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Why Transgender People Are Drawn To The Military

By Alan Zarembo, Los Angeles Times (TNS)

As a young psychiatry resident at Ohio’s Wright-Patterson Air Force Base in the 1980s, Dr. George Brown was surprised the first time he saw a transgender patient.

Estimates at the time were that for every 100,000 biological males in the general population, no more than three were transgender.

Brown figured the rate had to be even lower in the all-volunteer military. It made little sense to him that a transgender person would choose to join an institution that by its nature had no tolerance for deviance.

Yet over the next three years, Brown saw 10 more transgender patients — all of them seeking hormone therapy and male-to-female gender reassignment surgery. He began to suspect that the military, despite its ban on allowing transgender people to serve, was somehow attracting them at a disproportionately high rate.

The Pentagon is now weighing whether to lift its ban on transgender service members and is expected to do so next year. As the policy is reviewed, researchers are citing evidence that bears out Brown’s hunch of three decades go.

Transgender people are present in the armed services at a higher rate than in the general population.

The latest analysis, published last year by UCLA researchers, estimated that nearly 150,000 transgender people have served in the military, or about 21 percent of all transgender adults in the U.S. By comparison, 10 percent of the general population has served.

The findings have pumped new life into a theory that Brown developed to explain what he had witnessed. In a 1988 paper, he coined it “flight into hypermasculinity.”

His transgender patients told him that they had signed up for service when they were still in denial about their true selves and were trying to prove they were “real men.”

“I just kept hearing the same story over and over again,” said Brown, 58, now a professor at East Tennessee State University and a specialist in gender identity issues at the Veterans Affairs Medical Center in Mountain Home, Tenn.

Some patients had deliberately chosen the military’s most dangerous jobs. In one case described in the paper, a 37-year-old patient with a long history of cross-dressing had been a laboratory technician on a base in Germany but gave that up to become a combat helicopter pilot at the height of the Vietnam War, a job with a high death rate.

Colene Simmons, 60, says she is one of Brown’s longtime patients. She started life in rural Georgia as O’Day Simmons. A 185-pound champion wrestler in high school, Simmons protected other students from bullies and had no problem getting girlfriends.

But the tough exterior belied inner fantasies.

Simmons had escaped a physically abusive father and grown up in a Christian group home.

“God doesn’t make mistakes,” the house mother said after discovering Simmons trying on a curtain as if it were a dress.

As the demons grew stronger, Simmons enlisted in the U.S. Marine Corps in the hope of fighting them off. “I wanted to prove to myself that I was a man,” she explained.

Stationed at Camp Geiger, N.C., in the late 1970s, Simmons occasionally left the base and drove 80 miles to a thrift store to buy women’s clothes and check into a motel room alone to play dress-up.

Simmons later married and had two children, but that could not erase her feelings any more than spending four years in the military.

She eventually underwent hormone therapy and surgery and legally changed her name. Remarried to another woman, she considers herself a lesbian. They live in rural northeast Tennessee.

“Colene doesn’t talk much about the military,” said Jane Simmons, her wife.

For all the attention gender identity has received recently — including Olympian Bruce Jenner’s transformation to Caitlyn Jenner and Army Pvt. Bradley Manning’s emergence as Chelsea Manning after being convicted of leaking classified documents — even the size of the transgender population is open to wide speculation.

The U.S. Census Bureau does not collect data to determine it, so researchers must extrapolate from other, smaller surveys.

In 2011, Gary Gates, research director at UCLA’s Williams Institute, which is devoted to public policy questions related to gender identity and sexual orientation, estimated that 3 of every 1,000 U.S. adults are transgender — at least 100 times the presumed rate in the 1980s.

Figuring out how many transgender people serve in the military is even harder, because they can be kicked out if they reveal themselves.

“We’re working largely in a vacuum,” Gates said.

His estimates are based on demographic tweaks to the results of a 2008 nationwide survey of more than 6,500 transgender people that was conducted by activist groups.

Among those assigned male at birth, Gates found that 32 percent had served in the military, compared with 20 percent of men in the general population who had served.

