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SANTA CLARA, Calif. (AP) -- Colin Kaepernick's protest of the national anthem is apparently winning support from some military veterans on Twitter. The San Francisco 49ers quarterback sparked controversy during the NFL's preseason by sitting instead of standing during the "Star-Spangled Banner." Kaepernick says he's protesting what he describes as oppression of minorities in the United States. Some who have criticized the protest said it was insulting to veterans. But some people who identify themselves as veterans have tweeted pictures of themselves in uniform and messages of support under the hashtag VeteransForKaepernick . One says he served to protect freedoms, not a song. Another says protesting is every American's right. Kaepernick says he will continue his protest ahead of Thursday's preseason game in San Diego.    
The Army reservist who killed five Dallas police officers last month showed symptoms of post-traumatic stress disorder after returning home from Afghanistan in 2014, but doctors concluded that he presented no serious risk to himself or others, according to newly released documents from the Veterans Health Administration. Micah Johnson had sought treatment for anxiety, depression and hallucinations, telling doctors that he experienced nightmares after witnessing fellow soldiers getting blown in half. He also said he heard voices and mortars exploding, according to the documents obtained by The Associated Press under the Freedom of Information Act. "I try to block those out, but it is kinda hard to forget," Johnson told his care provider, according to the documents. Johnson, 25, was the sniper who targeted the officers at the conclusion of a peaceful march July 7 in downtown Dallas, where demonstrators were protesting fatal police shootings in Minnesota and Louisiana. Armed with an assault rifle, he took multiple positions as he fired. Hours later, authorities used a bomb-carrying robot to kill him. During his deployment, Johnson was largely confined to base in an area of Afghanistan that had seen heavy combat but that was relatively quiet when his unit arrived in November 2013, according to his former squad leader. Upon his return to the U.S. nine months later, Johnson told doctors he was experiencing panic attacks a few times a week, including once while at Wal-Mart, where there was an unspecified conflict that required a police response, the records said. "Veteran states hearing all the noises, fights and police intervening caused him to have palpitations, 'My heart felt like someone was pinching it while it was beating fast,'" the records state. Johnson said he began shaking, felt short of breath and got chills following the Wal-Mart incident. The records do not show that Johnson was formally diagnosed with PTSD. The type of screening that he underwent is typically a first step to determine if the patient should be referred for further assessment to a mental health professional, said Joel Dvoskin, a clinical and forensic psychologist in Tucson, Arizona. Doctors eventually decided that Johnson presented a low risk for suicide or for hurting anyone else. Johnson was "not acutely at risk for harm to self or others," according to a medical record from a visit on Aug. 15, 2014. The patient was "not felt to be psychotic by presentation or by observation." The reservist who specialized in carpentry and masonry told health care providers he had lower back pain and was avoiding "crowds of people and when in the public, scanning the area for danger, noting all the exits, watching everyone's actions." "I feel like I can't trust all of these strangers around me," Johnson told his doctor, who noted that he had taken to drinking since his return to Dallas, consuming three to four shots of vodka up to three times a week. "It's hard for me to be around other people and I am so angry and irritable." Records from the Aug. 15 visit state that Johnson described his childhood as "stressful." His responses to a section of the form titled "Sexual/Physical/Emotional Abuse History" were redacted. Johnson was also advised to talk with a health care worker about erectile dysfunction. Johnson was prescribed a muscle relaxant, an antidepressant and anti-anxiety and sleep medication, and a nurse offered him tips on managing anger, records show. He also saw a psychiatrist and was further evaluated for his PTSD symptoms in September of that year, but the physician noted that his mood was "better." When providers called Johnson in October 2014, he requested to put off further assessment for PTSD, saying he was busy remodeling his mother's house, according to the records. He had previously told providers he planned to find a job in construction and that his long-term goal was to become a self-defense instructor. Johnson's mother, Delphene Johnson, has said her son sought medical care from the VA for a back injury but got no help after filling out forms and going to meetings. He "just finally gave up," she told TheBlaze, a news site founded by conservative talk show host Glenn Beck. Dallas VA spokesman Ozzie Garza did not immediately respond to questions regarding Johnson's treatment within the VA North Texas Health Care System, the second largest VA health care system in the country. In May 2014, new patients seeking mental health care at the Dallas VA faced a 50-day average wait, then the 10th longest in the nation. The mother of Gavin Long, the former Marine and Iraq war veteran who killed three law enforcement officers July 17 in Baton Rouge, Louisiana, told PBS' Tavis Smiley that her son had post-traumatic stress disorder and unsuccessfully sought the VA's help.   BY GARANCE BURKEASSOCIATED PRESS
