PTSD can be both a specific disorder and a

metaphor for all deployment- and stress-related

disorders and difficulties. Veterans with severe,

or even moderate, and persistent symptoms of

PTSD, and everyone who has had professional

or personal contact with them, must recognize

the suffering and disability it can cause. VA

research has led to effective strategies for

diagnosis, treatment, and rehabilitation. But this

isn’t the whole story. In addition to PTSD, deployment and related stresses can give rise to other

mental health conditions, a spectrum of milder

and more self-limiting conditions, and problems

in returning and readjusting to the family,

work, education, and life in the community.

Although America has not yet reached the

point where mental illness is free from stigma,

the media and the public are starting to recognize that, no matter how strong and well

trained, our service men and women can be

vulnerable to PTSD. Framing requests for care

in terms of PTSD may make it easier for some

veterans to come to the VA for help. Therefore,

one of the first steps in evaluating veterans

who express concerns about PTSD must be to

determine whether or not they have it. They

may. But they may have depression or panic

disorder or generalized anxiety or a selflimiting adjustment disorder or symptoms

related to mild traumatic brain injury or mild

and non-specific symptoms of stress. Moreover, it isn’t “either-or.” All too often, veterans

may have two or three of these conditions. 

While the media and the public may not make

these distinctions, providers must. People who

are concerned that they may have PTSD

require and deserve comprehensive clinical

evaluations. They may have PTSD, some othe

condition, or they may have a normal reaction

to abnormally stressful and difficult experiences. Regardless, the VA is here to provide

care for them.

PTSD is the most common of the provisional

mental health diagnoses in those returning

veterans who are seen in medical facilities.

From the start of the conflict in Afghanistan in

2002 through the end of September 2006, th

VA saw about 34,000 veterans with a provisional diagnosis of PTSD in its medical center

and clinics. This figure represents about 10

percent of the number of veterans with PTSD

who are seen in VA medical centers and clinic

in any given year. Although the number of

these patients is substantial, they are by no

means flooding the VA system. 

Many returning veterans with symptoms of

PTSD have been seen in both medical facilitie

and Vet Centers, and an additional 5,000 have

been seen only in Vet Centers. The medical

facilities and the Vet Centers complement eac

other in providing mental health care. In a

sense, the VA has two separate but interacting

mental health systems for combat veterans.

Most basically, the medical facilities provide

treatment for mental health conditions, either

in mental health specialty services or, increasingly, in primary care. In contrast, the Vet

Centers provide counseling for mental health

problems, focusing on readjustment issues.

Both systems provide evidence-based 

FORUM

Post Traumatic Stress Disorder (PTSD) as Metaphor

By Ira R. Katz, M.D., Ph.D., Deputy Chief Patient Care Services Officer for Mental Health, Office

of Patient Care Services

Contents

Director’s Letter 2

Response to Commentary 3

Research Highlights 4

HSR&D National 

Meeting 7

May 2007 VA Health Services Research & Development Service

A publication of the VA Office of Research 

& Development, Health Services Research 

& Development Service, Center for

Information Dissemination and Education

Resources, in conjunction with AcademyHealth

translating research 

into quality health care

for veterans

continued on page 
2 ■ Forum/May 2007

Director’s Letter

psychotherapy for PTSD. With two systems,

and two ways of providing care, the VA is

more likely to reach those in need.

Who are the veterans with provisional diagnoses of PTSD? These veterans’ symptoms

led a provider to enter a diagnosis or a “rule

out” diagnosis on the medical record on at

As this, my first FORUM letter goes to press, I am fast

approaching my six-month anniversary as Director of VA’s

Health Services Research and Development Service (HSR&D).

It is an exciting and challenging time for me and I am proud to

follow in a long line of outstanding Directors that includes

Peter Goldschmidt, Dan Deykin, and more recently John

Demakis. I hope to build on their experience and leadership. 

I am an epidemiologist by training and I have been a

clinician/researcher in VA since the late 1970s. My first HSR&D

funded project was born out of work with colleagues at St.

