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-----------------------------------------------------------1--------------------------------------------------------------------------------- Medical Record Progress Notes ---------------------------------------------------------------------------------------------------------------------------------------------- NOTE DATED: 05/06/2002 14:04 C&P VISIT: 04/26/2002 13.30 MENTAL HEALTH C&P Bldg 114 IDENTIFYING INFORMATION: Mr. Rowland is a 55-year-old, Army Veteran who served in Vietnam during 1967. He was assigned to a support company which was attached to the 32nd artillery base at Tay Ninh His tasks consisted of making deliveries, repairing vehicles, and pulling guard and perimeter duty. The Veteran is 0% service connected and was seen on 4/27/02 for the purpose of a PTSD compensation and pension exams. ______________________________________________________________________________________________
I Hugh C. Rowland served in Viet Nam during October of 66, to October 67,
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The Veteran presented on time and was accompanied by his wife. He was insistent that she stay with him throughout the assessment .Mr. Rowland presented in a defensive way, attempting to control the interview, and was not very forthcoming. He clearly was distrustful and made it clear that as the interviewer was not a Vietnam veteran he "couldn't begin to understand". His intimidating manner was not conducive to encouraging probing, and detailed inquiry. His overall manner reminded me of how many veterans first presented some twenty years ago when they first encountered treatment sources. Mr. Rowland has not. been involved in any treatment around his war experiences and made it clear he was not interested in treatment at this time. More will he said of this in the discussion section of the report. ______________________________________________________________________________________________
It’s not easy to explain how I felt at that first meeting, I was defensive, only because I was in unfamiliar surroundings, and I was distrustful because I did not know the man that was going to dig into my personal feelings that I have been fleeing from for over 30 years. In my mind this man could not begin to understand living that type of combat life 24/7 to know what it would be like to be shot at, mortared, at any time of any day or night and still do your job and do it right. I was not attempting to control the interview. I was distrustful but it is the system not the interviewer. I was in need of help when I first came back and I asked for help in 1968, and I was told I did not have a problem. I still have the same problems, and since I started dealing with my claim it has just gotten worse, I am having a really hard time handling all this. I have a very hard time letting someone I don’t know anything about and telling them things about my life that I have been hiding from for over 30 years. Things my wife doesn’t even know about. ______________________________________________________________________________________________
The examination consisted of a thorough review of the C-file, a review of the SIS dated 4/15/02, and a clinical interview to include the Clinician Administered PTSD Scale. In addition, he was Administered the Personality Assessment Inventory (PAI).
RELEVANT PRE-SERVICE HISTORY: Mr. Rowland's father died when he was 14. This was a significant loss to him. He characterized his father as like a "DI" but though, a disciplinarian, he was reportedly not abusive. He reported that his mother was unable to control him as his father had and he assumed an attitude that he now was the man of the family. Finances were tight, and he was involved in shoplifting in part to help the family. This lead to some minor problems with the law, and reportedly he was given the choice of going to reform school or the military. ______________________________________________________________________________________________
My Dad was hard working man who loved his children and wife very much and worked very hard to support us. When he died I was lost. After a period of time mom got my brothers, my sister and my self straightened out and we went on with our life. My mother was in total control all the time, I will admit that sometimes I did not like it BUT she was definitely in control. The shoplifting incident was a one time thing, I got caught by the store security, my mother was called and told about what I did. My mom and the store manager talked for awhile, I was told if I made restitution in the amount of ”I think the amount was $30.00” and stay out of the store that the store manager would not press charges and that is what happened. I did not do this to support my family! And I had NO problems with the law. I went in to the military because I wanted to. I asked mom if she would sign for me and she said yes. I come from a ranch life and the freedom that gave me. To living in town, I was board I wanted to go to Viet Nam and be a hero like my older half brothers. I had quite a sheltered life, I didn’t realize how good that I had it till I joined the Army, but the Army was fine, hard but fine. Then I went to Viet Nam, what ______________________________________________________________________________________________