NEW YORK (AP) -- Two congressmen want federal authorities to investigate why a former Navy gunner apparently killed himself on the grounds of a veterans' hospital in New York. Peter Kaisen, 76, a retired police officer from Islip, was found Sunday in a parking lot at the Veterans Affairs Medical Center in Northport suffering from a gunshot wound to the head. His wife, Joan Kaisen, told Newsdayhe had been suffering from back pain so bad he was unable to sit for more than a few minutes. Doctors at Northport told her husband earlier this year there was nothing more they could do to ease his suffering, she said. Tom Farley, a longtime friend and fellow veteran, told The Associated Press that Peter Kaisen visited the hospital once or twice per month but didn't tell anyone where he was headed when he made the 30-mile trip from his home Sunday. "We all think there is probably some depression," Farley said. "Maybe he wanted meds. Maybe he wanted to sit and talk. I don't know. None of the family knows." Kaisen's body was found outside his car in a parking lot near a community living center at the edge of the hospital's suburban campus just after noon Sunday, about 10 minutes after he arrived at the site, officials said. A spokesman for the hospital, Christopher Todd Goodman, declined to discuss Kaisen's patient history at the VA but said the hospital had no evidence that he sought treatment at the emergency room, entered any hospital buildings or had any interactions with staff or patients on the day he died. "The Northport VA stands ready to cooperate with any investigative body that believes more information is needed," the hospital's director, Philip Moschitta, said in a statement. "At no point did the staff in this facility fail to do the right thing by our patients." U.S. Reps. Peter King, a Republican, and Steve Israel, a Democrat, sent a letter to the FBI and to the secretary of the Department of Veterans Affairs on Thursday asking for a "transparent" investigation into the death, following a media report - denied by hospital officials - that Kaisen had sought emergency mental health care at the hospital but had been turned away. "It is critical that our nation's veterans feel they can trust the services provided by their VA medical facilities, and that their health and wellbeing is of the upmost priority," they wrote. A spokeswoman for the FBI in New York said agents responded to the scene, but since nothing criminal was discovered, a subsequent review would be conducted by the VA. Joan Kaisen told Newsday her husband served on a Navy supply ship, the USS Denebola, from 1958 to 1962.   BY JAKE PEARSONASSOCIATED PRESS
CONCORD, N.H. (AP) -- A nonprofit group with New Hampshire roots is putting a new spin on back-to-school shopping by helping equip 10 classrooms for refugee children in Iraq. TentED was created in 2014 by three U.S. Army veterans, two of whom met as student at the University of New Hampshire. Rather than starting from scratch, the group works with existing educational aid programs to raise money and deliver what it calls "last mile" essentials, such as school supplies, bus transportation and recreational activities. The group has funded about 15 projects in the past two years in the Kurdistan region of Iraq and is partnering with an organization that is building a new school for more than 250 children. Construction started in May and is expected to be done in the next four weeks in time for the fall term, said Billy Ray, Middle East director for the partner organization, World Orphans. "These kids have got to get back into the routine of school and learning," he said. "The scarring has to stop, and this is our chance to roll back the years that ISIS has stolen from them." During emergencies - whether natural disasters or manmade conflicts - education gets overlooked, TentEd co-founder Zach Bazzi said. But he argues that approach could result in entire generations of children growing up without basic literacy and critical thinking skills. "You don't want people starving or going without water or shelter, but I'd also argue that education needs to be up there," he said. Bazzi served in the Army and Army National Guard from 1997 to 2008 and later worked as consultant and volunteered in refugee camps in Iraq. When he returned to the U.S. in 2014 for graduate school, he teamed up with Scott Quilty, a fellow UNH graduate and Army veteran who lost his right arm and leg to a roadside bomb in Iraq. TentEd's third co-founder is Patrick Hu, an Army veteran Bazzi met when both served in Afghanistan. All three have day jobs. Hu is a market researcher at AT&T Mobility in Atlanta; Quilty heads MedScribes, a medical staffing company in Durham and Fuquay-Varina, North Carolina; and Bazzi is the Middle East manager for a nonprofit called Spirit of America and is based in Washington, D.C. He frequently travels overseas to implement TentEd activities, identifying and responding to specific needs. "We don't build schools, we don't design schools. We're simply a rapid, efficient, responsive funding platform," he said. For the current project, the group is trying to raise $12,500 to outfit 10 classrooms with desks, whiteboards and other materials. Ray said that amounts to about 5 percent of the overall school construction budget, but he greatly appreciates Bazzi's help. "It feels like he's one of our cheerleaders, and really an advocate for us," he said. "He's basically crowd funding for our projects, and that's just cool."   BY HOLLY RAMERASSOCIATED PRESS
