Post Magazine: A Soldier Twice Wounded
Monday, February 26, 2007; 12:00 PM
What hurt Richard Twohig just as much as being thrown from an Army vehicle in Iraq was the military's insistence that he hadn't been injured that badly.
Paula Span tells Twohig's story in this week's issue of Washington Post Magazine. Joining her in the online conversation is Mark Waple, a Fayetteville, N.C., attorney representing Richard Twohig.
Read the Story: Battle Worn ( Post Magazine, Feb. 25)
A transcript follows.
Paula Span is a contributing writer for The Magazine .
Paula Span: Thanks for joining us, everyone. Attorney Mark Waple, a former judge advocate, is also here to respond to questions and comments. And I expect some service members, civilian attorneys representing them, and the Army brass itself to drop by. Lots of questions already, so let's dig in.
Richmond, Va.: Thank you for this informative article. I hope the Army realizes that this kind of treatment of injured soldiers affects their recruitment levels more adversely than the country being at war (after all, a lot of soldiers enlist because of their patriotic desire to defend the country and our interests). The Army, and indeed, all branches of the military, ought to err on the side of providing benefits for at least five years after the injury so that the full extent of the injury may be more fully evaluated. My heart goes out to Mr. Twohig, and all those in similar circumstances.
Paula Span: A lot of these soldiers hoped to have a military career, and they are not looking to leave the service. Sometimes, being forced out is painful emotionally, as well as financially.
Rockville, Md.: Thanks for reporting on yet another poorly run government program. I do have a question, though. It staggers the imagination that the Army would claim he is only 10 percent disabled, which seems appalling, while the VA gives a full 100 percent disability, which may be a little too high. How on earth can the standards be that different? Or is it different people interpreting the same standard?
I'm a lawyer who handles workers comp cases in Montgomery. I've never had anything nearly this serious, but I've never seen anything like this enormous gap. A lot of it is almost boilerplate and never goes to court: broken wrist, 10 percent of the use of the arm. When it does go to court, maybe over something like a broken back, we're usually arguing in the 5-10 percent range.
Good luck to Mr. Twohig and his family.
washingtonpost.com: Battle Worn ( Post Magazine, Feb. 25)
Paula Span: There frequently is a significant disparity between VA and military ratings, even though they use the same ratings guidelines. One reason is that the VA gives ratings for more conditions. The military rate only those injuries that are considered "unfitting" for performing one's military job. The VA rates all injuries. It's also more oriented towards civilian employability.
That said, there also seems to be a difference in attitude. A retired disability review specialist from the VA wrote me to say that the VA's informal credo was: Approve if you can, deny if you must. The Army, he said, seemed to have the reverse belief. Many service members would agree.
I was moved by your article on this disabled soldier and angered to say the least by the roughshod way the U.S. Army has treated him.
It seems to me that the "system," if you can call it that, has been stacked against men and women like him who answered the call and get the shaft when it is the Army's turn to do what's right.
I would hope that his mother would contact Rep. Murtha and other members of Congress to get this corrected in short order and get the officials running the Army's scam indicted for falsely rating the injuries and depriving them of an impartial and medically accurate assessment.
And I think the latest revelations of the Walter Reed Hospital disgrace is not only the tip of the iceberg of deceit and neglect but is the absolute failure of the administration to correct its perpetuation of the neglect that our service men and women have had to endure,
Paula Span: Actually, I think the disability story and the Walter Reed outpatient stories are different facets of a common problem. One of the major reasons there are so many soldiers in limbo at Walter Reed, stretching the Army's ability to house and support them, is that they are waiting for the disability system to wind on. It does sound like Congress -- and the Defense Department itself --will be paying more attention now.
Honolulu, Hawaii: I've had many years experience in the VA rating veterans cases and have found quite a few poor decisions by the PEB which we rated considerably higher. There have also been many cases which were denied service connection by the military which the VA decided differently. Will the military ever consider having their people trained by the VA in the use of the rating schedule? Lack of adequate training seems to be a significant factor in many of the decisions coming out of the boards.