Mr. Rowland also had problems in school, as he was learning disabled and found reading and writing difficult. His parents took him out of school in the 5th grade. He apparently was in and out of school, eventually completing two years of high school according to his DD214. The SIS dated 4/15/02 notes in regard to social functioning that “he had no socialization and never know what it was like to play games and do other kinds of child activities.” I point out these elements to suggest the Veteran had adjustment problems prior to entering the service. ______________________________________________________________________________________________
I did have a hard time in school, I had a hard time reading and writing, but that did not stop the Army from taking me. My parents did not take me out of school I made it to the 11th grade and was having a hard time with my school work, that is when I asked my mom if I could joined the Army. When I was a child on the ranch I had other kids to play with, horses to ride, plus I was in the local 4H and the local Boy Scouts, I had more enjoyable childhood activities on the ranch then most kids have in any town. ______________________________________________________________________________________________
RELEVANT PSYCHIATRIC HISTORY: The Veteran’s service record noted a Pre-induction consultation that stated “ mild neurotic sleep problem, mild anxiety which does not appear disqualifying-warrants trial of service” Hence again, pre-service issues are noted. I also noted on an evaluation done in 1968 by Peter Doyle M. D., neuropsychiatrist , that concluded there was no neuropsychiatric condition and the Veteran had made “a good social / occupational adjustment since getting out”. ______________________________________________________________________________________________
Any young boy away from home for the first time would probably feel a mild neurotic sleep problem or mild anxiety especially when one day your in a boys world, and the next you’re in mans world. As I stated above I asked the Army for help when I came back from Viet Nam, I don’t remember all that whet on but I do remember being told to go home, that everything would be all right when I adjusted to home. That never happened, a veteran trying to get a job at that time was quite hard, the only work I could get was washing cars and sweep floors that was the only kind of work I could find. I have spent most of my life working for my self. I had a very limited social life after Viet Nam, and the main reason for this was Viet Nam Veterans were not warmly accepted. ______________________________________________________________________________________________
Currently the Veteran is seen by Dr. Hayrend, a psychiatrist. The Veteran reports he has know Dr. Hayrend, for 33 years but has only seen him professionally for about the last year. There is a letter from Dr. Hayrend in the C-file dated 1/14/02 that indicates the Veteran has major depression, PTSD and is also paranoid. The only medication the Veteran takes apparently is valium on a p. r. n. basis.
SUBJECTIVE COMPLAINTS: The Veteran in a letter in the c -file cites his stressors as minor shrapnel wounds, the leveling of villages by artillery that he helped maintain, an incident in which a child lured some GIs into a tent and then set off a grenade and being disillusioned when .he came home to an antiwar riot in Oakland. At this point, the only one of these ** THIS NOTE CONTINUED ON NEXT PAGE ** ---------------------------------------------------------------------------------------------------------------------------------------------- ROWLAND, HUGH CLYDE Boise-531 Printed: 05/13/2002 13:23 557-72-4849 DOS: 04/08/1947 Pt Loc: OUTPATIENT Vice SF 509
-----------------------------------------------------------------------2--------------------------------------------------------------------- MEDICAL RECORD Progress Notes ---------------------------------------------------------------------------------------------------------------------------------------------- 05/06/2002 14:04 ** CONTINUED FROM PREVIOUS PAGE ** stressors that is verifiable is the minor shrapnel wounds. ______________________________________________________________________________________________
I am not being seen by Dr. Hayrend, I did see him 4 or 5 times for my symptoms of PTSD he ran some tests on me and told me I have several symptoms of PTSD. The medication I am taking on a regular schedule are as fallow ( Hydrocodone / APAP Norco 10/325 for pain from wounds I received in Viet Nam (shrapnel wounds, left and right leg, lower back and left hip) (Kidney stones brought on by dehydration ) (Fluoxetine HCL 20MG, Temazepam 15MG cap, valium 10MG ) ( to help me deal with the depression, PTSD, Continuing flashbacks, night sweats, that are caused from things that happened to me and others in Viet Nam. My major stressors are remembering the fighting the killing of people I didn’t even know, I was 19 years old I didn’t even know why I was doing this, other than the fact they were trying to kill me. Seeing all the death and body parts after fire fights especially when some of the body’s were people I had shared a meal with earlier that day. The way I dealt with it was NOT getting close to anyone so I did not hurt so much when someone was killed. The girl that lured the men into the tent and then pulled the pin on a grenade could not have been over 14 years old I still don’t understand how a person that young could be made to do something like that. Coming home and seeing all the hate shown to the men coming home from Viet Nam was a shock to me, I thought we were heroes and quickly realized my own country treated Viet Nam Veterans like they committed a crime.
