Miss Ohio 2023, Madison Miller, performs a shift at a Silent Watch in Mansfield on Sept. 16, 2023.

Battlefield Breakthrough

Battlefield Breakthrough is a four-part series looking at mental health and one group's efforts to help local veterans struggling with PTSD. It began on Monday, Oct. 30 and runs through Thursday, Nov. 2.

ASHLAND — After three years of sending people to get Stellate Ganglion Block treatment through Silent Watch, Tim Chandler is convinced of its effectiveness for people struggling with post traumatic stress disorder. 

“I tell the vets that I talk to, ‘Go get this,’” Chandler said. “I can’t explain it — I can tell you how I felt.

“But you can’t comprehend it until you do it yourself.”

Silent Watch was founded to bring awareness to veteran suicide. Since 2020, the group has worked to fund veterans receiving SGB treatment, an experimental fix for PTSD.

Even though Chandler is convinced of SGB’s effectiveness, it has yet to be approved by the U.S. Department of Veterans Affairs.

Insurance doesn’t cover it, which is why groups like Chandler’s are stepping in to fill the gaps.

What’s the hold-up?

Sean Mulvaney, a doctor who has studied SGB treatment for PTSD for over a decade, said health insurance companies exist to make money.

He thinks there are many treatments not paid for by insurance despite great evidence. 

“They are not there to vet the quality of evidence on something,” Mulvaney said. 

He thinks health insurance aims to limit costs in order to remain profitable. 

The problem with the treatment getting approved by the VA, in Mulvaney’s view, is scalability. He said it’s a challenge to find physicians who can provide SGB treatments. 

“A lot of the time, the people that have the qualifications to do this, they don’t want to talk to people,” Mulvaney said. 

Any decision to offer SGB as an experimental procedure for PTSD would be made by the local VA facility leadership and provided by an anesthesiologist or intentional pain provider.

Gary Kunich, Public Affairs Specialist at U.S. Dept. of Veterans Affairs

Chandler agrees with Mulvaney. He thinks it will take years before the VA approves SGB treatment for coverage.

“I love the VA for what they do for veterans, for the most part,” Chandler said. “They do help veterans with a lot of stuff.

“But when it comes to the mental aspect of the veterans, I feel that they are about half a mile behind where they really need to be.”

Adam Boyce, the director of Ashland County’s Veterans Service Office, agreed with Mulvaney and Chandler. Boyce said it’s “shocking” the VA hasn’t adopted SGB as an official treatment. 

“It is definitely different than back in the day. But they do move slow on everything,” Boyce said. “It’s a big organization, so there’s a lot of parts.”

Gary Kunich, a public affairs specialist from the VA, told Ashland Source the VA doesn’t currently recommend SGB for PTSD treatment “due to the lack of conclusive treatment about its efficacy.”

“SGB is sometimes used to treat pain, so VA facilities may offer it in that context,” an email from Kunich stated. “Any decision to offer SGB as an experimental procedure for PTSD would be made by the local VA facility leadership and provided by an anesthesiologist or interventional pain provider.”

Kunich’s email also stated a VA study about SGB’s efficacy is underway. That study, according to Kunich, is funded by VA Clinical Science Research and Development. 

His email stated that though the VA doesn’t recommend SGB as a PTSD treatment “system wide,” individual VA facilities get to choose what interventions they provide.

Some may elect to provide SGB for PTSD. Kunich said that choice would be made by local VA leaders.

There are some efforts to help veterans get the treatment at the federal level.

U.S. Rep. Scott Perry, a Republican serving Pennsylvania’s 10th District, introduced the “Treatment and Relief through Emerging and Accessible Therapy Act (TREAT PTSD)” in 2021. Despite bipartisan support, there hasn’t been movement out of committee on the bill, according to Congress’s tracker. Credit: https://clerk.house.gov/Members/P000605

Rep. Scott Perry (R- PA 10th District), a U.S. representative from Pennsylvania, introduced the “Treatment and Relief through Emerging and Accessible Therapy Act (TREAT PTSD)” in 2021. 

The legislation aimed to “direct the Secretary of Veterans Affairs and the Secretary of Defense to furnish stellate ganglion block to veterans and members of the Armed Forces with post-traumatic stress disorder, and for other purposes.” 

It had bipartisan support.  

The legislation was introduced in the U.S. Congress in March of 2021. It got referred to the Committee on Armed Services and Committee on Veterans’ Affairs on March 8, 2021, according to Congress’s tracker.

There is no further action listed on Congress’s legislation tracking site.

It requires care

While SGB has been a promising treatment anecdotally, it still requires further study, according to Justin Baker, the clinical director of The Ohio State University’s Suicide and Trauma Reduction Initiative (STRIVE).

STRIVE studies the treatment and research of PTSD. It historically had a focus on military members.

Since it started, it has expanded to help people whose jobs can be traumatic, like firefighters or police officers.