Paula Span: Lack of training for the military people involved in the disability system is a problem that has been cited repeatedly in the past, yes. You'll find this in the GAO report issued last March (you can find it on the Web site: it's called Military Disability System: Improved Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve and Active Duty Service Members.) You'll find it in a very comprehensive RAND Corporation report in 2002, which you can buy on RAND's Web site. It comes up in a Defense Department Inspector General's report back in 1992. So these problems predate what the Pentagon likes to call the GWOT -- Global War on Terror.
It's exacerbated by the fact that military people rotate through assignments, so by the time they are experienced with the system, they move on. Veterans Affairs people like you get far more training. Whether the military and VA can cooperate on this issue -- well, that's an interesting idea.
Silver Spring, Md.: How does this disability "package" compare with the private sector?
I was on a flight to Munich last fall with a lot of young fellows. Turns out they were on their way to the Mideast under the employ of a well-known contractor.
I'm assuming they face similar occupational risks. What kind of care and benefits could those kids expect were they to suffer similar injuries?
Paula Span: That's a very good question, and I'm afraid I don't know the answer.
Washington, D.C.: The $2,700 per month payment from the VA is more than it seems. The payment is completely tax-free and not subject to garnishment by creditors. A sergeant major (the highest enlisted rank) who retires after completing 20 years of service receives about the same amount in retainer pay; however, that payment is subject to state and federal taxation, deductions for survivor benefit plan coverage at the option of the spouse, and division by divorce courts as a marital asset.
Paula Span: VA disability payments are untaxed, true.
washingtonpost.com: Battle Worn ( Post Magazine, Feb. 25)
Paula Span: I've had some folks asking how they could donate to the Twohigs. I'm not sure they really want people's checks, but I feel fairly confident they'd be glad if readers would a)let their Congressional representatives know that they'd like to see changes in the military disability system and b) offer your prayers, because Major Twohig is a devout woman who believes in the power of prayer.
Charlottesville, Va.: I am a second year law student and extremely concerned and angry about the difficulties that have faced our disabled veterans. It is disgraceful that they have sacrificed so much for their country and have been treated with so little compassion and dignity, not to mention competence, by our military. I wonder if there is a way for my law school classmates and me to contribute to their appeals or otherwise assist as volunteers? This is something I absolutely cannot stand around and do nothing about.
Paula Span: Thanks for bringing up a real issue: there's a crying need for pro bono attorneys to represent soldiers who can't afford thousands of dollars to hire civilian attorneys for these disability hearings. The problem is that this area of law is extremely complicated, not for amateurs with no experience in military regulations and law. I know that Rick Weidman of Vietnam Veterans of America has been thinking about trying to put together some sort of consortium through which experienced attorneys could train and backstop other attorneys willing to volunteer their time. It sounds to me like a fine idea
Mark Waple: In order to competently represent service member in this area of law, the attorney must have some medical background or experience, a knowledge of DOD directives,VA regulations and military regulations as well as at least some familiarity with the nuances of the medical board and physical board process. It is also very helpful to have access to the service members military treating physicians.
Mark Wale: It would be very helpful if installation legal assistance attorneys became involved in assisting these service members,but they haven't been authorized to do so since Vietnam.
Springfield, VA.: Just referencing on of your facts in your article about how difficult and draining, emotionally and financially, this process is. I am one of those service members who gave up. Thankfully, I was eventually able to be employed. But not before declaring bankruptcy because of my medical bills and lengthy unemployment. The Army will tell you it's doing right and taking care of the soldier. It does neither. I have already told recruiters to not call my house. I have forbidden my daughter and son to pursue a military career, for what it's worth.
Thank you for shedding an enormous light on this travesty. It's at least a step in the process to get it right.
Paula Span: Thanks for telling us about your experience. What an ordeal.
Central Virginia: Thank you so much for taking my questions -- I'm a military wife and your article gave me even more reasons to hope we avoid Walter Reed.
What do you think of that military fellow's assertion that the Post article was true but misleading? (I have MY opinion and it's not a good one, but I'd like to know yours.)
And what is your opinion of their attempt to do an end-run around the Post's articles and dilute the impact by inviting in a number of other journalists? Do you think it was/ will be successful?
Paula Span: I hope you avoid it too.