American Legion Social Media Manager Steve Brooks is following along or getting out ahead of the Legacy Run in what has to be a 70-foot long, 32-passenger Ford Transit, with visual journalists Lucas Carter and Clay Lomneth, to cover the 2016 Legacy Run. 6:26 a.m. – Pick up Lucas and Clay at Lucas’ apartment. Having just spent eight days in Shelby, N.C., with the two covering the American Legion World Series, I worry we may run out of things to talk about before we get to Kenneth N. Dowden Wayne Post 64 in Indianapolis. 6:45 a.m. – We get to Post 64, sans any awkward silences. Charles Gremlich, a member of the Sons of The American Legion Squadron at Post 200 in Boonville, Ind., waits on the overpass at the Odon, Ind., exit to show his support for the Run. “I haven’t seen this many motorcycles together at one time, except for on TV or YouTube,” he says. “I absolutely had to see it.” 7 a.m. – Assistant Road Captain Theardies “T-Man” Fisher, a member of Post 4 in Wichita, Kan., preps his bike. He’s on his ninth Legacy Run. “It’s like a new beginning,” he says of the first day of the Run. “Then you roll out and it all falls into place.” And why come back year after year? “"You get the bug,” he says. “It's for the kids, man. It's all for the kids." 7:11 a.m. – “Ride your ride, but stay tight,” Chief Road Captain Bob Sussan says during a ride briefing. “Ride safe.” 7:30 a.m. – Sussan is like a Swiss watch, and the Run leaves Post 64 at its appointed time. More than 290 motorcycles leave the post. 9:11 a.m. – The Run makes its first gas stop at a Walmart in Bloomington, Ind. – home of Indiana University, the greatest college in the history of the world. A similar Ford Transit van, looking like it has gone through a demolition derby or two, passes in front of us. “That’s what our van is going to look like when we’re done,” Clay says. 10:53 a.m. – On the same bridge, Post 64 members Linda Todd and Rick Fatout have driven nearly 90 miles to hold a flag as the Run passes. They’ve made it a tradition to do so when the ride heads out along I-70 near their post, but the Run didn’t use that route this time. “They deserve this because of what they’re doing for the kids who’ve lost their parents,” Todd says. 10:41 a.m. – We’ve now passed into Central Time and have gained an hour. We spent the first part of that bonus time on an overpass at the exit for Oakland City, Ind., where members of the Oakland City Fire Department have brought a fire truck holding a large U.S. flag. Legionnaires from area posts and other locals were there waving smaller flags as the Run passes underneath. Oakland City Fire Department Capt. Scott Trotter salutes the entire ride. “It’s an honor that The American Legion is coming through here,” he says. “We wanted to be here for the veterans.” 11:04 a.m. – Soon after, on the Exit 27 overpass, the Buckskin Volunteer Fire Department has a similar display set up. Future overpasses also will have supporters lining them. 12:05 p.m. – We arrive at the LST-325 Memorial in Evansville, Ind. The ship served in World War II in operations in North Africa and Italy, as well as on Omaha Beach during D-Day. Several TV stations are there to cover the ride. 12:12 p.m. – Pete Snowden is a student at the University of Southern Indiana. He’s also the commander of Post 324, which was established at the university in 2014. “The guys that are doing the ride and raising the money … anything we can do to help them out,” Snowden says. “It’s an honor for us.” 12:56 p.m. – The Run arrives at the memorial and are served lunch courtesy Post 324. 1:25 p.m. – Craig Pulver, the adjutant and a Legion Rider from Post 84 in Otsego, Mich., is on his first Legacy Run. He tears up when asked about his reaction to the flags and people standing along the overpasses on the highway. “It’s awesome,” he says. “You can’t ride underneath one of those without thinking other things: Guys that you had to leave behind and what we’re doing now. It’s just great.” 2:05 p.m. – National Commander Dale Barnett and Past National Commander Jim Koutz are among those taking part in a wreath-laying ceremony at the LST-325 Memorial. Barnett praises Indiana’s Eighth District for its hospitality and for the support the Run has seen so far. 3:45 p.m. – I want a chocolate-dipped cone. Clay concurs it sounds good. So we find a Dairy Queen roughly five minutes from our next stop. I get the dipped cone; Clay and Lucas go for Blizzards. Lucas is somewhat dismayed the restaurant’s happy hour is only on weekdays. 4:07 p.m. – The Run arrives at the Kentucky Veterans Cemetery West for a wreath-laying ceremony. More than 30 Kentucky Legion family members are waiting and greet the group with applause. 