the help that they need, get the resources they need, and having an advocate contact organizations and service providers to see where the hold up is, and that’s something that my team does several times a day.

RAY: Okay, Sheree in San Diego, good morning. You’re on These Days.

SHEREE (Caller, San Diego): Good morning, and thank you for taking my call. I am the spouse of an active duty navy service member and after ten years of marriage and several deployments, I recently came across a comprehensive website called Military OneSource. And what they have, they offer services that run the gamut of mental health services to families and even active duty members that the active duty member can seek mental health services and this isn’t something that goes into their record, their service record, because I know that there is some concern that not everything – not their medication information may be shared, and there is concern that if they’re feeling that they need to seek help that they may be tagged as this person is a little unstable or however they may feel about it. But Military OneSource has been really helpful in linking families with programs. Families that have children, there are support programs for the children. They, there’s a – they have different resources for continuing education for spouses, so I found that to be really helpful and after over ten years of being married to a service member, we’ve never lived on base or in a military housing community so sometimes I think families can be a little disconnected if you’re not in that immediate circle, living on base or living in a military housing community where that information is more easily accessible. But there are programs out there and there are support groups and there is help, and I think you just need to be a little more focused and aggressive into seeking out these support systems. But I have found Military OneSource has been extremely helpful, and if they don’t have that thing that you’re looking for, they have a lot of referral programs that they can point you in that direction.

RAY: Laura, have you heard of this Military OneSource website?

OWEN: I have and your caller makes some excellent points that I’d like to address. This is a new kind of war that we’re fighting. Never before have we fought a war where citizen soldiers, national guards and reservists were being called up and serving multiple deployments. You know, in the Vietnam era, our – we had a draft and now we have a professional military of volunteers, people who joined up wanting to serve their country, and that’s a difference. But, also, these multiple deployments for citizen soldiers who never expected to maybe get called up and spend three years away from their families, from their jobs. And this is a different kind of a war because this is a 360 conflict. There are no battle lines and there is no R&R. Our service members don’t get to leave the front lines and go spend a weekend recovering in a friendly retreat somewhere. That’s very different, too. We are expecting our professional soldiers to be on 24/7 and that causes a strain. So, again, we are seeing a whole different demand on our professional soldiers in a way that we’ve never seen that before. And as a result, we are – they – our veterans are coming home with a whole list of differing concerns. You know, Afghanistan is different from Iraq and those who support it in the theatre surrounding those are coming back with different issues than those who served in direct combat. And San Diego is a big navy and a big Marine Corps population but there are, you know, we have Air Force and we have Army and their experiences are different, too. So Military OneSource is a great, one-stop shop to reach out to all of our veterans with a host of differing concerns and interests and provide them with that information.

RAY: Okay, tomorrow we talk more specifically and in greater detail about the problems presented by multiple deployments. Lynn in North Park, good morning. You’re on These Days.

LYNN (Caller, North Park): Good morning. Can you hear me?

RAY: Yes.

LYNN: I have a friend who is in a situation similar to what you were just describing actually, where he was – is a navy reservist, a teacher when he’s not deployed. He has what I would consider severe PTSD, tried to access services through Balboa but like he couldn’t because there were so many triggers for his PTSD, walking into the hospital and out of the hospital, and so he made the choice to not access services. And then I lost track of him and next thing I know, he’s redeployed to Afghanistan. I’m wondering about the choices that are being made to redeploy people who already have severe PTSD.

RAY: Okay, let – I’ll tell you what, we’ve got two or three of these in a row, so Brian, let’s talk to Brian in Pacific Beach also. You have a friend, a customer, who’s not stable, is that correct?

BRIAN (Caller, Pacific Beach): Indeed. I have a car parts business based in San Diego. We ship all over the world every day. And we had a gentleman who represented himself as a Iraq vet call up and order a bunch of parts and we sent off the parts and then we, of course, gave him a tracking number and the eve of delivery, he calls up and suddenly doesn’t want anything. He wants to cancel everything. And, okay, he cancels everything and everything comes back. But it didn’t end there. Now he’s calling and saying we misled him and he’s sending threatening e-mails. He tells us he’s getting on a plane to come out and attack everybody and we’re wondering who do we call? We’re in the same parking lot as the San Diego Police station, and I’m afraid this guy is going to do death by cop or something. Who do we call in the military to get this guy some help?