For those assigned female at birth, that figure was 5.5 percent, compared with 1.7 percent of all women.

Other measures suggest even bigger differences between transgender people and the rest of the population in terms of military service.

In 2011, nearly 23 out of every 100,000 patients in the VA system had a diagnosis of gender identity disorder, which is used to describe gender identity issues that lead to significant levels of psychological distress and has been associated with high suicide risk.

That’s five times the rate in the general population.

The comparison comes with a caveat. In 2011, the VA began providing hormone therapy and other nonsurgical treatment for transgender patients, a strong motivation for some people to seek a diagnosis.

Though Brown developed his theory around male-to-female transgender service members, the draw of a hypermasculine environment may also help explain why female-to-male transgender people join the military.

The theory has been a topic of debate among activists and researchers. Although most say it has validity, some worry that its simplicity undermines the full humanity of transgender people.

“It dehumanizes the community and reduces it to this narrative,” said Jake Eleazer, a transgender veteran and doctoral student in psychology at the University of Louisville in Kentucky.

He and others point out that there are many reasons transgender people join the military: adventure, money for college, family tradition and other factors that attract all recruits.

They also say it is possible that transgender people are more likely to have certain traits or skills that draw them to service, or that on the whole they are socio-economically disadvantaged, discriminated against or rejected by their families in a way that leaves them fewer other options.

But there is not enough data to test those ideas.

Whatever the reasons that transgender people join, their presence has become one of the government’s most powerful arguments for lifting the ban.

“Transgender men and women in uniform have been there with us, even as they often had to serve in silence alongside their fellow comrades in arms,” Defense Secretary Ashton Carter said in a July statement announcing that the Pentagon would review the ban starting with the premise that it should be rescinded.

Brown predicted that even if the ban is lifted, the military will continue to attract transgender 18- to 20-year-olds who have yet to come to terms with their true selves.

As a place to hide, consciously or subconsciously, the military, with its order and uniformity and prohibitions on self-expression, may be unrivaled.

Jennifer Long, who joined the Army in 1983 as Edward Long, managed to suppress her feminine identity for her first 22 years of duty as a drill sergeant, paratrooper and security official at the detention camp at Guantanamo Bay, Cuba.

“You’re in very gender binary roles,” she said. “It doesn’t leave any room. There’s no gray area.”

Eventually, though, she could no longer run from herself. After a second divorce in 2005, Long attempted suicide.

“You want to make it all go away,” she said. “You can’t be who you want to be.”

Then Long started meeting other transgender people online and dressing as a woman off-duty in the evenings and on the weekends.

After a deployment to Iraq in 2008, she began taking hormones with plans to leave the military and live openly as a woman. A combat duty assignment in Afghanistan delayed her retirement until 2012.

Now 50, Long lives in New Jersey and works as a financial adviser.

“If I could have remained on duty, I would have,” she said.

Photo: Chelsea Manning is one of many male-to-female transgender adults who have served in the military. Many have said they joined the military to be in a hypermasuline environment — but it did not stem their feminine urges. torbakhopper/Flickr

Seniors Boost Number Of Veterans Deemed Unemployable

By Alan Zarembo, Los Angeles Times

Jack Behunin received welcome news last year from the Department of Veterans Affairs: Due to war-related medical conditions, he was being declared unfit to work, boosting his tax-free monthly disability compensation from $1,850 to $3,000.

Not that he had any interest in a job. The World War II veteran in Burbank, Calif., is 90 years old.

His case is not an aberration. Senior citizens have helped make the benefit — known as individual unemployability — one of the fastest-growing expenditures in the VA disability system. The number of “unemployable” veterans has nearly tripled since 2000, to 321,451, with the majority at ages when most people have already stopped working.

Government data show that 56 percent of the beneficiaries are at least 65 years old. Eleven percent are 80 or older.

Being classified as unemployable can add $1,100 to $1,900 to a veteran’s monthly disability pay, which often comes on top of Social Security.