4:16 p.m. – Richard Page, commander of the honor guard at Post 236 in Calvert City, Ky., is at the cemetery, along with approximately 17 other members of his honor guard. “We just want to honor these Riders for what they’re doing,” says Page, who traveled an hour and 20 minutes to get here. “It’s a wonderful thing, and I believe we need to support what these folks are trying to do.” 4:55 p.m. – We pull into Fort Campbell Post 233 in Oak Grove, Ky. There, Michael “Joker” White – a past ALR chapter director there – has been cooking 200 hot dogs and hamburger over charcoal for two hours. 5:12 p.m. – The ride pulls into Post 233. “We want to do whatever we can for the Legion Riders on the Legacy Run,” White says. “We’re definitely proud to have them stopping here.” 5:15 p.m. – National Commander Dale Barnett, who rode a couple legs of the ride on the back of Georgia Legionnaire Bob Brown’s bike, says the idea for his Awareness Walks for Veterans came from, in part, the Legacy Run. “They had some real vision about how to reach out and be aware,” he says. “My project this year was awareness walks – to get out of the post. I took a lesson from the Legacy Ride because I saw how successful it was. It’s the same concept: It’s getting out in a community and telling our story.” 5:45 p.m. – Donations are presented, including $6,000 from Post 14 in Ponca City, Okla., and $4,000 from the Legion family at Post 253 in Royal Oak, Mich. The total for the day is $25,575, bringing the amount raised so far to $428,239.76.
NOTRE DAME, Ind. - Notre Dame opened up one of their gym facilities to over 30 men and women looking to take part in a warrior workout. Whether to progress mentally or physically- “For me I think it’s all about the confidence, you know so you’re in here you’re doing stuff, you’re getting active you’re interacting with people,” said Joe Weismantel. These warriors are working to overcome service-related injuries. “We’re just showing them that although they have those injuries, they have a new normal now. So it doesn’t mean you can’t do something, you just gotta do it a little bit differently,” said Samantha Eldridge, the Physical Health and Wellness Coordinator for Wounded Warrior Project. The Wounded Warriors Project is a non-profit organization helping to honor and empower recovering warriors. “They were starting to see tons of troops coming back from overseas with injuries and so they really felt the need to support these guys who were coming back in any way that they could,” said Eldridge. They teamed up with Notre Dame athletic coaches to host a warrior workout Monday at the Joyce Center. “Events like this is hopefully a good kick start back into the fitness world,” said Eldridge. Their goal with this event is to help veterans in their recovery process as they continue to transition into their normal lives. “People of all different categories and different injuries and different situations are making it through and are progressing and doing better and working with each other and not just kind of going quiet into the night,” said John Iversen. “You know, you’ve got world class athletes being trained by these folks so they’re teaching us some really good stuff,” said Weismantel. If you’re a veteran looking to attend one of the upcoming events- “We have 20 different programs and they’re all free to our veterans and service members.” said Eldridge. You can find out more information about their programs by clicking here.    By Andrea Alvarez
The Red Knights New York Chapter 42 motorcycle club will hold its fifth annual “Bucket Brigade” charity ride Aug. 27 to benefit The Wounded Warrior Project. The cost of the ride is $15 for drivers and $5 for passengers. Registration will be from 8 a.m. to 9:30 a.m. at The Bath Volunteer Fire Department, 50 E. Morris St. in Bath. The ride will start at 10 a.m. at the Bath Volunteer Fire Department, and riders will travel approximately 100 miles around the Finger Lakes region, finishing at the Hammondsport Fire Department. There will be food and drinks available for purchase along with raffles, a silent auction, a 50/50 drawing, and live music. Last year's ride raised more than $4,500 and overall, the annual ride has raised more than $17,600 for the Wounded Warrior Project. For more information, call 814-203-0029 or email ny42@redknightsmc.com.   by Jeff Murray
The Legacy Run is about raising money for The American Legion Legacy Scholarship Fund. But on Monday, the Legacy Fund briefly took a backseat to one of the Legion’s other critical funds: Operation Comfort Warriors (OCW). Before more than 300 Legion Riders and their passengers departed Oak Grove, Ky., they witnessed an OCW donation to the Warrior Transition Battalion (WTB) at nearby Fort Campbell. A gift of $15,000 worth of items was presented to the WTB leadership at the Valor Hall Conference and Event Center. The donation included two NordicTrack treadmills, archery compound bows, arrows, bicycle/wheelchair racing gloves, bike helmets, stationary bike trainer blocks and three portable shelter canopy tents to provide recovering servicemembers with shaded areas. The donation also included 100 MP3 players pre-loaded with a program that will help servicemembers dealing with sleep issues to get into their REM-cycle of sleep without having