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The Other Victims of Battlefield Stress; Defense Contractors

February 27th, 2010 by WhiteRose

The Other Victims of Battlefield Stress; Defense Contractors’ Mental Health Neglected
by T. Christian Miller, ProPublica – February 26, 2010 1:48 am EST

On the one-year anniversary of her husband's suicide, Barb Dill breaks down at her husband's tombstone. Wade Dill, a Marine Corps veteran, took a contractor job in Iraq. Three weeks after he returned home for good, he committed suicide (Francine Orr / Los Angeles Times / Redding, CA / July 16, 2007).
On the one-year anniversary of her husband’s suicide, Barb Dill breaks down at her husband’s tombstone. Wade Dill, a Marine Corps veteran, took a contractor job in Iraq. Three weeks after he returned home for good, he committed suicide (Francine Orr / Los Angeles Times / Redding, CA / July 16, 2007).

REDDING, Calif. — Wade Dill does not figure into the toll of war dead. An exterminator, Dill took a job in Iraq for a company contracted to do pest control on military bases. There, he found himself killing disease-carrying flies and rabid dogs, dodging mortars and huddling in bomb shelters.

Dill, a Marine Corps veteran, was a different man when he came back for visits here, his family said: moody, isolated, morose. He screamed at his wife and daughter. His weight dropped. Dark circles haunted his dark brown eyes.

Three weeks after he returned home for good, Dill booked a room in an anonymous three-story motel alongside Interstate 5. There, on July 16, 2006, he shot himself in the head with a 9 mm handgun. He left a suicide note for his wife and a picture for his daughter, then 16. The caption read: “I did exist and I loved you.”

More than three years later, Dill’s loved ones are still reeling, their pain compounded by a drawn-out battle with an insurance company over death benefits from the suicide. Barb Dill, 47, nearly lost the family’s home to foreclosure. “We’re circling the drain,” she said.

While suicide among soldiers has been a focus of Congress and the public, relatively little attention has been paid to the mental health of tens of thousands of civilian contractors returning from Iraq and Afghanistan. When they make the news at all, contractors are usually in the middle of scandal, depicted as cowboys, wastrels or worse.

No agency tracks how many civilian workers have killed themselves after returning from the war zones. A small study in 2007 found that 24 percent of contract employees from DynCorp, a defense contractor, showed signs of depression or post-traumatic stress disorder, or PTSD, after returning home. The figure is roughly equivalent to those found in studies of returning soldiers.

If the pattern holds true on a broad scale, thousands of such workers may be suffering from mental trauma, said Paul Brand, the CEO of Mission Critical Psychological Services, a firm that provides counseling to war zone civilians. More than 200,000 civilians work in Afghanistan and Iraq, according to the most recent figures.

“There are many people falling through the cracks, and there are few mechanisms in place to support these individuals,” said Brand, who conducted the study while working at DynCorp.”There’s a moral obligation that’s being overlooked. Can the government really send people to a war zone and neglect their responsibility to attend to their emotional needs after the fact?”

The survivors of civilians who have committed suicide have found themselves confused, frustrated and alone in their grief.

“If I was in the military, I’d at least have someone to talk to,” said Melissa Finkenbinder, 42, whose husband, Kert, a mechanic, killed himself after returning from Iraq. “Contractors don’t have anything. Their families don’t have anything.”

Some families of civilian contractors who have committed suicide have tried to battle for help through an outdated government system designed to provide health insurance and death benefits to civilian contractors injured or killed on the job.

Under the system, required by a law known as the Defense Base Act, defense firms must purchase workers’ compensation insurance for their employees in war zones. It is highly specialized and expensive insurance, dominated by the troubled giant AIG and a handful of other companies. The cost of it is paid by taxpayers as part of the contract price.

But the law, which is designed to provide coverage for accidental death and injury, blocks payment of death benefits in the case of almost all suicides. Cases linked to mental incapacity are the lone exception, judges have ruled.

joint investigation last year by ProPublica, ABC News and the Los Angeles Times revealed that contract workers must frequently battle carriers for basic medical coverage. While Congress has promised reforms, there has been no discussion of changing the law when it comes to suicides involving civilian defense workers.

The military, by contrast, allows survivors to receive benefits in cases in which a soldier’s suicide can be linked to depression caused by battlefield stress.

Hundreds of soldiers have committed suicide since the war in Afghanistan began in 2001, according to studies by the Army and the Department of Veterans Affairs. In response, the Defense Department has become more active in trying to prevent suicide than its hired contractors, military experts said.

The military is “aggressively trying to reach people and do intervention beforehand and set up suicide awareness programs,” said Ian de Planque, a benefits expert at the American Legion, the nation’s largest veterans group. “Awareness of it has increased. I don’t know that it’s transferred over to the civilian sector at this point.”