Louis VA and Washington University, when we came up with

the idea to develop a patient pill monitoring device to evaluate

the role of medication adherence on blood pressure control. Since that time my research

interests have evolved from examining patient and provider behavior, to examining the short

and long term effects of war on medical and psychiatric health, examining medication

adverse effects, and now addressing pharmacogenomic related issues. 

Ensuring data security and protection, always a major component of VA research, has been

an especially high priority in my first few months as Director. VA has adopted new security

policies and procedures, security training has been mandated, and all investigators have 

certified their commitment to the highest standards of protection. While challenging, this

thorough privacy and security review and enhancement will improve our systems and ensure

that we are doing all that we can to protect the privacy of the veterans we serve and to 

preserve their trust in us. 

Another part of my role as Director—and one that I find immensely informative—is the

review of all HSR&D manuscripts accepted for publication. These manuscripts are submitted

by our investigators and I review each to determine which might require special briefings for

VA senior leadership. In just my first few months, I received more than 80 manuscripts on

diverse topics such as the Gulf War, diabetes, and health care disparities that were accepted

for publication in all sorts of journals. It is clear to me from this amazing productivity that VA

HSR&D investigators are among the top investigators in the nation. 

This was certainly evident in March, when the Scientific Merit Review Board reviewed 128

proposals. Of these, we expect to fund 26. In addition, we expect to fund 12 of the 39 excellent applications for Career Development Awards. I encourage all VA investigators to keep

sending us your high quality research proposals and notification of articles accepted for 

publication. Your efforts continue to improve the health and care of veterans. I look forward

to working with you. 

Seth A. Eisen, M.D., M.Sc.

Director, HSR&D

least one occasion, including many for

whom the diagnosis reflects the patients’

concerns. Many of these veterans do have

PTSD, but not all. What sort of care should

the VA provide? The VA should provide the

care the veterans need and want as determined by diagnoses and findings derived

from clinical evaluations, as well as their

preferences and values. For some, it may b

provided in specialty mental health care se

tings; for others, it may be provided in

primary care; and for still others, it may

involve readjustment counseling in Vet

Centers.

What about veterans without specific diagnoses or problems? Here, there is a need to

balance reassurance with caution.

Sometimes providers underestimate the

importance of telling patients that their

responses are normal, and that they are

okay. However, we also need to recognize

that PTSD can have a delayed onset, maybe

more frequently in patients with mild and

non-specific symptoms, and that even

milder symptoms, when persistent, can

take a toll. Care for these veterans should

include education about stress and

resilience, information about available

resources and the effectiveness of treatment, and ongoing monitoring of both

symptoms and day-to-day functioning. 

PTSD can be a serious illness, but there is

much more to the mental health of returning veterans than the identification and

treatment of PTSD. The VA’s focus on clin

cal programs and research on PTSD is

important, both for returning veterans and

the country as a whole. So is its attention t

the rest of the story. ■

“In addition to PTSD, deploymen

and related stresses can give rise

to other mental health conditions

a spectrum of milder and more

self-limiting conditions, and prob

lems in returning and readjusting

to the family, work, education, an

life in the community.”
Forum/May 2007 ■ 

Response to Commentary

The Returning Veteran: Research Required 

By Josef I. Ruzek, Ph.D., National Center for PTSD, VA Palo Alto Health Care System

Dr. Katz reminds us that while the label

post traumatic stress disorder or “PTSD”

can be applied in a narrow technical sense,

it often serves as a broader metaphor representing an array of post-deployment 

difficulties that can challenge veterans.

Our task is to help veterans with a range of

post-deployment problems in living, not

just with PTSD. If we are to do this, it is

crucial that research be used to help us

better understand what is happening to

veterans in their “readjustment” environments: in the family, at work, at school,

and in the larger community. 