to use medication. During his tenure as national commander from 2012-13, Jim Koutz helped raise more than $1 million for OCW. He was on hand for the donation. “It’s just something we need to do to take care of our troops,” he said. “We just don’t go buy a bunch of items and take it to the troops. This is what the commanding officers at these Warrior Transition Units tell us that (recovering servicemembers) have been asking for.” Lt. Col. Chip Finley, commander of the Fort Campbell Warrior Transition Battalion (WTB), was on hand to accept the donation. He said the approximately 250 servicemembers recovering at Fort Campbell will greatly benefit from the items. “I greatly appreciate you guys’ efforts,” Finley said. “Roughly 85 percent of the soldiers (in the WTB) will never, ever wear a uniform when they leave our battalion. They head out as veterans to hopefully do great things. Part of that rehabilitation … are things like this (donation). With this equipment that we truly, definitely need, this will help us provide a start for them. We could not do this without your efforts and your contributions.” Brian Keller, the state sergeant-at-arms for the Department of Missouri’s Legion Riders and a member of Sons of The American Legion Squadron 347, helped OCW coordinator Bruce Drake pack up the equipment and deliver it to Valor Hall. “It shows how much we support them (and) how much we want them to get better to proceed with their healing,” Keller said of the donation. “These are tools to help them do it. This is the whole reason I joined (the SAL): to give back. I wasn’t a warrior. I was looking for my way to give back.”   By Steve B. Brooks
While anthropologists cannot pinpoint one reason tattooing began or held fast over the course of humanity, one reason tattooing persists is to signify a warrior. The tradition of tattooing is a mainstay in American military history, from the Revolution to today. The age-old practice of tattooing can be found on mummies dating as far back as 4000 B.C. Cultural anthropologists attribute the spread of tattooing or body-marking culture to a variety of human traits, ranging from religion to magic to experience and memory. Outside of religious or ancient ceremonial trends—especially among tribal people worldwide—the connection of the body with patriotic sentiments has, for centuries, been a motivating factor in perpetuating the art of tattoo among warriors. Furthermore, some anthropologists argue that early tattooing was a form of therapy. “Tattoos and other permanent forms of body modification have been paramount in establishing the status and reputation of warriors for hundreds, if not thousands, of years,” Lars Krutak, a tattoo anthropologist and the host of Discovery Channel’s Tattoo Hunter, told Medium’s “War is Boring” blog in 2014. Romans & Tribal MarkingsIn Western culture, tattoos find roots in the Roman Empire. Roman soldiers were tattooed with permanent dots—the mark of SPQR, or Senatus Populusque Romanus—and used as a means of identification and membership in a certain unit. The Greek word Stizein meant tattoo, and it evolved into the Latin word Stigma meaning a mark or brand. Typically, tattooing was associated with lower classes (criminals, slaves and gladiators) as well as Thracian (Southeastern Indo-European tribe) infantry. Additionally, tribal warriors of the British Isles embraced the practice of tattooing. Picti people of Caledonia (now Scotland) were known as “the Painted People” because of their tattoos. Celts were known to paint their bodies with spiral motifs—recognized as Celtic knots today. Some American tribes affiliate certain “paint”—body paint, rather than puncture tattooing—with success in war. Maori tribes of New Zealand have specific tattoo patterns and placement—known as moko—that tell of the wearer’s ancestry and social standing. Maori warriors would behead slaves and tattoo the heads in order to barter for weapons and ammunition from visiting Europeans during the 1700s. “Use of paint during warfare is very common throughout North America and Australia,” wrote Wilfrid Dyson Hambly in his 1925 book The History of Tattooing. “The desire to impress one’s foes may be uppermost in the case of an advancing army of Indians or Australians who have used the red war paint very freely.” Throughout Gallipoli (Turkey), Malta and France, soldiers and sailors sported markings. But the sweep of Christianity stifled tattooing in much of the Western world when, in 787 A.D., Pope Hadrian I outlawed tattooing. Resurgence in Western CultureIn the 18th century, at the height of British colonial exploration, Capt. James Cook’s expeditions to the Far East resulted in a renewed fascination with the age-old practice of body marking. Sailors returned with permanent reminders of their travels and marks of seaward superstition. The use of tattoos as identification continued, spreading to sailors in America. During the American Revolution, sailors’ American citizenship papers were often disregarded by British Navy ships—destroyed in some cases—so seamen tattooed their identification information as a way to avoid being illegally recruited by the British navy. The 19th century British army commander Frederick Roberts encouraged tattoos on troops, saying: “Every officer in the British army should be tattooed