September 2023 — MHCE Newsletter

News from MHCE 

SEPTEMBER 2023 EDITION 

Marijuana Is Not the 

Solution for PTSD 

See page 26 

Monthly Newsletter 

The Naval Postgraduate 

Dental School Celebrates 100 

Years of Academic Excellence 

Established in February 1923, 

the Naval Postgraduate Dental 

School serves as the cornerstone 

for the Navy Dental Corps’ 

postgraduate training and is the 

primary force generating producer 

of dental specialists for the Fleet. 

Academically aligned with the 

Uniformed Services University 

of the Health Sciences, under the 

leadership and support of the Naval 

Medical Leader and Professional 

Development Command, NPDS 

provides advanced specialty 

programs for dental officers, 

graduating over 20 dental specialists 

annually. 

Established in February 1923, the 

Naval Postgraduate Dental School 

(NPDS) serves as the cornerstone 







of the Health Sciences (USUHS), 

under the leadership. 

Established in February 1923, the 

Naval Postgraduate Dental School 

(NPDS) serves as the cornerstone 







of the Health Sciences (USUHS), 

under the leadership and support 

of the Naval Medical Leader 

and Professional Development 

Command (NMLPDC), NPDS 

provides advanced specialty 

programs for dental officers, 

graduating over 20 dental 

specialists annually. Since its 

establishment, NPDS had trained 

2,500 dental officers. At the heart of 

this operation are highly qualified, 

hand selected faculty members and 

hard charging enlisted and civilian 

staff. The largest Directorate under 

NMLPDC, NPDS comprises 

approximately 200 officers, enlisted 

and civilians. 

February 3rd, 2023, marked 100 

years of developing the future 

leaders of the Dental Corps. Recent 

Chairman and former Specialty 

Leader of the Operative Dentistry 

Department at NPDS, Captain 

Richard Adcook, said, “there is 

great satisfaction in being part of 

making the new generations of 

Dental Corps specialists in the 

military. That also goes to the 

overall impact that the school has 

provided to the Navy Medicine 

enterprise over the years. NPDS has 

played a long and important role 

of supporting the dental needs of 

the Force through making various 

dental specialists who provide care 

and training around the world.” 

NPDS continues to uphold a culture 

of academic excellence that has 

culminated in the maximization 

of oral health and readiness of the 

Joint Service member through 

outstanding scientific, evidencebased 

instruction and conducting 

WWW.MHCE.US 

cutting-edge research—research 

that serves to innovate the science 

of dentistry and further establish 

Navy Medicine as a forerunner in 

the advancement of novel clinical 

techniques and quality oral health 

care delivery. 

This year’s NPDS live graduation 

ceremony took place on June 

9th, 2023, with CAPT Steven M. 

Stokes, Dean of NPDS, as Master of 

Ceremonies. Distinguished guests 

joining the Dean on stage were 

CAPT Walter D. Brafford, Dental 

Corps Chief and Commander, Naval 

Medical Forces Support Command 

who delivered the commencement 

remarks and Dr. Jonathan Woodson, 

President of the Uniformed Services 

University of the Health Sciences. 

Dr. Woodson conferred Master of 

Science degrees in Oral Biology to 

qualified graduates who completed 

necessary requirements for the 

advanced degree. The graduating 

class consisted of 21 residents and 

one fellow receiving certificates, 

representing Army, Navy, and 

Air Force, across seven training 

programs. These graduates will go 

on to assignments across the Fleet, 

including overseas and operational 

billets. Among the graduates, 

Lieutenant Commander Anika 

Islam, Dental Corps, United States 

Navy, reflected on her experience 

at NPDS. “The biggest take-away 

from my time at NPDS that will 

Continued on page 8

2 | MHCE - News www.mhce.us SEPTEMBER 2023 EDITION

WWW.MHCE.US Monthly Newsletter | 3 

TO ADVERTISE 

contact Kyle.Stephens@mhce.us



Focus on Oversight a Key for Success at 

CoreCivic 

In the corrections industry, maintaining high standards of 

operation is imperative to meeting the needs of the individuals 

in our care. That's why CoreCivic adheres to a stringent set of 

guidelines set forth by our own standards, as well as those of our 

government partners and the American Correctional Association 

(ACA). 

Founded in 1870, the ACA is considered the national benchmark 

for the effective operation of correctional systems throughout 

the United States. To become accredited, a facility must achieve 

compliance with ACA mandatory standards and a minimum of 

90 percent non-mandatory standards. CoreCivic facilities adhere 

to ACA standards, and in 2020, CoreCivic earned an average 

ACA audit score of 99.6 percent across all facilities. 

Key ACA audit areas include facility personnel, resident reentry 

programs, resident safety, health care, and more. 

holds our facilities and staff to a high standard. To be able to 

represent our facility and receive reaccreditation in person is an 

honor." 

Adhering to ACA standards is only one part of CoreCivic's 

commitment to robust oversight. When government partners 

utilize CoreCivic's services, we are held not only to our own 

high standards and those of the ACA, but we are often held to 

the same or higher accountability of our public counterparts 

through stringent government contracts, unfettered access to 

our facilities for our partners, and hundreds of on-site quality 

assurance monitors. 

We provide access to our government partners, with most of 

our facilities having government agency employees known as 

contract monitors who are physically on-site to ensure we are 

operating in line with partner guidelines. 

Recently, the ACA held in Nashville, Tennessee, its 151st 

Congress of Corrections, an annual convention that brings 

together corrections professionals from across the country. In 

addition to various workshops and events at the convention, the 

ACA Commission on Accreditation also held panel hearings to 

award accreditation to correctional facilities that meet the ACA's 

rigorous requirements. Listed below are the seven CoreCivic 

facilities that earned reaccreditation this year, with mandatory/ 

non-mandatory scores: 

• Bent County Correctional Facility - 100/99.0 

• Citrus County Detention Facility - 100/100 

• Eloy Detention Center - 100/100 

• Lake Erie Correctional Institution - 100/99.3 

• Saguaro Correctional Center - 100/99.8 

• Stewart Detention Center - 100/100 

• Tallahatchie County Correctional Facility - 100/100 

"The accreditation process is very important," said Warden 

Fred Figueroa from Eloy Detention Center, one of the seven 

CoreCivic facilities that was awarded reaccreditation. "ACA 

To maintain our own high standards, annual on-site audits covering 

all operational areas are administered to ensure compliance with 

contractual and regulatory obligations and corporate-mandated 

requirements. Each CoreCivic Safety facility is audited by our 

internal quality assurance division, which is independent from 

our operations division. Facilities are expected to be audit-ready 

year-round, maintaining continuous compliance with numerous 

applicable standards. 

CoreCivic employs 75 staff members dedicated to quality 

assurance, including several subject matter experts with extensive 

experience from all major disciplines within our institutional 

operations. 

"A lot of hard work goes into preparing for these audits," 

Figueroa said. "Once they're complete, the staff can see their 

accomplishments and feel proud." 

Having multiple levels of oversight helps CoreCivic maintain 

a safe environment for those in our care. By holding ourselves 

accountable to our own high standards, along with our 

government partners' and ACA's standards, CoreCivic continues 

to be a trusted partner working to better the public good.