At an annual cost of at least $4 billion, the benefit is part of a rapidly expanding disability system expected to cost $60 billion this year. Federal reports have singled out unemployability as an example of how a system operating under rules established decades ago has not kept pace with modern times.

“VA’s compensation program does not reflect the current state of science, technology, medicine, and the labor market,” the Government Accountability Office concluded in a 2006 report.

GAO researchers are now examining the benefit to determine how many veterans classified as unemployable had left the labor force voluntarily.

Behunin farmed cotton and alfalfa for nearly a decade after the war, and then spent 17 years at car dealerships, one year selling more Pontiacs than any other salesman in the country. He worked for his son selling mulch into his 80s until they had a falling-out.

He said he made $50,000 his final year.

An avid traveler, he did most of the driving this summer on a 10,000-mile road trip to Alaska with his wife.

But his job as a gunner during the war sandwiched him between two loud machine guns in a B-24 bomber and badly damaged his hearing. He has worn hearing aids since the 1960s.

The war also resulted in what he described as a mild case of post-traumatic stress disorder.

Behunin probably could have been collecting disability pay for decades, but he didn’t apply until a friend suggested it about seven years ago. He wound up with a 90 percent disability rating for hearing loss, tinnitus, and PTSD. Being declared unemployable raised his pay to the 100 percent level.

He said it provided a much-needed supplement to the $2,900 in Social Security that he and his wife collect each month.

“What kind of job could I get?” he said. “I couldn’t stand up all day on a retail floor.”

When the VA created the unemployability benefit in 1934, Social Security didn’t exist. Manual labor was the only option for most workers, and the Great Depression was in full swing.

The benefit was a safety net for veterans who couldn’t work because of health problems that began in the military and whose disability ratings, based on a formula combining their conditions, fell shy of 100 percent.

In 1945, as disabled World War I veterans continued to fall out of the workforce, the VA adopted a regulation ensuring eligibility to veterans of any age. That decision underlies much of the current growth.

More than half the 137,343 veterans approved since 2010 were 65 or older, including 13,684 who were at least 75, according to VA statistics.

The largest group served in the Vietnam era. Many joined the disability system over the last decade as the VA expanded eligibility for PTSD and diabetes, heart disease, prostate cancer, and other common conditions on the presumption they were caused by exposure to the herbicide Agent Orange, used to clear jungle vegetation in the war.

Once in the system, veterans are eligible for the unemployability benefit if their ailments are deemed too severe for them to work and their disability ratings reach a certain threshold, usually 60 or 70 percent, depending on their mix of conditions.

William McMath, a psychologist who conducts disability examinations at the VA Medical Center in Northport, New York, said decisions about unemployability are often subjective and that it is easy to be swayed by elderly veterans who are struggling financially.

Joe Meredith, who served in Vietnam and now works in northern Michigan helping veterans secure disability benefits, said many of his clients have had long careers and use the unemployability provision to supplement their retirements.

“Someone has spent 30 years working for General Motors, 30 years in the military or 30 years driving a bus,” Meredith said. “Now they are retired. And guess what? They’re a Vietnam veteran and they’re going to jump on the bandwagon.”

He said he advocates for them as a way to right the wrongs of the past — a draft system biased against the underclass and poor treatment after the war.

“If a guy gets $3,000 a month, maybe that evens the score a little,” he said.

The unemployability benefit has been controversial for at least a decade.

The GAO’s 2006 report said the law does not give clear standards for classifying veterans as unemployable. The VA inspector general has found widespread geographic variation in how it is awarded.

Restricting the benefit to veterans younger than the full retirement age for Social Security — 65 or 67, depending on the recipient’s birth year — would save $17 billion over the next decade, the Congressional Budget Office estimated last month.

To provide context, the report noted that 37 percent of U.S. men 65 to 69 remain in the labor force. That figure falls to 11 percent for men over 74.

Advocacy groups have attacked age caps as unfair to veterans who want to keep working.

Joe Violante, national legislative director for Disabled American Veterans, said any age cap would be arbitrary and noted that many U.S. senators are 65 or older.

