Back from Iraq with Plenty of Problems

Paul Miles returned from Iraq needing help with the death in his head. He got prison.

Seeking leniency in Miles's sentencing, Voldberding collected sworn statements from 38 friends and relatives attesting to Miles's character before the war. These included Boy Scout leaders, elementary schoolteachers and clergy. One glowing statement came from Robert Allen Jr., the administrator of a pre-vocational center for mentally retarded adults in Shreveport. He wrote that Miles volunteered to play Santa Claus at the center on at least two occasions.

"He gave out gifts, went from table to table talking to clients, made snapshots with each person and generally helped the MR clients to have a positive and memorable experience," Allen wrote. "Very few 18-19-year-olds would have reached out to others this way."

Which is all well and good, but John Ratcliffe, U.S. Attorney for the Eastern District of Texas, is quick to point out that "prior military service is not a license to commit crimes." (Lisa Flournoy, the prosecutor who handled the case, declined to comment for this story).

Miles blogged that Iraqi children were the only signs of "innocence" he saw during his tour.
Photos Courtesy Curtis Miles
Miles blogged that Iraqi children were the only signs of "innocence" he saw during his tour.
Miles and his sister went on a Christian mission to Moldova in 2006.
Photos Courtesy Curtis Miles
Miles and his sister went on a Christian mission to Moldova in 2006.

Ratcliffe says he was well aware of the campaign to paint Miles as a man in need of treatment, not incarceration. He says he received countless e-mails, letters and phone calls urging him to drop the charges. He also received calls from the media and he told at least one newspaper that he was not in the position to give Miles "a pass" — a rather odd statement, since, as the head prosecutor, he's the one who decides whether or not to charge someone.

He also mentioned that Miles certainly had the right to present a PTSD-based defense before a jury — a right he waived when he never got that diagnosis.

"Mr. Miles, like every criminal defendant, had every right and opportunity to tell and convince a jury that he did not commit a crime or that he had some medical condition that excused his crime," Ratcliffe says. "Mr. Miles chose not to present evidence at trial to justify or excuse his conduct. Mr. Miles chose to plead guilty to the crime that he committed, and he was sentenced according to the law."

Moreover, he added that "my understanding is medical experts examined Mr. Miles and reviewed his records and history and those experts determined that...he did not have post-traumatic stress disorder, that he is in fact bipolar, but that is a condition that is not and cannot be caused by military service."

(Ratcliffe is correct: Bipolar disorder is genetic. However, military service can potentially exacerbate preexisting conditions. Sleep deprivation, for example, can trigger manic episodes.)

One stumbling block in this area is the U.S. Department of Defense-mandated Post-Deployment Health Assessment given upon demobilization. To start with, the assessment only screens for PTSD, depression and substance abuse. It only asks about any troubling thoughts a person has had in the last month. To really drive that one home, "in the last month" is in all caps. Any nightmares or feelings of detachment from others that occurred, say, 32 days earlier instead of 31 do not count.

According to joint Department of Defense/Department of Veterans Affairs guidelines, service members who respond positively to at least three out of four specific questions may be at risk for PTSD. However, DOD health care providers make the final call as to who in the at-risk population is flagged for further evaluation. (A 2004 study in The New England Journal of Medicine estimates that 15 percent of service members deployed to Iraq and Afghanistan may develop PTSD. The U.S. Government Accountability Office has used that percentage in its analysis of VA services).

A 2006 report from the GAO stated that, because there is no protocol for these health-care providers to follow, it is difficult to measure whether those who need treatment will get it. In reviewing the health assessments of close to 180,000 service members, the GAO found that 5 percent were at risk for PTSD, yet only 22 percent of those were referred for further evaluation. The percentage of those referred also varied among military branches. "DOD cannot provide reasonable assurance that [Iraq and Afghanistan veterans] who need referrals receive them," the 2006 report states.

Other GAO reports claim that the VA has responded sluggishly to recommendations its own Special Committee on PTSD has issued since 1985.

"Officials at six of seven medical centers told us that they may not be able to meet an increase in demand for PTSD services and...the VA Inspector General found that VA's PTSD capacity data are error-prone and inadequately supported," a 2004 GAO report states.

And while the DOD/VA assessment only screens for PTSD, the Iraq Clinician Guide states that deployed psychiatrists should be aware of signs of other mental illnesses.

"Clinicians should keep in mind that most combatants are young and that it is during the late teens and early twenties...when vulnerable individuals with family histories of psychopathology...are at greatest risk for psychological decomposition...caused by the stress of war. As a result, a very small number of veterans of the Iraq War may present with stress-induced severe mental illness."

According to the Guide, "currently deployed psychiatrists report good success in treating ASD [Acute Stress Disorder], PTSD, and depressive disorders...Only those military patients with psychotic symptoms, bipolar disorders and suicide risk are evacuated to a higher echelon of care."
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