In May 2008, during a campaign stop in Charleston, West Virginia, then-presidential candidate Barack Obama gave a passionate speech about the inadequate care war veterans had received, particularly those suffering from post-traumatic stress disorder, under the Bush administration's tenure in office.
Without identifying him by name, Obama cited the case of Grover Cleveland Chapman , a World War II veteran from Greenville, South Carolina, who had been repeatedly denied PTSD benefits by the Department of Veterans Affairs. After his final appeal for treatment was turned down in April 2008, Chapman took a cab to his local VA clinic, sat down in front of the facility, and pulled out a loaded Smith & Wesson revolver. He pointed the .38 caliber revolver to his temple and squeezed the trigger. He was 89 years old.
"How can we let this happen? How is that acceptable in the United States of America? The answer is, it's not. It's an outrage," Obama said at the time. "And it's a betrayal - a betrayal - of the ideals that we ask our troops to risk their lives for. ...
"We have to understand that for far too many troops and their families, the war doesn't end when they come home. Just the other day our own government's top psychiatric researcher said that because of inadequate mental health care, the number of suicides among veterans of Iraq and Afghanistan may actually exceed the number of combat deaths. Think about that. Think about how only half of the returning soldiers with PTSD receive the treatment they need. Think of how many we turn away - of how many we let fall through the cracks. We have to do better than this."
Although Obama has taken steps to overhaul the VA - he nominated retired Army Gen. Eric Shinseki as secretary of Veterans Affairs and Tammy Duckworth, an Iraq war veteran whose combat wounds cost her both of her legs, as assistant secretary of public and intergovernmental affairs - he still hasn't nominated an assistant and deputy assistant secretary of defense for health affairs to tackle some of the lingering mental health issues plaguing the military, particularly for those veterans who have served mulitple towards of duty in Iraq and Afghanistan.
And while Obama was successful in getting Congress to radically increase the VA budget, his administration has struggled to deal with a massive benefits backlog that has nearly topped 1 million, an epidemic of veterans' suicides that has reached historic levels this year, and an unprecedented number of Iraq and Afghanistan war veterans who suffer from PTSD and traumatic brain injury and still cannot obtain adequate treatment.
Afghan Vets Suffering
The mental health crisis afflicting veterans of both wars will only worsen now that Obama said he intends to send tens of thousands of additional troops to battle in Afghanistan.
In fact, a disturbing new study released last month by the Army Mental Health Advisory Team underscores that point:
The study, the sixth one the Army has conducted in Iraq and Afghanistan since 2003, found that an increasing number of soldiers serving in Afghanistan are suffering from some type of mental health related injury and "significantly lower morale" compared with previous years due to an uptick in violence and multiple deployments.
The Mental Health Advisory Team surveyed 638 Soldiers from 27 maneuver platoons and 744 Soldiers from 25 support or sustainment platoons.
"About 14 percent of the Soldiers surveyed met screening criteria for psychological problems, which is similar to the findings of the 2007 assessment in Afghanistan," the study concluded. "Soldiers with three or more deployments had higher rates of psychological problems and marital problems. The team also found barriers to behavioral-health care were higher than in previous years."
Remarkably, there are only 40 mental health care professionals in Afghanistan and about 68,000 US soldiers currently deployed there, thousands of whom are on their second, third and, in some cases, fourth deployment. The additional troops Obama intends to deploy would bring the total number of troops in the region to roughly 100,000.
The advisory team recommended "increasing the number of behavioral-health personnel in [Afghanistan] and maintaining a low ratio as troop numbers surge, and appointing a senior theater-wide behavioral-health consultant and noncommissioned officer."
The Army wants to have at least one mental health care professional in place for every 700 soldiers. That would require sending 60 mental health care professionals to the region this month to support the soldiers who are currently stationed there, but it’s unclear what the plans would be, if any, to send in additional workers to support a troop surge.
Paul Sullivan, executive director for Veterans for Common Sense, said he is troubled that "for all the talk about expanding the Afghanistan War or winding down the Iraq War, there remains very little discussion about our troops in the trenches and our veterans struggling here at home."
Historic Number of PTSD/TBI Cases Predicted
Of the 1.9 million US soldiers who have been deployed to Iraq and Afghanistan thus far, as many as 700,000 will suffer from PTSD and traumatic brain injury, according to a recent report published by Stanford University. A similar study released by the RAND Institute in April 2008, estimated that 350,000 Iraq and Afghanistan veterans would suffer from PTSD. But the Stanford study, unlike the RAND report, factored in a delayed onset of PTSD, which accounts for the larger number of projected cases.
Veterans advocacy groups say the Obama administration and staunch veterans advocates like Shinseki and Duckworth have been unable to cut through the bureaucratic red tape that continues to permeate the VA and the Department of Defense. Moreover, the agency has not fully met its goal of hiring additional mental health professionals, leaving veterans who need immediate treatment on the brink of suicide.