“This is about how we can save money on the backs of disabled veterans,” Violante said.

A 2007 study for the VA found that veterans classified as unemployable had a higher mortality rate than other veterans with similar standard disability ratings — evidence that on the whole the designation was not arbitrary.

Elected officials have been unwilling to touch the benefit. The last to try was then-Sen. Larry Craig (R-ID), who held a hearing on it in 2005 but found little support.

Craig’s concerns included that the benefit was hurting younger disabled veterans by creating an incentive not to work. A total of 16,663 recipients — or 5 percent of the total — are under 40.

Sen. Patty Murray (D-WA), argued that the benefit was being used as intended and reviewing it would add to the stigma many veterans feel when seeking help.

While a standard disability rating, even 100 percent, carries no restrictions on working, the unemployability benefit requires recipients to earn less than the federal poverty cap of roughly $12,000 a year.

Isaiah Kyseth left the Army in 2007 after damaging discs in his back during a training exercise and suffering more injuries in an off-duty car accident. He never went to war.

The VA eventually rated him 80 percent disabled and declared him unemployable, he said.

His rating covers not only his back, he said, but also a hernia repaired while he was serving and PTSD from the car accident and the deaths in Iraq of several soldiers from his unit.

Kyseth had hoped to make the military a career. “I lost my entire sense of purpose,” he said.

For a time he attended music school in Hollywood under the GI Bill, hoping to become a producer. But he said he’d rather keep his 100 percent payments than work.

“I am permanently disabled for the rest of my life at 31.”

AFP Photo/Jean-Sebastien Evrard

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Scientists Find A Possible Biomarker For PTSD In Rats

By Alan Zarembo, Los Angeles Times

Scientists have been looking for a blood test or other biological marker for post-traumatic stress disorder, which can be difficult to diagnose.

Experimenting in rats, they may have found one.

In a study published this week in the Proceedings of the National Academy of Science, researchers stressed out dozens of laboratory rats by exposing them to used cat litter. Even though the rats had never been exposed to a cat, they recognized the scent of cat urine as a threat.

Seven days later, the researchers tested the rats for symptoms of PTSD. Animals were deemed to be affected if they cowered in a closed section of a maze — counter to their instinct to explore — and failed to habituate to a loud clapping-like noise, continuing to jump even after hearing it 30 times.

The researchers then analyzed gene expression in blood and two parts of the brain. The rats with what were seen as PTSD symptoms had a distinct pattern of glucocorticoid receptor signaling.
Glucocorticoids are a class of hormones. The most important is cortisol, which is released in response to stress and plays a crucial role in metabolism and the immune system.

In a second phase of the experiment, rats were injected with corticosterone — a hormone that activates the glucocorticoid receptors — an hour after they were placed in a cage with the cat litter.
Compared with rats that did not get the injections, they showed far fewer PTSD symptoms when they were tested a week later.

The lead researcher, Dr. Nikolaos Daskalakis, a neuroendocrinologist at Mount Sinai Hospital in New York, said clinical trials are already underway to see if a glucocorticoid given quickly to survivors of serious car accidents can help prevent PTSD.

In the aftermath of trauma, some people are more vulnerable than others to develop PTSD. Researchers are still trying to figure out why.

Photo via WikiCommons

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With U.S. Encouragement, VA Disability Claims Rise Sharply

By Alan Zarembo, Los Angeles Times

LOS ANGELES — As Malvin Espinosa prepared to retire from the Army in 2011, a Veterans Affairs counselor urged him to apply for disability pay.

List all your medical problems, the counselor said.

Espinosa, a mechanic at Fort Lee in Virginia, had never considered himself disabled. But he did have ringing in his ears, sleep problems, and aching joints. He also had bad memories of unloading a dead soldier from a helicopter in Afghanistan.

“Put it all down,” he recalled the counselor saying.

Espinosa did, and as a result, he is getting a monthly disability check of $1,792, tax free, most likely for the rest of his life. The VA deems him 80 percent disabled due to sleep apnea, mild post-traumatic stress disorder, tinnitus, and migraines.

