SEATTLE — Tim Juneman went to a Department
of Veterans Affairs psychiatrist in January 2008 to talk about his recurrent thoughts of suicide.
The 25-year-old Washington State University
student was an Iraq war veteran who had survived a year of tough fighting that left him with a twin diagnosis of post-traumatic
stress disorder (PTSD) and traumatic brain injury.
His biggest worry, according to notes taken
by the VA psychiatrist, was a looming call back to active duty by the Washington National Guard. The order would have sent
the specialist back to Iraq.
A VA psychiatrist hospitalized Juneman but
never notified the National Guard unit of his patient's distress over redeployment. Juneman was released that month, then
missed follow-up appointments.
In early March 2008, Juneman hanged himself
in his Pullman apartment. His body was discovered some 20 days later, The Spokesman-Review newspaper reported.
His death underscores an unsettling new
reality for VA health care providers. Unlike in decades past, they now often treat veterans headed back to war. And this can
pose an ethical challenge for VA doctors if they think PTSD, traumatic brain injury or other unhealed wounds could put a patient
or others at greater risk on the front line.
Confidentiality rules generally prevent
them from informing active-duty commanders of a veteran's medical problems, unless the veteran signs a release.
In some instances, veterans may resist signing
a release, even when they have serious cases of PTSD and traumatic injury.
These veterans might be floundering in civilian
life and look forward to a return to combat, seeing that as a way of putting their lives back on track. Or their sense of
duty makes them balk at opting out of service, even if they are reluctant to return to the war.
VA officials say they must comply with privacy
rules and are not required to share a veteran's health status with the Defense Department, according to a statement released
by the VA in response to a Seattle Times inquiry.
But VA rules do allow disclosure under certain
limited circumstances. These exceptions include "to assure the proper execution of a military mission," according to a VA
privacy statement. But VA officials define such exceptions narrowly, and the patient information typically is released only
if the military requests it.
"It's not broad brush; it's a very rare
thing," said David Bayard, a VA spokesman.
Jacqueline Hergert, Juneman's mother, says
the VA should have contacted the National Guard about her son's plight.
"In Tim's case," Hergert said, "he had already
been placed under suicide watch, and somebody should have told his unit. Perhaps doing that would have saved my son. What
he really needed was for the VA to be an advocate for him."
As a growing number of combat veterans head
back to war zones, the gaps in knowledge about the mental health of reservists are a concern to some National Guard leaders.
"The VA is very protective of this information,
as they should be," said Lt. Col. Carol Munsey, deputy state surgeon for the Washington Army National Guard. "But if you're
talking about a person who is not doing well, then the command needs to know about it."
Young men drafted into past wars usually
returned to civilian life free of obligations to continue serving in the Reserves or the National Guard.
But things have changed as an all-volunteer
military, whose numbers represent less than 1 percent of the nation's population, has become responsible for fighting two
long-running wars.
Each enlistee typically has an eight-year
service obligation. The active-duty portion might involve multiple tours in a war zone, and returning soldiers face more years
of possible call-up to Reserve or National Guard units that remain a key part of the military campaigns in Iraq and Afghanistan.
That means soldiers' medical care can be
fragmented: VA doctors treat them when they return to civilian life; they're back to Army doctors if they are called up again.
Army doctors and commanders generally do
not have access to VA medical records that might help them assess whether a veteran should return to front-line duty.
Instead, it's largely up to the veteran
to decide what — if anything — should be disclosed to commanders.
At a VA Puget Sound counseling session last
year for veterans with PTSD and traumatic brain injury, the topic aroused intense debate, said Mark McPherson, a Washington
National Guard veteran from Seattle.
"I had a very strong discussion with one
of these guys and told him he wasn't doing any favors to himself or others by not disclosing," McPherson said. "But he was
a sergeant, and he wanted to go. For a lot of these guys, the only part of their identity that seems to make sense anymore
is the one that fits into the uniform."
For VA officials, confidentiality is an
important part of their outreach effort to help persuade veterans to seek treatment.
A 2008 study by the Rand Corp. found that
nearly 20 percent of men and women who served in combat reported symptoms of post-traumatic stress disorder. Yet nearly half
had not sought treatment, with many fearing that could harm their military careers, according to the study.
VA officials worry that number would rise
even higher if confidentiality standards were loosened.
Munsey, the state's deputy surgeon, says
some Washington Guard veterans do volunteer to release VA information about PTSD and other health issues. The state Guard
also has all soldiers headed for deployments fill out a health checklist.
When issues are disclosed, some soldiers
still are able to deploy if doctors conclude they won't put themselves or others at undue risk.
"It's all self-reporting," Munsey said.
"All the soldiers are required to go through the process. But how do I know they are telling the truth?"
When Tim Juneman first sought help from
the VA in early 2008, he was trying to leave the military behind and fashion a new career as a speech pathologist.
Serving with the Fort Lewis-based Stryker
Brigade had put him into the thick of the Iraq war. His brigade was slammed by more than 1,380 roadside bombs during a year
in Mosul, according to a brigade tally.
After four years in the Army, Juneman opted
to finish his military commitment by serving in the Washington National Guard.
He thought the Guard would grant him at
least two years stateside, according to his mother. In 2007, he enrolled at Washington State University. He struggled with
headaches, insomnia and other problems, but his studies appeared to be going well.
Then, in the fall of 2007, he learned that
his National Guard unit would be sent to Iraq the following summer.
"He was coping the best he could, but I
think this overwhelmed him," Hergert said. She said she was unaware of her son's suicidal thoughts.
But Juneman apparently was forthright with
the psychiatrist.
Juneman was having strong thoughts of suicide,
which included a plan to hang himself, the psychiatrist wrote in notes from a Jan. 5, 2008, appointment obtained by Juneman's
family. Juneman said he learned of his deployment a couple of months ago and believed that was the trigger for the worsening
of his depression, the psychiatrist wrote.
Hergert said copies of the notes were found
in her son's apartment. She wondered if he intended to show them to his commanding officers. She doesn't know if he ever considered
signing the form to allow his medical records released to the Guard.
Hergert said that would have been a difficult
decision for her son who, despite his problems, felt a profound duty to serve.
At his National Guard unit in Spokane, no
one had seemed aware of the depths of Juneman's despair.
"It breaks our heart to lose somebody the
way we lost that soldier," said 1st Lt. Keith Kosik, a spokesman for the National Guard. "Had we had any indication that he
was struggling with those kinds of things, we would have done everything we could have to get him help."