Baker said the long-term effects of SGB treatment remain unknown. They’ve been discussed in isolated case studies, but Baker said there hasn’t been a randomized controlled trial detailing the long-term impacts of SGB treatment.

Baker and Mulvaney both said therapy — a traditional treatment for PTSD — remains an important part of helping with PTSD.

“It is my belief at this point that pairing Stellate Ganglion Block with therapy is optimal,” Mulvaney said. 

But Mulvaney said he likes evidence, and that’s the reason for an ongoing study at STRIVE. 

That study, funded by the Navy Seal Foundation, aims to look at the effects of combining SGB treatment with cognitive processing therapy.

Cognitive processing therapy is a PTSD treatment known to be effective. It’s still too early to tell the results of that study, Baker said. 

STRIVE is currently in the process of applying treatments. 

Baker said he thinks part of therapy is matching with a good provider — somebody that you trust.

Many people in STRIVE’s lab were or are service members themselves. They’re all trained on military culture, which matters, Baker said. 

“I think being able to not have to translate what you mean when you’re talking to somebody, I think that helps,” Baker said.

He added the important thing with therapy is that people shouldn’t stop trying to go. 

“Just because you don’t have a good experience with one doesn’t mean that’s how it is for every therapist, but I get it. It’s hard to open yourself up and then have to do that again,” Baker said. “That can feel extremely vulnerable.”

For more information on the study or to sign up to participate, Baker said people can visit STRIVE’s website.

It’s not perfect

Chandler and Mulvaney both said another part of the issue with mental health and the military is the culture. Chandler said speaking up is something you’re trained not to do, so asking for help becomes a challenge. 

“You don’t want to do that, because your buddies are over here standing strong,” Chandler said.

But he encourages people interested in SGB to try to access the treatment. Boyce, the director of the Veterans Service Office in Ashland agreed. He said it’s important to take the first step and ask for help. 

As much as suicide and PTSD are problematic, I think it’s also important to share that, overall, service members and veterans are very resilient and well-adjusted.

Justin Baker, Clinical Director of The Ohio State University’s SUicide and Trauma Reduction Initiative

Still, Chandler is quick to admit the treatment isn’t foolproof. He says that’s because it’s specific to treating PTSD.

“There’s people with other issues — bipolar, schizophrenia, anything else — it’s not going to affect … It’s strictly for the symptoms of PTSD,” Chandler said. 

He said people he’s referred have had experiences where the treatment didn’t work like they’d hoped. 

But, he said, maybe their anxiety dropped by a few points. Or, maybe they’re getting an extra half hour of sleep at night.

Even if it’s not perfect, Chandler thinks it makes a difference. 

According to Baker, with STRIVE, not all veterans face PTSD and mental-health challenges. In fact, many return from stints serving their country and do well, never needing treatment for mental-health issues. 

“As much as suicide and PTSD are problematic, I think it’s also important to share that, overall, service members and veterans are very resilient and well-adjusted,” Baker said. “I think we get … focused that this is all veterans, and it’s actually a small percentage of them. It’s still a meaningful percentage.

“It doesn’t mean we stop working. But I think it’s important too, to also talk about that many are doing very well.”

The final word

Mulvaney said until SGB is a standard treatment for PTSD, he won’t view his work as complete. 

Even though there’s still work to be done studying and understanding SGB as a treatment for PTSD, Chandler focuses on the success stories he’s seen. 

In Ashland alone, Chandler says, he can share a dozen stories about how SGB has positively impacted veterans. 

It gives (veterans) a life back. That’s why we promote it.

Tim Chandler, President of Silent Watch

There’s the young man who served in Iraq and Afghanistan and came home struggling with PTSD. Silent Watch helped him get SGB treatment.

Silent Watch had a tent set up at its events throughout the month of September. The group’s logo is shown here, at an Ashland Silent Watch event from Sept. 24, 2023.

Now, according to Chandler, he’s become a leader in the Veterans of Foreign Wars group, reconnected with his daughter and secured a job. 

There’s a Vietnam veteran who received the treatment. Chandler said the veteran feels the best he has in 50 years, and reconnected with his wife, children and grandchildren.

There’s the veteran from Florida who contacted Chandler for help receiving the treatment, showing Silent Watch’s reach extends beyond just his hometown. 

It all started with Jane Roland, the former director of Ashland’s Veterans Service Office, posting a video on Facebook.

The Silent Watch board member said helping more veterans access the treatment is rewarding. She also said it continues to be important to bring light to the issue of veteran suicide. 

“I think at least drawing attention to it and drawing your community’s attention to it, maybe drawing attention of a veteran who may be contemplating that and then we can talk to them and say, ‘Hey, there’s help out there,’” Roland said.

She added two people — Chandler and Boyce — credit her with saving their lives. Chandler’s work, along with Silent Watch’s, has saved more since, Roland said.

“It gives (veterans) a life back,” Chandler said. “That’s why we promote it.”

Ashland Source's Report for America corps member. She covers education and workforce development, among other things, for Ashland Source. Thomas comes to Ashland Source from Montana, where she graduated...