Caring for Veterans on the Cheap
How the Veterans' Administration has been shortchanging soldiers who come back
wounded.
Judith Coburn
April 28 , 2006
On the eve of his Marine unit's assault on Falluja in November, 2004, Blake
Miller read to his men from the Bible (John 14:2-3): "In my father's house,
there are many mansions: if it were not so, I would have told you. I leave this
place and go there to prepare a place for you, so that where I may be, you may
be also."
A photograph of Miller's blood-smeared, filthy face, so reminiscent of David
Douglas Duncan's photos of war-weary Marines in Vietnam, is one of the Iraq
War's iconic images. Over a hundred newspapers ran it. But as the San Francisco
Chronicle reported recently, Miller, a decorated war hero, has been shattered
psychologically by Iraq. Disabled by flashbacks and nightmares, he continues to
pay daily and dearly for his service there.
His eloquent commitment to his fellow Marines is the highest value in military
life. But the Bush administration, which sent Blake Miller, his fellow Marines,
and 1.3 million other Americans (so far) to war in Iraq and Afghanistan
apparently does not share this commitment.
Much has been written about how President Bush and Secretary of Defense Donald
Rumsfeld waged war on the cheap, sending too few ill-equipped young soldiers --
30% of them ill-trained Reservists and National Guardsmen -- into battle. But
little has been reported about how shockingly on-the-cheap the homecomings of
these soldiers have proved to be. The Bush administration awarded Blake Miller a
medal, but it has fought for three long years to deny soldiers like him the care
they need. While Miller and his men were being thrown into the fire in Falluja,
the White House was proposing to cut the combat pay of soldiers like them. (Only
an outburst of outrage across the political spectrum caused the administration
to back off from that suggestion.)
The Veterans Administration, now run by a former Republican National
Committeeman, has been subjected to the same radical hatcheting that the White
House has tried to wield against the rest of America's safety net. Cutbacks,
cooking the books, privatization schemes, even a proposal to close down the VA's
operations have all been in evidence. The administration's inside-the-beltway
supporters like the Heritage Foundation and famed anti-tax radical Grover
Norquist like to equate VA care with welfare. Traditionally, however, most
Americans have held that the VA's medical care and disability compensation was
earned by those who served their country.
Unfortunately, in our draft-free country, the fight to protect the Veteran's
Administration and to fully fund it has gone on largely out of public sight.
Other than the Washington Post and the Associated Press, relatively few
journalistic organizations have bothered to regularly cover the VA. The fight
over it that White House hatchet men, VA political appointees, and their allies
in Congress have had with Congressional critics (Democratic and Republican)
along with veterans' organizations has been monitored closely only by veterans'
websites like Larry Scott's VAWatchdog.org, veteransforcommonsense.org and
military.com.
"Enron-styled Accounting"
While national deficits soar, thanks in part to skyrocketing war costs, veterans
of Iraq and Afghanistan are flooding into the increasingly underfunded VA
system. The Pentagon says that 2,389 Americans have died and 17,648 have been
wounded in combat in Iraq (and another 285 have died in Afghanistan). But these
casualty figures seem to be significant undercounts. After all, 144,424 American
veterans have sought treatment from the VA system since returning from those
wars, not including soldiers actually hospitalized in military hospitals.
These figures were wrested only recently from the Veteran's Administration after
years of fruitless demands from Democrats on the House Veterans' Affairs
Committee. The 144,424 figure includes not only many of those 17,648 reported
wounded in combat by the Pentagon -- if that figure is, in fact, accurate -- but
those wounded psychologically, those injured in accidents, and those whose
ailments were caused or exacerbated by service in the war. (Think of war, in
this sense, as an extreme sport in its toll on the body.) Of course, neither
Pentagon, nor VA figures for the wounded include estimates of those soldiers or
veterans who don't show up at a Department of Defense (DoD) or VA facility.
Among these casualties are post-combat-tour suicides (who obviously can't show
up) and the victims of diseases like leischmaniasis, caused by the ubiquitous
sand flies in Iraq, who often suffer on their own.
Nonetheless, the VA has admitted -- and it's been confirmed by an Army study --
that a staggering 35% of veterans who served in Iraq have already sought
treatment in the VA system for emotional problems from the war. Add this to the
older veterans, especially from the Vietnam era, pouring into the VA system as
their war wounds, both physical and emotional, deepen with age or as, on
retirement, they find they can no longer afford private health insurance and
realize that VA health care is -- or, at least in the past, was -- more generous
than Medicare.
Just as the Pentagon failed, after its March 2003 invasion of Iraq, to plan for
keeping the peace, guarding against looting, fighting a resilient insurgency, or
handling a civil war, so has the Veterans Administration failed to plan for
caring for casualties of the war. The VA admitted recently that 33,858 more vets
showed up for treatment in just the first quarter of FY2006 than were expected
for the entire year. Do the math yourself. Multiply times 4, assuming that the
war goes on injuring Americans at current levels, and you get a possible
underestimate of 135,000 casualties for the year.
