Pain of war is gender neutral

War changes a woman, in ways both great and small.

When relatives set off New Year’s firecrackers, Denisse Ramos, 25, of Las Vegas notices her hands clench. It reminds her of mortar attacks in Iraq.

Whenever Sharon Dixon, 50, of North Las Vegas sits in a quiet room to read, the nonstop ringing in her ears is more noticeable and distracting. It’s the legacy of surviving the blast of an improvised explosive device in Iraq in 2003.

For more than a decade, Las Vegan Rhonda Decker, 46, has been unable to sleep past about 4 a.m. Ever since serving in the Gulf War, followed by a 2004 tour to Kuwait and Iraq, she suffers from disturbed sleep patterns.

Local female veterans agreed to discuss how their post-war lives are different. Those interviewed all belong, or used to belong, to National Guard or military reserve units that deployed to Iraq or Afghanistan.

STATE EXCEEDS U.S. AVERAGE

Nevada is currently home to an estimated 985 women who have served in the global war on terrorism. They are almost 13 percent of the state’s veterans who have deployed either for Operation Iraqi Freedom, or to Afghanistan for Operation Enduring Freedom, according to Carole Turner, deputy executive director of the Nevada Office of Veterans Services.

On average, 10 percent of U.S. forces there at any given time are female, according to Lory Manning, a career Navy woman who now analyzes military demographics for a think tank in Washington, D.C.

Invariably, local women vets are proud they served. And pragmatic about coping with the personal after-effects of war.

A soldier first, a woman second, is how Tara Ketchem, 21, describes herself. Going to war is "an experience a lot of people will never have," says Ketchem, who served this year in Iraq with a military police unit based in Henderson.

The VA isn’t just your grandfather’s VA anymore. Beyond the prostate surgeries or Alzheimer’s care for veterans of the Korean War and World War II, Veterans Affairs medical clinics today increasingly treat veterans who are young and female.

While stationed in Kuwait, Army Reservist Decker jumped off a piece of transport equipment and landed wrong. When she returned to the States, the military gave her reconstructive knee surgery. Ketchem is pursuing VA treatment for a shoulder injury she suffered in Iraq during mandatory physical training. For the ringing in her ears, a condition called tinnitis, the VA is working to get Dixon, a former Guardswoman, a high-tech at-home treatment device.

Care for health problems contracted in the military is free for life. But even for regular health care, apart from service-related injuries and illnesses, today’s veterans are more apt than ever to visit the federal agency. A federal law enacted earlier this year allows combat veterans to receive such care free for five years — and beyond, depending on income.

Recent veterans are taking advantage: 44 percent of female veterans of Iraq-Afghanistan and 40 percent of male veterans have gone to the VA for care. That contrasts with the bulk of veterans. From all prior eras combined, only 15 percent of female veterans, and 22 percent of men, have patronized VA services, according to Patricia Hayes. She is chief consultant to the Department of Veterans Affairs’ strategic health care group for female veterans.

Veterans Affairs is unable to pinpoint how patronage of its services is affected by the climbing cost of private-sector health insurance, or a gender-based difference in employment benefits when veterans take civilian jobs, according to Hayes, who is based in Washington D.C. She attributes the higher turnout to a new VA program to actively invite veterans, by phone and letter, to access their federal benefits.

But the most noticeable impact of female patients on the VA is probably the expansion of scope, since 1992, to uniformly offer the medical specialties and services unique to women — including childbirth and prenatal care.

"We’re still paying for only 1,500 pregnancies" a year, nationwide, Hayes said recently by telephone.

Today the agency directly pays the private-sector health providers of pregnant veterans. But as military demographics shift, the consultant can foresee a day when VA hospitals in large metro areas may have childbirth units.

"I had great service there," Ramos, who is in the Nevada Army National Guard, says of her visits to the local women veterans clinic, 901 Rancho Lane.

She goes for regular checkups and treatment of minor complaints.

"I haven’t had a big injury that I can judge them by," she said.