Readjustment Tasks

What happens in the family interactions of

those with PTSD and other post-deployment

problems? What is the process through

which couples cope with stressors and

mental health symptoms? How do mental

health problems affect workplace performance? What determines variation in work

functioning among those experiencing significant symptoms? Why do some veterans

cope well after deployment, especially those

who do well in the face of continuing mental

health symptoms? The broader impact of

PTSD symptoms and other trauma-related

problems in various domains of functioning,

and the processes by which those problems

affect functioning, has not received the

degree of research attention necessary to

inform efforts to improve outcomes. 

Clinically-Relevant Research

Dr. Katz alerts us to the need to provide

comprehensive care, and most of the

issues that he highlights can only be

addressed adequately if we know something

about them, that is, if research is mounted

that describes and models them. If we are

to provide effective care and function as a

learning organization that can systematically improve its processes, we will need

research examining veterans’ and 

families’ perceived needs, treatment preferences, perceptions of stigma, and mental

health help-seeking behaviors. We will need

to know more about approaches to patient

education, family involvement in treatment,

psychological and pharmacological interventions, and aftercare/relapse prevention.

We will need an expansion of research on

assessment methods to encompass not only

traditional topics like differential diagnosis,

but also the processes by which assessment

information is used to inform treatment

planning and implementation. 

Integrated Treatments, Partial PTSD,

and Dissemination Are Top Priorities

Most of our veterans have more than one

problem, so that treatment of co-occurring

disorders (e.g., PTSD and depression, panic

disorder, generalized anxiety disorder, or

traumatic brain injury) will be the rule

rather than the exception. In recent years,

integrated treatments for PTSD and substance abuse have received increasing

research attention, and it is important to

accelerate this trend within a range of comorbidities. Studies will be needed as well

to better investigate the impact of subthreshold or partial PTSD, so that those

without diagnosable disorders who

nonetheless experience difficulties after

deployment will get the help they need. 

The increasing evidence base on treatment

for PTSD and other mental health problem

has charged us with developing and studying systems for dissemination of empirically-supported practices. But this is a relativel

new field, inside and outside the VA, so tha

researchers can make significant contributions by studying dissemination methodolo

gies and a large set of issues related to the

dissemination task (e.g., the degree to

which evidence-based treatments can be

modified for the real-world of treatment

delivery without diminished effectiveness). 

Towards Systematic Treatment

Improvement

Evidence-based care will also require development of more sophisticated systems with

in VA mental health for the ongoing monitoring of symptoms and functioning, and

for outcome measurement. Dr. Katz also

notes that our patients may be seen in primary care or mental health clinics, in VA

service settings and Vet Centers. What is th

nature of the care that is being offered in

those treatment environments, and what

variables influence the effectiveness of that

care? What determines how our veterans

move through the system, and how do the

parts of the system interrelate? How can

they be made to complement one another? 

Arguably, we need much more research spe

cific to our veteran population and to our

health care system. But that research must

be designed specifically to inform the devel

opment of our helping interventions and

systems of care; it must focus on issues and

variables susceptible to deliberate change,

and as Dr. Katz argues, address a full range

of post-deployment problems in living,

including PTSD. Many believe that research

must influence practice. Now is the time fo

researchers to demonstrate their central

importance to the systematic improvement

of services. ■
Screening is an important aspect of prevention and early intervention for many diseases and conditions. The World Health

Organization describes ten criteria for initiating a screening program. Below, we discuss each criterion along with issues that

should be considered in the VA for clinically

effective post traumatic stress disorder

(PTSD) screening.

The condition should be an important health

problem. With prevalence in the VA of

approximately 11.5 percent, PTSD is considered an important health problem for veterans. Veterans with PTSD have significantly

worse functioning status in every domain

when compared to their counterparts who

do not suffer from this condition. PTSD

prevalence in the VA is likely growing due

to the influx of veterans who served in

Southwest Asia and the fact that those with

PTSD may disproportionately seek VA care.

A recent study found that 13 percent of

Operations Iraqi Freedom (OIF) and

Enduring Freedom (OEF, Afghanistan) veterans had a clinical diagnosis of PTSD. The

true prevalence is likely higher.