The 41-year-old father of three collects a military pension along with disability pay — and as a civilian has returned to the base, working full-time training mechanics. His total income of slightly more than $70,000 a year is about 20 percent higher than his active-duty pay.

Similar stories are playing out across the VA.

With the government encouraging veterans to apply, enrollment in the system climbed from 2.3 million to 3.7 million over the last 12 years.

The growth comes even as the deaths of older former service members have sharply reduced the veteran population. Annual disability payments have more than doubled to $49 billion — nearly as much as the VA spends on medical care.

More than 875,000 veterans of the Afghanistan and Iraq wars have joined the disability rolls so far. That’s 43 percent of those who served — a far higher percentage than for any previous U.S. conflict, including World War II and Vietnam, which had significantly higher rates of combat wounds.

Disabled veterans of the recent wars have an average of 6.3 medical conditions each, also higher than other conflicts.

Incentives to seek disability ratings have increased due to changes in VA policy, including expanded eligibility for post-traumatic stress disorder and a number of afflictions that affect tens of millions of civilians.

Nearly any ailment that originated during service or was aggravated by it — from sports injuries to shrapnel wounds — is covered under the rationale that the military is a 24/7 job.

The disability system was unprepared for the massive influx of claims, leading to backlogs of veterans waiting months or longer to start receiving their checks.

But once the payments begin, many veterans say, they are a life-saver.

Ray Lopez struggled to keep a steady job after leaving the Marines in 2001. Stints as a TSA screener, insurance agent, and soft drink salesman ended badly.

At 35, Lopez is rated 70 percent disabled for back, shoulder, and knee pain, as well as post-traumatic stress disorder from having witnessed a deadly helicopter crash off the coast of San Diego.

He couldn’t support his wife and two children, he said, without the monthly $1,800 disability check. “If it wasn’t for that, I’d be on the streets,” he said.

Lopez trains boxers three days a week and is pursuing a community college degree.
___

The generosity of veterans benefits is on an upswing in a pendulum arc as old as the republic.

During the Revolutionary War, disability payments were limited to soldiers who lost limbs or suffered other serious wounds.

Lobbying by Civil War veterans led to coverage that included peacetime injuries and illnesses.

After World War I, compensation was scaled back to cover only combat injuries and diseases contracted in war. But World War II brought an expansion to include all conditions that appeared during service or shortly afterward.

In the 1950s, President Dwight Eisenhower — a former five-star general — tried to rein in the costs. He found little support in Congress, and the basic system has remained the same ever since.

The VA uses a formula that combines a veteran’s conditions into a rating of between 0 percent and 100 percent — in 10 percent increments. The higher the rating, the larger the disability payment.

Nearly half of those in the system have ratings of 30 percent or below. They can apply for higher ratings if ailments grow worse.
“The disability system has this escalator quality,” said David Autor, an economist at MIT. “Once you get on, you just keep going up.”

The current benefits boom began with a political battle over Agent Orange and other herbicides used to clear jungle brush in Vietnam.
In 1991, Congress and the VA started paying veterans who had served on the ground there — meaning possible exposure to Agent Orange — and went on to develop diseases that eventually included lung and prostate cancer.

Then in 2001, the VA added Type 2 diabetes to the list. The disease affects 1 in 4 U.S. senior citizens and has not been definitely linked to Agent Orange. But veterans groups lobbied to include it.

“The feeling was, let’s give them whatever they need and move on,” said Anthony Principi, the VA secretary at the time. Through 2013, the number of veterans receiving compensation for diabetes climbed from 46,395 to 398,480.

The Obama administration added three more conditions in 2010: Parkinson’s disease, a rare form of leukemia, and ischemic heart disease. Since then, more than 100,000 cases of heart disease — the leading cause of death in the United States — have been added to the disability rolls.

Veterans of all generations also have been encouraged to apply for compensation for post-traumatic stress disorder, with Vietnam and the recent wars driving the growth in roughly equal measure over the last decade.

