Veterans Studies Interest Group Listserv Issue #44 July/August 2020

The Veteran’s Creed 1. I am an American Veteran 2. I proudly served my country 3. I live the values I learned in the military 4. I continue to serve my community, my country and my fellow veterans 5. I maintain my physical and mental discipline 6. I continue to lead and improve 7. I make a difference 8. I honor and remember my fallen comrades

The Veteran’s Creed has been officially adopted by the following VSOs: American Legion, AmVets, AUSN Association of the United States Navy, DAV (Disabled American Veterans), Blinded Veterans Association, HillVets, Iraq and Afghanistan Veterans of America, Jewish War Veterans, Military Order of the Purple Heart, NCOA and Coast Guard Chief Petty Officers Association, Paralyzed Veterans of America, ROA (Reserve Officers Association), Student Veterans of America, Team Red White and Blue, Team Rubicon Global, TREA The Enlisted Association, Veterans of Foreign Wars and Wounded Warrior Project.

This month’s Listserv includes Veterans and Race; VA Covid-19 Update; VA Telehealth Care and Agreement with Walmart’s; Nurse Kills Veterans with Insulin; New Suicide Effort; Pre-World War II Draft; Ex-Marine Catches Baby in Fire; Two Centuries; and, President Makes 70th Anniversary Visit to the Korean War Memorial

Veterans and Race The demographics of the U.S. veteran population is changing and will change even more in the coming years. In line with its action plan, the VA’s Office of Health Equity has, published a website with useful data on racial and ethnic minority veterans. The website projects what the veteran population of minorities will be over the years 2019 to 2045. According to the estimate, there will be increases in the proportion African-American (12 to 15%), Hispanic (8 to 12%) and other race (1.5 to 3.3%) veterans and a decrease in non-Hispanic white veterans (74 to 61%). As for geographic distribution of these various groups, Georgia is projected to have the largest number of African Americans; Florida, non-Hispanic whites; California, Asian; and Oklahoma, native American veterans.

These changes have important implications for the care of veterans especially in light of disparities in care both within and outside the VA healthcare system. As recommended by the Congressionally mandated Commission on Care in 2016, the VA needs to expend resources on both eliminating disparities in care and increasing cultural competency. Information about the VA’s Office of Health Equity is here, Center for Minority Veterans here and Center for Women Veterans here.

1 Projected proportion of all veterans by race/ethnicity 2019-2945. From VA.

VA Covid-19 Update Summary of VA COVID-19 Efforts week of July14-20

In other numbers: The COVID-19 fatality rate for VA patients, who are generally sicker than those in civilian systems, is about 6% as against 4% for the general public. Hospitalization rates of VA COVID-19 patients have been trending downward and initial shortfalls in PPE have abated. About 1% of VA employees have tested positive.

2 VA Telehealth Care and Agreement with Walmart’s The above summary chart also shows VA’s extensive telemedicine efforts which is, in fact, a portent for the future of all post-pandemic healthcare. With COVID-19, telehealth use has markedly increased everywhere, and experts predict that this will continue in future years. In line with its pioneering efforts in this area, VA is expanding its telehealth collaboration with Walmart’s in what VA Sec. Robert Wilkie calls “the wave of the future” for VA. The first site was at Asheboro NC and efforts will primarily be in rural areas where about 25% of veterans live. At each site, Walmart’s donates equipment and space. Services are variable but will include primary care, nutrition, mental health and social work as well as prescriptions. Each site partners with a VA hospital and the effort will save considerable hours of travel time for patients in remote areas. One snag that we are finding throughout the healthcare system: individuals in these areas may lack and need to be given the appropriate equipment to transmit to telehealth sites from home.

Nurse Kills Veterans with Insulin We have seen insulin as a murder weapon before. Nursing assistant Reta Mays, age 46 years, of the Louis A. Johnson Medical Center in Clarksburg WV VA hospital has pleaded guilty to injecting 7 veterans with lethal doses of insulin and an intent to murder and another veteran who died 2 weeks later. It was an 11-month killing rampage in 2017 and 2018. Mays is a 46-year-old Army National Guard veteran who had served in both Iraq and Kuwait though she had no certification or license to care for veterans. During the “graveyard shift”, on a medical and surgical ward, Mays injected patients with insulin she was not authorized to administer. The patients had heart disease, stroke, cancer and diabetes but were not near death. She confessed to the crimes and also stated she was being given medication for PTSD. The indictments followed a 2-year investigation by the VA Inspector General after, embarrassingly, it had taken the hospital almost a year to detect the crimes. They still do not know why she did it.

New Suicide Effort Despite considerable efforts at addressing the problem, the suicide rate in veterans remains stubbornly at just under 20 per day. It has not moved significantly. More veterans died of suicide between 2005-2017 (nearly 79,000) than in the wars in Vietnam, Iraq and Afghanistan combined (about 65,000). Now there is a new effort from the White House which follows a yearlong interagency review. On July 7, the White House announced The President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS), a comprehensive federal effort in coordination with community providers. PREVENTS is looking to change the culture surrounding mental health and suicide prevention “through enhanced community integration, prioritized research activities, and implementation strategies that emphasize improved overall health and well-being.”

REACH, a key component of the initiative, is essentially a public health effort directed at all Americans who will be asked to participate. Some specific steps include more federal and community coordination on veterans’ outreach, reinforcing the Veterans Crisis Line hotline (1-800-273-8255 press 1) and a public awareness campaign led by second lady Karen Pence. A REACH website asks all American to pledge to commit to “help change

3 the national conversation around mental health and suicide” by taking a number of steps including to increase awareness of the problem by information about resources, use of safe messaging and encouraging lethal means safe storage (firearms being a major vehicle of suicide in veterans)

The House Veterans Affairs committee responded to the report with its own effort in two new suicide prevention bills by Chairman Mark Takano building on the Veterans’ Acute Crisis Care for Emergent Suicide Symptoms (ACCESS) Act unveiled earlier this year. That legislation calls for free emergency mental health care (via the Veterans Crisis Line) for veterans in crisis regardless of whether they receive care at VA hospitals. The VA now has only limited access to suicide victime since 14 of the 20 veterans/day who commit suicide are not enrolled in VA.

