So this is my personal experience with drugs – prescription drugs, that is.

I think it all started with a pair of back-to-back cataract surgeries in May. I was a difficult patient, and it took a vast amount of anesthesia to put me down. The improvement in my eyesight was startling and wonderful, but a few days after my second surgery, I began hiccupping.

For the first three or four nights, the hiccups subsided as I slid into sleep. But then they got more severe and began to keep me up most of the night.

On a Sunday afternoon after seven days and nights of non-stop hiccupping, I visited a doc-in-the-box and was told I had a sinus infection that may have been causing the hiccups. I was prescribed some antibiotics and told to return if the hiccups hadn’t quit in four or five days.

But I couldn’t make it that far. By Monday evening, each hic had turned into a stutter of five or six hiccups. My whole diaphragm was in prolonged spasms, and it was getting harder to breath. Indeed, my diaphragm had frozen a couple of times after spasms, and I had to slam my chest down on my knees to break the paralysis. I worried that I wouldn’t be able to breathe.

Time for the emergency room at the Charleston (WV) Area Medical Center.

Over the next four days, a CAT scan showed no brain tumors, an MRI found no irregularities in my throat and chest, and an endoscopy revealed no hernias or ulcers in my stomach. In short, there was no physiological reason for me to be hiccupping.

So a neurologist prescribed a pair of spasm blocking drugs, and I was sent home, still hiccupping. When I awoke the next morning, though, the hiccups were gone.

They’ve been gone for more than three weeks now. I’m weaning myself off the spasm-blocking meds, and I’m optimistic that I may be free of that nightmare. It’s now been four days without medication or hiccups.

But there’s a lesson to be learned here for someone like me who’s been skeptical of the vast amounts of psychotropic drugs being used to “treat” PTSD.

Without medical help, I was unable to cure something as simple as a case of the hiccups. But the spasm-blocking meds re-booted my system, allowing me to return to normal. And perhaps that is what’s needed for a short time for some of our combat-stressed vets.

UCLA has released a new study of brain damages caused by concussions. The current study this spring involves retired football players, but UCLA says the next phase of its ongoing study will involve military veterans.

There’s an interesting new twist on this research, though. The degenerative brain condition known as chronic traumatic encephalopathy (CTE) can only be diagnosed after death during an autopsy to reveal abnormal tangles of a protein called tau in sections of the brain that control mood, cognition and motor function.

However, scientists are now using PET scans (positron emission tomography) to look for the tau tangles in the brains of living athletes.

And they’re finding that there are some remarkable differences in the brains of retired NFL players who have suffered concussions that set them apart from the scans of healthy people and from those with Alzheimer’s disease.

Using FDDNP, a chemical marker that binds to tau tangles and amyloid beta plaques, researchers found that the former athletes had four stages of tau deposits that could signify early to advanced levels of CTE.

“These different stages reflected by the brain marker may give us more insight into how CTE develops and allow us to track the disease over time,” said Dr. Vladimir Kepe, one of the study’s authors and a research pharmacologist at the Geffen School of Medicine.

Participants also underwent MRI scans and neuropsychological testing to determine whether they had symptoms consistent with CTE, Alzheimer’s dementia, or normal aging.

“We found that the imaging pattern in people with suspected CTE differs significantly from healthy volunteers and from those with Alzheimer’s dementia,” said Dr. Julian Bailes, an author of the study and director of the Brain Injury Research Institute at NorthShore University HealthSystem in Evanston, Ill. “These results suggest that this brain scan may also be helpful as a test to differentiate trauma-related cognitive issues from those caused by Alzheimer’s disease.”

Compared with healthy people and those with Alzheimer’s the former athletes had higher levels of FDDNP in the amygdala and subcorticol regions of the brain, areas that control learning, memory, behavior, and emotions.

On the other hand, people with Alzheimer’s had higher levels of FDDNP in the cerebral cortex, which controls memory, thinking, attention and other cognitive abilities.

Researchers say that more expanded studies will help them understand better how different types of head injuries may contribute to chronic brain disorders. This could help doctors and scientists to test treatments that could delay the progression of the disease before significant brain damage occurs.

Hundreds of pages of VA emails that were requested and received by Charles Gatlin and his wife, Ariana Del Negro, testify to the growing rift between the veteran and the agency designated to serve him.

There’s a “Gatlin White Paper,” dated Oct. 21, 2011, which says: “The veteran and his representative, Ariana Del Negro (also his spouse) have alleged that both VHA and the Fort Harrison VARO (VA regional office) have acted unethically in handling the veteran’s claims and that VHA physicians have retaliated against the veteran. Neither VHA nor VGA management have found any evidence to support the allegation.”

Before declining to meet with Gatlin again because he had contacted his congressman, Rep. Denny Rehberg, former Fort Harrison VA Director Steven Young wrote a private inquiry on Aug. 24, 2012, to seven of his colleagues: “I am considering sending the following message and wondering whether anyone finds this objectionable. I don’t necessarily want to raise up the issue that I don’t see any more value in meeting again (Dr. Bonde and I have both met with them).” Dr. Trena Bonde was VA chief of staff at Fort Harrison at the time.