Most of the brass seems to have swallowed hard and vowed to make improvements, Kiley aside. The Defense Department didn't argue last year when the Govt Accountability Office issued the latest in a series of critical reports on the disability system that goes back to the early 90's. The question is, will they all make good on their promises?
I can't speak for my Post colleague, but just for myself when I say that I'm delighted when other reporters and news organizations pick up on my stories. It may "dilute" the impact a bit because most of them cannot devote the time and space to a subject as the Post Magazine, or the two-part series that Priest and Hull wrote. But it still helps spread the word, and that's why most of us are in this business.
Woodbridge, Va.: To answer Silver Spring's question, U.S. contractors working in the Middle East are covered under the U.S. Safe Harbors Act. Many companies doing work in Iraq, etc., participate in the program.
Paula Span: Thank for enlightening us. Though it sounds like some companies don't participate.
Army v. the other services: As an attorney who regularly appears before all of the services' PEB panels, I am often stunned at the disparity between the ratings assigned by Army panels and the more generous ratings assigned by those of the other services. Your story is all the more revealing since the panel at Walter Reed is the most generous of the three Army panels. However, some things remain consistent- Nick Gnemi still seems to be a lone voice in the wilderness when it comes to giving the soldier the benefit of the doubt in Army proceedings.
Paula Span: And the service member IS supposed to get the benefit of the doubt when there are gray areas.
But you are bringing up a persistent problem in the disability system: inconsistency. How your case is resolved can depend on which service branch you are in. The Navy may rate the same injury differently from the Air Force or the Army, which is not supposed to happen. Within the Army, the Fort Lewis PEBs and the Sam Houston PEBs are perceived to be more or less "soldier-friendly" than Walter Reed's. This is one of the areas that the RAND report and the GAO both emphasized, and the Pentagon says it is working on it.
I haven't found much consensus, by the way, among civilian attorneys as to which PEB is the most generous or the stingiest. Everybody seems to have his or her favorite or least.
Alexandria, Va.: I'm curious about one of the cases you mentioned in passing in your article -- the soldier who injured his back during a "martial arts test" aboard ship. It seems to be a recreational activity undertaken at his discretion. I worked with a young man recently who was collecting VA disability pay for the rest of his life because he broke his finger in a drunken fight while on leave.
As much as I support the troops (as a vet myself and brother of a combat wounded vet) some of these claims seem like an unfair burden on the taxpayer, and detract from legitimate claims like Mr. Twohig's.
Paula Span: No, not at all "recreational". That Marine was a martial arts instructor, doing his job. Moreover, service members who are injured "due to own misconduct" are not eligible for military retirement.
Anonymous: I have to say I was appalled to learn of the different statuses granted for different levels of leg amputation ... the system is really sick.
Mark Waple: Granted the disability methodology is archaic and cumbersome, but there are understandably different ratings for different types and degrees of leg amputations. It should be noted,however, that when there is doubt about the applicability of the percent disability, the doubt, by regulation, is to be resolved in favor of the higher rating.
Arlington, Va.: I don't know about the previous questioner, but $2,700 isn't a lot, when you take into consideration, HEALTH INSURANCE FOR HIS CHILDREN, which they may soon lose because his ex-wife wants out of the Navy. And my monthly take-home, after taxes, is about $2600, and I don't have kids. So I still have tons of sympathy for this guy, none at all for Army brass for not fulfilling their responsibility to Mr. Twohig.
Paula Span: Plus, most people who get VA benefits aren't rated at 100 percent, as Richard Twohig is, so they get smaller checks.
Washington, D.C.: I was again appalled at the treatment of our troops returning injured from serving their country. This article on top of the Walter Reed article just makes me enraged at the treatment they are receiving. The physical wounds are easy to see and you can't deny what is in your face. But it appears that the psychological wounds are getting 'dismissed' for lack of a better term. I am a young adult and unfortunately my generation will be dealing with the fall out from this war for many years to come.
washingtonpost.com: Soldiers Face Neglect, Frustration At Army's Top Medical Facility ( Post, Feb. 18)
Paula Span: You will, indeed.