According to the Military Times, the House and White House efforts are complementary with the House effort geared toward federal intervention and the White House effort geared toward the idea of suicide as a problem for the entire medical public. A major earlier report from the VA on suicide is summarized in Listserv #5 with an update in Listserv #24,

Pre-World War II Draft An interesting new book on the pre-World War II draft entitled “The Rise of the G.I. Army, 1940-1941” by Paul Dickson was recently reviewed by the Wall Street Journal. Before World War II, U.S. sentiment was strongly against the draft, but the German invasion of Poland that began World War II changed all that. On that day (September 1, 1939), the U.S. Army numbered fewer than 200,000 men, less than Portugal. Equipment was poor and “most officers valued horse cavalry more than tanks” In the next 828 days to Pearl Harbor (December 7th, 1941), the U.S. built a war machine that was more than capable of fighting Hitler and the Japanese.

In the book, Dickson reviews the challenges in accomplishing this end and argues that the Civilian Conservation Corps (CCC), a New Deal program to provide work during the depression, was the precursor to the army draft. This extensive program, which had planted over 3 billion trees and trails and shelters in over 800 parks, was run by the Army and organized under General Douglas MacArthur.

Nearly half the men drafted in the first 12 months didn't make it into the military - 100,000 because they were illiterate. “Another group was toothless or lacked more than half of their teeth”. The book makes special note of three valuable military exercises, the largest which was called the Louisiana Maneuvers and utilized 400,000 men engaged in a mock war. According to General Dwight D Eisenhower, the value of these exercises was “incalculable” and he concluded that “the race across France was forecast on the roads in Louisiana and September 1941” On the downside, the Army was still segregated and there were many stories of rejections of African Americans some of whom had fought bravely in World War I. All in all, a worthwhile read.

Ex-Marine Catches Baby in Fire

4 A video of a former Marine has gone viral. It is of Phillip Banks catching a 3-year-old boy from a burning building. Banks is a security guard and was working out in a friend's apartment when he heard the screams and ran out to help. Once a Marine, always a Marine.

Two Centuries Both sides of the Atlantic have honored centenarian veterans. Retired Marine first sergeant John Forritor turned 100 on July 6. Forritor fought in both World War II and the Korean War and is one of the few surviving Marines who marched 55 miles from Camp Elliott in San Diego to christen Camp Pendleton which became so important in Marine history. He later taught at Palomar College and post retirement runs a historical website. The former Marine gave a short speech in his dress blues at the Pacifica senior living Center in Vista CA where he was honored. As he said “I enjoyed the first 100 years but I don't know what I'll do from here on out.” Forritor fought in some of the Marines most brutal battles including Iwo Jima and the escape from the . “frozen” Chosin Reservoir where his men were surrounded by Chinese troops 4 times as numerous. He won several medals including the Navy-Marines Commendation Medal with Combat V and the Presidential Unit Citation Ribbon. Although wounded by flying shrapnel in the Chosin retreat, he refused a Purple Heart.

On the other side of the pond, 94-year-old Queen Elizabeth II knighted 100-year-old World War II veteran “Captain Tom” Moore in Windsor Castle garden. Moore did not wear a COVID mask so to maintain social distancing he was knighted by a very long sword that belonged to Queen Elizabeth's father, George VI. Called a ‘one-man fundraising machine,” Captain Tom is known for his efforts in raising an astonishing $40 million for the National Health Service charities by doing laps across his garden. He told the BBC that he would not kneel before the Queen “because if I did I'll never get up again” Captain Tom had served in India during World War II.

Queen Elizabeth II conferring a socially distanced knighthood on Captain Tom Moore with a 6-foot sword. From Royal.UK

5 President Makes 70th Anniversary Visit to the Korean War Memorial To commemorate the 70th anniversary of the start of the Korean War, sometimes called “the forgotten war,” President Trump and First Lady Melania Trump participated in a wreath laying ceremony at the Korean War Veterans Memorial. The wreath laying was accompanied by a rendition of taps in honor of the 36,574 Americans killed in the war which spanned the 3 years from June 25th, 1950 to July 27, 1953. The Korean War Memorial, which is near the Lincoln Memorial, had been dedicated on July 27th, 1995, the 45th anniversary of the war. It commemorates the 5.8 million Americans who served. There are 19 stainless steel 7-foot-tall statues of an advanced party that includes 14 army, three Marines and one Navy and Air Force. Engraved on the walkway adjacent to the memorial are markers listing the 22 nations that contributed troops to the United Nations efforts in the war . There is also a mural that includes more than 2400 photographs from the Korean War.

Also, in May, the U.S. military announced that it identified the remains of three more Americans killed during the Korean War. Recently efforts to recover remains have stalled somewhat amidst difficult relations between the United States and North Korea after a successful previous effort in 2018 (See Listserv #22). One set of remains was identified as Army Corporal Charles S. Lawlor of the 1st Cavalry Division. He was reported missing on November 2, 1950.

There will be no separate August issue of the Listserv. Monthly schedule will resume in September.

The Listserv is available as an archive on the Georgetown University Library website under the title “Veterans Interest Newsletters”.

Joel Kupersmith, M.D. Director, Georgetown University Veterans Initiatives Professor of Medicine

Stats Section Annual veteran suicide From VA

6 Veteran Suicide Rates per 100,000 By Age From VA

.

7