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In regards to the wounds, he said the first occurred on his first day with his unit and was a result of a grenade accidentally set off by friendly forces. The second time he was wounded he said he was taking supplies to a small air strip "when all hell broke loose". He dove under a truck while the firefight went on for about an hour. He received several shrapnel wounds which he reports he took care of himself and did not seek medical attention. ______________________________________________________________________________________________ In regards to my wounds, a grenade fragment hit me as I walked in to the company area, I did not know what was going on, a GI grabbed me and took me to a bunker. I had a small piece of shrapnel in my left knee, I pulled it out and cleaned the wound. I was told at that time to stay away from sick call for something that small or I would end up pulling company area duty. After the all clear horn, I went to the company commander office and reported in. All anyone has to do is check the morning reports for the last part of October 1966 to the first part November 1966. The above mentioned fire fight, it was a mortar attack in Cu Chi, it started just as I was pulling in to the company area. I did get under the truck, I received ONE small piece of shrapnel in my left hip and it left a small cut on my left hip, I rapped it and went on with my duties. ______________________________________________________________________________________________
In regards to the young girl and grenade incident, he heard an explosion and along with other soldiers ran to the tent and the scene he saw is one he reportedly can’t seem to get out of his mind. This reportedly continues to affect him because when he sees his granddaughter he is further reminded of the incident. As I had never heard of an incident like the one the veteran reports, I discussed his report with several Vet Center staff and several staff in our outpatient PTSD program. None of the staff, some with many years of experience, had ever heard of a similar situation. Though the incident could have occurred as described, the staff stated that it wasn't very likely. In regards to the alleged riot, the Veteran said over 200 soldiers were initially kept on the plane they cams Lame in, by demonstrators that were throwing rocks and cans at the soldiers. They were told they couldn't leave the plane until the crowd was dispersed. The Veteran said this was not acceptable to the men who left the plane and "leveled” and dispersed the crowd. The Veteran remembered this as happening in October 1967.
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In regards to the girl and the grenade, the people that were in the general area that day are most likely the only ones that know of the incident. As for Dr. Pittman asking his staff and others about this incident and no one had ever heard of a similar situation, if I told you about a man being gored to death in Idaho by an elk, this is an incident that doesn’t happen every day. How many of Dr. Pittman’s staff would know about that, and if they don’t know, does that mean that it didn’t happen? “We were warned all the time that the children could be just as dangerous as the adults” They were not there, I was, and it happened. As for the riot, check the records or newspapers August 13, 1967 and you will find there was a riot against Viet Nam Veterans in August 13, 1967. The part about leveling the crowd is NOT right, we were kept on the plane for awhile there was some name calling, some throwing of cans and rocks and the demonstrators were controlled by the local police! Not the men coming home. The demonstrators were on the out side of the terminal. ________________________________________________________________________________________________________
Another aspect of this story that was noteworthy was that the troops “came back carrying our weapons”. I checked an almanac of the Vietnam war that indeed made note of the major demonstration in Oakland in October 1967; however, there are a number of elements in the reported story that are troublesome. For one thing, the SIS reports he was in Vietnam from November 1966 to November 1967. However, this is more confusing as his service medical record indicates he was at Fort Benning Georgia in September of 1967. Also when I checked with my experts, they found it very unlikely that any group of civilians would be allowed to get close to a plane returning troops home. They were also not aware of any documented large scale encounter between troops arriving home and demonstrators. Finally the allegation that troops were allowed to return on a plane while in possession of their weapons had never been heard of by any of the experts I consulted with. I have gone into some detail here as the Veteran alleges that the incident was critical to the development of his PTSD. He was coming home thinking he was a hero only to find out he was a “baby killer” which was traumatic and reportedly is at the core of what continues to bother him. As he put it, “Right there it went to hell in a handbag”. ______________________________________________________________________________________________
I don’t remember when we turned in are weapons it was either in Viet Nam or Oakland but we DIDN’T carry them on the plane! All our gear was put in the belly of the plane. You check my records and you will find I did not leave Viet Nam until October 1967, Terry Tippery at the Vet center can verify this using my records. So if I was in Viet Nam in October 1967 how could I have been in at Fort Benning Georgia in September of 1967? I thought I was coming home a hero, to find out I was a baby killer. YES, right there it went to hell in a handbag, I came back to my own county and was made to feel like trash.