There's a general consensus among vets groups, service members I've spoken to and civilian attorneys that the injuries you can't see -- psychiatric disorders, post-traumatic stress disorder, etc. -- are harder to get ratings for. One problem is that the military physicians who treat the injured are knowledgeable about medicine, but they're not always conscious of exactly what phrases and words and measurements and documentation will help their patients with their subsequent disability ratings. There are online templates to help doctors with this, but there also seems to be a need for better training so that all parts of this system work efficiently together.
Washington, D.C.: I was captivated reading your article on the sad, unfortunate tale of Richard Twohig. He served his country by fighting in the war in Iraq, was very seriously injured and unable to receive the full benefits of disability for his family.
Richard Twohig, and others like him in the military, deserve the best treatment that our country can give to him and his children. From the article it appears that his mom is doing everything in her power to help her son.
It is time for someone in power to step up to the plate and give Richard Twohig and others like him the best that our country can offer to one who served his country so well during a time of war.
Paula Span: The Twohigs -- I spoke with Belinda a day ago -- are glad that this issue is coming to public attention. She's an amazing woman, by the way. And a believer that the military will do right by her son, even now.
Silver Spring, Md.: I read this article with mixed feelings.
I can't say that I feel the Army deserted Twohig because he is covered by the VA have my own health insurance problems, so the issue of the un-covered children with a mom who can work and get coverage doesn't strike me as unusual in today's economy. It's not a gold-plated arrangement, but very few of us have that these days.
I do have some questions. If Twohig earns income on the farm, will that disqualify him from the VA payments? Is he receiving any counseling to help him try to manage his issues? I think it's well accepted that living with a chronic illness is stressful and that self-management can help. Will he be able to get tuition assistance under his current disability, so if he's able to go to school later he can re-train? Is there any evidence that the Army doles out full disability more often to those injured directly in battle?
Mark Waple: No. Richard, if medically able, can be employed and not lose his VA disability compensation. Full employment may jeopardize that compensation. Fortunately, Richard is eligible for VA medical care and help with any special needs such as outpatient therapy. I am not aware that the Army PEB is "doling" out medical retirements--combat related or otherwise. When the injury is determined to be combat related, there are favorable tax considerations that come into play.
Paula Span: Let me add that while a lot of children are not covered by health insurance in this country, people who volunteer for the military (if they think at all about getting hurt) do so believing that if they're disabled, they will be cared for -- including health coverage for their dependents. The system and benefits do exist -- the question is whether they are being distributed fairly.
Sewickley, Pa.: More than anything your story emphasized for me how important the print media are. Our corporate-owned, bottom-line oriented infotainment business obsesses over the remains of a ex-centerfold while stories like this one go unreported until someone like you does this terrific work. Our little military family thanks you. Will the country/administration, in your opinion, really begin to focus attention on the problems of returning vets or will we continue to avert our gaze preferring the endless tape-loop of Anna Nicole showing off her silicone?
Paula Span: You're welcome, and obviously I share your affection for news media -- print or broadcast -- that can give reporters or producers the time to delve into complicated subjects like this. Priest and Hull spent months on their Walter Reed stories. I began my reporting on the disability system well over a year ago, and have worked on it on and off ever since.
Honestly, I think there will be attention to issues affecting returning vets from Iraq and Afghanistan, because this is a problem that truly crosses partisan boundaries. But follow-up will be a question -- once the reporters move on to other stories, will they come back and see whether promises of change have been kept?
washingtonpost.com: Battle Worn ( Post Magazine, Feb. 25)
washingtonpost.com: Soldiers Face Neglect, Frustration At Army's Top Medical Facility ( Post, Feb. 18)
Washington, D.C.: This is a great article Paula. The medical board/physical board evaluation process needs some revising and should give the soldier the benefit of the doubt in evaluations.. America so far has used the slogan "Support our Troops". Lets see it happen on this one.. You Paula, know me well and my struggles with this process?
Paula Span: This comment, I believe, comes from one of my favorite soldiers, Sgt. David Yancey of the Mississippi National Guard, who has been at Walter Reed for nearly two years now. For much of the first year, he was undergoing treatment, including multiple surgeries, for his injuries after his vehicle ran over an explosive device in Iraq. But his narrative summary -- which is supposed to start the disability process - -was written last March. It's supposed to take no more than 30 days after that to get a medical evaluation board report -- but Yancey didn't get his until late October.