Based on their responses, Young wrote Gatlin: “Subsequent to the last message we exchanged, we have received a formal written inquiry from Congressman Rehberg on your behalf. In light of that formal inquiry, I have a commitment to respond in a formal written manner to the congressman. Consequently, I think it appropriate to not meet at this time and allow the formal process to proceed.”

On Feb. 14, 2013, Koryn Arnold, veterans service center manager at Fort Harrison, alerted her colleagues that Ariana Del Negro was planning to call the office of then-VA Secretary Eric Shinseki. “Also for the first time that I know of, she started using foul language,” Arnold added. “She started dropping the f-bomb. Nice, huh?”

Gatlin filed a complaint with the Montana Board of Psychologist, the state board in Helena that licenses psychologists, arguing that the screening assessment known as RBANS wasn’t adequate to measure his cognitive ability; that staff psychologist Robert J. Bateen wasn’t qualified to interpret it because he wasn’t a neuropsychologist; and that Bateen incorrectly characterized the results of that test. The board began hearing testimony in that case on Oct. 4, 2012, and that case developed a robust conversation within the VA.

On Nov. 13, 2013, Arnold, wrote Dr. Gregory Normandin, Bateen’s boss: “Based on the current situation with Dr. Bateen, do you have any idea how many exams he has conducted in the last 6 months? It’s sounding like my leadership will at least want a second signature on his pending claims that we have not yet rated. We plan on holding pending claims with a Bateen exam for now until we have a chance to talk about the best course of action.”

On Nov. 21, 2013, Arnold again wrote to Dr. Normandin: “We’ve found approximately 10 pending claims with exams performed by Dr. Bateen. We will be returning them as insufficient as we’ll need an additional signature on his exams., I just wanted to give you a heads up.”

Normandin asked why the second signature, and Karl Pfanzelter, assistant director in Salt Lake City, responded, also on Nov. 21: “The status of an examining physician is quite important. I will communicate our concerns with Mr. Ginnity (John Ginnity, former acting medical director at Fort Harrison) since some of the information we have reviewed is quite sensitive in nature. Ultimately, I will ask for some reassurances that no statuses have been changed.”

On Sept. 4, 2014, the Montana Board of Psychologists agreed with Gatlin on all three issues. In particular, it questioned why a full neuropsychological workup was required to diagnose a TBI, but only a simple screening tool like the RBANS test was used to determine the level of disability on which benefits would be paid. Since Bateen was licensed by the state, it directed him to reverse his rating and recommend a full neuropsychological workup.

On Nov. 19, 2013, Amy Kelly, risk manager at Fort Harrison, wrote: “Think I have the ‘silver bullet’ found in Montana code that exempts psychologist when operating under federal duty.”

Subsequently, VA’s interim undersecretary of health, Dr. Carolyn Clancy, wrote Montana Sen. Jon Tester to say that Fort Harrison currently employed three other psychologists who are administering the RBANS tests, adding that they are not licensed by the state and don’t need to be because it is a federal facility.

Dr. Normandin, Bateen’s immediate supervisor, wrote the VA Office of Regional Counsel on Jan. 13, 2015, seeking legal representation for Bateen, saying “The interests of the United States are at stake in that the treatment (RBANS) was within the standard of care.”

But the licensing board decision is not the only issue on which Gatlin and the VA have been locking horns.

On Jan. 6, 2014, Pfanzelter wrote: “Mr. Skelly (Jon Skelly, then director of the Salt Lake City regional VA office), Koryn Arnold and I have all spoke with Mr. Gatlin and his spouse on a number of occasions in the past. He and his wife simply do not agree with the responses we provide to their inquiries. Ultimately, they remain dissatisfied with the process and what answers they receive from any of us. That being said I will reach out and speak with the veteran.”

Early in 2014, Gatlin and his wife began wondering what the VA was saying about them behind their backs, so they filed a Freedom of Information Act request for all VA correspondence relating to them. A Jan 31, 2014, response to what was deemed “sensitive FOIA 14-02123-F request” gave two estimated costs for compiling all that information: one estimate was $1,659 and the other $1,456. That was substantially more than the $150 Gatlin had indicated they’d be willing to pay.

On March 26, 2014, Mary Elwood, executive assistant to the VA chief of staff at Fort Harrison, wrote: “I received a call from the caregiver of a Montana veteran saying she got a letter from the director referring to a provider training module for TBI. She is asking for a copy of this video. Swears it is for personal use only. However, there are some issues with the veteran in question. I am giving this to Gail Wilkerson also and if you could call Gail before you call the caregiver and commit to giving a copy of this video, it would be best.

Gail Wilkerson, congressional liaison at Fort Harrison, responded the same day: “I do not recommend providing this publicly.”

WASHINGTON D.C. – Echoing a state licensing board, a VA appeals board here has ordered the Fort Harrison (Mont.) VA Hospital to provide a full neurological examination for a former University of Montana graduate student with a traumatic brain injury.

