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The profound strain of eight years of war on the volunteer force permeated a day-long conference of military leaders, policymakers, health experts and family advocates as they shared ideas to address the "unseen injuries" of post-traumatic stress disorder and traumatic brain injury.

A theme struck by many participants, including Navy Adm. Michael Mullen, chairman of the Joint Chiefs, was that government must seek greater involvement from communities across the country to support wounded warriors, traumatized veterans and damaged military families.

Mullen expressed concern over rising numbers of homeless veterans, slow expansion of a pilot program to streamline the disability evaluation system and a lack of solutions from medical research for timely diagnosis and treatment of PTSD and traumatic brain injury.

Mullen said he and his wife Deborah also are seeing more families — both spouses and children — being worn down by the strain of long and frequent deployments by loved ones to Iraq and Afghanistan.

"When they go home after the parade, when they go home after the recognition ceremony, their dreams haven’t changed … to raise a family, go to school, send their kids to school, own a home … The only way I can see us meeting [those needs] is through a community-based connection, a broad connection, that is sustained for them over the entirety of their lives," Mullen told the 2009 Defense Forum in Alexandria, Va. It was sponsored jointly by the U.S. Naval Institute and the Military Officers Association of America.

"When I talk about a long time, think decades," Mullen said. "These are 20-somethings who are wounded [and] these are 20-something spouses with a couple of children who have 50, 60, 70 years to live. That’s where this sustained effort has got to come in."

Leslie Kammerdiener, mother of severely wounded Army Cpl. Kevin Kammerdiener, visibly moved attendees with her account of how the VA has failed to provide adequate support to her and her son on multiple occasions since Kevin was injured in Afghanistan in May 2008.

One of their worst experiences occurred Labor Day weekend last year when she and Kevin, who was severely burned and lost the left side of his brain to an explosion, arrived at the VA Polytrauma Center in Tampa, Fla., for follow-up treatment and no one knew he was coming.

"We had no medications for him. We had no bed for his burned body and we had no food for his feeding tube — for 30 hours," Leslie said. "My son suffered for 30 hours because this system was not ready."

Just a week ago, she said, Kevin signaled that he wanted to take his own life by hanging. She called the VA hospital for help.

"Days went by and nobody called me." Finally, she confronted VA doctor at a social event "and said, ‘Look, you guys have to help us … I’m not trained. I’m not a nurse. I’m not a neurosurgeon. I’m not a psychologist. I’m not a therapist. I’m just a mom. And I don’t have any help with this.’"

Leslie told the forum, "It’s a very sad thing that this country — your Army or your VA or whatever — has let us down so incredibly. And I am asking you to step up to the plate and take care of somebody who went over there and did what you asked him to do."

Forum attendees gave her a standing ovation in support for what she and her son have sacrificed and endured. Asked later to list any part of the system that has worked well, Leslie praised the help she has received through her advocate in VA’s Federal Recovery Coordinator Program.

Shannon Maxwell, wife of retired Marine Lt. Col. Tim Maxwell who suffered a penetrating brain injury in Iraq five years ago, said she has "seen great improvement" in support of wounded warriors. She credited the Corps own special commitment to its Marines. During recovery, Tim Maxwell’s shared experiences led to establishment of its Wounded Warrior Barracks (Maxwell Hall) at Camp Lejeune and its Wounded Warrior Regiment.

On the same panel with the spouse care-givers was Noel Koch, deputy undersecretary of defense for transition policy and care coordination. He said, "I’m not going to sit here and tell you what a great job we’re doing."

Obviously affected by the Kammerdieners’ story, Koch said with self-deprecating sarcasm, "We do some things well. Power Point. We do storyboards. We have dynamite [office] conferences … We generate paper. The thing that we don’t do very well is see anything come out of it [to] provide care for our wounded warriors."

Koch said current wars are presenting unique difficulties for the military because of duration and because the fight is by a relatively small force of volunteers who must deploy over and over again. The fact that "less than one percent of our population" defends the nation today, Koch said, creates special obligations and special frustrations.

"We don’t know how to deal with the ones with traumatic brain injury or PTSD. PTSD has been around, under various names, forever, back to at least the First World War" when it was called shell shock. "To this day we don’t really have a good sense of it," Koch said, describing how a Vietnam veteran like him can be sitting alone 40 years later and begin to cry.

How to test for it and treat it, he added, is still being debated.

A separate panel at the forum had leaders of recent combat tours describing troublesome gaps in stress counseling before, during and after deployments because the supply of counselors isn’t equal to demand.

Another panel discussed successful partnerships between federal, state and local advocates for warriors and families. Online links touted by participants included, and

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