And he's still going through the system, though he hired a civilian attorney a year ago in hopes of making the process smoother and fairer. It looks like Sgt. Yancey may now be retired, finally, but it's been a very long struggle. I frankly think most soldiers would've just thrown up their hands and taken their severance checks and gone home, believing that they couldn't fight the system. And while Yancey was marooned at Walter Reed waiting, his father died at home. It's been a mess.
Timeliness has been a consistent problem with the PEB system for years. The GAO report shows that a quarter of active duty soldiers and more than half of reservists and Guardsman do not get their cases adjudicated within the guidelines the Pentagon has established.
Virginia Beach, Va.: While the Army denied Mark Waple a continuance and thus forced the soldier to proceed with military counsel, did you have a chance to interview military counsel to find out what happens when they take leave, are ill, etc? Do they pass their cases along to the remaining counsel to proceed as scheduled or are these cases continued?
Mark Waple: Understandably,from time to time, the military or government civilian attorney assigned to a PEB case will be absent for various reasons. Usually, the case is reassigned to another attorney, but this is rare and typically done well enough in advance of any formal hearing to be certain the transfer is seamless .This usually prevents any need for a delay of the formal hearing.
Washington, D.C.: COL Martin Tittle, Reserve Component Advisor, U.S. Army Physical Disability Agency, Washington, D.C. - Paula, just wanted you to know PDA is standing by for participation. COL Tittle is doing the talking here.
LTC Kevin Arata
Paula Span: Please go ahead and weigh in, Colonel.
Pittsburgh, Pa.: Army Times is reporting that the number of soldiers rated for permanent disability retirement has gone from 642 in 2001 to 209 in 2005. Yet the Army claims that this is not a cost-cutting measure. Can they really say that with a straight face in light of 15,000 - 20,000 injured in Iraq/Afghanistan?
Paula Span: The Army does indeed say that there's no budgetary consideration involved. Notice, too, that the Army is retiring, either permanently or temporarily, a much lower percentage of its injured than either the Air Force or the Navy (which includes Marines). The Army and I had some discussion about why that might be true, and several theories are advanced in my story, but the bottom line is that the Army really couldn't say. This goes to the consistency issue that has come up so often.
Virginia Beach, Va.: Jack Gately-
One point that most soldiers do not grasp when appealing findings of the formal panel is that they must request a copy of the audio recording and arrange to have it transcribed in order to show that the record was complete and that the formal panel's findings went against the weight of the evidence. I usually hire a certified court reporter to do so and assumes that Mark does the same. After all, it is unreasonable to expect that the reviewing authority will simply listen to each recording from all of the appeals filed. This also allows you to use a highlighter to mark and bound favorable testimony, etc.
Paula Span: Good point. This is from another civilian attorney who represents service members in disability hearings.
Mark Waple: This is correct. The hearings are placed on CD and the CD is given to the service member. It is invaluable if an appeal needs to be taken.
Arlington, Va.: Thank you Ms. Span for your look at a part of our nation's medical system -- one that appears off the track. It brought tears to my eyes.
Captain, USN (Ret)
Paula Span: Thanks.
Paula Span: We still have lots of folks participating, so we're going to continue the discussion for another 15 minutes or so.
After which, discussion will continue at 1:30 on Washington Post Radio at 107.7 FM or 1500 AM. Or you can listen on your computer from www.washingtonpostradio.com. I will be a guest, and so will retired Major Lionel Walton, who was in the story.
Fairfax Station, Va.: Paula, great story. We are using it prominently on our Web site Empowering Veterans. Are you going to continue pulling the thread of the systematic "low balling' of disability benefits.
Paula Span: The Magazine probably will not, but I am sure our other reporters will follow up.
Washington, D.C.: What exactly is his medical condition? All I read is a bunch of vague symptoms. I'm sorry he got thrown off his vehicle and hit his head, but if he's going to claim 100 percent disability, I would want to have more concrete evidence. We have vets getting shot and having limbs blown off.