It’s a decision that could have implications for thousands of vets with TBI across the state and around the country — but the VA flatly says that won’t happen.

The case involves Charles Gatlin, a Ranger-qualified former Army captain who suffered a brain injury after a large car bomb knocked him unconscious near Kirkuk, Iraq, in 2006.

The Army put Gatlin through a three-day battery of neuropsychological tests in 2006, 2007 and 2009 and concluded he had suffered significant attention problems, processing speed deficits and persistent frontal lobe dysfunction. After three years, the final test concluded, the injuries had stabilized and appeared to be permanent.

Retired from the Army with a 70 percent TBI disability rating, Gatlin and his wife, Ariana Del Negro, returned to Montana. At the Fort Harrison VA hospital, staff psychologist Robert Bateen ran Gatlin through a short screening exam, concluded that his cognitive deficits were not significant, and dropped his TBI disability rating to 10 percent, although he also added a 30 percent rating for post-traumatic stress disorder.

Gatlin, who recently graduated from UM with a pair of masters’ degrees, appealed that ruling to the VA Board of Appeals two years ago, but also filed a complaint with the Montana Board of Psychologists, the state board in Helena that licenses psychologists, arguing that the screening assessment wasn’t adequate to measure his cognitive ability; that Bateen wasn’t qualified to make the assessment because he wasn’t a neuropsychologist; and that Bateen incorrectly characterized the results of that test.

The licensing board agreed on all counts last September. It directed Bateen to reverse his assessment and request a full neurological examination of Gatlin. Bateen did, but the VA did nothing.

In a ruling released last week, the Board of Veterans Appeals said the Montana Board of Psychologists ruling requires further action. It directed Fort Harrison to do the following:

“Schedule the veteran for a VA TBI examination by a neuropsychologist to determine the severity of service-connected TBI. All subjective and objective manifestations attributable to this disability must be identified and addressed. All necessary tests and studies should be conducted, to include any neuropsychiatric testing necessary for an adequate opinion.”

It ordered a re-adjudication of Gatlin’s claim based on the new examination.

“If any decision is adverse to the veteran, issue a supplemental statement of the case and allow the applicable time for appeal. Then return the case to this board,” directed the panel of three veterans law judges.

In a separate opinion, the VA Board of Appeals also ordered new testing of Gatlin’s depth perception and fine motor skills, and it directed that the claim be handled expeditiously.

Gatlin’s wife, however, remains dubious of any VA re-examination after three years of institutional resistance at Fort Harrison, and within the VA system.

“It is completely and utterly unethical for anyone at Fort Harrison to see Charles related to a benefits examination,” Del Negro explained via email. “Not only because it was mishandled from the get-go, but also because the bounty of emails (from the VA) shows how many people from Ft. Harrison and throughout the entire VA system were in on the mission to protect Dr. Bateen. There is no way for Charles to be able to receive a fair and unbiased evaluation by anyone in that system.

“And because it would be impossible to get a fair shake by an examiner in the system and in this state, the only logical approach is for the VA to conduct a records review and/or defer to a records review that we would have conducted by a specialist,” she added.

But since the Montana Board of Psychologists concluded that the RBANS test wasn’t sufficient to measure neurological impairment due to a TBI and that Bateen wasn’t qualified to make neurological diagnoses, Del Negro argues that all vets diagnosed by Bateen ought to have their cases re-evaluated.

At the Montana Board of Psychologists hearing in December 2012, Bateen estimated he had conducted 9,000 evaluations.

“A records review is also owed to the other 8,999 veterans seen by Dr. Bateen,” Del Negro wrote. “It’s unrealistic to think that neuropsych can see everyone, but at the very least, the system should conduct an independent audit of those cases to determine whether or not a veteran does need more specific testing.”

That’s not going to happen, wrote the VA’s interim undersecretary of health, Dr. Carolyn Clancy, in a letter to Montana Sen. Jon Tester on Nov. 12, 2014.

“The department strongly supports Dr. Bateen’s supervisor and counsel and sent a letter to the Montana Board expressing our strong disagreement with the Montana Board’s conclusions,” Clancy wrote. “As VA was not a party to the stipulation, it does not have any impact on VA or our employees other than Dr. Bateen.”

Fort Harrison currently employs three other psychologists who are administering the RBANS tests, Clancy wrote, adding that they are not licensed by the state and don’t need to be because it is a federal facility.

“Additionally, VA disagrees with the Montana Board’s finding that VA protocols for TBI, C&P (compensation and pension) examinations are insufficient,” she added.

But Del Negro argues that VA raters failed to note Bateen’s misinterpretation of her husband’s screening test results, as well as the vast variance between the full neuropsychological exams and the RBANS.

“The fact that overt problems and inconsistencies were not noted by Fort Harrison Regional Office raters is a major concern,” she said. “It demonstrates that it wasn’t just Bateen who failed — it was the entire system.”

At the Montana Board of Psychologist hearing, Bateen testified that the RBANS screening tests were uniform at VA facilities across the country.

