America's Veterans Left in the Lurch

Two years ago, Lorin Bannerman, a 43-year-old Sergeant in the Army National Guard, came home to his wife saddled with baggage from Iraq. He didn’t receive a full mental health screening from a veterans’ hospital for seven months and wasn’t diagnosed with Post Traumatic Stress Disorder, or PTSD, for months after that. Two years later, Bannerman and his family bear the lingering scar. He and his wife are now separated.

Jon Town knows he incurred short-term memory loss and severe hearing damage from the shrapnel that struck his neck in Iraq in 2005. Yet he’s been deprived of a signing bonus, disability pay, and medical support because his discharge papers state he had a personality disorder before he enlisted in the Army. Ever since, he’s been in a vicious struggle with the Department of Defense (DoD) and the Department of Veterans Affairs (VA). For now, he is unemployed and lives with his wife and son at his parents’ home in Findlay, Ohio.

This January, Jonathan Schulze requested admission to a Minneapolis VA. The former marine was haunted by the many casualties he had witnessed and deaths of close friends. But the VA’s waiting list extended through March. Schulze knew he couldn’t wait that long, so he went to a different VA in St. Cloud, Minnesota. He told a staff member there he was suicidal but was met with a similar response: He was number 26 on their waiting list. Four days later, Schulze committed suicide.

In the wake of stories like Schulze’s tragic demise, which got ample media coverage, more commonplace stories like Bannerman’s and Town’s emerge. And recent coverage of the decrepit conditions at Walter Reed, the military’s flagship hospital outside of Washington, D.C., has prompted a wave of enraged veterans with similar experiences to speak out. Though Walter Reed is run by the Department of Defense, all of these stories call attention to the VA’s appalling ineptness to adequately care for returning veterans. Chronic under-funding, nightmarish paperwork, and a cumbersome transition from DoD payroll to the VA system are hampering the VA’s ability to provide basic healthcare and dispense benefits to recent veterans.

While the VA has been traditionally under-funded over the years, a number of recent studies show that the department is increasingly ill-equipped to deal with the veterans in the system in spite of the rosy rhetoric of VA Secretary James Nicholson. And by such accounts, the VA is woefully unprepared for the possible influx of future veterans: the tens of thousands currently deployed in the war on terror.

“Before this war, during peacetime, the VA was staffed for a peacetime military,” Steve Robinson, director of government relations at Veterans for America, said during testimony in January before Senate Veterans Affairs Committee. “When the nation surged to this war, the VA did not surge with it. Now the VA finds itself playing catch up and in many states, they find themselves overwhelmed.”

Chronic Funding Shortfalls
Many critics attribute the VA crunch to lack of adequate funding. Chronic funding shortfalls happen year after year because much of the VA budget is beholden to the vagaries of federal discretionary spending -- a system through which the VA healthcare system competes with such programs as education and air and space travel.

This appropriations process has left the VA in a consistently vulnerable position, Carl Blake, the National Legislative Director of Paralyzed Veterans of America, said before the U.S. Senate Committee on Veterans’ Affairs to advocate for the 2008 budget in mid-February. “No Secretary of Veterans Affairs, no VA hospital director, and no doctor running an outpatient clinic knows how to plan and even provide care on a daily basis without the knowledge that the dollars needed to operate those programs are going to be available when they need them.”

And despite a $2.8 billion increase in the VA’s budget for Fiscal Year 2007, which officially started on October 1, 2006, VA hospitals are only seeing that money now because, up until mid-February, it has been held up by Congress. Such delays force VA hospitals to hold off on hiring much-needed medical staff and to postpone long overdue construction projects.

In the past, when the VA has been under funded, veterans have waited weeks or months for medical appointments, paid higher co-payments, and have even been turned away for treatment. In the last two years, the VA ran out of money to provide health care. It was then forced to request an emergency supplemental budget request for $2 billion in part because it had an unexpected 2 percent increase in patients, half of whom were from Iraq and Afghanistan.

These shortfalls occurred because the VA was basing its 2004 and 2005 projections on 2002 pre-invasion data, according to a February 2006 Government Accountability Office (GAO) report.

Not Prepared for New Veterans
Such shortages are indicative of an overall lack of preparedness. Lobbyists at Veterans for America and The American Legion have complained that there is not enough trend analysis coming from the VA itself. So they encouraged Linda Bilmes, the co-author of a report on the economic costs of the Iraq war, and professor at Harvard’s Kennedy School of Government, to research the budgetary requirement for caring for returning veterans. What she found was that, as a whole, the United States is not ready to care for the servicemen and women from Iraq and Afghanistan.

Part of the problem is an uninformed public, Bilmes wrote in her January 2007 report, “Soldiers Returning from Iraq and Afghanistan: The Long Term Costs of Providing Veterans Medical Care and Disability Benefits.” All too often, the media highlight the number of deaths in Iraq rather than call attention to those wounded, injured or sick.