"With 42 percent of troops still deployed to Iraq and Afghanistan it is crucial that the DOD improve transitional support and that the VA increase the number of mental health staff in order to provide mental health care and compensation in a timely manner," said Michael Blecker, executive director of Swords to Plowshares, a veterans group based in San Francisco, after the study was released in September. "These delays are unacceptable because they create overwhelming stress and health complications for veterans."
Sullivan said his group briefed several "congressional and [Obama] administration offices about the ongoing shortage of mental health care professionals to treat and diagnose returning veterans and to conduct medical evaluations for all soliders who are tapped to deploy to Iraq or Afghanistan , many for a second or third tour of duty.
"Our military is not following the law: leaders have not hired enough medical professionals to conduct the required pre- and post-deployment medical exams and provide care," Sullivan said. "The failure of top military leaders is shocking, and President Obama must take action and hold top military leaders accountable for not taking care of our nation's most important national security asset - our troops."
The 1997 Force Health Protection law requires the military to conduct medical examinations for soldiers returning from combat. But Sullivan and other veterans advocacy groups claim the Defense Department has routinely skirted the law.
Ira Katz, the deputy chief patient care services officer for the Veterans Health Administration, however, disputes Sullivan's assertions. Katz told Truthout that soldiers receive a post-deployment mental health screening when they return from Iraq and Afghanistan and are re-evaluated three to six months later in a post-deployment reassessment. In both cases, soldiers who show signs of PTSD receive additional treatment.
"We do know that multiple deployments increases PTSD and related problems," Katz said. "PTSD is most common, but it's not the only problem."
He pointed to substance abuse as another problem veterans struggle with upon returning from combat.
Katz and Sullivan have sparred before over veterans' mental health care.
Katz was one of the VA officials identified last year in a federal court case involving a federal lawsuit filed against the agency by Sullivan's group as trying to cover up the extent of suicides and suicide attempts among veterans who were treated or had sought help at VA hospitals around the country.
On February 13, 2008, Katz, who was then the VA's mental health director, and Ev Chasen, the agency's chief communications director, exchanged e-mails discussing a public relations strategy for handling this troubling news, according to evidence made public in the federal court case in Northern California.
The exchange came in the context of how to handle inquiries from CBS News, which was reporting on the surge of suicides among US veterans – reaching an average of 18 per day – with part of that rise attributed to soldiers returning from the wars in Iraq and Afghanistan.
In an e-mail headlined "Not for the CBS News Interview Request," Katz notified Chasen that the VA had identified some 1,000 suicide attempts per month among war veterans treated by the VA.
"Shh!" Katz wrote to Chasen. "Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?"
The lawsuit against the VA, which Sullivan and Veterans United for Truth filed in July 2007 in an attempt to get the agency to immediately treat veterans who show signs of PTSD and are at risk of suicide and overhaul the internal system that handles benefits claims, is currently before the Ninth Circuit Court of Appeals, where a decision is expected soon. A lower court judge dismissed the complaint last year stating in an 82-page ruling that "the court can find no systemic violations system-wide that would compel district court intervention."
Sullivan pointed out that it's holdovers like Katz who are part of the problem because they continue to downplay the seriousness of the issue.
And that’s exactly how Katz characterized the suicide epidemic he sought to conceal.
While the Army's latest figures show that 211 active-duty and non-active-duty veterans have committed suicide this year, Katz told Truthout that from 2001 to 2007 there has been a 10 to 15 percent decrease in suicide among vets who received care from the VA. He said it takes two years to process accurate statistics.
Katz also said the VA has stepped up mental health services and increased VA mental health staffing by 40 percent since 2005.
But at a briefing last month for reporters after the Army released the suicide statistics, Gen. Peter Chiarelli, vice chief of staff of the Army, said although the Army has hired 900 mental health care professionals over the past two years, "I see a shortage today of somewhere in the vicinity of, I would argue, 800 - 750 to 800."
"The reason why I'm having a problem with mental health care providers is, United States society as a whole is having a problem with mental health care providers," Chiarelli said.
Sullivan said the record number of suicides is indicative of a "failure of leadership in the military to implement solutions," such as implementing a "robust anti-stigma campaign that encourages our troops to seek mental health care and discourage officers from discriminating against soldiers who seek care."
Chiarelli said the Army is "working very, very hard ... to eliminate the stigma long associated with seeking and receiving help. This is a matter of life and death, and it is absolutely unacceptable to have individuals suffering in silence because they're afraid their peers or superiors will make fun of them or, worse, it will adversely affect their careers."
The "program" the general spoke specifically about in hopes of removing the stigma associated with PTSD was simply a questionnaire soldiers fill out as part of the Army's suicide prevention efforts, which Sullivan said falls far short of what needs to be done to treat veterans.
