1. © 2015 Willcox & Savage, P.C. 1 Their Own Worst Enemies: Cultural Obstacles to Veterans’ Healthcare Access and How the Law Can Help Presented by William A. M. Burke, JD, MA Associate December 7, 2015

2. © 2015 Willcox & Savage, P.C. Introduction ~ 22 million veterans in the U.S. Post-9/11 Vets present growing challenge: –Most are in their 20s or 30s (2.6 million total) –Population expected to increase by 42% from 2014 to 2020 –~30% have a service-connected disability, almost twice the rate of vets generally –More likely to be dependent on VA healthcare, lack health insurance*, receive food stamps Physical vs. Psychological Wounds –52,351 wounded in action in Post-9/11 combat ops, but: –Military Services reported at least 10,000 new PTSD diagnoses each year since 2008 –Over the same period, more than 25,000 new TBI diagnoses / year A large, growing population of young Veterans facing life-long mental health challenges

3. © 2015 Willcox & Savage, P.C. Prevalence of Mental Health Challenges in Veterans PTSD: –2-4 times more prevalent in OIF/OEF Vets –Up to 31% suffer PTSD within one year of return –Not just combat: 20,000 military service members sexually assaulted in just one year – 1% of male, 5% of female troops assaulted Substance Abuse –PTSD & Alcohol Abuse comorbidity: 30-59% –Vets more likely to smoke, Vets w/ PTSD twice as likely as other Vets Other Hidden problems –More likely to experience sleep disorders –Higher incidence of depression VA’s healthcare priorities: no service-connected disability = Group 7 or 8) Difficulty obtaining service-connection for PTSD, Substance Abuse, TBI inhibits access to VA healthcare

4. © 2015 Willcox & Savage, P.C. Lieutenant Dan & the Wounded Warrior Paradox Media portrayals highlight: –Physical wounds: “good” wounds –PTSD: risk that a veteran will “snap” –E.g., Lt. Dan, Rambo Vets don’t want to be singled out, distrusted Suck-it-up Ethos: Vets downplay health challenges 4 Vets’ desire to be “normal” Fears re: PTSD Wounded Warriors = physically wounded vets Self-reinforcing cycle leads Vets to underreport stigmatized problems

5. © 2015 Willcox & Savage, P.C. Subject-matter Specific Obstacles MST: Difficult subject made worse by –Organizational / structural impediments –Cultural resistance / military hero-worship PTSD / TBI: Invisible wounds –VA distrust of private medical providers’ diagnoses –Effects increase over time Gulf-war syndrome: personally embarrassing symptoms including: –menstrual disorders, –skin conditions, –irritable bowel syndrome, –functional vomiting, –functional constipation 5 Private nature of key problems reinforces cultural barriers

6. © 2015 Willcox & Savage, P.C. Way Forward More legal, medical professional pro bono help for veterans struggling to get VA recognition DoD / Military services working on MST, enough? VA disability compensation program is backwards: push for top-to-bottom reform Advocate more nuanced approaches to veterans’ programs