RVOEC (Returning
Veterans Outreach,
Education and Care)
Program
Matt Camardese, MSW
Baltimore VA Medical Center
VA Maryland Healthcare
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Total OIF/OEF enrolled in MD/DC (VISN 5) VA
system: 11,984
 Male: 75% (approx)
 Female: 25% (approx)
 945,423 GWOT (Global War on Terror) veterans
have left active duty and become eligible for VA
health care since fiscal year 2002 (as of Jan 09)
• 51% former Active Duty Troops
• 49% Reserve and National Guard Troops
Demographic Characteristics of OEF and
OIF Veterans Utilizing VA Health Care
% OEF/OIF Veterans
(n = 299,585)
Sex
Male
Female
88 %
12
<20
20-29
30-39
≥40
6
52
23
19
Air Force
12
Age Group
Branch
Army
Marine
Navy
65
12
11
Unit Type
Active
Reserve/Guard
51
49
Rank
Enlisted
Officer
92
8
Common Issues
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most common issues reported by this
population (as cataloged by VA’s CPRS
from encounter data from VA appts)
--Diseases of Musculoskeletal
System/Connective System (710-739)
--Mental Disorders (290-319)
--Diseases of Nervous System/ Sense
Organs (320-389)
Frequency of Possible Diagnoses
of OEF/OIF Veterans
Diagnosis
(Broad ICD-9 Categories)
Infectious and Parasitic Diseases (001-139)
Malignant Neoplasms (140-208)
Benign Neoplasms (210-239)
Diseases of Endocrine/Nutritional/ Metabolic Systems (240-279)
Diseases of Blood and Blood Forming Organs (280-289)
Mental Disorders (290-319)
Diseases of Nervous System/ Sense Organs (320-389)
Diseases of Circulatory System (390-459)
Disease of Respiratory System (460-519)
Disease of Digestive System (520-579)
Diseases of Genitourinary System (580-629)
Diseases of Skin (680-709)
Diseases of Musculoskeletal System/Connective System (710-739)
Symptoms, Signs and Ill Defined Conditions (780-799)
(n = 400,304)
Frequency *
%
49,272
3,988
17,274
93,028
9,677
178,483
146,611
68,295
83,771
129,656
44,812
67,384
197,078
167,959
12.3
1.0
4.3
23.1
2.4
44.6
36.6
17.1
20.9
32.4
11.2
16.8
49.2
42.0
Frequency of Possible Mental Disorders
Among OEF/OIF Veterans since 2002*
Disease Category (ICD 290-319 code)
PTSD (ICD-9CM 309.81)+
Nondependent Abuse of Drugs (ICD 305)++
Depressive Disorders (311)
Neurotic Disorders (300)
Affective Psychoses (296)
Alcohol Dependence Syndrome (303)
Special Symptoms, Not Elsewhere Classified (307)
Sexual Deviations and Disorders (302)
Drug Dependence (304)
Acute Reaction to Stress (308)
*
**
+
++
Total Number of
GWOT Veterans**
59,838
48,661
39,940
31,481
22,216
9,878
5,802
5,577
4,447
3,721
Note – These are cumulative data since FY 2002. ICD diagnoses used in these analyses are obtained from computerized administrative data. Although
diagnoses are made by trained healthcare providers, up to one-third of coded diagnoses may not be confirmed when initially coded because the
diagnosis is “rule-out” or provisional, pending further evaluation.
A total of 120,049 unique patients received a diagnosis of a possible mental disorder. A veteran may have more than one mental disorder diagnosis and
each diagnosis is entered separately in this table; therefore, the total number above will be higher than 120,049.
This row of data does not include information on PTSD from VA’s Vet Centers and does not include veterans not enrolled for VHA health care. Also, this
row of data does not include veterans who did not have a diagnosis of PTSD (ICD 309.81) but had a diagnosis of adjustment reaction (ICD-9 309).
81% of these veterans (39,282) had a diagnosis of tobacco use disorder (ICD-9 305.1).
Common Distress Responses
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Sleep Problems—difficulty falling asleep; staying asleep or waking
early and difficulty getting back to sleep
Restlessness---being jittery, fidgety or showing a high degree of
nervous energy
Hypervigilant—oversensitivity or anticipation about things in
environment that are viewed as a threat to self/other (e.g. loud and
sudden noises or movements)
Social Withdrawal---Avoiding family/friends and social activities that
veteran had previously enjoyed. Wanting to be alone---e.g. “Bunker”
Intrusive Thoughts—memories of deployment that could be
triggered by environment or feeling as if they are back in war zone.