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I administered the clinician Administered PTSD Scale for DSM4. The Veteran was a bit reluctant but, complied to an extent. No endorsed symptoms of re-experiencing traumatic events an a very high rate. For example, he said he had intrusive memories, "all the time, daily". He reported having nightmares every night. He reported having flashbacks "daily since I started this (C&P process)". I believe the reported frequency of these symptoms is exaggerated as I have never had them reported at this level of frequency in the past. it would be particularly unusual given the nature and extent of the reported stressors. In regards to symptoms of avoidance, he reports making major efforts to avoid things that would remind him of the war. When asked about things that reminded him of the war, he replied, "people like you". He avoids TV and movies about the war. He has given up hunting. He reports great difficulty in recalling much of what happened in Vietnam. He said that ______________________________________________________________________________________________
I don’t remember when we turned in are weapons it was either in Viet Nam or Oakland but we DIDN’T carry them on the plane! All our gear was put in the belly of the plane. You check my records and you will find I did not leave Viet Nam until October 1967, Terry Tippery at the Vet center can verify this using my records. So if I was in Viet Nam in October 1967 how could I have been in at Fort Benning Georgia in September of 1967? I thought I was coming home a hero, to find out I was a baby killer. YES, right there it went to hell in a handbag, I came back to my own county and was made to feel like trash.
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** THIS NOTE CONTINUED ON NEXT PAGE ** ---------------------------------------------------------------------------------------------------------------------------------------------- ROWLAND, HUGH CLYDE Boise-531 Printed: 05/13/2002 13:23 557-72-4849 DOB: 04/08/l947 Pt Loa: OUTPATIENT Vice SF 509
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much of what he was reporting came from “what I know, not what I remember”. He clearly has feelings of detachment and estrangement from others but this also predates his military service. He clearly has a restricted range of affect.
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What I reported to Dr. Pittman is what I could remember, and what I remember come from over two hundred pictures that I took while I was there. I count on what I see in the pictures, the pictures are captured time, I have to believe what I see at this time, then what I hear. I do have feelings of detachment and estrangement from others but this has been brought on by the general public over time. It has been just the last few years that the public has started thanking their Veterans for there time and service. The part about “predates has military service” I think I have made it clear what my life was like before I went into the military. It is how a story is told, to how it is perceived, you are reading the same story being told in two different ways. You are reading it as Dr. Pittman perceived what I said. Plus you are reading it as I remember living it.
______________________________________________________________________________________________ In regards to symptoms of increased arousal, he reports sleep disturbances. He acknowledges irritability. He reported problems with concentration and saying, "I get lost. I'll be sitting down doing something and then I’m lost". He is hypervigilant, "constantly" checking his perimeter. It is not clear that his Vietnam experience, accounts totally for these experiences. For example, Dr. Heyrend reports the patient is paranoid which may account in part for his hypervigilance.
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I did and still do report sleep disturbances, irritability and trouble with concentration, I had these and other problems and sill do have these problems brought on by my tour and what I experienced in Viet Nam. As far as hypervigilant goes (checking his perimeter) as Dr. Pittman puts it, I am probably a little more sensitive to what goes on and around my property than most. In Viet Nam controlled paranoia is what kept me alive and I still suffer the same feelings today. I still wake up in a cold sweat with the feeling that something is wrong, the only way to get rid of that feeling is to go and walk up and down the street so I can see nothing is wrong. At this time this probably happens one or two times a month. Before I started my claim it was about four or five times a year.