WWW.MHCE.US Monthly Newsletter | 7

8 | MHCE - News www.mhce.us SEPTEMBER 2023 EDITION 

be most valuable to me throughout my career is that it takes a village! I 

am forever grateful for the invaluable mentorship, top notch camaraderie, 

lifelong friendships, and priceless memories from here. Without the staff 

and co-residents I was blessed to be around, I would not be as successful as 

I am today as a graduate of NPDS. I am sincerely thankful for being selected 

to be a part of this prestigious institution of academic excellence.” LCDR 

Islam completed a two-year residency program in Endodontics. 

It is with great pride that NPDS celebrates 100 years of unwavering 

dedication to world class academic instruction, clinical skill development 

and sustainment in direct support of operational requirements, the Warfighter, 

and Force readiness. 

After Years of Delays, 

Army Releases New 

Suicide Prevention Plan 

Short on Answers 

Three soldiers at Fort Cavazos, Texas, died by suicide in the past two weeks. 

But those deaths aren't unique to the installation formerly known as Fort 

Hood. At least two soldiers have died by suicide every week this year on 

average in the part-time components and on active duty at bases across the 

service, according to internal documents reviewed by Military.com. 

There isn't a singular problem, as suicide is typically a complex constellation 

of issues both personal and environmental, though soldiers have pointed to 

quality-of-life issues and a breakneck schedule constantly being away from 

home, despite the U.S. being in a period resembling peacetime, as adding 

stressors to their service. 

But as the Army has struggled to grapple with the continued prevalence 

of suicide, the service has had no universal guidance for how leaders are 

expected to respond if a soldier is in the midst of a mental health crisis, a 

fundamental building block for combatting the problem of self-harm. 

Three years ago, the Army sought to craft a policy outlining its first major 

suicide prevention doctrine, an effort senior leaders highlighted to Congress 

in May. 

Earlier this month, the Army quietly published that doctrine to combat 

suicide three years after it originally intended. The new policy, which goes 

into effect on Sept. 8, has no clear guidance for how service members are 

supposed to take action if someone in their ranks has declining mental health 

or suicidal ideation, despite promises that the new doctrine would help 

provide direction. 

"This isn't a serious answer to what I'm seeing," one command sergeant 

major told Military.com on the condition of anonymity to avoid retaliation 

for speaking candidly with the press. "We've been great about talking about 

this stuff, I think the culture is close to where we need it to be ... or at least it 

has come a long way. What are those immediate steps a junior leader takes 

when their soldier is in trouble? We're getting a bit lost in the sauce." 

The service has more than a dozen official minor resources on suicide 

prevention and response, which are not formal doctrine and instead mostly 

short pamphlets and PowerPoint presentations, but the August release is the 

first major doctrine on the subject meant to consolidate information on how 

commanders should work to prevent suicides within their formations and 

respond if a soldier dies. 

Last year, the Army saw at least 255 soldiers die by suicide. Decisions on 

whether to provide a soldier mental health counseling, give them time away 

from the field, or simply ask whether they are considering self-harm is 

largely left up to company-level leaders who usually have no formal training 

on the subject. The lack of a universal set of guidelines has left individual 

units to craft their own ad hoc approaches. 

Instead of clear guidelines on intervention, the new doctrine focuses on 

articulating warning signs and risk factors, such as a soldier having a poor 

relationship with their spouse or financial problems. 

"It's about the layers that are influencing the individual," one Army official 

with direct knowledge of how the policy was written said during an interview 

that was arranged by the Army public affairs office on the condition of 

anonymity. "We're identifying those risk factors. ... This is the first time in a 

suicide reg [regulation] we're talking a bit broader." 

Senior leaders have long listed suicide as a top concern for the force. Michael 

Grinston, who recently retired, spent much of his tenure as sergeant major 

of the Army shifting the conversation on suicide from how units respond 

to how leaders can prevent deaths, all while trying to reduce the stigma of 

seeking help, sometimes by talking about his own struggles while routinely 

highlighting policy changes to the press. 

But this new suicide prevention doctrine, once touted by Army leadership 

ahead of its arrival as a key tool for combating the problem, was quietly 

completed without fanfare. Grinston's successor, Sergeant Major of the 

Army Michael Weimer, hasn't publicly mentioned the new policy. Weimer's 

office did not return requests for comment. 

The doctrine itself directs Army officials to highlight the new policy to the 

press as a means of assuring soldiers know of its existence. 

But burying the release of the policy was intentional, according to multiple 

Army officials interviewed by Military.com, largely due to the fact that the 

doctrine is years behind schedule and offers little help for units struggling to 

curtail deaths by suicides, as service leaders promised Congress. 

"This regulation is a step in the right direction; at the same time, we're 

cognizant this isn't the be-all, end-all. We have more work to do," one Army


official with direct knowledge of 

the policy's release told Military. 

com on the condition of anonymity 

to speak openly about the process. 

In May, Military.com reported on 

the death of Spc. Austin Valley, 

an infantryman assigned to the 1st 

Infantry Division at Fort Riley, 

Kansas. His unit found him during 

an attempted suicide while they 

were deployed to Poland. After 

sending him back to Kansas, he died 

by suicide 30 days later. He was not 

There are also suggestions in the 

document that safe gun storage and 

National Guardsmen and Reservists 

temporarily relinquishing their 

personal firearms to a military arms 

room would be helpful, but those 

situations would be voluntary and 

the policy suggests those actions 

can quickly get ensnared in local 

legal protections. 

But much of the new rule set 

is seemingly incomplete, or, as 

another Army official noted, "wasn't 

also known to face greater risk of 

suicide. 

The form for commanders to collect 

data on a soldier who died asks 

for over 100 data points, including 

whether the soldier was diagnosed 

with sleep disorders or whether 

family members expressed any 

concerns. But it does not require 

a review of the soldier's social 

media history, where troops are 

increasingly asking for help and 

posting suicide notes. 

service, as Facebook's user base 

grows in age and X, formally known 

as Twitter, is a poor and narrow 

sampling of the demographics of 

the rank and file. On the forum, 

Kinmuan says about once a month 

a soldier posts something that 

requires immediate intervention, 

such as a suicide note. Grinston's 

office previously worked with the 

moderation team on Reddit, but that 

social media outreach has faded 

after his retirement. 

transferred into inpatient care, and 

he sought mental health care outside 

of the military on his own dime after 

his return to the U.S. In interviews 

with Military.com, his parents say 

there were no meaningful actions 

by the Army to keep him safe. His 

unit seemingly had no checklist to 

make sure he had all the resources 

he needed or mitigated his access to 

means of killing himself. 

A Military.com review of more 

than 300 suicides in the force in 

well thought-out." A form meant to 

track data on suspected suicides 

still requests that commanders note 

whether the deceased soldier has a 

passing score on the Army Physical 

Fitness Test, or APFT, a test that 

is no longer in use by the service. 