Veterans are encouraged to share with others (censored for loved
ones) and seek help if sxs persist for more than 1 or 2 months
More Serious Concerns
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Violence– Could be caused by Physical/Emotional problems and
exacerbated by drugs/etoh. Violence towards self/other needs to be
addressed immediately and safety plan for children/loved ones. Could be
response to perceived threats, perceived betrayal, differences in
expectations, or, viewed as necessary to maintain sense of safety by the
veteran.
Risk-Taking Behaviors—could be trying to get “rush” back, or, could be
viewed as necessary to maintain safety (e.g. driving fast/rapid lane
changes, carrying loaded weapon on person), sexual promiscuity, looking
for fights, or “policing” environment
Substance Use—Increased use of alcohol and illicit drugs, even nicotine
and caffeine (energy drinks like water) causing changes in overall health
and well-being and mood. Medications (e.g. opiates, benzodiazepines)
could have been prescribed for injury/mood/sleep in theater and may no
longer be needed.
Depressed mood—guilt, sadness, numbness, feeling alone
PTSD
PTSD
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A1—exposure to traumatic event (war, sexual trauma, car accident)
A2a—event involved actual threat to well-being of self/other
A2b—response involved fear, helplessness or horror
B: Re-Experiencing: Intrusive thoughts/memories,
dreams/nightmares, feeling as if you were back in situation
(flashback—true dissociation), physical sxs: rapid heart beat and
sweating, getting upset when remided of trauma
C: Avoidance: efforts to avoid thoughts of trauma, staying away from
people/places/things that remind Pt of trauma, trouble remembering
events, loss of interests, numb/detached from others, changes in
future plans
D: Arousal: trouble sleeping, irritability/anger, watchful/on guard,
difficulty concentrating, easily startled
PTSD Treatments
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Individual Interventions: CBT, CPT, Prolonged Exposure, Skill-Building,
Supportive Therapy, Education
Group Therapy: Specific groups (sleep hygiene, “HEAT,” anger mgmt)
cohort groups, substance abuse & PTSD, family groups
Support Groups
Family Therapy: Baltimore VA partners with UMD’s Family Intervention
team, specific groups for family members with and without veteran
Residential Treatment: intensive residential for PTSD and Dual Diagnosis
(PTSD w/ Substance Abuse) at Baltimore, Perry Point, DC, Martinsburg and
Coatesville VAMC’s. Stabilization residential programs offered for aftercare,
step-down and return to care.
Group and Individual treatments also available for sub-threshold PTSD, or,
specific sxs of PTSD
Families
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Pay attention to behaviors and communication of veteran for any warning signs;
every veteran is unique and one size does not fit all
Discuss expectations, new roles and go slowly
Partnership: handle barriers together and share in successes
Review available literature thru VA or on web (Battlemind.org, ncptsd.va.gov,
networkofcare.org, militaryonesource.com), book “Courage After Fire” available for
free at many VA’s.
Communicate with other families pre, during and post deployment for support and
help (especially important for National Guard and Reserve members)
VA clinicians available to consult with as needed and as allowed by confidentiality.
Family members can help with scheduling appts.
Refrain from over-reacting/pathologizing, BUT, do communicate concern and offer to
help as needed
Do not accept violent/disrespectful/self-destructive behavior and could be a cry for
help. Use 911, ER’s and VA National Suicide Hotline: 800-273-TALK
Many service members re-adjust very well and over time sxs may resolve without Tx.
Others may need professional help and family members can often serve as impetus.
Addressing stigma: doesn’t mean veteran is “crazy”, re-adjustment counseling should
not affect security clearances as written into law (this is new; had served as barrier).
Common report from veterans accessing VA Care is sense of “aloneness”
OEF/OIF Outreach
Clinical Reminders (Post-Deployment Screening)
-Done on phone and during initial visits to identify
MH concerns (PTSD, Substance Abuse and
Depression), GI complaints, skin concerns, TBI,
MST, Suicide risk, and general medical
-Why? To identify issues early and not limited to
those who come into the VA. All those enrolled
in VA and identified as GWOT veteran need to
be screened and VAMHCS requires above 90%
completion rate at all times.
OEF/OIF Outreach
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Post-Deployment Health Re-Assessments: Done
90 days after detachment from Active Duty.
