Esther Schrader has a compelling article in the Sunday edition of the Los Angeles Times
detailing the obstacles faced by Operation Iraqi Freedom veterans who have come home in need of medical care or other assistance from the government. Suffice to say, it hasn't been easy. And though these vets are accustomed to fighting for what they need, it really chaps my hide to read about the structural issues facing the VA which have set the conditions for these kinds of situations.
For Briseno and his family — as for thousands of others wounded in the Iraq war — the transition from the life they knew as soldiers to a future as disabled veterans is filled with frustration and pain. The military is more efficient than ever in treating its wounded. But after the battle-scarred leave Army hospitals, they often find themselves on their own in an unfamiliar and difficult-to-navigate thicket of benefits and services.America's vets deserve better.
Since the wars in Afghanistan and Iraq began, 6,239 troops had been wounded in action, according to a recent Pentagon count. Of those, 57% were so severely injured that they were unable to return to duty. Medically retired from active duty military service, they need immediate assistance from the Department of Veterans Affairs healthcare system.
The surge of newly disabled veterans represents a challenge of a magnitude unseen since Vietnam.
Aware of potential pitfalls, the Army and the VA have started programs to reach out to the most severely wounded soldiers. Among the steps being tried are putting social workers in hospitals where the severely wounded are being treated, adding benefits experts willing to meet bedside with soldiers and creating call centers that offer advice and help after the injured are sent home.
The pilot programs are small and nascent, and both the Army and the VA acknowledge they are not nearly enough.
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In looking to the government for their healthcare needs, new veterans follow a long line of their predecessors who, since the Civil War, have been assured that the country they fought for would make its best efforts to take care of them.
But there have always been difficulties in following through. And the VA is a difficult bureaucracy to navigate in even the best of circumstances, much less when dealing with devastating injuries.
For decades, the VA, with 7.5 million veterans enrolled, has struggled to keep up. At any one time, more than 3,000 vets are waiting for their first visit to the doctor. Those whose injuries from battle qualify them for disability compensation often wait six months to two years to receive it. The VA has taken steps to cut the wait for veterans of the Iraq and Afghanistan wars, said Terry Jemison, a VA spokesman. In recent months, it has begun to station benefits experts at the military bases of returning units. Newly discharged soldiers who have been helped by these experts have waited 54 days on average to get their first veteran disability compensation checks.
But with the VA's costs increasing by 10% to 15% a year, with aging facilities in need of modernization and with the newly disabled veterans draining resources, "the system is under a strain, a serious strain," said David Uchic, spokesman for Paralyzed Veterans of America, which was founded in 1946 to represent soldiers with spinal cord injury or disease.
When we were attacked on 9/11, our nation went to war. Our leaders launched a war in Afghanistan to go after Al Qaeda, and then launched another war in Iraq purportedly as part of the global war on terrorism. Since 9/11, we have sent significantly more than a quarter million men and women into harm's way to fight for our country. We knew that many of these men and women would be shot at, and we knew that some would be wounded. Some would even die, no matter how well we did our jobs. Yet, despite this knowledge, we failed to adequately "plus up" our military medical systems to deal with the bow wave of casualties. And more significantly, we failed to invest in the VA when we had the opportunity in 2002 and 2003 to deal with the numbers of combat vets now streaming out of the service into VA hands. In my eyes, that's a breach of the sacred trust which exists between soldiers and the state. Our volunteer forces goes into harm's way with the expectation that they will be taken care of. And yet, as Ms. Schrader's story indicates, there a number of soldiers who have not been adequately or effectively taken care of by the VA system.
Some time ago, the Wall Street Journal reported on a similar case
, that of Army Spec. Jason Stiffler, and his seemingly endless fight with the VA and Army bureaucracies that handle disability payments. A major problem exists in the disability evaluation and adjudication stage of the process, where there exists a tremendous bottleneck due to too few resources and too much demand. The short-term answer is probably to do more of what the VA has been doing for some time -- to augment its medical evaluation staff with civilian medical personnel on contract, and to farm out the evaluation work itself to civilian health-care providers. At some point, this surge in disability evaluations will pass, and I think that's the best way to bridge the gap between supply and demand.
There's a second problem though, and that stems from the lack of resources in the entire VA system to take care of America's vets. Simply put, there are too few beds, too few docs, too few clinics, and too little money to provide the care for this generation of combat veterans. 10 or 20 years ago, this might not have been such a big deal. But civilian health care is increasingly expensive, and the military can't externalize the burden of providing for veterans' medical care as easily as it could in the past. Vets (like all of us) have to pay more for their medical care than in the past, and that often means making choices about how much coverage to take. Insurance companies are going to enforce policy exclusions more strictly, and will be loath to pay for injuries sustained in combat when they should ostensibly be handled by the VA or the military. And so, the veteran will be caught in the middle, between shrinking VA medical care capabilities and increasingly expensive civilian health care options.
Over time, this crunch may ease. The U.S. veteran population today stands at 25 million. However, it is shrinking due to the aging of the WWII/Korea generation, and the fact that our all-volunteer force produces a significantly lower number of veterans than the old conscription-based force did. Thus, in 10 years, today's vets may have an easier time getting medical care because they won't be competing with as many WWII and Korea vets. But I'm not sure that's a good answer, because there is a crunch today, and our veterans need care today. We can't just push this problem off into the future.
The long-term answer is probably to invest more money in the VA -- both to upgrade its infrastructure and to build more capacity. Such investment will cost real
money -- measured in federal budget terms as money that exceeds 10 figures. But it will be well spent. These are America's finest sons and daughters, and they have gone into harm's way for us. Providing adequate VA medical care for them is, quite literally, the least that we can do.