Symptoms of post-traumatic stress disorder (PTSD) bring the horrors of the battlefield home. Twenty-six percent of Iraq and Afghanistan veterans who seek care at the VA have PTSD. (Photo: Joe Raedle / Getty Images)
As the number of veterans seeking health care continues to rise, the VA is straining to meet demands.
Amid talk of a drawdown of troops in Iraq, new statistics from the Department of Defense (DoD) and the Department of Veterans' Affairs (VA) show that US casualties are still climbing quickly. Iraq and Afghanistan battlefield injuries and deaths number 81,361, up from 72,043 last January, according to data obtained through a Freedom of Information Act request by Veterans for Common Sense (VCS). Veteran patients - including those who didn't seek care until their return home - shot up to 400,304 (from 263,909 in December 2007).
For the thousands of soldiers flooding the VA, mental illness tops the list of ailments. Forty-five percent of VA patients have already been diagnosed with mental health conditions, including a startling 105,000 diagnosed with post-traumatic stress disorder (PTSD). These data do not include the incalculable number of mentally ill veterans who have not received a diagnosis or haven't sought treatment at the VA.
Health care for veterans has improved substantially in the past year, mostly due to legislative changes and funding boosts, according to Raymond Kelley, legislative director of AMVETS. The recently passed Dignity for Wounded Warriors Act entitles veterans to up to five years of free health care for military-related medical conditions. Other legislative victories include improvements to VA facilities, increased mental health care research and a boost for the claims processing system, which has been vastly understaffed and overburdened throughout the "war on terror."
However, many barriers to adequate care and compensation remain, particularly for veterans filing for disability benefits. Delays and denials of those claims are routine. Among vets with PTSD, 59 percent have not been approved for benefits, meaning that their claims are pending or rejected - or that, due to any number of deterrents, they have not filed a claim.
According to Paul Sullivan, executive director of VCS, the average wait-time for veterans to receive an answer after filing for disability compensation is more than six months. A recent VCS lawsuit against VA showed that PTSD patients face even longer delays.
"That's wrong and it needs to get fixed now, especially during the recession when the veteran may also be out of work due to their disability," Sullivan told Truthout. "While veterans wait, their homes are foreclosed. Renters are evicted. Cars are repossessed. Some families often lack food or utilities while VA dawdles endlessly. Many veterans become homeless waiting for disability benefits."
More than 809,000 veterans (from all wars and peacetime) are currently waiting on pending claims.
Sullivan points to the case of Iraq veteran Scott Eiswert, who committed suicide after the VA rejected his PTSD disability compensation claim for the third time. After his death, the VA went further, denying Eiswert's life insurance benefits.
Jennifer Pacanowski, an Iraq veteran now living in Pennsylvania, waited two and a half years to receive a PTSD diagnosis, and nine months for her PTSD claim to be processed. In the meantime, her mother paid for all her medical care. Most of Pacanowski's efforts to utilize the VA yielded only frustration.
"Every time I reached out to the VA for help, they tried to have me admitted into the psych ward, which scared me, since all I needed was to talk to someone," Pacanowski told Truthout. "My family doctor from childhood tried to help with meds and treatment but [dealing with] combat veterans was a completely new thing for him, so it was hit or miss, with months of med changes and severe depression and anxiety, so I could not function."
Pacanowski still can't get all she needs from the VA. Since receiving her diagnosis, she has been eligible for full mental health benefits. However, the VA is overbooked, crowded and understaffed, and can only offer Pacanowski an appointment once every three weeks. So her family still shoulders much of the burden, paying for a private psychologist who can fill in the gaps.
According to Kelley, some claims are adjudicated quickly - usually those of recently discharged vets with very clear medical documentation of their condition. However, if a veteran doesn't visit the VA soon after returning home, or can't supply what the VA deems clear documentation, the claim could linger for years.
Moreover, the VA's intimidating bureaucracy deters some veterans from filing a claim at all. The process is arduous and sometimes convoluted, and, since a positive result is never guaranteed, vets sometimes abandon their attempts.
"We understand from speaking with veterans that some veterans are discouraged from filing claims because the claim form is 23 pages," Sullivan said. "I have watched veterans turn away in disgust when handed the stack of redundant forms VA requires."
The current, bulky method for filing claims also leaves a high margin for error, increasing the chances of denial. VCS suggests shortening the claim form to one page. According to Kelley, veterans should consult an officer from a veterans' service organization before filing a claim, to make sure it is correct and complete.
Pacanowski points to other reasons why veterans - especially those with PTSD - avoid the VA.
"I know many veterans with PTSD from all wars," she said. "Most are afraid to go to the VA because of fear of judgment and the constant run-around you get … The vets I know that don't go to the VA receive most help from fellow veterans. Or try and forget."
Self-medication, including drugs and alcohol, is also a popular alternative to the intimidating bureaucracy of VA treatment, according to Pacanowski.
With the advent of the Obama administration, veterans' organizations are hopeful that many of their long-sought goals will be realized. The House Veterans' Affairs Committee, too, is looking to make significant headway under the new president. According to Rep. Bob Filner, chairman of the committee, top priorities include providing the VA with "sufficient and timely funding," expanding access to health care for veterans in rural areas, and rebuilding the compensation and benefits system.
"We have a remarkable opportunity to make progress this year when it comes to veterans' issues," Filner told Truthout. "President Obama has laid out an ambitious agenda and the House Veterans' Affairs Committee is committed to bringing results to our veterans and their families."
Kelley points to the stabilization of VA funding as a key priority for the coming years. Under the current system, the VA budget remains uncertain each year until the annual appropriations bills are passed. This makes it difficult to plan long-term projects or expand ongoing initiatives.
"There has been a long-running problem with VA receiving a sufficient, timely and predictable budget," Kelley told Truthout. "AMVETS supports legislation that will allow Congress to provide advanced appropriations for VA healthcare, allowing VA to know well in advance of their budget so they can begin hiring personnel and planning infrastructure projects."
VCS is pushing for another measure to increase efficiency at the VA: automatic approval of disability claims for Iraq, Afghanistan and Gulf War veterans who have been diagnosed with PTSD. The extra claim-approval step often means months or years of painful limbo for ill veterans, and according to Sullivan, eliminating it would be a legally and scientifically sound move.
Filner confirmed that when it comes to the claims process, the VA has a long way to go. Moving into the new governmental climate, he stresses the urgency of addressing the issues keeping patients from receiving proper treatment.
"We must make progress in rebuilding the VA's broken benefits system," Filner said. "We need to thank veterans for their service by granting their claims and providing appropriate care."