Even more distressing, the San Diego Union recently reported that mentally ill
soldiers are being sent back to war armed only with antidepressants and
anti-anxiety drugs. The Union quotes Sydney Hickey of the National Military
Family Association as saying that "more than 200,000 prescriptions for the most
common antidepressants were written in the last 14 months for service members
and their families." According to the Union, an Army study also found that 17%
of combat-seasoned infantrymen suffer from major depression, anxiety, or
Post-Traumatic Stress Disorder (PTSD) after a single tour in Iraq. California
Sen. Barbara Boxer has called for an investigation.
Are such chronic underestimates merely the result of incompetence? Not according
to the Government Accountability Office (GAO), Congress's investigative arm. In
a series of reports on the Veterans Administration over the last three years,
the GAO found that the VA's top officials submitted budget requests based on
cost limits demanded by the White House, not on realistic expectations of how
many veterans would actually need medical care or disability support.
In repeated testimony before Congress, top VA political appointees have opposed
demands by veterans' groups like the American Legion and the Disabled Veterans
of America to increase significantly funds for medical care and disability
payments for the new patients now flooding the system. Top VA officials assured
Congress that more money wasn't needed because the agency had stepped up
"management efficiencies." But the GAO found that, from 2003-2006, there were no
obvious management efficiencies whatsoever to offset the increased treatment
costs from the Iraq War, nor did the VA even have a methodology for reporting on
such alleged efficiencies.
While the GAO's findings, when describing the VA's budget manipulations, were
couched in such relatively polite bureaucratic euphemisms as "misleading,"
"lacked a methodology," and "does not have a reliable basis," the conclusions
nonetheless were striking. "The GAO report confirms what everyone has known all
along," American Legion National Commander Thomas L. Bock commented. "The VA's
health-care budget has been built on false claims of 'efficiency' savings, false
actuarial assumptions and an inability to collect third-party reimbursements --
money owed them. This budget model has turned our veterans into beggars, forced
to beg for the medical care they earned and, by law, deserve. These deceptions
are especially unconscionable when American men and women are fighting in Iraq
and Afghanistan."
Some veterans are calling it fraud. Rep. Lane Evans (Dem.-Ill.) of the House
Veterans' Affairs Committee calls it "Enron-styled accounting."
Budget Busting
The economic realities of the wars the Bush administration has taken us into
are, in truth, budget busting. A recent study by Nobel prize-winning economist
Joseph Stiglitz and Harvard management expert Linda Biones -- that actually
factored the costs of "coming home" into war expenditures -- sets the total cost
of the Iraq War between $1 and 2 trillion, including $122 billion in disability
payments and $92 billion in health care for veterans.
Pentagon health-care costs for soldiers still in the military have doubled in
the last five years and are projected to total $64 billion or 12% of the
official Pentagon budget by 2015, according to William Winkenwerder, Jr.,
Assistant Secretary of Defense for Health Affairs. Soaring American medical
costs are only partly to blame. Advances in combat medical care have also meant
that far more wounded soldiers are being kept alive than in earlier wars, many
of them with serious brain injuries and/or multiple amputations. Taking care of
these tragically maimed soldiers for life will be extraordinarily costly, both
in terms of medical care and their 100% disability payments. (The VA rates
disability on a scale of 0 to 100%, which then determines the size of the
monthly disability payment due a veteran.)
Even before recent veterans began flooding the system, the VA was already
underfunded and being criticized for poor services. Then, three years ago, Rep.
Evans and Rep. Chris H. Smith, (Rep.-NJ), Chairman of the House Veterans'
Affairs Committee, raised the alarm that the VA, already short of funds, would
face a catastrophe as the troops began returning from Iraq.
Smith was rewarded for his efforts to sound the alarm by being removed not just
from his chairmanship, but from the committee altogether, by the House
Republican leadership. Similarly, in November 2004, VA head Anthony Principi was
forced out by the White House because of his opposition to the VA being
shortchanged in the budget the White House demanded -- so lobbyists for veterans
believe. But Principi seems not to have suffered from his VA experience. The Los
Angeles Times reported recently that a medical services company Principi headed,
and returned to after running the VA, earned over a billion dollars in fees,
much of it from contracts approved while Principi was VA chief.
The VA admits its disability system was overburdened even before the
administration invaded Iraq; and, by 2004, it had a backlog of 300,000
disability claims. Now, the VA reports that the backlog has reached 540,122. By
April 2006, 25% of rating claims took six months to process -- no small thing
for a veteran wounded badly enough to be unable to work. An appeal of a rejected
claim frequently takes years to settle. One hundred twenty-three thousand
disability claims have been filed already by veterans of Iraq and Afghanistan.
Yet, in its budget requests, the administration has constantly resisted
congressional demands to increase the number of VA staffers processing such
claims.
The True Cost of Coming Home
Congress has fought the White House over its low VA budgets for several years.