Birgitt Eysselinck has spent years trying to prove that her husband’s death in Iraq was related to stress from his job with a company specializing in the removal of land mines and explosive ordnance. So far, courts have sided with the insurance firm, Chicago-based CNA, in denying Eysselinck’s claim. (CNA declined to comment, citing privacy reasons.)

Eysselinck, 44, said that neither federal judges nor insurance adjusters understand that civilian contractors face many of the same risks in Iraq and Afghanistan that soldiers do. Her husband, Tim Eysselinck, endured mortar attacks and frequently traveled across Iraq’s dangerous highways, she said.

“There is a huge percentage of contractors who are silently suffering,” Eysselinck said. “That obviously puts them and their families at risk. Communities are bearing the brunt of this, especially the families.”

* * *

Wade Dill was working at a local pest control company when he decided to take a job with KBR in Iraq in late 2004. The money was good – almost $11,000 a month for handling extermination and hazardous material disposal, more than double his normal salary.

“He said this was our opportunity,” Barb Dill said. “He could start a college fund for our daughter, pay off the mortgage and have a nice retirement. He told me at his age, 41, he didn’t know if he had enough years left in him to give us what he wanted.”

Wade started that December, working on bases in central and northern Iraq. Violence was ever present. A base near Mosul was shelled frequently. He told Barb that a mortar landed close enough to temporarily deafen him. Once, he called her sobbing.

“My husband never cried, ever,” she said. “Marines don’t cry. A young man, a soldier, had put a pistol to his head and blown his brains out. And Wade had to go in and clean up after they removed the body – he had to clean up brain matter and blood. It really upset him.”

Barb Dill noticed a change in her husband when he returned home for a visit in December 2005. The couple had been high school sweethearts, married for 15 years. They had troubles, but had always worked them out. Now, he seemed moody and often angry, lashing out at her and their daughter, Sara.

“He would say hateful things to me and our daughter – things he had never said before.” Dill said. “This was a man that loved his little girl and his wife. He always called us his girls.”

When Wade returned for another visit in June 2006, he abruptly quit his job and began acting erratically, Dill said. He ripped the wiring out of appliances, smashed mirrors and poured lighter fluid on their furniture.

After a few weeks, Wade took a room at a local motel. On July 15, he asked Barb to come see him. Their conversation spiraled into a confrontation. Frightened and angry, Barb sped off in her car. The next day, the Shasta County coroner’s office called to tell her that Wade’s body had been found in the room.

“He told me that he was sick and needed help,” Dill said. “I told him to get help and then we would talk. The last time I saw him was in my rearview mirror.”

Dill soon found herself in financial difficulty. Her husband had always taken care of the bills. He had spent lavishly with his higher salary, buying two BMWs during trips home. Now, Dill discovered the couple was $300,000 in debt on their mortgage and car loans.

She plunged into depression, struggling to cope with her daughter’s grief and the sense that she had failed her husband in his time of need. She sold the cars and nearly lost her home after falling behind on mortgage payments.

She suffered mostly by herself. Except for a handful of Web sites, no support groups exist for widows of civilian contractors. The federal government offers no counseling for civilians returning from work in war zones.

Dill said that she felt abandoned by everyone: her husband’s employer, the insurance company and especially the federal government, which oversees the Defense Base Act system through the Labor Department.

“Shouldn’t our government be responsible for the companies they hire?” Dill said. “Shouldn’t our government take care of its own people, who are doing jobs our government, ultimately, wanted them to do?”

* * *

Survivors of civilian contractors whose death is related to their work in Iraq have the right to apply for compensation benefits that pay up to $63,000 a year for life.

Dill applied, asserting that her husband’s PTSD made him an exception to the rule against payments in suicide cases. Her claim was denied by AIG, KBR’s insurance provider.

She protested, sending her claim into a dispute resolution system run by the Labor Department. Her case is still grinding its way through the system, which can take years to produce a final result.

Experts hired by the family and the insurance company differed on what led to Wade Dill’s suicide.

A psychiatrist hired by her attorney found that job stress in Iraq was one of the factors that drove Wade to suicide: “The bottom line is that the combination of physical separation and work-related stress resulted in increasingly emotional distance, greater distortion of the relationship, increasing emotional intensity, and a pattern of increasing erratic behaviors that culminated in suicide,” wrote Charles Seaman, an expert in PTSD.

A Labor Department examiner recommended that AIG pay the claim, but the company refused. AIG and KBR declined comment about the case. In court filings, AIG has argued that the Defense Base Act does not cover suicides.

AIG attorneys also have said that Wade Dill’s actions were related to marital and family problems. A psychiatrist hired by AIG testified at a hearing in San Francisco in January that he had performed a “psychological autopsy” on Wade Dill based on interviews with his family and court documents.

The psychiatrist, Andrew D. Whyman, said his evaluation led him to conclude that Dill suffered from depression and that his suicide was unrelated to the violence he witnessed in Iraq.