Another direction highlights that 

so-called "shame events" can 

lead to a suicide, but at the top of 

a list of those at risk, the doctrine 

highlights perpetrators of abuse, but 

doesn't mention victims who are 

"Soldiers are on social media. To 

completely avoid that space is 

crazy," Kinmuan, the moderator of 

the Army Reddit forum who asked 

to be identified by their username 

in order to protect their identity, 

told Military.com. "The Army isn't 

looking or thinking about social 

media being an avenue for these 

communications." 

The Army Reddit forum is 

effectively the town square for the 

Going forward, the service is 

planning new initiatives set to 

reduce the risk of suicide by firearms 

and medication, though there is no 

clear timeline on those efforts. 

"We recognize that suicide is a 

complex problem that defies a onesize-fits-all 

solution but we will 

continue to actively lean forward," 

Lt. Gen. Kevin Vereen, who 

oversees quality of life policies in 

the Army. 

recent years shows that death by a 

self-inflicted gunshot wound is the 

most common method of suicide, 

with male junior enlisted and young 

noncommissioned officers being 

the most at-risk demographics. 

The new doctrine outlines some 

broad guidelines, establishing 

that commanders should consider 

quartering soldiers on base if 

they have suicidal ideation and 

own personal firearms. But the 

document is unclear on when those 

dramatic steps should be taken. 

Multiple Army officials with direct 

knowledge of how the policy was 

written said there is hesitation 

to outline guidance, in fear that 

commanders will stick too closely 

to doctrine and not view suicide 

risks as unique, but those officials 

agreed that offering no guidance is 

also a risk.


Military Assistance to Maui Swells to 700 as 

Recovery Teams Aid in Identifying Remains 

Three soldiers at Fort Cavazos, Texas, died by suicide in the 

past two weeks. But those deaths aren't unique to the installation 

formerly known as Fort Hood. At least two soldiers have died 

by suicide every week this year on average in the part-time 

components and on active duty at bases across the service, 

according to internal documents reviewed by Military.com. 

There isn't a singular problem, as suicide is typically a complex 

constellation of issues both personal and environmental, though 

soldiers have pointed to quality-of-life issues and a breakneck 

schedule constantly being away from home, despite the U.S. 

being in a period resembling peacetime, as adding stressors to 

their service. 

policy, which goes into effect on Sept. 8, has no clear guidance 

for how service members are supposed to take action if someone 

in their ranks has declining mental health or suicidal ideation, 

despite promises that the new doctrine would help provide 

direction. 

"This isn't a serious answer to what I'm seeing," one command 

sergeant major told Military.com on the condition of anonymity 

to avoid retaliation for speaking candidly with the press. "We've 

been great about talking about this stuff, I think the culture is 

close to where we need it to be ... or at least it has come a long 

way. What are those immediate steps a junior leader takes when 

their soldier is in trouble? We're getting a bit lost in the sauce." 

But as the Army has struggled to grapple with the continued 

prevalence of suicide, the service has had no universal guidance 

for how leaders are expected to respond if a soldier is in the 

midst of a mental health crisis, a fundamental building block for 

combatting the problem of self-harm. 

Three years ago, the Army sought to craft a policy outlining its 

first major suicide prevention doctrine, an effort senior leaders 

highlighted to Congress in May. 

Earlier this month, the Army quietly published that doctrine to 

combat suicide three years after it originally intended. The new 

The service has more than a dozen official minor resources on 

suicide prevention and response, which are not formal doctrine 

and instead mostly short pamphlets and PowerPoint presentations, 

but the August release is the first major doctrine on the subject 

meant to consolidate information on how commanders should 

work to prevent suicides within their formations and respond if 

a soldier dies. 

Last year, the Army saw at least 255 soldiers die by suicide. 

Decisions on whether to provide a soldier mental health 

counseling, give them time away from the field, or simply ask 

whether they are considering self-harm is largely left up to


company-level leaders who usually have 

no formal training on the subject. The lack 

of a universal set of guidelines has left 

individual units to craft their own ad hoc 

approaches. 

Instead of clear guidelines on intervention, 

the new doctrine focuses on articulating 

warning signs and risk factors, such as a 

soldier having a poor relationship with 

their spouse or financial problems. 

"It's about the layers that are influencing 

the individual," one Army official with 

direct knowledge of how the policy was 

written said during an interview that was 

arranged by the Army public affairs office 

on the condition of anonymity. "We're 

identifying those risk factors. ... This is 

the first time in a suicide reg [regulation] 

we're talking a bit broader." 

Senior leaders have long listed suicide 

as a top concern for the force. Michael 

Grinston, who recently retired, spent 

much of his tenure as sergeant major of the 

Army shifting the conversation on suicide 

from how units respond to how leaders can 

prevent deaths, all while trying to reduce 

the stigma of seeking help, sometimes


by talking about his own struggles while 

routinely highlighting policy changes to 

the press. 

But this new suicide prevention doctrine, 

once touted by Army leadership ahead of 

its arrival as a key tool for combating the 

problem, was quietly completed without 

fanfare. Grinston's successor, Sergeant 

Major of the Army Michael Weimer, 

hasn't publicly mentioned the new policy. 

Weimer's office did not return requests for 

comment. 

The doctrine itself directs Army officials 

to highlight the new policy to the press as 

a means of assuring soldiers know of its 

existence. 

But burying the release of the policy was 

intentional, according to multiple Army 

officials interviewed by Military.com, 

largely due to the fact that the doctrine 

is years behind schedule and offers little 

help for units struggling to curtail deaths 

by suicides, as service leaders promised 

Congress. 

"This regulation is a step in the right 

direction; at the same time, we're 

cognizant this isn't the be-all, end-all. We 

have more work to do," one Army official 

with direct knowledge of the policy's 

release told Military.com on the condition 

of anonymity to speak openly about the 

process. 

In May, Military.com reported on the death 

of Spc. Austin Valley, an infantryman 

assigned to the 1st Infantry Division at 

Fort Riley, Kansas. His unit found him 

during an attempted suicide while they 

were deployed to Poland. After sending 

him back to Kansas, he died by suicide 

30 days later. He was not transferred 

into inpatient care, and he sought mental 

health care outside of the military on his 

own dime after his return to the U.S. In 

interviews with Military.com, his parents 

say there were no meaningful actions 

by the Army to keep him safe. His unit 

seemingly had no checklist to make sure 

he had all the resources he needed or 

mitigated his access to means of killing 

himself.


A Military.com review of more than 300 

suicides in the force in recent years shows 

that death by a self-inflicted gunshot 

wound is the most common method of 

suicide, with male junior enlisted and 

young noncommissioned officers being 

the most at-risk demographics. 

The new doctrine outlines some broad 

guidelines, establishing that commanders 

should consider quartering soldiers on 

base if they have suicidal ideation and 

own personal firearms. But the document 

is unclear on when those dramatic steps 

should be taken. Multiple Army officials 

with direct knowledge of how the policy 

was written said there is hesitation to 

outline guidance, in fear that commanders 

will stick too closely to doctrine and not 

view suicide risks as unique, but those 

officials agreed that offering no guidance 

is also a risk. 