“This may have lead the public to underestimate the deadliness and long-term impact of the war on civilian society and the government’s pocketbook,” she wrote in the report.

As the war expands in the decades to come, all discretionary spending, not just the dollars apportioned for the VA, could be affected by the cost of the war. Bilmes shows, for example, that over the next 40 years, the funding needs of veterans’ benefits could become so expensive that it will comprise an additional major entitlement program that will need to be financed through borrowing if the United States remains in debt.

But it’s not just the media skewing public perception. The DoD is also at fault. In a deliberate public relations strategy, the department limits its casualty numbers to only those service members hit by bullets and bombs. This definition, in effect, obscures more than half of the veterans in need of VA assistance. And the VA has followed suit. As of November 2006, the VA listed 50,508 non-mortally wounded veterans and has since halved that number to 21,649 to conform with the DoD’s estimates.

“For VA’s purposes, it doesn’t matter if the veteran was shot or run over by our tanks, the VA will still need to provide medical care for that casualty,” said Robinson, who contends that this is DoD and VA spin.

Beyond the spin, though, such VA scrambling betrays other profoundly problematic disconnects between the two departments. For instance, the DoD and the VA maintain incompatible paperwork and tracking systems. So disabled veterans may find themselves left behind when they’re transitioning from the DoD payroll to VA care. This was what happened with Town. Not well-informed about eligibility status from one system to the next, he’s been left in the lurch.

Bilmes notes that even a regularly discharged veteran will typically wait six months for a disability check from the VA. And it’s during that critical window that veterans are most vulnerable to suicide, substance abuse, homelessness, unemployment, and divorce.

Mental Healthcare Neglect and Inconsistency
By many accounts, the VA’s biggest failure is to competently provide for its veterans’ mental healthcare needs. Bannerman’s and Schulze’s stories perfectly illustrate this pattern. With more soldiers surviving traumatic wounds than any prior war and living in a constant state of uncertainty due to extended deployments, many veterans come home debilitated with PTSD, acute depression, and traumatic brain injury.

In a May 2006 issue of Psychiatric News, Frances Murphy, the Under Secretary of Health Policy Coordination at the VA, said that some veterans never get the treatment they need because “waiting lists render that care virtually inaccessible.” And a February 2007 McClatchy Newspapers investigation confirms her statement. Based on an analysis of 200 million VA records, interviews with mental health experts, veterans and their families, McClatchy Newspapers found that nearly 100 local VA clinics provided no mental health care in 2005. And rural and western states -- parts of the country where a disproportionate number of soldiers in the war on terror were raised -- tend to feel the crunch the most.

Veterans’ mental health care is also “wildly inconsistent” from state to state, McClatchy Newspapers found. While some veterans receive individual psychotherapy, others meet with social workers. Echoing that same sentiment, Bilmes wrote that because of the overwhelming backlog in disability claims benefits in the VA system, veterans in different parts of the country can have very different experiences with the VA simply because they happen to be located in an area with a greater backlog. The current claims backlog is anywhere between 400,000 and 600,000.

“Obviously something is wrong,” Robinson said about the lack of uniformity from one VA to the next.

And for Robinson, a case like Schulze’s death raises some serious policy questions about the VA’s overall lack of consistency: “When a veteran presents himself and asks for help, who is screening him? A technical administrative person?”

What can be done?
The story of Schulze’s suicide appears in the current issue of Newsweek. But Joseph Chenelly, the National Director of Communications at AmVets, took issue with the article’s suggestion that nothing is being done to rectify the situation. He says a lot of people are working hard to effect change on this front, just sometimes to no avail.

Either way, Chenelly is working to help educate soldiers’ families while their loved ones are still enlisted. “We need to be talking to them all the time,” he says, so that they aren’t unprepared for all of the bureaucracy. He also recommends streamlining the VA system, so veterans can file their claims electronically.

Virtually all of the veterans’ organizations who cosponsored the Independent Budget, an independent assessment of veterans’ funding needs, have been arguing for years that the VA budget be made a part of the mandatory federal budget. Chenelly said that Nancy Pelosi expressed sympathy for that when she was campaigning, and he is eager to see what happens now with a Democratic majority in Congress. Essentially, some argue that more money would solve all of the staffing shortages and supply adequate funding for proper construction to VA facilities.

Bilmes recommends automatically granting all or some of the claims with subsequent auditing to deter fraud, much like the IRS does, to remedy the backlog. She also recommends increased use of Vet Centers, those little outposts in strip malls around the country where a veteran can go to talk with a social worker about paperwork or his personal struggles.

There is a lot that needs to be done, Dennis M. Cullinan, the Director of National Legislative Service for the Veterans of Foreign Wars, said in a conversation about lost medical records from the DoD computers to the VA system. “The impetus for a seamless transition is there,” he said. “But for the congressional leadership, it’s more a question of political will.”

The other part of the problem, Cullinan said, is that for a president who recently requested more money for military recruiting, veterans’ needs are simply not a high priority.