“Take out the Iraq experience, (the suicide) would have happened,” Whyman testified. “He had a choice. … He could have chosen not to do that.”

Barb Dill insists her husband came back from Iraq a changed man.

“No matter how strained our relationship could get at times, we always pulled out of it with no problem,” Dill said. “Iraq changed all that.”

Now, she said, she is trying to hold her life together. A final decision in her case is not expected for months.

“We’re just slowly sinking,” she said. “It’s hard to be strong.”

Watch a preview of ‘Disposable Army,’ a documentary currently being produced by Mark Crupi, which contains interviews with Barb Dill and T. Christian Miller.

Disposable Army: Read the complete coverage of injured defense contractors and their struggles to receive promised medical care.

Write to T. Christian Miller at T.Christian.Miller@propublica.org.

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Posted 5 months ago at 10:01. Add a comment

Study: Fast morphine treatment may prevent PTSD

February 1st, 2010 by WhiteRose

By LINDA A. JOHNSON
Associated Press Writer

Quickly giving morphine to wounded troops cuts in half the chance they will develop post-traumatic stress disorder, according to a provocative study that suggests a new strategy for preventing the psychological fallout of war.

Researchers at the U.S. Naval Health Research Center led the study of about 700 troops injured in Iraq from 2004 through 2006.

“It was surprising how strong the effect of the morphine was,” said study leader Troy Lisa Holbrook, an epidemiologist at the naval center. The findings were published in Thursday’s New England Journal of Medicine.

Whether the Pentagon will adopt the practice on the battlefield remains to be seen. Dr. Jack Smith, acting deputy assistant secretary of defense for clinical and program policy, said in an e-mail that the “very interesting findings” are “likely to stimulate further research.”

About 53,000 troops returning from Iraq and Afghanistan have been treated for PTSD, a disorder in which someone who has endured a traumatic event keeps re-experiencing it and the fear it caused. Patients often have trouble with work, relationships, substance abuse and physical ailments.

Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it.

It was unclear whether it was the fast pain treatment or something specific to morphine that made the difference.

But researchers theorize that simply easing pain might reduce the severity of the psychological trauma, or that prompt relief might alter the way the brain remembers the attack or injury – in essence, causing the mind to file away the episode as less traumatic.

Troops in the study initially were treated at military medical facilities in Iraq, mainly for wounds caused by roadside bombs, bullets, grenades or mortar fire. A few dozen had burns or were hurt in crashes or falls. The decision on whether to give morphine was up to the individual doctor, based on the patient’s condition.

Of the 696 troops in the study, 493 – about 70 percent – were given morphine, most within an hour of injury. Two years later, 147 of them had developed PTSD. Of the 203 not given morphine early on, 96 developed PTSD.

That worked out to a 53 percent lower risk of developing PTSD for those treated early with morphine. No other factor, such as the nature or severity of injuries, had much effect on the chances of developing PTSD, Holbrook said.

“These are provocative and thought-provoking findings that should lead scientists to investigate the underlying mechanisms” in future studies, said JoAnn Difede, a PTSD researcher at New York-Presbyterian/Weill Cornell Medical Center.

Difede and Barbara Rothbaum, who heads the Trauma and Anxiety Recovery Program at Emory University School of Medicine, said that until more research backs up the findings, the study probably won’t lead to many more patients in civilian emergency rooms getting morphine.

“At this point, I don’t see it having a huge impact” for civilians, Rothbaum said.

A second study in the journal found that Army wives were more likely to develop depression or sleep problems the longer, or the more times, their spouses were sent to Iraq or Afghanistan.

That study, by researchers at the University of North Carolina and elsewhere, examined medical records for outpatient care of about 250,000 wives of active-duty soldiers from 2003 through 2006.

Compared with wives whose husbands stayed home, those whose husbands were deployed for up to 11 months were 18 percent more likely to be diagnosed with depression and at least 20 percent more likely to be diagnosed with sleep disorders, anxiety and acute stress.

For wives whose husbands were deployed for more than 11 months, problems were even more common: They were at least 24 percent more likely to be diagnosed with depression or anxiety, and about 40 percent more likely to be diagnosed with acute stress or sleep problems.

The researchers didn’t have data showing whether husbands were deployed or at home when the wives were being treated for mental health problems.

That meant the scientists couldn’t conclude whether those problems were caused by worries about the spouse’s safety and the difficulties of being a single parent, or by stress caused by the returning spouse’s psychological problems or other behavior changes.

“I suspect that if you look at the Reserve and National Guard wives, the toll might be even worse,” because they have less social support than families living in a military community, Rothbaum said.

She said the effects of deployment on children also need to be studied so the military can figure out how to provide more help to families.

On the Net: http://www.nejm.org

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Posted 5 months, 4 weeks ago at 18:03. Add a comment