with his regimental crest. Not only does this encourage esprit de corps but also assists in the identification of casualties.” (Among many campaigns, Roberts served in Afghanistan during the Second Anglo-Afghan War in 1878.) Two prominent tattoo artists of the 19th century—Tom Riley and Sutherland Macdonald—both served in the British armed forces. Riley fought with the army in the Second Boer War in South Africa from 1899-1902, as well as Sudan, and Macdonald also served in the British army in the 1880s. Around the same time, British sailor George Burchett learned the art of tattooing. He joined the navy at 12 years old and, after his service and some years travelling the world, Burchett opened a tattoo parlor in England, and trained under Riley and McDonald. He eventually became known as the King of Tattooists—allegedly tattooing members of the upper class as well as royalty. Migration to the U.S.German immigrant Martin Hildebrandt is believed to have opened the first tattoo shop in New York City in 1846. He travelled the country tattooing Civil War soldiers. Civil War veteran Wilbur F. Hinman wrote in his novel Corporal Si Klegg and His Pard: “Every regiment had its tattooers, with outfits of needles and India-ink, who for a consideration decorated the limbs and bodies of their comrades with flags, muskets, cannons, sabers and an infinite variety of patriotic emblems and warlike and grotesque devices.” Hinman served with the Ohio 65th Volunteer Infantry. This trend of tattooing military servicemembers persisted. It’s said that even Smedley Butler sported a tattoo of the Marine Corps emblem. “Interesting cases of present-day employment of tattooing to express social solidarity are common enough among soldiers,” Hambly wrote. “Military men not infrequently mark themselves with something which shows allegiance to their profession, for example, the date of a battle, cross-guns, a flag, a cannon, or a pyramid of bullets. Naval men prefer a ship or an anchor, and sometimes the marking does not merely connect the wearer with some particular army, but further identifies him with a certain corps. Thus a cavalryman tattooed a horse on himself.” Hambly claims in his book that at the time of publication (1925) some 90% of U.S. Navy sailors were tattooed. The popularity of tattooing in port towns throughout the U.S. stirred the tattoo business. In 1918, August Coleman—“Cap” as he was known among his clients—opened a tattoo parlor in Norfolk, Va., making a living by tattooing sailors. Franklin Paul Rogers, who became known for his development of modern tattooing machinery, studied under Coleman from 1945-50. As a child, Rogers met a Spanish-American War veteran who was heavily tattooed, and the future father of American tattooing got his first tattoo at 21 in 1926. He is best known for his “old-school” tattooing style, modeled by such current tattoo artists as Ed Hardy. Norman Keith Collins—known best as “Sailor Jerry”—was highly influential in the American tattooing world. He served in the Navy, joining in 1930, and traveled much of Southeast Asia. He learned about the practice, becoming influenced by the culture and tattooing style of that area. His style shaped tattoo trends throughout the U.S. in the mid-20th century and remains popular today. Superstition and TraditionAfter WWI, tattooing lost its social status, though continued to be a mainstay in the military. “Two reactions seem to be possible in persons who see a tattoo on someone,” wrote Samuel M. Steward, a prominent tattoo artist during the mid-20th century, in his book Bad Boys and Tough Tattoos: A Social History of the Tattoo with Gangs, Sailors and Street-Corner Punks, 1950-1965. “One is complete fascination, a feeling that here is the ultimate stud, the great macho…the far-traveling sailor…The other is a complete revulsion: the tattoo represents the epitome of sleaze…everything that intelligence and sophistication have conditioned you to despise.” For many, superstition and tradition played a role in motivating U.S. troops to get tattoos. Certain symbols represented the location a sailor had been— dragons for Asia, hula girls for Hawaii, a fully rigged ship for Cape Horn. Others symbolized a sailor’s job or experience —a swallow for every 5,000 miles sailed, an anchor for a boatswain or chief. Some sailors believed tattooing a pig and a rooster on the arches of each foot would prevent them from drowning. “In order to express sympathy for a shipmate, one sailor had tattooed a picture of a steamship over which were the words, ‘Empress of Ireland,’” Hambly wrote. The practice remained popular, however, throughout the Korean and Vietnam wars. “On summer weekends the sailors flocked into my shop in such numbers that it was necessary to have a policy of ‘Navy first,’ requesting the city boys to come back later, or on another day,” Steward wrote. Irving Berlin even wrote a song about it. “A Sailor’s Not a Sailor (‘Til A Sailor’s Been Tattooed)” was performed by Ethel Merman. Tattoos TodayIndeed, the topic of tattooing in the U.S. Navy (as well as all military services) has become more divisive in recent years. A 1986 issue of All Hands (the official magazine of the Navy) published an article imploring sailors to reconsider getting a tattoo. Though for the modern veteran, tattoos from