There are also suggestions in the 

document that safe gun storage and 

National Guardsmen and Reservists 

temporarily relinquishing their personal 

firearms to a military arms room would 

be helpful, but those situations would be 

voluntary and the policy suggests those 

actions can quickly get ensnared in local 

legal protections. 

But much of the new rule set is seemingly 

incomplete, or, as another Army official 

noted, "wasn't well thought-out." A form 

meant to track data on suspected suicides 

still requests that commanders note 

whether the deceased soldier has a passing 

score on the Army Physical Fitness Test, 

or APFT, a test that is no longer in use by 

the service. Another direction highlights 

that so-called "shame events" can lead to 

a suicide, but at the top of a list of those at 

risk, the doctrine highlights perpetrators 

of abuse, but doesn't mention victims 

who are also known to face greater risk 

of suicide. 

The form for commanders to collect data 

on a soldier who died asks for over 100 

data points, including whether the soldier 

was diagnosed with sleep disorders or 

whether family members expressed any 

concerns. But it does not require a review 

of the soldier's social media history, 

where troops are increasingly asking for 

help and posting suicide notes. 

"Soldiers are on social media. To 

completely avoid that space is crazy," 

Kinmuan, the moderator of the Army 

Reddit forum who asked to be identified 

by their username in order to protect 

their identity, told Military.com. "The 

Army isn't looking or thinking about 

social media being an avenue for these 

communications." 

The Army Reddit forum is effectively the 

town square for the service, as Facebook's 

user base grows in age and X, formally 

known as Twitter, is a poor and narrow 

sampling of the demographics of the 

rank and file. On the forum, Kinmuan 

says about once a month a soldier posts 

something that requires immediate 

intervention, such as a suicide note. 

Grinston's office previously worked with 

the moderation team on Reddit, but that 

social media outreach has faded after his 

retirement. 

Going forward, the service is planning 

new initiatives set to reduce the risk 

of suicide by firearms and medication, 

though there is no clear timeline on those 

efforts. 

"We recognize that suicide is a complex 

problem that defies a one-size-fits-all 

solution but we will continue to actively 

lean forward," Lt. Gen. Kevin Vereen, 

who oversees quality of life policies in 

the Army.


New Treatments for 

‘Quiet Disease’ Prostate 

Cancer 

Prostate cancer is one of the most 

common cancers in men, with the 

National Cancer InstituteOpens 

Cancer.gov site estimating 

over 280,000 diagnoses in 

2023. However, promising new 

treatments and updated testing 

guidelines are leading to better 

patient outcomes. 

"Prostate cancer accounts for 

nearly 27% of all new cancer 

diagnoses and more than 10% 

of cancer deaths in men," 

said Dr. Gregory Chesnut, a 

urologic oncologist and associate 

professor of surgery at the 


of the Health SciencesOpens 

USUHS site. “It’s a very real 

disease.” 

New Treatments Approved 

by the U.S Food and Drug 

Administration 

According to Chesnut, two recent 

advances in prostate cancer 

treatment may lead to improved 

outcomes for patients. One is a 

method for more precise detection 

of cancer cellsOpens FDA site 

outside the prostate, using an 

imaging test for prostate-specific 

membrane antigen protein. 

"It was approved by the U.S. Food 

and Drug AdministrationOpens 

FDA site to find recurrent or 

metastatic prostate cancer, or 

to guide primary treatment 

in certain high-risk prostate 

cancers," said Chesnut. "It’s now 

offered widely throughout the 

United States." 

The second new advancement 

is in radiologic treatment of 

prostate cancer that is metastatic, 

which means cancer cells can 

spread to other parts of the body. 

A medicine that uses a small 

amount of radioactivity to kill 

cancer cells was approved by the 

FDA in March 2022, according 

to Dr. Kevin Banks, a radiologist 

and nuclear medicine physician 

at the San Antonio Military 

Medical Center. 

"It travels through the blood 

stream, seeking out prostate 

cells wherever they are in the 

body," said Banks. "It binds to 

the prostate-specific membrane 

antigen protein on the prostate 

cancer cell surface and delivers a 

microscopic amount of radiation. 

The specific type of radiation 

given generally travels less than 

one millimeter, and no more than 

a maximum of two millimeters, 

allowing it to kill the cancer 

cells while leaving surrounding 

healthy tissue unharmed." 

Prostate Cancer Survival Rate 

Higher for Military Health 

System Beneficiaries 

In addition to new treatments, a 

study from USUHSOpens article 

on PubMed offers good news for 

men being treated for prostate 

cancer within the MHS. The 

study found the five-year survival 

rate for late-stage prostate cancer 

is higher for MHS beneficiaries 

than for the general public. 

"Ultimately, all men, whether 

you had high-risk or high-stage 

prostate cancer did better across 

all age groups and across all 

ethnicities within the MHS," 

said Chesnut. 

"The disease rates were the same 

whether they were treated inside 

or outside of the MHS, but the 

outcomes were better. I think 

that's a recognition of what we 

do well in the military," said 

Chesnut. "We screen patients 

well, we have access to primary 

care for appropriate screening 

and counseling, and access to 

specialty care. Patients have 

access to urology care, to medical 

oncology care, to radiation 

oncology care. It’s often all in 

the same building." 

Banks thinks there could even be 

better results to come. 

"The results are certainly positive 

and show the quality of care 

being provided by the Defense 

Health Agency," he said. "The 

data would have been from 

before [the medicine] entered 

use in the MHS, so hopefully any 

follow-up research would show 

an even better five-year survival 

rate for our beneficiaries." 

Changes in Testing Guidelines 

Chesnut said changes to prostate 

cancer screening guidelines, and 

a new understanding of how 

to treat prostate cancer in early 

stages, is also helping patients. 

"Testing for prostate cancer is 

important because it’s a disease 

which is treatable and curable if 

detected at an early stage, and it's 

localized to the prostate," said 

Chesnut. "Our intention is for 

curative treatment, and we have 

excellent outcomes." 

However, Chesnut said prostatespecific 

antigen tests, the primary 

prostate cancer screening test, 

were not being recommended 

from 2012 through 2018. 

"For patients and doctors, 

when there’s a prostate cancer 

diagnosis, the instinct is, we need 

to go to general quarters and we 

need to treat this," said Chesnut. 

"Prior to 2012, patients were 

sometimes being treated when 

they didn’t need treatment. Now 

we know better. You don't have 

to treat every prostate cancer. 

We serve our patients best when 

we diagnose prostate cancer 

in a timely manner, when we 

correctly identify which cancers 

need immediate treatment 

and which can safely undergo 

surveillance. Personalized 

treatment decisions and use of 

emerging technologies for the 

individualized treatment plan is 

best for each patient." 

The U.S. Preventive Services 

Task Force now recommends 

men ages 55 to 69 make individual 

decisions about screening for 

prostate cancerOpens CDC site 

after discussing the benefits and 

harms with their doctor. 

Chesnut recommends prostate 

cancer screening be a routine part 

of men's health conversations 

like mammograms are for 

women. "It’s easy for us to talk 

past prostate cancer, because it's 

not going to get the big headlines. 

It’s a sort of a quiet disease."