There should be a treatment for the condition.

Effective treatments exist for PTSD, including cognitive behavioral therapy and medications (especially SSRI’s). The VA and

DoD have jointly published treatment

guidelines that recommend implementation of evidence-based practices.

Facilities for diagnosis and treatment should be

available. Within VA, there are PTSD and

mental health specialty clinics with excellent capability for PTSD diagnosis and

Research Highlights

Post Traumatic Stress Disorder: To Screen or

Not to Screen

By Kathryn M. Magruder, M.P.H., Ph.D., and Derik E. Yeager, M.B.S., both with the Ralph

H. Johnson VA Medical Center, Charleston, South Carolina, and the Medical University of

South Carolina

treatment. Their capacity, however, is limited and will be sorely taxed as routine

screening is implemented and as the VA

“catches up” on PTSD screening for veterans of all war eras—not just those who

served in OIF or OEF.

There should be a latent stage of the disease.

It is unclear whether actual symptoms of

PTSD worsen over time; however, previous

studies found an increased risk of both

medical comorbidities and psychiatric

comorbidities, especially substance use disorders.

There should be a test or examination for the

condition. A number of excellent screening

tools exist, including the PTSD Checklist

(PCL), the SPAN, and the four-item Primary

Care PTSD Screen (PC-PTSD). In addition,

there are diagnostic tools such as the

Clinician Administered PTSD Scale (CAPS),

as well as the PTSD modules of the

Structured Clinical Interview for DSM-IV

(SCID) and the Composite International

Diagnostic Interview (CIDI).

The test should be acceptable to the population.

Though the diagnostic tools may be lengthy

and may bring up unwanted memories for

some patients, they are considered acceptable in terms of risk and time.

The natural history of the disease should be

adequately understood. Veterans with the

most severe immediate post-traumatic reactions are at greatest risk for chronic PTSD.

While the course of PTSD may vary with

relapses and remissions, many veterans will

remain symptomatic—some for decades

after exposure to a traumatic event.

4 ■ Forum/May 2007

There should be an agreed policy on whom to

treat. In theory, all VA patients who qualify

for a PTSD diagnosis could be treated.

The total cost of finding a case should be economically balanced in relation to medical

expenditure as a whole. Given the relatively

inexpensive screening procedure, the VA in

house capabilities for diagnostic follow-up,

the relatively moderate cost of treatment,

and the medical and psychiatric problems

that are apt to result from lack of treatmen

it is likely that the economics will favor

screening for PTSD.

Case-finding should be a continuous process.

Several studies have shown that PTSD can

occur as many as 20 years following the in

tial traumatic exposure. For OIF/OEF veter

ans, peak symptom expression may be month

or even years following deployment. Thus,

it is important to have in place a system

that will screen throughout the lifespan.

Many veterans are still unwilling to accept 

diagnosis of or treatment for PTSD.

Clinicians need to explain screening and

diagnostic results in a way that is non-stigmatizing. Providers must offer educational

information and motivate veterans to accep

treatment. Capacity is yet another problem

at PTSD and mental health specialty clinics

Building capabilities in primary care may

help to ease both problems, as treatment in

primary care is less stigmatizing, more

timely, and more integrated into overall

healthcare. As the VA implements screening for PTSD, consideration of these issues

will help to build a more effective, comprehensive program. ■

VA/DoD Clinical Practice Guideline for 

the Management of Post Traumatic Stress

available at www.oqp.med.va.gov/cpg/PTSD

G/ModB_Sum508.pdf.
Forum/May 2007 ■ 

Joe is a 24 year-old retired marine who was

stationed in Baghdad. During his tour, he

witnessed the deaths of several close comrades. When a roadside bomb exploded outside of his vehicle he sustained a head

injury. Now home, he experiences daily

headaches and poor concentration, which

have limited his ability to find work. He

feels that he is a failure. He has become

depressed, has disturbed sleep, intrusive

thoughts related to combat, and increased

anger and irritability. He feels that he

should be strong enough to “deal” with his

problems himself and has been embarrassed to seek mental health care. 