Some veterans said they have lived with the disorder ever since leaving the military. Others kept it at bay until recent wars or major life changes released old demons. The economic uncertainties of retirement age also gave veterans more incentive to apply.

As post-traumatic stress disorder claims boomed, the Obama administration made them easier to win.

The VA had long required documentation of a traumatic event that resulted in post-traumatic stress disorder. But in 2010, in keeping with the current science, the administration said a qualifying trauma could simply be a fear-inducing situation such as traveling through enemy territory.

More than 1.3 million veterans of the Vietnam era received $21 billion in disability pay last year. From Afghanistan and Iraq, the cost was $9.3 billion — but it is growing fast.

Among disabled veterans of recent wars, 43 percent have tinnitus, the most common condition. Rounding out the top 10 are back or neck strain, knee problems, post-traumatic stress disorder, migraines, arthritis of the spine, scars, ankle trouble, defective hearing, and high blood pressure.

“They’re filing for the basic wear and tear of military service, not combat injuries,” said Phillip Carter, a veterans expert at the Center for a New American Security, a nonpartisan think tank.
___

The expansion of disability benefits signals a change in attitude about the purpose of the payments, long intended to compensate veterans for lost income. Studies have found that many disabilities in the system have no effect on average earnings. One showed that veterans receiving disability pay tend to have higher total incomes than those who do not.

In the age of an all-volunteer military and after two unpopular wars, disability pay has come to be seen as a lifetime deferred payment for service.

Espinosa, the Fort Lee trainer, said his monthly $1,792 disability check is scarcely making him rich. All of it goes for his son’s college education.

He has filed new claims for back and knee pain, gastrointestinal problems, and vertigo in an attempt to boost his 80 percent disability rating.

“I believe my disability rating — and I’m not trying to sound greedy — should be 100 percent,” he said. “I know what I went through.”

Photo via WikiCommons

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Super-Cooled Livers Could Bring New Flexibility To Organ Transplants

By Alan Zarembo, Los Angeles Times

In liver transplantation, the biggest inequity is geographic. When organs become available, they are generally offered first to patients nearby. A big part of the reason is that once a liver is harvested from a cadaver, it remains viable for no more than 12 hours.

As a result, waiting times vary dramatically across the country depending on supply and demand. Liver patients in Los Angeles, for example, typically wait years longer — and become far sicker prior to surgery — than those in northern Florida.

Now a group of Harvard University researchers has come up with a preservation technique that could one day allow livers to be shared more easily around the world.

In a paper published this week in the journal Nature Medicine, the scientists describe an experiment in rats in which livers were preserved for up to four days before transplantation.
Of the 12 rats that received four-day-old livers, seven survived for at least three months. Transplantation after three days worked perfectly: All six rats in that group survived.

In comparison, no rats survived after receiving three- and four-day-old livers preserved in the standard ice-cold solution — a breakthrough in transplantation when it was invented at the University of Wisconsin in 1980.

The new method relies on super-cooling. Livers were stored at minus 6 degrees Celsius in a chemical bath that prevented them from freezing. Freezing destroys delicate cell membranes.
The livers were slowly warmed before surgery.

The experiment marks the first time that a liver has been successfully transplanted after four days of storage — in any species.

But will the technique work in people? The scientists wrote that preserving human livers could require changes to the chemical solution or the protocol of cooling and warming.

One challenge is that human livers are more vulnerable to freezing than rat livers because of their size. There are other differences in liver biology as well.

But if the researchers can make it work, extending preservation time could have profound effects on the transplant system. Livers could be flown around the country or the world where they are needed most, equalizing waiting times and reducing organ shortages in the places with the highest demand and the lowest supply.

More than 15,700 people in the United States are waiting for liver transplants.

Photo: Rusty Clark via Flickr

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Experts Settle On Two Definitions For Mysterious Gulf War Illness

By Alan Zarembo, Los Angeles Times

LOS ANGELES — More than two decades since the first U.S. invasion of Iraq, medical authorities can’t agree on a definition of Gulf War illness, the mysterious array of ailments afflicting many veterans of the conflict.