Paula Span: There's nothing vague about Richard Twohig's symptoms. Veterans Affairs has rated him for post concussion headaches at 50 percent, cognitive and mood disorder at 70 percent, chronic left shoulder dislocation at 20 percent, cervical radiculopathy (pain or numbness radiating from an orthopedic injury) at 20 percent, plus tinnitus (ringing in the ears) and hearing loss.
This notion that you aren't "really" injured if you still have all your arms and legs is part of what veterans have been fighting for a long time. Frankly, the current system has its roots in a time when most jobs required physical strength. Someone who has cognitive and psychiatric symptoms may be as or more handicapped in the current workplace.
Falls Church, Va.: The article mentioned the difficulty getting treatment for wounds that do not show physically. The other "untold story" is the deep trauma that affects all soldiers who experience combat, whether or not they are diagnosed with PTSD.
In his book "War and the Soul," Dr. Edward Tick claims that Americans "deny that war changes its participants forever, promoting instead the belief that vets and survivors can return home and simply resume an ordinary civilian identity."
He recommends reading, "Man's Quest for Meaning" by Viktor Frankl for all those seeking to heal from war, violence and atrocity. He also recommends the following book written by a former Vietnam Combat Medic (turned psychologist)for anyone wishing to help survivors of extreme trauma recover, find meaning and rebuild lives of service:
"Existential Family Therapy: Using the Concepts of Viktor Frankl" by Dr. Jim Lantz.
Will The Washington Post be reporting on this aspect of recovery which is also so necessary? You can be a guiding force.
Paula Span: More on the subject from someone better read than I.
I think this is why the press has reported a considerable amount on PTSD and on the high degree of other psychological symptoms after war, but especially after Iraq. And yes, I think it will continue.
Washington, D.C.: COL Martin Tittle, Reserve Component Advisor, U.S. Army Physical Disability Agency, Washington, D.C.
I appreciate all the comments from the readers this afternoon. Since the inception of the Global War on Terror, many of our cases have become tougher to adjudicate, as the cases are generally more complicated due to the types of injuries our Soldiers face on today's battlefield.
The Army has instituted additional training for the medical community and the PEB board members, and provided detailed requirements for the medical evaluation board contents to ensure that all medical board issues are fully documented on Soldier cases appearing before a Physical Evaluation Board.
I just want to say that the Army takes each case seriously in its review process at the U.S. Army Physical Disability Agency. We base our decisions upon an objective analysis of all the evidence in the Soldier's case file, and that which has been presented by him to support his case. We treat each case fairly, and it is the Army's desire to make sure that we take care of our Soldiers in the best way possible.
Paula Span: The word from the Army itself.
Virginia Beach, Va: Hi Paula!
One point that should be emphasized to individual soldiers is that military counsel may not assist them with the preparation of a Board of Corrections petition after the U.S. Army Physical Disability Agency has denied an appeal from the findings of the Formal Panel. However, that was a superb article and kudos to Mark Waple for his persistence in helping this family.
Mark Waple: Appeals to the service Boards for Corrections of Military Records in these types of cases are unfortunately complex and the service member will need help pointing out the medical reasons why a disability retirement is warranted. And, as in Richard's case, there is usually a need for medical experts and referral to medical literature. It is correct that military attorneys may not represent a service member in such appeals.
New York, N.Y.: Well written article! Why is it that the gov't is not getting the fact that they are missing very important issues like: Not properly gauging injuries and the less than decent standards at the rehabilitation centers?
Paula Span: I think various branches of the government -- including the Government Accountability Office, members of Congress, the Pentagon itself -- are getting it now.
Alexandria, Va.: My names is LTC (Retired )Michael Parker who was referred to in Kelly Kennedy's Army Times article on this same subject. It is a shame you did not return any of my calls or e-mails to you on this subject nor did you respond to the e-mail I sent to Mr. Ricks last September with detailed information on the techniques and practices used by the PEB's to keep ratings down or deny benefits all together via EPTS determinations. Your piece would have been able to show where the bodies are buried, so to speak, if you had responded.
Paula Span: I beg your pardon -- I don't recall getting email from you.
The Army Times story is well done, by the way, and you can see it on the Army Times website.
Paula Span: My thanks to everyone who joined us today. The conversation will continue on Washington Post radio. And I am happy to hear from readers and service members at email@example.com
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