MILITARY HEROES 

WE WANT YOU TO JOIN CENTURION HEALTH AND CONTINUE TO SERVE 

When you joined the military, you dedicated your life 

to serving our country. At Centurion Health, we 

dedicate our lives to transforming the health of the 

communities we serve, one patient at a time. 

CONTINUE YOUR MISSION OF 

SERVICE WITH A TRANSITION INTO 

CORRECTIONAL HEALTHCARE 

Centurion is actively recruiting for the following positions 

Registered Nurses 

LPNs 

Mental Health Professionals 

Psychologists 

Psychiatrists 

Primary Care Physicians 

Dentists 

and additional healthcare disciplines 

BENEFITS 

•Controlled environment with a te am 

approach 

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Some Private Companies Charge Hefty Fees to Help 

Veterans With Disability Claims 

When Glenn Janssen decided to file a claim for disability 

benefits with the Department of Veterans Affairs (VA) 

last year, he dreaded the prospect of dealing with federal 

bureaucracy and paperwork. 

Janssen, 57, lives in Portugal with his wife and has worked 

as a government contractor since leaving the Army in 2004. 

The Gulf War era and Louisiana National Guard veteran 

wanted to put in a claim for tinnitusopens in a new tab or 

window and back and shoulder problems from his years in 

the service. But he worried that trying to manage the process 

from overseas would be a nightmare. 

So, when another veteran, who's also a trusted friend, 

suggested he contact a private company, Trajector Medical, 

to handle the filing process for a fee, it seemed like a great 

solution. He called and, after skimming the company's 

contract, he signed up. That quick decision may cost him a 

bundle in both money and hassle. 

"I was too trusting, and I didn't really read what I signed," 

Janssen said. 

More than a quarter of the nearly 5 million U.S. veterans 

opens in a new tab or window have a disability related to 

their military service, and they have various ways to file a 

claim for tax-free monthly disability payments. 

The Honoring Our PACT Actopens in a new tab or window, 

enacted last August, made it easier for many veterans who 

had been exposed to burn pits and other toxic substances to 

qualify for healthcare and disability benefits. The law added 

more than 20 conditions, from cancers to chronic respiratory 

illnesses, that the VA now automatically assumes were 

caused by serving in Vietnam and the Gulf War or other 

postings. 

Veterans can apply on their own, filling out paperwork 

online, gathering and submitting their medical records, 

and undergoing a medical evaluation. They can also 

tap into a network of thousands of service organization 

representatives, claims agents, and attorneys who have been 

vetted and approved by the VA to aid veterans. Under federal 

rules, veterans who use accredited assisters can't be charged 

a penny for help filing the initial claim. If they subsequently 

want to appeal a VA decision, the agency limits how much 

the approved representatives can charge. 

Unaccredited companies face no such restrictions. 

Sometimes calling themselves "medical consultants" 

or "coaches," these businesses advertise their fee-based

WWW.MHCE.US Monthly Newsletter | 17


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services to veterans, suggesting they 

can provide quick turnaround times 

on claims and higher benefit checks 

than if veterans choose a VA-approved 

representative. 

"What we've seen are people signing 

away, in advance, a portion of the 

benefits that are due them," said Jim 

Rice, assistant director of the Office 

of Servicemember Affairs at the 

federal Consumer Financial Protection 

Bureau (CFPB) in Washington, D.C., 

regarding the practices of some of 

these companies. The CFPB and the 

VA jointly published a cautionary 

blog postopens in a new tab or 

window in February, noting reports 

that "unscrupulous actors have misled 

some veterans into paying hundreds of 

thousands of dollars in illegal fees." 

To be eligible for disability 

paymentsopens in a new tab or window, 

veterans must have an injury or illness 

caused or worsened by their military 

service. The Department of Veterans 

Affairs assigns veterans a disability 

rating from 0% to 100%, depending on 

the degree of disability. A higher rating 

means a higher monthly paymentopens 

in a new tab or window. 

The contract that Janssen signed said 

he would pay Trajector Medical the 

equivalent of five times the amount 

of any increase in his monthly VA 

compensation, which is part of the 

basic billing structureopens in a new 

tab or window the company outlined 

in 2022 congressional testimony. 

When he was awarded a 10% disability 

rating for tinnitus, the company billed 

$829.60, five times the monthly award 

of $165.92 for a 10% disability. When 

his rating was later increased to 40%, 

the company informed him he owed 

an additional $2,829.70, five times his 

monthly increase of $565.94. 

The problem was that the company 

had done virtually nothing to help him, 

Janssen said. At the very beginning of 

the process, he said, the company sent 

him what he thought looked like three 

boilerplate paragraphs describing his 

injuries. "All they provided was a cutand-paste 

canned response in a VA 

form for me to submit," Janssen said of 

what the company supplied last July. 

In November, Janssen said, after 

months passed with no word on his 

case or assistance from Trajector, he 

contacted the company to cancel his 

contract. But the company did not 

respond to his request, he said. 

On his own, Janssen said, he scheduled 

appointments and flew back to the U.S. 

for medical evaluations in December 

and February. Also on his own, he said, 

he filed secondary claims requesting an 

increase in his disability rating because 

of insomnia and migraines related to 

his tinnitus. (The VA denied his claims 

for back and shoulder injuries.) 

It wasn't until Janssen was approved 

for a higher rating from the VA that he 

said he heard from Trajector again. The 

company, which he said sometimes 

referred to him as a "battle buddy," 

sent him an email congratulating him 

on his new disability rating and billed 

him more than $2,800 for its assistance 

in obtaining it. 

"I called Trajector and raised bloody 

hell," Janssen said. "I will never pay 

this money." 

In March, Trajector agreed to waive 

its claim for the additional $2,829.70. 

But it still wants $829.60 for his initial 

rating, and a company representative 

told him during a telephone 

conversation it would start charging a 

1% monthly late fee. 

Trajector declined a request to discuss 

its services and to comment on Janssen's 

case. But in congressional testimony 

last year, Evan Seamone, Trajector's 

general counsel and legal manager, 

said that "private sector companies 

like Trajector meet an important and 

unfulfilled need that is not being met 

by existing free resources." 

Still, Janssen is not the only veteran 

who is unhappy with Trajector 

services. Trajector holds an A+ rating 

from the Better Business Bureau, but 

dozens of complaintsopens in a new 

tab or window have been filed with 

the organization that describe similar 

experiences. 

Trajector has responded with 

variations of this comment: "We have 

helped tens of thousands of veterans, 

like you, obtain the most accurate 

disability rating for their conditions. 

We apologize that you have not been 

satisfied with our customer service or 

overall experience." 

Veterans organizations have grown 

increasingly concerned about the 

activities of businesses not accredited 

by the VA promising such assistance. 

"They are predatory companies that 

charge outrageous amounts to veterans 

to access their benefits," said Ryan 

Gallucci, executive director of the 

Washington, D.C., office of Veterans 

of Foreign Wars (VFW), an accredited 

veterans service organization (VSO) 

with more than 2,300 representatives 

worldwide. Gallucci made similar 

comments in his April 2022 Capitol 

Hill testimonyopens in a new tab or 

windowabout unaccredited assisters. 