“The evaluation that I conduct is the same one that’s conducted at VA centers throughout the United States,” he said. “They’re standardized procedures, that is, that everyone conducting one of these examinations who is a clinical psychologist will follow the same format, and administer essentially the same test.”

The VA gives him about two hours to do each exam, he testified. Half an hour is spent reviewing the medical records, then an hour is spent getting the history and mental status from the patient. The neuropsychological screening takes the final half hour, he said.

“My screening is the same screening that is done by every psychologist that works for the VA doing a TBI examination,” he added.

One of the hearing examiners asked whether it might be more useful to base assessments on earlier, more extensive neuropsychological testing.

“You may well be correct,” responded Bateen. “But again, I have to operate under the guidelines as established by the VA, and the VA has in essence said that we don’t need to do all of this, that we – Maybe it’s financial. I don’t know. You know? My exam is a whole lot cheaper than doing a two-day neuropsych exam.”

As elderly inmates in the Maine State Prison face their own deaths, there’s a lot of soul searching – particularly among the incarcerated veterans.

“One vet asked me, ‘Who is going to forgive me before I die?’” remembers Kandyce Powell. “Tears were running down his face. He said, ‘I have spent so many years of my life keeping things stuffed away inside myself. Things I don’t want my family to know. But I don’t know what I will tell them when I’m dying and I don’t have the strength to keep it stuffed in anymore. And who will like me after they learn what I have done? I did those things because I was told to do them, but that still doesn’t make them right.’”

It was a tough moment for Powell, executive director of the Maine Hospice Council and Center for End of Life Care in Augusta, Maine.

And it’s getting tougher as our prison population ages. According to the Bureau of Justice Statistics, the number of inmates 55 years or older rose from 3 percent nationally in 1991 to 8 percent in 2011. About a year ago, 270,000 prisoners out of a total population of 1.5 million were 50 years or older, it said.

That trend holds true at the maximum-security Maine State Prison, where about 21 percent of the inmates are older than 50 years and 15 percent of the 980 inmates are veterans, said chaplain Kevan Fortier, who is a vet himself.

In the prison, Powell and her colleagues have put together a remarkable program to train inmates to help their fellow inmates dump their emotional baggage in their waning days. And in helping others prepare for their own deaths, the volunteers are also beginning to find the keys to their own atonement.

“We are all searching for forgiveness and atonement, but especially the vets who have done some things they’d still rather not talk about,” Fortier told me. “It’s a struggle, especially for the vets who don’t feel worthy of forgiveness and acceptance. Some have held out for so long they don’t know to approach forgiveness.”

One way of helping imprisoned vets accept themselves is through a pinning ceremony, which is essentially an honoring ceremony.

“Self-forgiveness is a critical piece,” said Karen Flynn, director of the hospice unit. “So we all come in with an unconditional positive attitude to help them see themselves differently. One of our most active volunteers, a Vietnam vet, started to cry at his pinning ceremony and said no one had ever done that for him before.”

Since vets prefer to talk with other vets who have a better understanding of what they have been through, the hospice program tried to pair them. All the volunteers are inmates, however.

“Almost all the vets who have died in the infirmary have had some level of PTSD, so we call in the vet volunteers to help them,” Powell said. “One former helicopter pilot was having a flashback and screaming that he was drowning, so one of our volunteers went to his bed, put his arms around him and told him he was going to take care of him. He worked on calming him down until the vet finally started crying and went to sleep.”

In addition to the volunteers, about half the prison staff are vets “and some, by their own admission, have PTSD,” said Powell. That made for a very supportive environment for the prison hospice program when it began more than seven years ago.

Since then, the Veterans Administration has recognized its effectiveness and used its principles for its national Hospice-Veteran Partnership program, in which the VA partners with hospice organizations to provide end-of-life care for vets and their families.

In the prison, though, here’s an additional benefit. Helping others turns out to be hugely therapeutic for the inmates.

“You get a sense of purpose as far as your life having meaning,” Robert “Paco” Payvant, serving an 18-year-sentence for robbery and aggravated assault, told Kelley Bouchard of the Portland (Maine) Press-Herald. “I’ve been doing time since the 1980s. Opening myself up, working in partnership with other men, it’s changed my life. When the needs of another person aren’t just equal to my own, but greater than, it’s love. You give love, you get love.”

Brandon Brown, serving a 17-year sentence for attempted murder after shooting a man outside a bar in 2008, said it had also changed his life.

“We get so much thanks from the staff in the infirmary, I feel like I matter for once,” Brown told the Press-Herald. “We’ve all caused someone a lot of pain along the way. I live every day with the pain I caused my family, my victim and his family. It’s an unpayable debt. But this work is a second chance to do something meaningful. This is the most important work I’ve ever done.”

I’ve been wrestling with a thorny issue recently: “Why do some people persist in snatching defeat from the very jaws of victory?”

It’s a question raised by our son-in-law Jason’s recent passing. He died at the age of 43, and the cause of death was acute alcoholism. He left behind a loving wife and 7-year-old daughter, a two-story house that he paid cash for, and more money than was frankly good for him. He always said that he wouldn’t live past 45, and that became a reality this past Nov. 18.