Unfortunately, Joe’s problems are common.

Reports in the medical literature and media

have highlighted the emergence of mental

health disorders, particularly post traumatic

stress disorder (PTSD) among veterans of

Operations Iraqi Freedom (OIF) and

Enduring Freedom (OEF, Afghanistan)

(Hoge et al., 2006; Seal et al., 2007). In

contrast to PTSD, depression has been less

well described in this new generation of

combat veterans. Historically, among male

Vietnam era combat veterans, rates of

depression were three times higher than

among civilian men (Jordan et al., 1991). 

Risk Factors for Depression vs. PTSD

Certain combat experiences may be more

likely to produce depression than PTSD.

These include the loss of comrades, isolation, physical hardships, and personal

injury. On returning home, coping with

new physical problems and disabilities,

changes in core relationships, unemployDepression in Veterans Returning from Iraq and

Afghanistan

By Karen H. Seal, M.D., M.P.H., Shannon E. McCaslin, Ph.D., and Charles R. Marmar, M.D.,

San Francisco VA Medical Center

ment, financial stress and PTSD itself may

pre-dispose veterans to post-deployment

depression. These risk factors are in contrast to factors more likely to produce acute

stress and/or PTSD such as witnessing or

personally experiencing a life-threatening or

traumatic event. Individual veterans, such

as Joe, may have experienced a combination

of risk factors predisposing them to depression, PTSD, or some combination of the two.

Joe’s symptoms of headache and poor concentration following a blast injury are suggestive of traumatic brain injury (TBI).

Depression has been shown to occur in 25

to 50 percent of patients with TBI (Jorge et

al., 1993) and may represent either primary

neurogenic symptoms of TBI and/or psychiatric symptoms secondary to TBI. Depression associated with TBI may manifest as

lack of initiative, impaired emotional expressiveness, lower crying threshold, and fatigue. 

The natural history of depression, PTSD,

and co-morbid depression and PTSD varies.

O’Donnell et al. (2004) found that depression alone is more likely to remit than

either PTSD alone or comorbid depression

and PTSD. Grieger et al. (2006) found that

among OIF/OEF soldiers who had sustained severe combat-related physical

injuries, 79 percent of those screening positive for PTSD and depression at 7 months

had not yet met criteria for either disorder

one month after their injury. These findings

highlight the importance of repeated

screening for both depression and PTSD

several months post-deployment.

Evidence-based early treatment of depression, PTSD, and co-occurring disorders may

be combined effectively to prevent chronic

mental illness. Selective serotonin reuptake

inhibitors (SSRIs) are considered first-line

pharmacotherapy for both PTSD and

depression. Cognitive behavioral therapies,

which have demonstrated effectiveness for

the treatment of both isolated depression

and PTSD, have also been shown to

decrease co-morbid symptoms in veterans. 

New Approaches Needed

Despite the availability of evidence-based

treatments for combat-related depression

and PTSD, Hoge et al. (2004) noted that

only a minority of OIF/OEF soldiers and

marines who screened positive for psychiatric disorders had received mental health

care, largely due to stigma. In fact, stigma

regarding mental health treatment was

shown to be greatest among personnel

most in need of care. Stigma, as well as

other barriers to care, highlights the need t

develop new approaches to identification

and provision of mental health treatment.

Integrating mental health into the primary

care setting as well as internet or telephone

based psychotherapy has become increasingly important in the treatment of depression and PTSD.