In the latest attempt to settle the debate, the Department of Veterans Affairs commissioned the prestigious Institute of Medicine to develop a definition. But in a report released Wednesday, its experts said the symptoms — including joint pain, fatigue, headaches, rashes, digestive problems and cognitive impairment — vary so widely that there was no way to reach a scientific consensus.

So they chose two definitions.

The first, developed by the U.S. Centers for Disease Control and Prevention, takes a broad view of the illness. It may be most useful to doctors who don’t want to overlook any patients who may be afflicted.

A second, more restrictive definition was formulated by scientists studying Kansas veterans and may be better suited to research studies.

Defining the illness — and the universe of people who have it — is essential for investigating potential causes and standardizing treatments.

When veterans first began reporting a strange variety of opaque symptoms in the wake of the 1991 war, they were often met with skepticism. Many studies, however, have shown that service members deployed to the war went on to suffer a variety of health problems at a higher rate than those deployed elsewhere.

Up to one-third of the 700,000 U.S. troops who served in Operation Desert Shield and Operation Desert Storm are thought to be affected.

But without a blood test or other biomarker to distinguish Gulf War illness, it can only be diagnosed by its symptoms, many of which occur in other conditions such as chronic fatigue syndrome and fibromyalgia.

Severity ranges from mild to debilitating. In some cases, veterans became ill immediately after the war. Others got sick years later. Recovery varies too.

The biggest mystery is the cause. Exposure to pesticides, nerve agents and smoke from burning oil wells have all been investigated as possible culprits, without definitive results.

At the behest of the VA, the experts did resolve one debate.

When it first appeared, the illness was called Gulf War syndrome. Then other terms began appearing in the medical literature, including “unexplained illness” and “chronic multisymptom illness,” which became widely accepted.

Gulf War illness is the most appropriate name, the Institute of Medicine concluded in its report.

Photo: dmott9 via Flickr

Nearly One In Five Had Mental Illness Before Enlisting In Army, Study Says

By Alan Zarembo, Los Angeles Times

Nearly one in five U.S. soldiers had a common mental illness, such as depression, panic disorder or ADHD, before enlisting in the Army, according to a new study that raises questions about the military’s assessment and screening of recruits.

More than 8 percent of soldiers had thought about killing themselves and 1.1 percent had a past suicide attempt, researchers found from confidential surveys and interviews with 5,428 soldiers at Army installations across the country.

The findings, published online Monday in two papers in JAMA Psychiatry, point to a weakness in the recruiting process, experts said. Applicants are asked about their psychiatric histories, and those with certain disorders or past suicide attempts are generally barred from service.

“The question becomes, ‘How did these guys get in the Army?’ ” said Ronald Kessler, a Harvard University sociologist who led one of the studies.

A third study looked at the increased suicide rate among soldiers from 2004 to 2009. The study, which tracked nearly 1 million soldiers, found that those who had been deployed to Afghanistan or Iraq had an increased rate of suicide.

But it also found that the suicide rate among soldiers who had never deployed also rose steadily during that time. The study did not explain the cause.

The Pentagon did not make officials available Monday to discuss the studies.

The three studies are the first from a massive research initiative started in 2009 by the Army and the National Institutes of Mental Health in response to the surge in suicides.

In 2011, a representative sample of soldiers was extensively questioned and assessed for a history of eight common psychiatric disorders.

Traditionally, the Army has been psychologically healthier than the rest of society because of screening, fitness standards and access to health care. Soldiers committed suicide at about half the rate of civilians with similar demographics.

But researchers found that soldiers they interviewed had joined the Army with significantly higher rates of post-traumatic stress disorder, panic disorder and attention deficit and hyperactivity disorder than those in the general population.

Most notably, more than 8 percent of soldiers entered the Army with intermittent explosive disorder, characterized by uncontrolled attacks of anger. It was the most common disorder in the study, with a pre-enlistment prevalence nearly six times the civilian rate.

“The kind of people who join the Army are not typical people,” Kessler said. “They have a lot more acting-out kind of mental disorders. They get into fights more. They’re more aggressive.”

