Rostker Advises Vets: Don't Tough It Out


WASHINGTON, November 17, 1998 (GulfLINK) - Listening to and learning from Gulf War veterans is one of Bernard Rostker's primary missions as the special assistant for Gulf War illnesses. His nationwide visits to major military installations this year brought a greater awareness of veterans' health and wellbeing concerns. During meetings conducted at Fort Sill, Okla.; Fort Riley, Kan.; Fort Campbell, Ky.; Camp Pendleton, Calif., and Camp Lejeune, N.C. Rostker heard active duty veterans frequently asking the same question.

"If I sign up for the Department's medical evaluation program to find out why I don't feel well, will I be discharged from the military because I'm sick?"

Approximately one-third of the 697,000 service members who served in the Gulf War remain on active duty. For years now, some veterans have complained that their ailments have been met with disregard by the military establishment, or worse, with accusations of malingering. Rostker and his team of medical advisors have been communicating the message, facility by facility, that the military believes there are Gulf War veterans who are ill and encourages them to seek medical evaluation with the DoD's Comprehensive Clinical Evaluation Program.

"We want everyone who thinks he's sick to come forward and get help - not to tough it out," said Roskter during a town hall meeting at Fort Campbell, Ky. "It's difficult to be hurting and not get treated."

In the mind of the active duty veteran, Rostker's entreaty may pose a perceived risk. If getting medical help potentially threatens career or retirement benefits, a service member may choose to suppress illness.

"It's human nature to deny you're sick," said Army Dr. (Col.) Frank O'Donnell, deputy director, medical and health benefits collaboration, at the Fort Campbell meeting. "We're concerned that a lot of this is going on."

Rostker's medical team has encountered other concerns. Some service members worry that commanders will view their complaints as whining that will lead to a poor evaluation.

"That's an attitude we are trying to change by talking with operational people," said Navy Dr. (Capt.) Michael Kilpatrick, Rostker's director of medical and health benefits collaboration. "We recognize that symptoms are not psychosomatic. We're asking senior leaders to deal with Gulf War veterans in a more upbeat manner, to understand their anxiety and to encourage troops to get medical help for ailments."

He pointed out that about 80 percent of the Gulf War veterans who have been examined and are sick have medically recognized diseases that can be treated.

Veterans' fears may be misplaced. Officials at the Physical Disability Agency indicate that CCEP exams have not resulted in an increased level of medical board actions. Of 70,000 medical boards processed since 1991, 1,700 - less than 2.5 percent - were generated directly from CCEP exams. This would not substantiate soldier fear of medical boarding for Gulf War related conditions. Moreover, participation in the CCEP is not recorded in any personnel data that would be known to those making decisions affecting the veterans' careers.

The Department of Defense established the Comprehensive Clinical Evaluation Program in June 1994 in response to the medical concerns of individuals who served in the Gulf War. Participants enroll in the CCEP either by calling the toll-free number (1-800-796-9699), which provides information and referrals to individuals requesting medical evaluations, or by contacting their local military medical treatment facility.

Eligible beneficiaries include Gulf War veterans who are currently in one of the active or Reserve components, or are retired.

The two-phase program begins with a comprehensive medical examination comparable in scope and thoroughness to an in-patient hospital admissions evaluation. Standard laboratory tests including a complete blood count and urinalysis are conducted along with other tests as clinically indicated. Individuals who require additional evaluation after completing the appropriate Phase I evaluation may be referred to one of 14 Regional Medical Centers for Phase II evaluations. These evaluations consist of symptom-specific examinations, additional laboratory tests, and specialty consultations according to the prescribed protocol.

Phase III, for participants suffering from chronic, debilitating symptoms, was initiated by the Defense Department in 1995. The program is modeled after internationally recognized centers for management of chronic illness. The key objectives of the program are to provide improvement opportunities in work performance and other activities of daily living, to promote overall well-being and to actively involve each participant in creating an individualized care plan. The Specialized Care Center is located at Walter Reed Army Medical Center in Washington, D.C.

Rostker has used every resource at his disposal to publicize the program. However, he estimates from his conversations with veterans that perhaps as many as one in three active duty veterans suffering symptoms possibly related to their Gulf War service is not seeking medical evaluation - either due to fear of loss of career advancement or mistrust of the medical system. Rostker presented his concerns to the Joint Chiefs of Staff and the Assistant Secretary of Defense for Health Affairs during a July 8, 1998, meeting.

"Commanders at all levels should be aware of this potential issue since seeking treatment can have a positive effect on soldiers' health, unit readiness and chain of command credibility," he emphasized. "My impression is that the vast majority maintain positive attitudes and are striving to do their best to perform their duties."

Rostker's observations energized the Joint Chiefs of Staff. Gen. Dennis J. Reimer, U.S. Army chief of staff, directed that his commanders emphasize to troops the availability of quality medical care. He also requested that the Army surgeon general direct his medical commanders at all levels to stress the need to support soldiers who needed medical care.

Based on this directive, Lt. Gen. Ronald R. Blanck, the Army surgeon general, asked regional medical commanders to redouble their efforts to ensure that soldiers "on your installations have access to the CCEP evaluation process and that they are encouraged to use it if they feel they have an Operation Desert Storm problem."

Kilpatrick noted that reluctance to obtain medical evaluation when ill is not unique to those who served in the Gulf War. Many active duty fear that if access to medical treatment is used too often, the service member will be separated.

"We have to get active duty people to believe that medical is on their side," said Kilpatrick. "The last priority of medical is to separate. That only happens when they are not fit for duty."

Rostker and his team continue to deliver the message that the Department cares that veterans of the Gulf conflict receive the medical care they need.

"When the medical profession loses the confidence of the patient, you can do nothing more to help cure that patient. We need to win that battle," said Kilpatrick during an address to the Air Force Association Symposium at Fort Sam Houston, San Antonio, Texas.

In an effort to help alleviate the perception of mistrust many Gulf War veterans have toward the medical system, Army medical commanders and senior leadership have been asked to use their local public affairs officers to publicize the inherent value of timely and accurate evaluations.

Rostker is listening to what the veterans are saying, communicating their concerns and when possible, acting as an agent for change in the military culture. He urges active duty veterans of the Gulf War who think they are sick to register for the Comprehensive Clinical Evaluation Program through their local hospital or call the toll-free DoD Gulf War veterans hot line at (800) 796-9699.