A significant number of returning

OIF/OEF veterans such as Joe will suffer

from depression and/or PTSD with or with

out concurrent TBI and will be reluctant to

seek traditional mental health care. The VA

is on the forefront of supporting translational research to test and implement nove

approaches to increase early mental health

treatment engagement and retention

among OIF/OEF veterans. Continued support of these research and clinical endeavors ensures that veterans, such as Joe, do

not develop chronic mental illness and disability. This, in turn, may prevent unnecessary personal suffering, costs for the VA,

and public health burden. ■
Research Highlights

Substance Use in OIF/OEF Veterans: Substance

Use Disorder (SUD) QUERI Initiatives

By Patrick Calhoun, Ph.D., VISN 6 MIRECC and Durham VAMC, Lisa Najavits, Ph.D.,

National Center for PTSD and Boston VAMC, Thomas Kosten, M.D., SUD QUERI and

Houston VAMC, Daniel Kivlahan, Ph.D., SUD QUERI and VA Puget Sound

6 ■ Forum/May 2007

The mental health needs of our newest veterans include not only post traumatic stress

disorder (PTSD) and depression but also cooccurring and independent substance use

conditions. Recent Department of Defense

(DoD) data on active duty personnel suggest

that we need to anticipate substance use

problems among returning veterans.1

Thirty-two percent of the active duty personnel surveyed by DoD reported current

smoking and, among those, 40 percent

indicated that they intend to quit in the next

six months. This finding suggests the

importance of following VA policies to offer

and provide improved access to evidencebased smoking cessation treatments. While

the survey reported less other drug use over

the past month than in age-matched civilians, use of analgesics (3.3 percent) were

most common and three times higher than

use of marijuana (1.3 percent). Given concerns about pain management among postdeployment veterans, analgesic abuse is

likely to warrant immediate clinical attention.

The concern of alcohol misuse in 24 percent

of all anonymous survey respondents (AUDIT

scores > 8) is intensified since almost half

of those under 26 also reported binge

drinking (five or more drinks per occasion)

in the past month. In addition to young age,

service branch (Army and Marine Corps)

and deployment within the last year (e.g.

PTSD risk) predict this binge drinking. 

High Prevalence of Alcohol Misuse

Among Operations Iraqi Freedom (OIF)

and Enduring Freedom (OEF, Afghanistan)

veterans currently receiving VA care, initial

evidence also reflects high prevalence of

alcohol misuse, according to a recent analysis of responses to the 2005 Survey of

Health Experiences of Patients (SHEP).2

Although the 21 percent SHEP response

rate (1508 of 7156 eligible) warrants cautious interpretation, 18 percent of responding OIF/OEF veterans screened positive for

moderate to severe alcohol misuse based on

the AUDIT-C (total score > 4 for women; 

> 6 for men) with an additional 22 percent

screening positive for mild to moderate

misuse. Of all 605 patients who screened

positive, only 31 percent indicated that within the past 12 months a VA health care

provider had advised them to drink less or

to not drink alcohol.

Despite substantial rates of binge drinking,

few (~4 percent) OIF/OEF veterans who use

VA have been diagnosed or treated for a SUD.

Several reports indicate the reluctance of

OIF/OEF veterans to seek SUD care, but

among those veterans with a diagnosis,

approximately one-third have received SUD

specialty care; this figure is consistent with

treatment rates among other veterans with

SUD. The reluctance to seek care may be

decreasing and the number of OIF/OEF

patients treated for SUD has more than

doubled from 1,430 in FY05 to 3,047 in FY06.

Importance of Systematic Screening for

Alcohol Misuse

Together, these data highlight the importance in VA of ongoing systematic screening for alcohol misuse and appropriate clinical follow-up. With active SUD QUERI

involvement, VA has successfully implemented annual screening for alcohol misuse

with the AUDIT-C.3 However, increased

screening alone is insufficient and new per

formance measures are being considered

for FY08 that will emphasize appropriate

follow-up of AUDIT-C screening results.

Other SUD QUERI initiatives are focusing

on the implementation and evaluation of

provider education efforts including a webbased training program in motivational

interviewing led by Ken Weingardt from th

Palo Alto VAMC.