Of the 280 complaints sent to the 

VA Office of General Counsel from 

2018 to 2022, 40% were related 

to unaccredited individuals and 

organizations, according to Randal 

Noller, a VA spokesperson. 

Representatives for some unaccredited 

companies say most private operators 

are honorable and that the whole 

group is being targeted because of the 

activities of a few bad actors.


Veterans Guardian VA Claim 

Consultingopens in a new tab or 

window, another unaccredited 

company, has a similar billing structure 

to that of Trajector, charging clients a 

fee equal to 5 months' worth of any 

increase in benefits they receive. It takes 

a holistic approach to helping veterans 

whose cases may be complicated 

because they left the military years 

ago, for example, or are hoping to 

increase their existing disability rating 

or receive compensation for other 

conditions related to their service, said 

Mark Christensen, the company's chief 

of staff. 

VSOs are well suited to help recently 

discharged veterans file initial claims, 

which are typically straightforward, 

Christensen said, referring to 

accredited groups such as the VFW or 

Disabled American Veterans. But they 

may not be as effective at managing 

subsequent claims. 

It may be faster to work with a private 

company as well, he said. Going 

through adjudication with a VAaccredited 

lawyer may take years, 

he said. "We can take care of it in 6 

months." 

According to the VA, there is no 

statistically significant difference in 

the average number of days it takes 

any type of filer to complete a ratingrelated 

claim. In the current fiscal year, 

time frames have ranged from 129.7 

days to 139.4 days whether veterans 

make a claim unassisted (which would 

include those who use unaccredited 

representatives) or use VSOs, agents, 

or attorneys. 

Many of Veterans Guardian's clients 

had gone the free route initially, 

according to Christensen. In any given 

month, 60% to 70% of the company's 

clients report they used a free service 

in the past, he said, but they often turn 

to his company to get a better disability 

rating or approval for secondary 

conditions. 

Prominent veterans groups like the 

VFW, American Legion, and Disabled 

American Veterans are pressing for 

passage of the Guard VA Benefits 

Actopens in a new tab or window, 

which would rein in certain business 

practices by allowing the VA secretary 

to impose criminal penalties on people 

who charge fees to help veterans file 

disability benefit claims without VA 

authorization. 

Veterans Guardian supports changes 

that would allow unaccredited 

companies like itself to charge for 

services at any point in the process, 

as well as place caps on fees, and 

prohibitions on having doctors on 

the payroll or charging upfront fees. 

But the company doesn't support the 

Guard Act. 

The VA has tried sending ceaseand-desist 

letters to unaccredited 

companies that the VA found to be 

preying on veterans, said Diane Boyd 

Rauber, executive director of the 

National Organization of Veterans' 

Advocates, which trains accredited 

attorneys and agents. 

"The problem is that the VA only has 

authority to go after someone who's 

accredited," she said. "Part of the 

intent of the Guard Act is to give the 

VA some teeth."


Five Ways to 

Keep Your Brain 

Healthy 

The Department of Defense 

recognizes Brain Injury Awareness 

Month to raise awareness of the 

importance of improving brain 

health and identifying, caring for, 

and treating individuals affected 

by traumatic brain injury, or TBI. 

Focusing on brain health is key 

to mission readiness, and there 

are several steps that the military 

community – service members and 

veterans, health care providers, 

researchers, educators, and 

families - can take to maintain a 

healthy brain. 

Here are five ways to keep your 

brain healthy: 

1. Get plenty of sleep 

Getting restful sleep is one of the 

most important things you can do 

for brain health. Sleep also plays 

a pivotal role in recovery from 

TBI. You can improve your sleep 

regimen with these healthy sleep 

tips: 

Aim for a minimum of seven hours 

of sleep on a regular basis 

Avoid stimulants such as caffeine, 

nicotine, and energy drinks within 

six hours of your usual bedtime 

Exercise regularly, preferably 

finishing two hours before bedtime


Avoid alcohol within two 

hours of your bedtime 

Promote a sleep friendly 

environment; minimize 

noise and light and 

maintain a cool but 

comfortable room 

temperature 

Avoid use of smartphones 

or reading devices that 

give off light for two 

or more hours before 

bedtime. 

2. Protect your head 

Service members 

can limit their risk of 

experiencing a TBI by 

wearing a helmet or other 

protective equipment 

when training, deployed, 

or recreating. Many 

activities that service 

members engage in 

regularly, such as 

military training and 

sports or recreational 

activities, are potentially 

dangerous and could 

result in a TBI. 

When wearing a helmet 

while playing sports 

or riding a bike or 

motorcycle, always 

remember the following 

tips from A Head for the 

FutureOpens to a new 

webpage on the Health. 

mil webpage: 

Never wear a cracked or 

broken helmet 

Never alter a helmet 

yourself 

Regardless of wear and 

tear, always replace a 

helmet five years past 

the manufacturer's date 

to be sure it has the latest 

safety features 

3. Take care of your 

mental health 

The brain affects how 

we think, feel, and act. 

Damage to the brain, 

including from TBI, 

can affect physical 

function, thinking 

ability, behavior, mental 

health, and more. Severe 

TBIs increase the 

risk for mental health 

conditions such as 

anxiety and depression, 

as well as sleeping 

problems. Remember to 

seek medical treatment 

if you have symptoms 

of depression, anxiety, 

or other mental health 

concerns, especially 

if you have recently 

experienced a TBI. 

4. Build your social 

networks 

The ability to engage 

in productive personal 

and professional 

relationships, and 

positively interact with 

unit and command 

networks, is important 

to overall well-being 

and brain health. When 

you experience a TBI, 

changes to your personal 

and professional 

relationships are 

common. Some TBI 

symptoms, like mood 

swings and personality 

changes, can stress 

relationships. Friends, 

families, and coworkers 

who notice these 

changes, and are aware 

of a possible head 

injury, should encourage 

medical attention. 

Seeking medical 

attention for a potential 

TBI is a sign of strength, 

not weakness. 

5. Get regular exercise 

and eat a healthy diet 

Physical exercise is 

very beneficial for 

maintaining brain 

health. You can make 

a major difference in 

terms of how your body 

is functioning and, as a 

result, how your brain 

is functioning, through 

regular exercise. 

Good nutrition is also 

essential to everyone's 

good health and wellness, 

and to warfighter 

readiness. The right diet 

can improve physical and 

cognitive performance, 

positively impact your 

mental health, lower 

your risk of many 

chronic diseases, and 

even help with recovery 

from some injuries.


Physician Opportunities 

BERKSHIRE HEALTH SYSTEMS IS SEEKING COMPASSIONATE, COMMUNITY- 

FOCUSED PHYSICIANS IN THE FOLLOWING DISCIPLINES: 

ANESTHESIOLOGY • CARDIOLOGY • DERMATOLOGY • ENDOCRINOLOGY • ENT • FAMILY 

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organization, BHS is committed to partnering with local municipalities and community organizations 

to help the county thrive. Working at BHS offers a unique opportunity to both practice and teach in 

a state-of-the art clinical environment at Berkshire Medical Center, the system’s 298-bed 

community teaching hospital in Pittsfield, which is a major teaching affiliate of the University of 

Massachusetts Chan Medical School and the University of New England College of Osteopathic 

Medicine in Maine. 