In short, he had everything to live for, but he chose to die alone with a bottle.

At his memorial service last week in a big Catholic church in Stratford, Conn., Father Tom discarded the usual platitudes and surprised the mourners by wondering aloud why Jason couldn’t win his battle with the bottle.

While there’s undoubtedly a big genetic component to alcoholism, Father Tom said most people drink to numb the pain of abusive childhoods or conflict/wounded soul as adults. While there are avenues for their love to shine through, they’re in so much pain that it’s rare, and directed at the “innocent” – typically kids. Numb and guilt-ridden due to repeated failures, they isolate themselves and push others away.

That pretty much described our son-in-law.

He wasn’t a vet, but he was raised by alcoholic parents who neglected him. He often talked of being abused as a child, a situation later confirmed by a cousin who lived nearby. And a therapist confirmed a couple of years ago that Jason had PTSD levels that were off the chart.

After the memorial service, I visited the rectory to talk with Father Tom, who explained that men cannot fight this illness alone, but need God’s help and strength. He said we all have God’s love inside us, but that some people are in such pain that they can’t allow it to show through them.

Finally, Father Tom invited me to sit in at an Alcoholics Anonymous meeting that evening at the parish school. I did, and several of the men talked about relatives who needed help but wouldn’t admit that they were alcoholics.

That didn’t fit Jason. He’d been in and out of 21-day rehab programs for the past couple of years, and he admitted being an alcoholic. He also said he could quit drinking … but never wanted to.

Several people at the AA meeting mentioned that they only quit drinking when they hit the end of the line and were afraid that they would die if they continued drinking. But Jason had already been diagnosed with cardiomyopathy and had had a seizure. His doctors had advised him to quit drinking because, with a heart so severely damaged by alcohol, he would not survive the next heart attack.  Did he not care, did he not believe he would actually die, or was he just powerless over this disease?

Others at the AA meeting talked about enablers who always picked up the pieces and shielded the alcoholic from the consequences of his own actions. That fit in some ways because his father had always bought Jason’s way out of trouble. For a long time, it fit with our daughter as well, until she was forced to leave because she couldn’t watch the way alcohol was destroying him and she knew she needed to protect their daughter from witnessing the devastating and ultimately terminal effects alcohol was having on her father.

For a 43 year old man who had everything to live for, was it a self-fulfilling prophecy? Was it that he didn’t feel that he deserved to be happy?

That comes close to the homeostasis theory, which holds that hormones in the body are most comfortable in the state that they’re used to. A happy person looks for reasons to be happy because his hormones are comfortable there. Ditto a depressed person. It’s possible to break out of that cycle, but it takes energy and determination to break out of a depressive cycle and people in pain usually lack that energy. It’s kind of like a chicken raised in a coop that is afraid to venture outside the barn doors when they’re suddenly opened? Was Jason so familiar with failure that he couldn’t venture out to face true happiness?

I don’t know the answer (nor does my daughter, Sarah, who helped me write this). We’d welcome any thoughts you might have.

Two months after a state licensing board reprimanded a VA psychologist for an allegedly improper TBI assessment, there’s been no change – and the VA says there won’t be.

“This points to the issue of federal supremacy, which lies at the foundation of this case,” said a letter to the Montana Board of Psychology, signed by three VA officials in Washington, D.C. “Federal law controls on matters relating to this system.”

The case involves Charles Gatlin, now a graduate student at the University of Montana in Missoula. A Ranger-qualified former Army captain, Gatlin suffered a brain injury after a large truck bomb knocked him unconscious near Kirkuk, Iraq, in 2006.

The Army put Gatlin through a three-day battery of neuropsychological tests in 2006, 2007 and 2009 and concluded he had suffered significant attention problems, processing speed deficits and persistent frontal lobe dysfunction. After three years, the final test concluded, the injuries had stabilized and appeared to be permanent.

Retired with a 70 percent TBI disability rating, Gatlin and his wife, Ariana Del Negro, returned to Montana. At the Fort Harrison VA hospital, staff psychologist Robert Bateen ran Gatlin through a short screening exam, concluded that his cognitive deficits were not significant, and dropped his TBI disability rating to 10 percent, although he also added a 30 percent rating for post-traumatic stress disorder.

Gatlin appealed that ruling to the VA Board of Appeals last year and testified at a hearing in Washington, D.C., in October 2013. He hopes for a ruling next year.

But he also filed a separate challenge with the state board in Helena that licenses psychologists, arguing that the screening assessment wasn’t adequate to measure his cognitive ability, that Bateen wasn’t qualified to make the assessment, and that Bateen incorrectly characterized the results of that test.

The board agreed on all counts last September.

“To the extent Licensee asserts he was following the procedures of the VA, Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” said the board, which had the power to suspend his license.

It reprimanded Bateen, and it directed him to reverse his ruling and recommend that the VA find a board-qualified neuropsychologist to assess Gatlin’s brain injury. He did so, but the VA said it sees no reason to change its assessment.