Sullivan said he is concerned that, after 12 years, Katz and the military "intentionally confuse a 'medical examination' by a doctor, required by the 1997 Force Health Protection Law, and a 'self screening' performed by a soldier using a pencil and paper without a doctor’s exam."
"So long as the government fails to do the exams immediately upon redeployment home and then provide prompt treatment when needed, the tragic military and veteran suicide crisis will continue escalating," Sullivan said. "While there may be an Internet web site with an anti-stigma message, there is no multimillion dollar joint DoD-VA television, radio, and print campaign encouraging veterans to seek care. The reason DoD and VA refuse to do this is because such an effort would increase the number of patients flooding into an already overwhelmed system."
Katz disagreed. He noted that the Real Warriors Campaign, an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, is one program that aims to de-stigmatize mental illness among vets. He also said the VA has a suicide prevention hot line —implemented last year after revelations were made in federal court about the VA's substandard suicide prevention efforts.
"There are stigmas associated with mental health throughout America and that is just unfortunate," Katz said. "Where people have special concerns, though, is whether there are specific stigmas associated with mental health conditions when you're in the service and while you're in the Department of Defense."
Blecker, of Swords to Plowshares, added that it's "disheartening that even after witnessing the tragic effects that a lack of mental health diagnosis, treatment and compensation had on Vietnam veterans, we continue to stigmatize PTSD and other mental illnesses."
Journalist Aaron Glantz, author of the book "The War Comes Home: Washington’s Battle Against America's Veterans," said in an interview that Obama's plan to send as many as 35,000 additional troops to Afghanistan has to be matched with his administration putting more effort into improving and expanding the medical care veterans receive when they return from war to treat PTSD and other combat injuries, a proposal Sullivan said is already mandatory under the 1997 federal law, but one that he claims has not been implemented due to a lack of mental health care professionsals.
Glantz said it’s clear that PTSD cases will see a dramatic increase as more soldiers are shipped off to war. It's how these soldiers need to be treated when they return from combat that concerns him.
"That is something that everyone in the military, the VA and our society as a whole needs to understand," Glantz said. "It's going to take a national mobilization to really welcome our soldiers home in a meaningful way that hasn’t happened yet."
Massive Benefits Claims Backlog
Recently, Sullivan's group obtained internal documents from the VA under a Freedom of Information Act request that shows the ongoing neglect of veterans who suffer from PTSD and traumatic brain injury.
According to the documents, the VA treats about 300 newly discharged Iraq and Afghanistan veterans per day and the agency receives around 330 new disability claims per day from veterans of both wars.
As of June, more than 480,000 Iraq and Afghanistan war veterans were treated at VA facilities throughout the country and nearly half have been diagnosed with at least one type of mental health condition, such as PTSD or traumatic brain injury, according to the documents.
But the VA has only approved about 59,000 benefits claims for PTSD out of the 134,000 veterans who have been specifically diagnosed by the agency as suffering from the disorder, the documents show.
Sullivan said, "that’s the real and unreported VA scandal."
"After eight years, VA still fights against PTSD benefits," Sullivan said. "The cause remains the heavy anti-veteran and anti-PTSD policies of the Bush administration."
But VA appears to be providing veterans with some relief.
Within the next month or two the VA will implement new PTSD benefits rules aimed at streamlining the way VA processes PTSD disability claims.
Still, Sullivan said Obama and Shinseki should pay closer attention to the Veterans Benefits Administration, one of the few agencies remaining under full control of former Bush administration political appointees.
Shinseki appears to have heeded warnings about cleaning house.
Two weeks ago, Adm. Patrick Dunne, the under secretary for benefits for the VA since 2006, announced his resignation, effective early next year. Dunne replaced Adm. Daniel Cooper, another Bush appointee who was forced to resign in 2006 following revelations that he used his office to promote fundamentalist Christianity.
Though Shinseki's office dismissed rumors that Dunne was forced out, numerous veterans groups said they were privately told by VA officials that Dunne was asked to step down due in large part to several high-profile scandals that took place on his watch, such as the shredding of benefits claims at VA regional offices and the VA's mishandling of the post-9/11 GI Bill benefits payments to veterans.
Obama, meanwhile, has said the Veterans Health Care Budget Reform and Transparency Act he signed at the end of October will "harness new technologies" and "cut the red tape and backlogs."
Still, Sullivan said unless the Obama administration enacts immediate reforms, veterans will continue to suffer in the short term.
"Veterans wait, on average, about five to six months for an initial decision from VA for a disability compensation claim, plus another four or five years if the veteran appeals VA's decision," Sullivan said, adding that his group projects more than 1 million veterans will be treated by VA at a cost of $1 trillion over 40 years. "We remain deeply concerned that the backlog of veterans' claims recently reached 950,000 [which accounts for all wars] and continues rising."