during and after their military service tell a story and can be used as a form of therapy or recognition. Such projects as Service Ink (see the May 2016 issue) have emerged, encouraging veterans to tell their stories via tattoo. VFW Post 9488 supports a program called Operation Tattooing Freedom, which provides free tattoos as a means of cathartic release for veterans experiencing PTSD or chronic pain. “A month out of boot camp [in 1999], I had 11 tattoos—typical sailor tattoos,” said Lewis Hunt, former commander at Post 9488 in Charlotte, N.C. “When I’m getting tattooed, I tend to go to a neutral place. The worries of the world go away, and I can be in the moment.” Hunt himself suffered from PTSD as a result of his service in Afghanistan from 2001-02. He had been on sleep medications for five years and was having issues at home that were affecting his family. “I talked with my tattoo artist for awhile,” Hunt said. “He was also a veteran. We talked about what we’d dealt with, where we were at. When I got up from getting that tattoo, I felt so much better. My issues didn’t go away, but I was able to work through it. I realized how much that tattoo positively affected other parts of my life.” In 2009, the Army reported that some 90% of combat soldiers had at least one tattoo—a much higher percentage than the one in five people in the general population with a tattoo. Themes typically included pride in service, patriotism, unit identification and memorials. Army Regulation 670-1 has been updated frequently in the past few years—most recently no longer limiting “the size or number of tattoos soldiers can have on their arms and legs.” (Army Times, April 10, 2015.) Air Force regulations (AFI 36-2903) allow tattoos as long as they are not excessive (defined as visible in uniform on more than 25% of the exposed body part). As of April 2016, the Navy’s current regulations allowed sailors to sport one neck tattoo and full sleeves (tattoos covering the entirety of a person’s arm). “Society is changing its view of tattoos, and we have to change along with that,” former Army Chief of Staff Gen. Ray Odierno told Military Times in April 2015. “It makes sense. Soldiers have grown up in an era when tattoos are much more acceptable, and we have to change along with that.”
There’s a new way for veterans to access health care. Mobile apps—programs designed for devices such as smartphones and tablets—can help vets cope with ailments such as PTSD, TBI and general anxiety. Experts say this new frontier will require regulation and careful oversight. But the mental health field may be one area where veterans can use apps in addition to traditional health care to improve their quality of life. Today, both VA and other organizations are working to help create access to care—with the veteran in mind.According to “Meeting the Behavioral Health Needs of Veterans,” a study by the National Council for Behavioral Health, 30%, or nearly 730,000, of the 2.4 million active-duty and reserve military personnel who deployed to Iraq and Afghanistan will have a mental health condition requiring treatment. FOUR APPS IN ACTION The VA Office of Connected Health already has several apps geared toward mental health. Neil Evans, a primary care internist and acting chief of the office, said the apps are a way to add value to existing mental health treatment. This, in turn, increases the value of a patient’s health care. “These apps are all designed to be used along with existing therapy,” he said. “If you can augment the communication with their provider, and take those lessons and apply them in their daily life, that’s going to improve their experience.”The apps cover a range of mental health concerns—VA’s flagship app PTSD Coach was the first. Released in 2011, PTSD Coach is available in 95 countries and has been downloaded more than 300,000 times. But it’s not just for PTSD, said clinical psychologist Julia Hoffman, national director for mobile health at VA’s Mental Health Services. PTSD Coach was born out of the idea that patients wanted something to practice outside of therapy. So they talked with experts, clinicians and patients and developed an app to help patients tolerate stress in their everyday lives. “That is something anyone can identify with, not just people with PTSD,” Hoffman said. “Anybody with emotion dysregulation, anger, irritability [and/or] anxiety can benefit from this tool.” Developing PTSD Coach and the other apps for mental health constitute an incredible opportunity to dismiss the stigma that keeps some veterans from getting the care they need, she said. Three other apps are very similar in nature: PE Coach, ACT Coach and CPT Coach are more specific and designed to work with the type of therapy a patient is already receiving. The PE Coach app is for veterans, troops and others to use in Prolonged Exposure (PE) therapy for PTSD with a behavioral health professional, according to VA. As an aid for therapists during PE sessions, the app provides tools for patients to process their traumatic experiences and reduce anxiety and fear.