Many of the female Iraq-Afghanistan veterans contacted by the Review-Journal say they are taking either sleep-aid or anti-anxiety medications prescribed by doctors at Veterans Affairs. Some of the women still have duty-related nightmares, though less frequently as time passes.

"I have insomnia bad. I’m up all night. My mind is just racing," says Veronica Delarosa, 28, who got back in September from a tour in Iraq as Nevada Guard military police.

Dixon and Decker are both seeking treatment for memory and concentration problems they believe did not exist before they deployed.

Decker doesn’t know whether to blame possible chemical exposure during Desert Storm; enemy chemical weapons, pills given to troops to protect against nerve gas and pesticides used against sand flies are all suspected of negatively affecting U.S. troops. Chronic sleep deprivation because of a sleep disorder might be sapping her mental skills.

It upsets her that "the VA never gave me the time of day (on these long-standing problems) till after this last deployment," when she finally received a diagnosis and a service-related partial disability.

"I’d give back all this damn money for somebody just to tell me (the cause). Or to have these memories back," says Decker, who is able to continue in her occupation as a mail carrier. "What’s the whole point of going through life if you don’t have (detailed) memory of things? Sometimes it’s very upsetting."

To morph back into a civilian more easily, Delarosa says she recently followed the example of several other unit members, by seeing a marriage and family therapist. The person she consulted was not a psychologist. People hoping for a long career in the Guard, such as herself, don’t want promotions getting stalled because of a psychological medical history, she says.

A single parent, Delarosa says even Tommy, her 8-year-old, has noticed she is more restrained now, less emotional than before she served.

"He says, ‘Mommy, why don’t you cry no more?’ … My eye gets watery, but nothing comes out. Maybe one tear."

SLIGHT GENDER GAP FOR PTSD

Adjustment disorder is a condition, which can include depression or anxiety, that may arise as a person figures out how to adapt to a stressful experience, including combat. It falls into a medical spectrum that reaches PTSD, at its extreme, according to VA official Antonette Zeiss.

The PTSD acronym stands for post-traumatic stress disorder, which also brings emotional numbing, avoidance of reminders of the stressful event, and, "paradoxically, some overwhelmed sense" of the event via flashbacks and nightmares, says Zeiss, who is deputy chief of mental health for the Veterans Administration.

Female vets back from Afghanistan and Iraq are getting diagnosed with PTSD, along with the men, though at a lower rate. Zeiss believes the gap, almost 19 percent for women versus almost 23 percent for men, exists because a higher percentage of men are in front-line combat.

A woman who is active in Nevada veterans circles receives a partial disability payment for PTSD. But she so fears the stigma of being publicly identified that she declined to publish her name, age, service unit or dates of deployment in the global war on terror.

"I didn’t go to my boss and say, ‘I’ve been diagnosed with PTSD 30 percent.’ I didn’t go to human resources," she confides.

Relatives sometimes kid Ramos with the remark, "Denisse is psycho because she went to Iraq." In fact the 2006 UNLV graduate has a smart, well-balanced head on her shoulders. The young veteran paid her college tuition through an education benefit for members of the Nevada National Guard. So when she joined the Reserve Officers Training Corps in college, she didn’t need an ROTC scholarship.

But now, she hopes to use that ROTC privilege to pay for law school. She took the entrance exam for Boyd Law School in December, and plans to tackle next the application of her unused ROTC benefit to pay for law school.

In spring 2008, Dixon received a Purple Heart for the concussion and contusions she received from the IED in 2003. Three guys who were injured in the same incident also received Purple Hearts.

But it took Dixon four years — far longer than the others — to receive her medal. Curiously, she had to submit her application three times. And the final version did not contain more documentation than the earlier ones, she contends.

Also curious to Dixon is the happenstance that someone stole the Purple Heart out of her car trunk within a day or so of the award ceremony, before she had a chance to put it in her house. She received a duplicate medal, but the original has never been located, nor the perpetrator identified.

When asked whether gender bias factored into either the medal’s delay or its swift disappearance, Dixon just answers calmly, "It’s a good question."

Contact reporter Joan Whitely at jwhitely@reviewjournal.com or 702-383-0268.

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