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MD National Guard PDHRA’s are hosted by the
Baltimore VA (1 of 3 VA Medical Centers in Nation to
Host these events)
PDHRA Totals (as of Sept 2008):
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Events: 18
Veterans seen: 1,079
Veterans Enrolled in VA: 550
Primary Care Visits Scheduled: 339
Mental health visits Scheduled: 221
OEF/OIF Outreach
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Other Efforts:
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Annual Welcome Home Celebration (Navy Stadium 2008, Ripken Stadium 2007)
Visits to Reserve and Guard Centers and Active Duty Bases
Job Fairs (Northrup Gruman, Bolling AFB, Camden Yards)
Visits to Demobilization Sites (Ft. Dix)
Outreach Phone Calls
Reintegration events with MD Guard at 30 and 60 days post-deployment
Combat Call Center: direct referrals to local VA POC’s in Primary Care, Enrollment,
Seamless Transition and Mental health from outreach workers
Presentation at New Veteran Orientation
VAMHCS Cable Show—Veterans’ Health Watch
Public Service Announcements and Appearances in Local Media Outlets (Baltimore
Examiner and Sun, NPR Radio, WJZ, WBFF, WBAL)
In-Service presentations and advertisements at VA/DoD sites
Membership in Community Veteran Committees—Balt Co, Dept of Labor, Yellow Ribbon
Campaign
Presentations about OIF/OEF Issues in Community: NAMI Annual Conference, AA Co Police
and County Police Negotiation Teams throughout MD, Wendy’s HR, CCBC, HoCo Comm
College, PG Comm College, Northrup Gruman, Maryland Psychological Association,
Towson, Univ of MD, McVets Annual Conference, VISN 5 Conference
Specific OEF/OIF Programs
OEF/OIF Primary Care Clinic w/ behavioral health attached
 Women’s Health
 Acupuncture
 TBI Triage and Treatment team
 Seamless Transition Office
 Wounded Warrior program
 Patient Transition Advocates
 HUD/VASH program through Section 8 (includes case mgmt)
 Chronic Pain Clinic
 Polytrauma Team
*****Returning Veterans are eligible for 5 years of free VA care for all
deployment-related injuries and 180 days of free dental care from
end of deployment/release from Active Duty (date from DD-214
used).*******
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VA Contact Information
Medical Centers:
Baltimore: 410-605-7000 or (800) 463-6295
(Baltimore Seamless Transition Office—(410) 605-7259)
Perry Point: (410) 642-2411 or (800) 949-1003
Martinsburg: (304) 263-0811 or (800) 817-3807
Washington, DC: (202) 745-8000 or (888) 553-0242
Regional Offices (Benefits and Claims Applications):
Baltimore: 31 Hopkins Plaza
Baltimore, MD 21201
Phone: 1-800-827-1000
Washington, DC: 1722 I Street N.W.
Washington D.C., DC 20421
Phone: 1 800 827 1000
VA Contact Information
Vet Centers
Baltimore: (410)-764-9400
Aberdeen: (410)-272-6771
Silver Spring: (301)-589-1073
Washington, DC: (202)-726-5212
Elkton: (410)-392-4485
Alexandria: (703)-360-8633
Cambridge: (410)-228-6305
Community-Based Outpatient Clinics (CBOC’s)
Glen Burnie: 410-590-4140
Loch Raven: 410-605-7650
VA Contact Information
CBOC’s, continued
Ft. Howard: (410) 477-1800 or (800) 351-8387
Greenbelt: 301-345-2463
Washington, DC: 202-745-8685
Alexandria: 703-313-0694
Cambridge: 410-228-6243 or (877) 864-9611
Pocomoke: 410-957-6718
Charlotte Hall: 301-884-7102
Hagerstown: 301-665-1462
***OEF/OIF Veterans are eligible for 5 years of FREE VA Care for all
deployment-related concerns, as well as 180 days of free Dental
care from the date indicated on their DD-214 (Discharge papers)
RVOEC team
Baltimore Division
Matt Camardese, MSW 410-605-7000 ex 5732 (Loch Raven CBOC on Tuesdays)
Linda Zetter, CRNP 410-605-7000 ex 5659 (Glen Burnie CBOC on Fridays)
Sara Meyd, LCSW-C 410-605-7000 ex 5670
Perry Point Division
Pete Allman, LCSW-C
410-642-2411 ex 6167
Christina Watlington, PhD. 410-642-2411 ex 5427
Washington, DC Division
Jennifer Cho, LCSW-C 202-745-8000 ex 5912
Questions?
Matt Camardese, MSW
410-605-7000 ex. 5372
Matthew.Camardese@va.gov