“When people participate in it as prescribed, it really works,” Hoffman said. “However, it’s not without a drawback: it asks a lot of the patient and the therapist. It’s very difficult work.”One of the key features is that patients are asked to go through—in extreme detail—what their events were. The app has the capability to audio record PE therapy sessions directly onto the patient’s mobile device. This is used as homework, where the patient can listen back. And with the portability of a mobile device, the patient can now do this and other homework anywhere—and do it discretely. “Instead of carrying a big binder that says ‘PTSD’ to the whole world, [the patient] looks just like every other person who is also sitting there, looking at his phone,” Hoffman said. All of the apps are designed to create real, long-term clinical improvement so veterans can go on with the rest of their lives, Hoffman said. It is not intended to undermine or reinvent any of the highly successful interventions.PE Coach also can track symptoms over time to evaluate treatment progress and outcomes. Features like that decrease the time the patient spends in the therapy room—when that time would be better spent engaged with the behavioral health expert, Hoffman said. ACT Coach is another VA app. This one is designed for users who are in Acceptance and Commitment Therapy (ACT). Features include exercises to practice the ACT core concepts, as well as a way to log and track useful coping strategies.According to VA, CPT (Cognitive Processing Therapy) has been shown to be one of the most effective treatments for PTSD for both civilian and military-related traumas—VA also has an app for that. Like ACT Coach, CPT Coach also works in conjunction with a mental health care provider for users undergoing that particular kind of therapy. It contains support material for a complete course of CPT to help patients manage their treatment. This includes in-between session assignments, readings, PTSD symptom monitoring and mobile versions of CPT worksheets.ON THE WEB: GIVE AN HOURBarbara Van Dahlen is a clinical psychologist and president of Give an Hour, a non-profit that connects volunteers from the medical community with military personnel and their families. Medical providers offer their services for free, giving their time.Van Dahlen came up with the concept of connecting those in need with providers in 2004. She heard about vets coming home from Iraq and Afghanistan and dealing with the psychological consequences of war. She thought of Craig’s List, the online classified site connecting those seeking goods and services. So she asked herself why not take the same approach to mental health care?“We live in this virtual space to begin with,” she said, adding that there’s no overhead required for facilities—the providers use their already existing office space. Mental health care providers donate their time virtually, and users can receive care for free. Today, the group has more than 7,000 providers signed up. Veterans, family members and even non-married partners can participate for free. “There’s no money changing hands,” Van Dahlen said. But with advancements in technology comes a need to regulate this new frontier. “There are no guidelines yet,” Van Dahlen said about the apps. She added that it’s important to remember to treat this companion care in a responsible, healthy and appropriate way. “When people are vulnerable and hurting, we need to be really careful,” she said. “There’s tremendous potential here, but it’s kind of the wild, wild West.” Currently, Van Dahlen, VA and other industry leaders are working to help create guidelines.Health care apps may not be a solution for everyone, Evans said. But it is a key strategy for any health care system. “Having mobile tools for patients in general to better engage in their own health care and better understand and manage their health care is going to be a critical offering of any health care system as we move forward in the next couple of years,” he explained. BACK TO BASICSNo matter whether it’s online or on an app, technology is not a replacement for getting real-life assistance from a health care provider.“These technologies are not intended to replace proper mental health care with a trained professional,” Hoffman said. “What they are meant to do is to support ongoing care, including care that’s received from a mental health professional or primary care clinics, where many people actually seek mental health care options.”Evans said if you’re interested in how an app can help, start the conversation with your health care provider. “Health care is all about a relationship and open communication, so most providers are very open to a discussion on how to find the tools and approach to help their patient thrive,” he said. “Often times the provider is willing to try something new if the patient is excited about it and motivated to use it to improve his or her health.” Whether they are military or civilian, people should be mindful of others’ and their own mental health. “You might want to reach out, check on them, talk to them,” Van Dahlen said. “If you had a gash, you wouldn’t walk around with it oozing. There are things you can do to help that heal.”After seeking professional help, there are many additional methods, such as yoga or meditation that can aid. “Then you’re on your way to finding out what’s right for you,” Van Dahlen points out. “One size doesn’t fit all. Take advantage of the resources available to you. We all have the potential to recover.”