“Based on Dr. Bateen’s education, training and professional experience, Dr. Bateen was practicing within American Psychological Association ethical guidelines and accepted standards of care,” said a letter to the board last September signed by Dr. Thomas G. Lynch, assistant deputy under secretary for health for clinical operations; Lois Mittlestaedt, chief of staff to the under secretary for benefits; and Richard J. Hipolit, deputy general counsel.

“VA believes that Dr. Bateen did not conduct a neuropsychological evaluation, but rather conducted a cognitive screen,” they said, adding that the assessment screen, the Repeatable Battery for the Association of Neuropsychological Status (RBANS) was adequate.

“In the C&P (compensation and pension) examination that Dr. Bateen conducted for the VBA in this case, he did not administer the RBANS as part of a comprehensive neuropsychological battery, but rather administered it as a screening measure consistent with VA protocol,” said the letter. “While literature suggests that the RBANS may not be sensitive to milder forms of brain dysfunction, Dr. Bateen was not evaluating brain dysfunction but rather evaluating functional impairment for purposes of the veteran’s disability compensation claim.”

Furthermore, it said federal law trumps state regulations.

“The Montana Board of Psychology is not a subject matter expert on VA disability assessment for compensation purposes and thus is not in a position to determine what training would be appropriate for a clinical psychologist to conduct C&P examination,” it said.

“Additionally, VA will not abide by the recommendation of Dr. Bateen that ‘(his) former opinions with respect to Charles Gatlin be refused and that Charles Gatlin be reassessed for residual effects of TBI by a neuropsychologist having qualifications consistent with the criteria set forth by the National Academy of Neuropsychology,’” it added. “As stated previously, Dr. Bateen was qualified to conduct the TBI residual examination for VBA in this case.”

Meagan Lutz, a VA spokeswoman in Washington, D.C., said last week that while Bateen remains employed by the VA at Fort Harrison, he is not using the RBANS screening tool or assessing veterans for TBI.

With a growing sense of frustration, Del Negro, Gatlin’s wife, wrote directly to VA Secretary Robert McDonald, who recently took office with a pledge to reform the giant bureaucracy.

“I remain disappointed that the same level of public scrutiny and attention applied to healthcare operations has not also focused on the profound problems underlying disability benefits,” she wrote. “The financial strain placed upon veterans and their families as a result of inadequate, incompetent, and deliberate lowering of disability claims is untenable.”

Del Negro noted that Bateen said he had performed the same screening procedure on “hundreds of vets” and asked that McDonald order a comprehensive re-examination of all of them.

“On behalf of these other veterans and their families, I am asking for your help to ensure that the Fort Harrison VA (and all deciding members) uphold their duties to veterans and their families who may have been harmed by the actions of Dr. Bateen,” she wrote. “It is our hope that instead of expecting veterans to file new claims or appeals, the system will initiate a proactive approach to identify affected veterans and perform a records review and/or re-evaluation, as appropriate.

“Of note, the issues at play here specific to conducting C&P TBI exams are not unique to Fort Harrison,” Del Negro added. “They are endemic.”

Why is it so hard for a decorated war vet to get help from the VA, she asked.

“It is unfortunate that my husband and I find ourselves at war with a system that is supposed to fight for the veteran and his/her family, not against them,” Del Negro wrote, appropriately enough on Veterans’ Day.

“The appeal process for us has taken its toll. Charles and I have been fighting our claim since 2011. The ongoing financial strain placed upon us has been extremely difficult. The amount of energy and time devoted to fixing this situation has been exhausting. We have faced significant backlash, impropriety, and what I believe to be deliberate undermining by the system.”

In a telephone interview last week, Del Negro let a little of the frustration and pain out.

“This has been awful,” she said. “It has permeated every aspect of our existence, and it has exacerbated the impact of my husband’s brain injury. We’ve been living breathing and bleeding the VA every day, morning noon and night.”

Independent filmmaker Karen van Vuuren has produced a documentary that clearly shows that spiritual damage is a major part of post-traumatic stress disorder. That reality, unfortunately, is not yet recognized by most of the medical community.

“People have talked about PTSD as a brain injury, but I see it as a soul wound. And unless this is addressed as a soul injury, real healing is not possible,” van Vuuren told me this week from her home in Boulder, Colo.

“Go in Peace” was largely filmed in a soldiers’ home in Sandusky, Ohio, watching as hospice therapists tried to help aging vets suffering from PTSD put their lives in order during their final days.

In addition to some moving interviews with vets who talked about the pain, loss, grief and guilt that they experienced in combat, the documentary features two expert commentators: Dr. Ed Tick, founder of the non-profit Soldier’s Heart and author of “War and the Soul,” and advanced registered nurse practitioner Deborah Grassman, co-founder of project Soul Injury and author of “Peace at Last.”

Together, they talk about the causes of PTSD, which Tick has re-named “post-terror soul distress.”

One central conclusion is that soldiers are forced to take actions in combat so contrary to their own core values that they lose their sense of identity. That forces them later to try to construct a new, positive identity, one that includes their previous experiences.