RAY: Okay, Laura, let’s take that one right away.

OWEN: Okay, well, a number of issues on those two calls that I wanted to address. Any veteran who felt like they couldn’t access care through any of our outpatient clinics or from the larger hospital in La Jolla is free to walk into our veterans’ centers and we have those across San Diego County. There’s one in Escondido, there’s one in San Diego proper. And those veterans’ centers also provide mental health services in a much more relaxed, informal way. All of the records are handwritten and not kept electronically and it’s sort of a safe, intermediate area for veterans to make that first step to get help. They – And we actually have videogames and TVs and magazines and it’s more of a relaxing atmosphere, and these veterans’ centers were actually started by Vietnam vets many years ago as a way for veterans to come and be surrounded with other veterans and in a supportive, nurturing environment. We have turned those environments into also access for care centers and so that’s certainly an option for somebody who didn’t feel like they wanted to make the first step to walk into a hospital or an outpatient clinic. But I also wanted to say that we only take care of veterans after they’ve become veterans. Once a veteran is – Or when a service member is still on active duty, we have military treatment facility, MTF, and those are the military hospitals, we have liaisons there who identify veterans who will be getting discharged or who will be transitioning to us, and that’s a first step and that’s something new that’s happened as a result of these conflicts that we’ve learned that it’s too late to wait for the veterans to walk in the door on their own. And since we only – since we are the Department of Veterans Affairs, and that we don’t actually take care of active duty members in a comprehensive way, now we can certainly enroll them in benefits and reach out to them, but we don’t provide the actual beginning of service until they’ve become veterans. We have federal recovery coordinators who also serve as conduits between the DOD and the VA, so we are making efforts and we are starting new programs to reach out to veterans before they actually become, you know, discharged from the military. Now as for, you know, suicidality or homicidality, that’s something that we take incredibly seriously and we have a Veterans Suicide Hotline that a veteran who felt like they were in danger of harming themselves or having anger management issues could certainly call that. It’s a 24-hour hotline number, and they could access care through that way.

RAY: Katie, good morning, in San Diego. You’re on These Days on KPBS.

KATIE (Caller, San Diego): Oh, good morning. I’m worrying about those veterans that are way outside the system. Are we actually reaching out for them, the ones homeless on the street?

RAY: Laura?

OWEN: We are. We have a tremendous homely – homelessness outreach pro – team. And that’s something that we are aggressively pursuing, not just with OEF vets but Vietnam era vets and all other vets. That’s something that VA San Diego has a dedicated team to working with. But relatedly, there are veterans who might be enrolled in the system but who are geographically far from an outpatient clinic or they might – although they may not be homeless, they are too distant from an outpatient clinic or the hospital to get regular care. And we’re doing something very innovative and new and we’re doing what’s called telemedicine, and that is a service that we are beginning to offer for our veterans where they can do a videoconference with a care provider so they don’t actually have to come into the hospital. If you live 60 miles away from your nearest veterans outpatient clinic or hospital, you can sign up for the telemedicine clinic and they – you can meet with a provider and discuss your concerns electronically.

RAY: Laura, thank you. It’s been a pleasure.

OWEN: Thank you.

RAY: That’s Laura Owen. She’s program manager for the Veteran’s Administration San Diego Care Management Team. And we’ve been joined also by KPBS reporter Alison St John, the executive producer of our series this week “War Comes Home.” Thank you, Alison.

ST JOHN: My pleasure.

RAY: If you called in, thank you. If we didn’t get a chance to talk to you, please to go KPBS.org/TheseDays, post your comments there. And don’t forget, we’re going to be continuing to talk about this all week on These Days, talk about the challenges today’s veterans face all this week on These Days. Also, don’t forget if you want to know more, go to KPBS.org and we’ll have a special report on Friday night about homeless veterans as well. You’re listening to These Days on KPBS. I’m Alan Ray in for Maureen Cavanaugh.