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OBJECTIVE FINDINGS: The Veteran completed the PAI, The mean clinical scale elevation was more than two standard deviations above the mean of the normal standardization sample., In one instance his score was at about the 98th percentile of the clinical standardisation sample which was made up of inpatients and outpatients currently engaged in treatment. These are very high scores and not typical of a patient with PTSD as evidenced by the PTSD standardization group. What this suggests is that the Veteran has significant psychological issues in addition to any from his reported PTSD.
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I don’t know what PAI, means, In one instance my score was at about the 98th percentile of the clinical standardisation sample which was made up of inpatients and outpatients currently engaged in treatment. This tells me because my scores are high 98th percentile of the clinical standardisation sample which was made up of inpatients and outpatients currently engaged in treatment. I have tried to present the facts as I feel them, the psychological issues are the issues I have been trying to deal with since my tour in Viet Nam!
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In regards to mental status Mr. Rowland was clearly oriented in all spheres. His memory as assessed was intact. He had a fund of general information commensurate with his estimated above average IQ. His mood is moderately depressed and irritable. Affect had a restricted range. His interpersonal style is characterized by high needs far control and dominance and a low need for warmth. His thinking is logical, sequential and goal directed. He did not evidence frankly paranoia idea ions There was no evidence of bizarre thinking or behavior. He demonstrated goad verbal abstract reasoning ability. There is some question as to the adequacy of his judgment. However, He is felt to be competent to manage his own funds.
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I have trouble with my memory, as I stated earlier in this exam I will stand up to go do something take a few steps and by then I have forgotten why I got up, this happens quite often my mind just goes blank and I don’t know why. I carry my memory in my pocket “my PDA” is my memory, my wife will leave me notes daily to remind me of things I need to do and appointments I need to keep, she does this because sometimes I forget to put the information in my PDA. This problem is just one of the problems I have that make me irritable and depressed. Dr. Pittman said I have an interpersonal style and that I have a high need to control and dominance and a low need for warmth. I do have a need for a certain amount of control of my life just like most people, I have no need to dominate anyone, and if it wasn’t for the warmth and love I receive from my family I would have NO reason to keep going , if it wasn’t for the support of my family I probably would not be here. My wife manages our funds because I have a tendency to over spend, my wife has the ability to stick with a monthly budget, for the extra things we want she puts a little money away each month, till we have the money we need to buy the item we want. Where I would put it on a credit card and then try and make the monthly payments.
________________________________________________________________________________________________________ DISCUSSION: I am not, with the history as presented, prepared to say Mr. Rowland has PTSD. In addition to the noted problems in the history as reported, there are significant pre-service issues that affect his presentation as well as the course his life has taken. Dr. Heyrend notes psychiatric issues to include depression and being paranoid that further complicate sorting out any impairment solely a consequence of PTSD. The Veteran chose to present in a way that inhibited the gathering of information which was yet an additional problem.
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The history as presented pertaining to the time I spent in Viet Nam till the time of the exam was presented to the best of my ability. I had no way of controlling the way Dr. Pittman perceived what I was trying to tell him. As far as the pre-service issues I think this issue has been adequately explained in my above comments. I did not choose to present my self in a way that inhibited, or in any other way that would be disrespectful to Dr. Pittman.
________________________________________________________________________________________________________ If the Veteran chooses continue to pursue a claim for PTSD, the stressors he alleges beyond his shrapnel wounds need to be verified. In addition he needs to present at any future exam with a less defensive, more forthcoming attitude. An even more helpful option to ensure he gets a thorough and valid evaluation would be for him to engage in therapy where over time, the numerous factors could be further explored and understood. Edited 05/10/0213:00 by Pittman, William Singed by: /es / William Pittman, PhD ______________________________________________________________________________________________ I have chosen to pursue my claim, I have requested morning reports several times, and so has Mr. Terry Tippery my counselor at the VA center to verify what I have said, and all I get in return is a letter saying my records are on loan to another agency. ______________________________________________________________________________________________ Chief, psychology service 05/10/2002 13:00 ROWLAND, HUGH CLYDE Printed: 05/13/2002 13:23 557-72-4849 DOB:04/08/1947 Pt Loc: OUTPATIENT Vice SF 509 ----------------------------------------------------------------------------------------------------------------------------------------------
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