SUD QUERI is actively addressing effective

intervention strategies for OIF/OEF veterans with SUD and comorbid PTSD. Lisa

Najavits of the SUD QUERI is leading

National Center for PTSD collaborators

from Boston and Palo Alto, investigators

from the Mental Illness Research,

Education and Clinical Centers in VISNs 1,

6, 20, and 21, and the VISN 2 Center for

Integrated Healthcare to address co-occurring PTSD and SUD in OIF/OEF veterans.

Her “Seeking Safety” treatment program

for SUD complications of the post-deployment readjustment process is being activel

disseminated by the SUD QUERI throughout VA nationally, and evaluations are ongo

ing. The SUD QUERI will continue to

develop and implement best practice models like hers to effectively identify and treat

SUD in these at-risk veterans. ■

References

1 Bray RM, Hourani LL, Rae Olmstead KL,

et al. 2005 Department of Defense Survey

of Health Related Behaviors Among Active

Duty Military Personnel, December 2006.

2 Calhoun PS, Straits-Troster K, Kudler K.

Prevalence of Hazardous Alcohol Use and

Risk Reduction Counseling Among

OIF/OEF Veterans. Presented at the

National HSR&D Meeting, February, 2007

3 Bradley KA, Williams EC, Achtmeyer CE,

et al. Implementation of Evidence-based

Alcohol Screening in the Veterans Health

Administration. American Journal of

Managed Care 2006; 12(10):597-606.
Forum/May 2007 ■ 

More than 550 researchers, clinicians, and

policy makers participated in VA’s Health

Services Research & Development Service

(HSR&D) 25th National Meeting held

February 21-23 in Arlington, Va. The meeting, with the theme “Managing Recovery

and Health through the Continuum of

Care,” focused on a range of issues related

to improving care across the diverse veteran

population, including the needs of a new

generation of OIF/OEF veterans. The meeting showcased more than 90 paper sessions and workshops, and HSR&D investigators viewed 128 posters on veteran-related

health care issues. 

Hosted by HSR&D’s Rehabilitation

Outcomes Research Center for Veterans

with Central Nervous System Damage

(located in Gainesville, Fla.), the conference

addressed health care issues critical to managing long term recovery, which is particularly important to VA’s newest generation of

veterans, some of whom may face years of

rehabilitation. This urgent topic was

addressed by a panel titled “Changing the

Environment of Care for the Returning

OIF/OEF Veteran.” Other presentations

addressed a myriad of long term care issues,

including hypertension, diabetes, HIV

screening, telehealth applications in cardiac

care, and adherence to antipsychotic medications for those veterans suffering from

serious mental illness. 

Highlights

In his opening remarks, Joel Kupersmith,

M.D., VA’s Chief Research and Development

Officer, described the need for optimal information security, pledging that VA would

play a leadership role in this area. Seth Eisen,

M.D., M.Sc., newly-appointed Director of

HSR&D, reviewed HSR&D research priorities, including implementation, equity, mental health, women’s health, long term care,

research methodology, and genomics.

Seriously wounded in Iraq in 2003,

Captain, U.S. Army (retired), Jonathan

Pruden shared with participants his personal story of a lengthy recovery that required

20 surgeries. Captain Pruden described the

lessons he has learned from his own experience and in his advocacy work with wounded veterans. He emphasized the desire

among today’s young veterans to lead full

lives. Many of these veterans have suffered

amputations and want to do more than

learn to walk. These veterans want to run,

he said. He also urged that VA physicians

outside of specialized polytrauma centers

become familiar with the types of wounds

sustained by OIF/OEF veterans.

A special luncheon talk was given by VA’s

Acting Under Secretary for Health,

Brigadier General, U.S. Army (retired),

Michael Kussman, M.D., M.S., M.A.C.P.

A Recap of the HSR&D National Meeting

Douglas Owens, M.D., M.S., has received this

year’s prestigious Under Secretary’s Award for

Outstanding Achievement in Health Services

Research. The award recognizes a VA

researcher whose work has led to significant

improvements in veterans’ health care, has

made substantial contributions in training and

mentorship, and has enhanced the reputation

of VA research through national leadership in

the health services research field.