The researchers found that despite screening, pre-enlistment rates of depression, anxiety, bipolar disorder and substance abuse were on par with civilian rates.

Rates of suicidal ideation, planning and attempts were lower than in the general population but still significant, given the military’s practice of excluding recruits with a known suicidal history.

During their military service, the soldiers’ rates of most psychiatric disorders climbed well past civilian levels, several times the rate for some disorders.

A quarter of soldiers were deemed to be suffering from a mental illness — almost 5 percent with depression, nearly 6 percent with anxiety disorder and nearly 9 percent with PTSD. The percentage of soldiers who had attempted suicide rose from 1.1 percent to 2.4 percent.

Matthew Nock, a Harvard University psychologist who led the study on suicide, said more than 30 percent of suicide attempts that occurred after enlistment would have been prevented if the Army had excluded recruits with pre-existing mental health conditions.

Nock said he believed the Army should improve its screening of recruits, not to exclude them but to provide treatment to those who acknowledge a history of mental illness.

Screening out mentally ill recruits is not as simple as it sounds because the military largely has to rely on applicants to disclose their mental health histories.

“People who want to come into the Army are no fools,” said Dr. Elspeth Ritchie, a former chief psychiatrist in the Army.

“They know if you say you had a past suicide attempt, you’re probably not going to get in.”

Dr. Eric Schoomaker, who served as surgeon general of the Army until 2012, said more stringent screening “would just lead to driving the problems further underground.”

In addition, the military would not meet its recruiting targets if it were able to identify and exclude everybody with a history of mental health problems, experts said.

During the peak years of war, as the military was struggling to fill its ranks, some recruiters were known to discourage applicants from disclosing such problems.

U.S. Army Photo via Flickr.com

NFL Concussion Rates Are Lower At Higher Altitudes, Study Finds

By Alan Zarembo, Los Angeles Times

Here’s one solution to the National Football League’s concussion problem: Stop playing at sea level.

Researchers have found that concussion rates are about 30 percent lower in games played at higher altitudes.

The finding was based on an analysis of all 300 concussions reported during the first 16 weeks of regular-season NFL games in 2012 and 2013. (Week 17 data were not available, since only playoff-bound teams release them.)

For every 10,000 times a player suited up, there were 64.3 concussions. But that figure varied with elevation.

The concussion rate at the 24 stadiums situated less than 644 feet above sea level was 70 per 10,000. At the nine stadiums higher than that, it was 49.4 per 10,000. The nine stadiums — in ascending order — are in Indianapolis; Pittsburgh; Charlotte, North Carolina; Orchard Park, New York; Kansas City, Missouri; Minneapolis; Atlanta; Glendale, Arizona; and Denver.

The study, led by researchers from the University of Cincinnati (a low-altitude city), appears in the current issue of the Journal of Orthopaedic and Sports Physical Therapy.

Researchers used 644 feet as the dividing line between high- and low-altitude stadiums based on a 2013 study of high school football players. That study, which looked at more than 6,000 concussions, found nearly the same correlation between altitude and head injuries.

At 5,192 feet above sea level, only Denver’s stadium — Sports Authority Field at Mile High — is normally considered a high-altitude destination. But even at far lower elevations, atmospheric levels of oxygen are significantly lower than at sea level. That increases blood flow to the brain and pressure inside the skull.

The increased pressure may protect against concussions caused by a phenomenon known as “brain slosh.” When the head is subjected to sudden accelerations and decelerations, the brain, skull, blood and spinal fluid move at different rates because their densities vary.

Higher pressure, according to this hypothesis, essentially creates a tighter-fitting brain that is less prone to damage.

Head-ramming sheep and woodpeckers naturally have such protection, allowing them to withstand collisions much more forceful than those that cause concussions in people.

The researchers were unable to control for the use of supplemental oxygen by players off the field, which could change intracranial pressure. They suggested that could explain why Denver, where the use of supplemental oxygen is most common, did not have the lowest concussion rate.

AFP Photo/Patrick Smith