In the FY 2006 budget, all Congress could finally grant the VA was $990 million
above the agency's already meager request -- an increase of just 3.6% over the
previous year despite the rise in casualties to be treated. In fact, top VA
officials now admit it would take a 14% increase in the present budget simply to
keep up with the inflation in medical costs.
Rep. Evans estimates that there has been a $4 billion shortfall in VA funding in
the years 2003-06. In 2005, the White House admitted that, for medical services
alone, the VA was short $1 billion for the year -- and another estimated $2.6
billion in 2006.
What may ultimately swamp the Veterans Administration's ability to cope is the
emotional toll of combat -- unless it jettisons thousands of returning soldiers.
Nearly one in three veterans has been hospitalized at the VA, or visited a VA
outpatient clinic, due to an initial diagnosis of a mental-health disorder,
according to the VA itself. Its numbers are consistent with a recent Army study
on soldiers who served in Iraq or Afghanistan. Such a rate might add up over
time (depending on how long these wars last) to almost half a million veterans
in need of treatment -- or more. A 2004 study of several Army and Marine units
returning from Iraq and Afghanistan that appeared in the New England Journal of
Medicine found only 23-40% of those with PTSD had sought treatment. And
post-traumatic stress is called "post" for a reason -- its most serious symptoms
usually emerge long after the trauma is over.
Listen to the VA's own national advisory board on PTSD in a report released in
February, 2006:
"[The] VA cannot meet the ongoing needs of veterans of past deployments while
also reaching out to new combat veterans of [Iraq and Afghanistan] and their
families within current resources and current models of treatment."
The VA is now paying out $4.3 billion a year for PTSD disability to 215,871
veterans. The report also found that a returning war veteran suffering from
emotional illness now has to wait an average of 60 days before he or she can
even be evaluated for diagnosis, let alone treated. Forty-two percent of VA
primary care clinics had no mental-health staff members and 53% of those that
did had only one. Eighty-two percent of new patients needed to be in the most
intensive PTSD treatment programs, the VA report found, but 40% of those
programs were already so full that they could only take a few more patients; 20%
said they were too full to take any at all.
"VA's data show a 30% increase in the number of [Iraq and Afghan War] veterans
who have an initial diagnosis of post-traumatic stress disorder from the end of
FY 2005," says Rep. Michael Michaud (Dem.-Me). "I applaud the courage of these
veterans who have sought help, but the administration refuses to acknowledge
fully the demand and need for mental health services."
Further down the line: How many Iraqi veterans will eventually join the ranks of
the 400,000 homeless vets on the streets of American cities? (Right now the VA
takes care of only 100,000 such vets, according to the National Coalition for
Homeless Veterans.)
This dire situation has only encouraged the budget cutters and anti-government
radicals like Norquist, who once joked that he hoped to shrink the government
enough so that he could drown it in a bathtub. With PTSD rates soaring among
vets, the hatchets have been out not just when it comes to treating them, but
even when it comes to the diagnosis of PTSD itself. In 2005, the VA, under White
House pressure, announced that it was reopening 72,000 long-approved PTSD
disability claims for review, many of them for Vietnam veterans. Right-wing
columnists quickly swung into action with op-ed pieces insisting that many PTSD
claims were fraudulent. The VA backed off -- but only after a New Mexico
newspaper reported that a troubled Vietnam veteran with a 100% PTSD disability
killed himself upon fearing that the VA might review his case and a firestorm of
criticism from Congress and veterans' organizations followed.
Other White House ideas for cutting back the VA, including making vets pay
insurance premiums, higher co-pays and doubling Vets' costs for prescription
drugs, have also been beaten back by Congress. One VA response to its huge
backlog of claims has been to limit enrollment for its services. In January
2003, the White House ordered the VA to create a new temporary cost-cutting
category of "affluent" vets who would not be eligible to use the VA. But the new
category seems headed for permanency. And it sets the cut-off level for
eligibility for VA care so low -- around $30,000 for a so-called "affluent"
family of four -- that many vets who have been cut off can't possibly afford
health insurance and medical care on the private market.
In World War II, 12 million Americans fought on behalf of a nation of 130
million. Twenty-five percent of American men served in that war. They came back
heroes to a country more than willing to give them the latest medical care,
compensate them for their wounds, send them to college, and help them buy homes.
Fifty years later in Iraq -- an unpopular war -- only 1.3 million are fighting
for a nation of 300 million. "Never have so few sacrificed so much for so many,"
one Desert Storm veteran said recently. Iraq may be the wrong cause for
sacrifice. But Vietnam veterans taught us that once war starts we must be
willing to take care of everyone who gets hurt in it.
Judith Coburn has covered war and its aftermath in Indochina, Central America,
and the Middle East for the Village Voice, Mother Jones, the Los Angeles Times,
and Tomdispatch, among other media outlets.
Copyright 2006 Judith Coburn
This piece first appeared, with an introduction by Tom Engelhardt, at:
http://www.tomdispatch.com/indexprint.mhtml?pid=80291