The award recognizes Dr. Owens’ research in the areas of HIV and sudden cardiac death. His

influential work helped establish that routine HIV screening is cost-effective, even for low-prevalence populations. These findings played an important role in revision of the Centers for Disease

Control and Prevention’s HIV screening recommendations. Dr. Owens’ research has also

focused on the methodology of guideline development, and on biodefense and bioterrorism. Dr.

Owens is an outstanding mentor and leader, having mentored more than 45 trainees and served

as consultant to national and international health care agencies. Dr. Owens has served as a staff

physician with the Ambulatory Care Department of the VA Medical Center in Palo Alto, Calif. for

the past 20 years.

VA’s Acting Under Secretary for Health, Brigadier General, U.S. Army (retired), Michael

Kussman, M.D., M.S., M.A.C.P., presented the award at the HSR&D National Meeting.

Owens Receives Under Secretary’s Award for Outstanding Achievement

He identified several challenges including

data security and the complex health care

needs of OIF/OEF veterans. Acting Under

Secretary Kussman highlighted the challenges associated with post traumatic stress

disorder and traumatic brain injury (TBI),

and described post-deployment assessment

as an important component of meeting

these challenges. ■

To learn more about research presented at this

year’s National Meeting, visit the HSR&D

web site at www.hsrd.research. va.gov/about

national_meeting/. 

The 2008 HSR&D National Meeting

will be on “Implementation Across the

Nation: From Bedside and Clinic to

Community and Home.” The meeting is

tentatively scheduled for February 20-22

in Washington, DC. Watch the web for

details at www.hsrd.research.va.gov 
FORUM 

Geraldine McGlynn, Editor-in-Chief

Margaret Trinity, Editor

Editorial Board

Peter Almenoff, M.D., Director, VA Network #15,

Kansas City, MO

Martin P. Charns, D.B.A., Director, VA HSR&D

Center of Excellence, Boston, MA

Seth A. Eisen, M.D., M.Sc., Director, HSR&D

Joseph Francis, M.D., M.P.H., Deputy Chief

Research and Development Officer, Associate

Director, HSR&D QUERI, Central Office

Rodney A. Hayward, M.D., Director, VA HSR&D

Center of Excellence, Ann Arbor, MI

Shirley Meehan, M.B.A., Ph.D., Deputy Director,

VA HSR&D, Central Office

Michael J. Miller, M.D., Ph.D., Chief Medical

Officer, VA Network #1, Bedford, MA

Eugene Z. Oddone, M.D., M.H.Sc., Director, 

VA HSR&D Center of Excellence, Durham, NC

Alan S. Perry, M.H.A., FACHE, Director,

VA Central California Health Care System

Leader Sought for VA Quality Enhancement

Research Initiative

VA is undertaking a search for an important

leadership position in the Central Office:

HSR&D Associate Director for the Quality

Enhancement Research Initiative (QUERI).

The position is an exciting opportunity to

lead QUERI, which has been recognized by

the Institute of Medicine as "one of the

strongest examples of synthesizing the evidence base and applying it to clinical care..."

QUERI is an evidence-based quality

improvement program dedicated to the

translation of research findings into better

health care practices for veterans. QUERI

activities are supported by field-based

Coordinating Centers. 

The Associate Director will have primary

responsibility for providing scientific and

administrative oversight of the program,

including managing a budget of more than

$13 million. In addition, the Associate

Director provides programmatic leadership

to HSR&D and VA regarding quality of

care, and translation, dissemination, and

implementation of research findings. Dayto-day responsibilities include: policy development, strategic planning, budget oversight, monitoring all the individual program

components, and overall progress of QUERI.

The position reports directly to the Director

of HSR&D.

The successful candidate will have strong

clinical, scientific, and managerial backgrounds and will hold an M.D., or other

clinical doctoral degree. Full vacancy

announcement and application details may

be viewed at www.vhaexecrecruit.cio.

med.va.gov. Click on VA Central Office

Positions. Please note that the closing date

for this position is June 25th.