But Grassman points out that most soldiers fight for two things: cause and comrades. Ever since Vietnam, many soldiers have felt there was no good reason to be fighting someone else’s civil war in a foreign country. And most of them have lost some of their comrades in combat and feel guilty that they came home when the buddy they were supposed to be looking out for didn’t.

Therein lies the problem, according to “Go in Peace.” To heal, a vet has to want to heal, and many feel they don’t deserve it.

The solution in many cultures involves purification rituals that allow vets to rejoin society again without stigma. Vets need to forgive themselves, and that frequently involves redemption and atonement by doing something to make the world a better place.

That’s a neat summary of what I’ve come to call the “wounded soul syndrome,” which has not yet been recognized by the medical community as a major component of PTSD – but which should be.

“Go in Peace” also addresses the isolation that many vets experience because they feel they can’t talk about what they’ve been through and what they’ve done. In reality, the film says, that’s because society has turned its back on the vets, not having the strength to listen to what they so badly need to say.

“As a culture, we don’t want to know what these vets have been through,” notes van Vuuren. “And they recognize that we don’t want to know so they don’t want to tell us.”

Van Vuuren credits her father Jack as being the inspiration of her film. A World War II vet who suffered all his adult life with undiagnosed and untreated PTSD, Jack told his daughter in his final days that at age 14, he and a friend had strangled a Nazi soldier in their village in occupied Holland before fleeing to join the Allied forces.

“My father told me that the teenage German guard he killed was not much older than he was and ‘probably didn’t know why he was there.’ But, as my dad put it, ‘He was the enemy, and we had to take him out,’” van Vuuren says on her Web page, https://www.indiegogo.com/projects/go-in-peace-transform-a-veteran-s-life-film

“Jack had never shared anything about his wartime experiences,” she adds. “His ‘confession’ woke me up to all he had carried inside for all those years, and to my inability to recognize his grief and to create a safe environment for healing. In telling me this story of such an intimate killing, my father recognized, maybe for the first time, the human being in the first person he had killed. His sharing was a tacit plea for forgiveness.”

Now the film is beginning to be shown at conferences, but her goal is to raise funds for additional studio production to make it as good as it can be, then to make it available as a free resource for professional caregivers and families of veterans. Ultimately, she’d like to tour with the film and make it available to audiences around the country so that vets can find relief for their spiritual wounds.

“Treating PTSD with medication and not as a spiritual illness reflects the medical model, not the holistic approach, and that doesn’t work,” says van Vuuren.

There’s a landmark new state ruling out that sets a precedent with national implications for veterans. A state licensing board in Montana has barred a psychologist working for the VA at Fort Harrison from evaluating veterans for traumatic brain injuries.

The Montana Board of Psychologists ruled this month that Robert Bateen was not qualified to provide a neuropsychological assessment of Charles Gatlin, a University of Montana graduate student, and that he failed to provide an adequate standard of care.

And it rejected Bateen’s contention that he was merely following VA policy.

“Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” said the state licensing board.

“The implications of this ruling are enormous,” Gatlin’s wife, Ariana (cq) Del Negro, said Tuesday. “Not only does it establish a pathway for VA accountability, it also serves to protect the interests of veterans and their families going forward and provides just cause to re-examine the hundreds of other veterans who may have also been wronged by Bateen’s unlawful practice, including from years ago.

“Given that the Board pointed to obvious shortcomings in the VA’s own procedures, I would hope that this ruling also serves as a catalyst for VA reform across the country,” Del Negro added.

The VA at Fort Harrison did not return several calls seeking comment.

Gatlin, a former infantry captain, received head injuries when a truck bomb exploded near him on Sept. 28, 2006.

“He was exposed to three concussive forces: first the explosion; then the engine block from the vehicle which struck him in the back of the head as he was thrown into the air; and finally when he hit his head again after falling to the ground on his back, where he remained unconscious for at least 10 minutes,” Del Negro testified before the Senate Committee on Veterans Affairs.

After undergoing extensive batteries of neuropsychological testing in 2006, 2007 and 2009, Gatlin was discharged from the Army with a 70 percent rating for TBI.

But the VA basically ignored the Department of Defense tests. Bateen, who received a doctorate degree in clinical psychology from the University of North Dakota in 1975, administered a brief screening assessment called RBANS (Repeatable Battery for the Assessment of Neuropsychological Status).

Based on that assessment tool, Bateen dropped Gatlin’s TBI rating from 70 to 10 percent, then added another 30 percent disability for post-traumatic stress disorder (PTSD). Gatlin challenged that ruling before the VA Board of Appeals in Washington, D.C., last year, but there’s been no ruling yet.

However, the Montana Board of Psychologists ruled Sept. 4 that using RBANS was improper because it does not test executive function or motor skills.

“Because complainant’s medical history established that he had a TBI and had significant deficits three years post injury, it was improper for licensee to use RBANS as the testing instrument to determine complainant’s cognitive functioning and to use it for the basis to formulate his evaluation conclusions” it said.