At BHS, we also understand the importance of balancing work with quality of life. The Berkshires, a 

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Apply online at: berkshirehealthsystems.org


Study Links 'Forever 

Chemicals' to Testicular 

Cancer in Military 

Personnel 

Gary Flook served in the 

Air Force for 37 years, as a 

firefighter at the now-closed 

Chanute Air Force Base 

in Illinois and the former 

Grissom Air Force Base in 

Indiana, where he regularly 

trained with aqueous film 

forming foam, or AFFF -- a 

frothy white fire retardant 

that is highly effective but 

now known to be toxic. 

And multiple studiesopens 

in a new tab or window 

show that firefighters, 

both military and civilian, 

have been diagnosed with 

testicular cancer at higher 

rates than people in most 

other occupations, often 

pointing to the presence 

of perfluoroalkyl and 

polyfluoroalkyl substances, 

or PFAS, in the foam. 

and Uniformed Services 

University of the Health 

Sciences (USUHS) found 

strong evidence that airmen 

who were firefighters had 

elevated levels of PFAS 

in their bloodstreams and 

weaker evidence for those 

who lived on installations 

with high levels of PFAS 

in the drinking water. And 

the airmen with testicular 

cancer had higher serum 

levels of PFOS than those 

who had not been diagnosed 

with cancer, said study coauthor 

Mark Purdue, PhD, a 

senior investigator at NCI. 

"To my knowledge," Purdue 

said, "this is the first study to 

measure PFAS levels in the 

U.S. military population and 

to investigate associations 

with a cancer endpoint in 

this population, so that 

brings new evidence to the 

table." 

In a commentaryopens in 

a new tab or window in 

the journal Environmental 

Health Perspectives, Kyle 

Steenland, PhD, a professor 

at Emory University's Rollins 

School of Public Health, 

said the research "provides 

a valuable contribution to 

the literature," which he 

described as "rather sparse" 

in demonstrating a link 

between PFAS and testicular 

cancer. 

More studies are needed, 

he said, "as is always the 

case for environmental 

chemicals." 

Flook volunteered at his 

local fire department, where 

he also used the foam, 

unaware of the health risks 

it posed. In 2000, at age 

45, he received devastating 

news: He had testicular 

cancer, which would require 

an orchiectomy followed by 

chemotherapy. 

Hundreds of lawsuits, 

including one by Flook, 

have been filed against 

companies that make 

firefighting products and the 

chemicals used in them. 

But the link between PFAS 

and testicular cancer among 

service members was never 

directly proven -- until now. 

A new federal studyopens 

in a new tab or window for 

the first time shows a direct 

association between PFOS, 

a PFAS chemical, found 

in the blood of thousands 

of military personnel and 

testicular cancer. 

Using banked blood drawn 

from Air Force servicemen, 

researchers at the National 

Cancer Institute (NCI)


Marijuana Is Not the Solution for PTSD 

A growing number of states have identified post-traumatic 

stress disorder (PTSD) as an approved condition for 

medical marijuana. According to Colorado's Medical 

Marijuana Registryopens in a new tab or window, there 

are 70,533 patients as of February 2023 with an active 

medical marijuana registration in the state, and 10,734 of 

them indicate PTSD as the reason they are using medical 

marijuana. This is despite the lack ofopens in a new tab 

or window any high-quality, randomized, controlled 

studies proving that marijuana helps PTSD in the longterm. 

Because of this lack of evidence, the American 

Psychiatric Association adopted a policyopens in a 

new tab or windowin 2019 opposed to using medical 

cannabis treatment for PTSD. 

While many people find that cannabis seems to initially 

help PTSD symptoms, it likely does this by providing 

some temporary relief, numbing the individual and 

disconnecting them from the traumatic emotions. 

However, to keep the symptoms at bay, the individual 

often needs to use daily, sometimes multiple times a day, 

which can then set them up for significant consequences 

associated with daily cannabis use, such as cannabis 

use disorder (CUD), psychotic symptoms, cognitive 

problems, suicidal ideation, worsening depression and 

anxiety, and cannabinoid hyperemesis syndrome. 

Outcomes of Marijuana Use for PTSD: A Review of 

the Literature 

The problems with regular cannabis use in those with 

PTSD were demonstrated by a 2020 studyopens in a new 

tab or windowfrom Canada in which anonymous data was 

obtained from a phone app, Strainprint. In the study, 404 

medical cannabis users, self-identified as having PTSD, 

used the app to track symptoms of intrusive thoughts, 

flashbacks, irritability, and anxiety. The users would then 

indicate the strain of cannabis they were about to use and 

the effects on their symptoms. The results indicated that 

acute cannabis intoxication provided temporary relief 

from intrusions, flashbacks, irritability, and anxiety. 

However, baseline PTSD symptom ratings did not 

change over time, and the researchers detected evidence 

that people used higher doses over time to manage 

anxiety, indicating the development of tolerance to the 

drug. They concluded that while these results indicate 

that cannabis may reduce PTSD symptoms in the shortterm, 

it may not be an effective long-term remedy for the 

disorder.


There have been an increasing number of studies 

demonstrating that the use of marijuana can worsen 

PTSD over time. An observational studyopens in a new 

tab or windowassessed 2,276 veterans treated in VA 

PTSD treatment programs at the time of intake and then 

again 4 months after discharge. They found that those 

who had been using marijuana prior to the program 

but stopped had the lowest level of PTSD symptoms 4 

months post-discharge, and second lowest were those 

who never used marijuana. Those who started using 

marijuana again after the treatment program had the 

highest levels of violent behavior, alcohol use, and 

PTSD symptoms. 

A more recent studyopens in a new tab or window 

using the 2019-2020 National Health and Resilience in 

Veterans Study (NHRVS) data on 4,069 U.S. military 

veterans from around the country found that frequent 

cannabis use worsens PTSD symptoms in veterans. 

Those who used cannabis frequently were roughly 

twice as likely to screen positive for co-occurring major 

depressive disorder, generalized anxiety disorder, and 

suicidal ideation. They also showed small-to-moderate 

decrements in cognitive functioning. 

A prospective studyopens in a new tab or window of 

361 veterans returning from deployment in Iraq and 

Afghanistan found more frequent cannabis use linked to 

greater severity in PTSD-related intrusion symptoms 6 

months later and a prospective association from PTSD 

diagnosis to cannabis use disorder (CUD) diagnosis 

1 year later. Importantly, there was no evidence of 

improvement in PTSD-related intrusion symptoms or 

remission in PTSD diagnosis in association with longterm 

use of cannabis. The researchers concluded that 

these results strengthen the argument for a causal link 

between frequent cannabis use and subsequent greater 

severity of PTSD-related intrusion symptoms and the 

links between PTSD and CUD. 

This is especially concerning considering the evidence 

that CUD is associated withopens in a new tab or window 

suicidal ideation and suicide attempts in veterans. Another 

study found that while neither past 30-day heavy alcohol 

use nor opioid use predicted an increase in suicidal 

ideation or suicidal behavior, increased marijuana use, 

in the presence of elevated PTSD symptoms, strongly 

predictedopens in a new tab or windowsuicidal ideation, 

PTSD symptoms, and suicidal behavior in veterans. 