Furthermore, Bateen mischaracterized Gatlin’s assessment score, saying it was in the average range when it actually was in the low average range, the state board said.

“Licensee is not a clinical neuropsychologist and is not qualified to provide neuropsychological services,” the state hearing board said. Although Bateen has completed the Traumatic Brain Injury Course and the CPEP Traumatic Brain Injury Examination TBI Combo, “none of the foregoing is sufficient education, training, or experience to qualify a clinical psychologist for the practice of neuropsychology. Licensee is not trained in neuropsychological assessment.”

As a result, Bateen’s assessment of Gatlin violated five state administrative rules, it said.

In a stipulation signed by Montana Labor and Industry Department Counsel Tyler Moss, Bateen, and his attorney, Assistant U.S. Attorney Victoria L. Francis of Billings, the parties agreed that release of the agreement would serve as a public reprimand of Bateen. Francis did not return a call seeking comment Tuesday.

“Licensee is hereby prohibited from engaging in psychological evaluations involving or affecting TBI assessment without first obtaining additional training as approved by the board,” the stipulation said.

“Licensee shall recommend to the VA that based upon these proceedings and the findings and conclusions entered pursuant to this stipulation, licensee’s former opinions with regard to Charles Gatlin be refused and that Charles Gatlin be reassessed for residual effects of TBI by a neuropsychologist having qualifications consistent with the criteria set forth by the National Academy of Neuropsychology,” the stipulation concluded.

That final recommendation was the most significant of the entire stipulation, Del Negro said.

“With that recommendation, the state asserts its rights over the VA, thus establishing a working pathway for VA oversight that can be duplicated throughout the country,” she said. “In short, this ruling emphasizes that clinicians working within the VA system must uphold standards of care independent of whether the VA tells them not to.”

Del Negro noted that this ruling sets a precedent for any federal employees, including doctors, licensed by the state.

The Montana Board of Psychologists accepted the stipulation, saying: “The board, giving primary consideration to the sanctions that are necessary to protect and compensate the public and secondary consideration to any sanctions designed to rehabilitate Robert J. Bateen, approves, adopts and incorporates the stipulation into the final order.”

There are some fascinating new medical studies out that link heightened anxiety levels to deficits in new brain cell development.

“This realization could lead to novel approaches to treating a variety of anxiety disorders, including post-traumatic stress disorder (PTSD), because people who suffer from such conditions have trouble telling the difference between situations that merit fear and those that are innocuous,” say two Columbia University neurology professors, Mazen A. Kheirbek and Rene Hen, writing in the July 2014 issue of Scientific American magazine.

For years, scientists believed that adult humans stopped producing new neurons, but then about 20 years ago, evidence from the brains of adult rodents, monkeys and even humans showed that new neurons are being produced continuously in two areas of the brain, one of which is involved with smell and the other involved in learning, memory and emotion.

According to Kheirbek and Hen, one of the learning and memory functions that appear to involve new neurons involves pattern completion, which is laying a memory down so that it can be retrieved. The other involves pattern separation, which is recording details of an event so that it can be distinguished from other events.

The neurologists tested their theory in lab mice by shutting down neurogenesis, or the production of new neurons, in some mice and boosting it in others. Then they took the mice from their safe home cage and put them in another cage in which they got a mild electric shock.

“Animals lacking new neurons remained overly skittish, reacting in alarm in both environments, even after repeated trips to the harmless box proceeded without incident,” they reported. But that didn’t happen with mice with an increased number of new brain cells.

Several other studies have also shown that mice lacking in new neurons have been unable to distinguish between safety and danger, the neurologists said.

“If neurogenesis is, in fact, involved in pattern separation in humans, the finding could offer insights into the cause of anxiety disorders such as PTSD,” said the article, Add Neurons, Subtract Anxiety. “Psychologists have long suspected that the overgeneralization of memory contributes to anxiety disorders, which are marked by an exaggerated, sometimes crippling, fear response, even when the environment holds no immediate threat. Such inappropriate generalization could be the result of a diminished ability to distinguish between a past trauma and an innocuous event that shares some similarity with the traumatic event – for example, a picnic that is interrupted by a unexpected loud noise.

“Individuals with a normal capacity for pattern separation might flinch at the sudden boom but quickly realize that the park is not a war zone and continue with their lunch,” it said. “A veteran with impaired ability to carry out pattern separation, on the other hand, may be unable to separate the sound of a car backfiring from the memory of a battlefield – a mistake that could precipitate a full-blown panic attack.”

Researchers have found that most humans continue to add about 1,400 new brain cells per day to the hippocampus well into old age. While the authors speculated about a deficit in neuron production, they suggested no reason why so many vets would be experiencing this disorder.

They did, however, explain what cures the condition: exercise. Mice running on a wheel in their cages showed increased rates of neurogenesis.

And that may well explain why vets who are kayaking, whitewater rafting, hiking and mountain climbing are able to alleviate the symptoms of PTSD. They’re producing more new brain cells and reducing their anxiety levels.