An overview of peer-reviewed studies and randomized 

controlled trialsopens in a new tab or window in humans 

of THC or THC and CBD in PTSD from 1974 to 2020 

reported that low doses of THC (7.5 mg THC) can 

potentiate fear memory extinction in healthy volunteers 

and reduce anxiety responses in anxious and PTSD 

patients without inducing a psychotic effect. However, 

high doses of THC (greater than or equal to 10% THC), 

do not facilitate fear memory extinction and are related 

to clinically relevant anxiogenic and psychotic effects in 

healthy volunteers. The fact that most products available 

in medical and recreational marijuana dispensaries are 

greater than 15% THCopens in a new tab or window(with 

many in the 60-90% THC range) complicate attempts 

from patients to find products that help with PTSD. 

Evidence-Based Treatment Exists 

As an addiction psychiatrist and a medical director of a 

90-day inpatient treatment program, I have overseen the 

treatment of hundreds of people with PTSD. I know it 

is a very treatable condition. Evidence-based treatments 

have been shown to help permanently alleviate 

symptoms, allowing patients to process and assimilate 

their memories so they no longer bother the person 

when they are recalled. A recent meta-analysisopens in 

a new tab or window of randomized controlled trials of 

evidenced-based therapies found that narrative exposure 

therapy (NET), cognitive processing therapy (CPT), and 

eye movement desensitization reprocessing (EMDR), 

had the highest correlation with overcoming the PTSD 

diagnosis. 

I've seen that when a patient is actively using an 

addictive substance such as cannabis while attempting to 

engage in these therapies, the treatment is less effective. 

Another concern with cannabis use by someone in 

PTSD treatment is that cannabis users show increased 

susceptibility to false memoriesopens in a new tab or 

window. It is extremely difficult to treat fixed delusions 

or false memories that never actually happened. 

The evidence shows that marijuana does not treat PTSD 

in the long-term, and contributes to worsening symptoms 

and outcomes. Meanwhile, we have very effective, 

evidence-based treatments available for PTSD, which 

can eliminate the symptoms and the diagnosis. They are 

more effective when the patient quits using cannabis. It is 

imperative that treatment providers educate their patients 

with PTSD and follow the science when recommending 

treatment options. 

Libby Stuyt, MD, is an addiction psychiatrist in Colorado, 

and a board member of the International Academy on 

the Science and Impact of Cannabis. The opinions of the 

author are her own and do not necessarily reflect those 

of any organization with which she is affiliated.


Too Many Managers, Too 

Few Providers? Watchdog 

Tells Defense Health 

Agency to Reexamine Its 

Market Structure 

With the Department of 

Defense's reorganization of its 

health system complete, the 

Defense Health Agency should 

reevaluate its administrative 

structure and focus on ensuring 

that military treatment facilities 

are fully staffed, according to 

the Government Accountability 

Office. 

As part of military health system 

reforms launched by Congress in 

2016, the focus of the military 

medical commands shifted to 

supporting mainly active-duty 

military personnel and training 

for military missions, while 

DHA was responsible largely for 

providing care to non-military 

beneficiaries in military facilities 

and streamlining programs like 

administration, information 

technology (IT), logistics and 

training that once existed in 

triplicate under the separate 

Army, Navyand Air Force 

medical commands. 

The reforms also included the 

management transfer of roughly 

700 military hospitals, clinics 

and dental clinics from the Army, 

Navy and Air Force, which was 

completed in November 2022. 

With the arrangement, the 

military services are to provide 

personnel to staff hospitals and 

clinics while DHA is responsible 

for augmenting the uniformed 

providers with civilians or 

contractors, or shifting them 

from nearby military facilities. 

But staffing military hospitals 

and clinics with uniformed 

providers has always been a 

challenge, given not only a 

nationwide shortage of doctors, 

but also the demands of military 

duty -- frequent training, 

deployments, permanent change 

of station (PCS) moves. 

The COVID-19 pandemic also 

contributed to this strain, with 

providers called away to support 

the nationwide response to the 

pandemic. 

DHA has been working to 

mitigate staffing shortfalls at 

those facilities, according to 

a Government Accountability 

Office report published Monday, 

but the challenge has been 

enormous. 

In one case, at Naval Hospital 

Jacksonville, Florida, officials 

told GAO that the shortages 

were so bad, they expected they 

would not be able to provide 

around-the-clock services in the 

emergency room in the summers 

of 2022 and 2023. 

The hospital was only able to 

keep the emergency room open 

24/7 by using military providers 

from other military treatment 

facilities temporarily "despite 

Navy-wide shortages of such 

providers," according to the 

report. 

The Defense Health Agency is 

working to fully staff facilities 

by shifting civilian providers 

from nearby facilities, forging 

agreements with the military 

services, establishing a new 

system for monitoring human 

capital and instituting a new 

program to track and analyze 

staff shortages, according to 

GAO. 

But while it is focused on 

improving staffing at the 

hospital and clinic level, it has 

not reviewed the number of 

personnel it needs to staff the 

administrative structure that 

oversees these facilities. 

And that, GAO auditors said, 

may be problematic. 

DHA has clustered hospitals 

and affiliated clinics into 36 

"markets" overseen by 22 offices, 

with a staffing requirement of 

more than 1,400 people, a vast 

increase from 2018, when DHA 

envisioned two regions with two 

offices each. 

GAO said the Defense Health 

Agency needs to reevaluate this 

structure, because the estimate 

of 1,400 personnel in 22 offices 

"could be higher than needed 

and exceeds expected budgetary 

and personnel resources." 

"Until DOD reevaluates 

the efficiency of the market 

structure and updates personnel 

requirements, DOD may risk not 

accomplishing its vision for an 

integrated health delivery system 

that efficiently uses available 

personnel and budgetary 

resources," GAO auditors wrote 

in the report. 

GAO noted that its analysis of 

the Defense Health Program 

budget, which encompasses 

the Defense Health Agency, 

the military treatment facilities 

and non-military health-care 

programs like Tricare, in addition 

to all overhead, has shown that 

in terms of military treatment 

facility operations, the budget 

has remained constant when 

adjusted for inflation. 

DoD officials told the GAO that 

the transition is likely to lead to 

future savings as the Defense 

Health Agency matures, but 

GAO found that the extent to 

which the Defense Department 

has realized or will realize 

savings is "unclear." 

GAO recommended that 

DoD reevaluate its market 

management structure and 

establish performance goals for 

the reform initiatives and for 

monitoring savings. 

The Defense Department noted 

that it is currently reviewing 

the market-based management 

organization and partially agreed 

with the recommendations for 

setting performance goals. 

The leadership now in place 

is responsible for ensuring the 

undertaken reform initiatives 

improve "readiness, clinical 

outcomes, patient safety and 

patient experience," wrote 

Seileen Mullen, the principal 

deputy assistant secretary of 

defense for health affairs, in the 

DoD response to the report.

September 2023 — MHCE Newsletter

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