Washington — The wars in Iraq and Afghanistan may be winding down, but the long-term costs of caring for those wounded in battle is on path to rival the costs of the Vietnam War.
While Vietnam extracted a far higher death toll — 58,000 compared with 6,300 so far in the war on terror — the number of documented disabilities from recent veterans is approaching the size of that earlier conflict, according to a McClatchy analysis of Department of Veterans Affairs data.
The data, obtained under the Freedom of Information Act and detailing all disability payments to veterans of all wars, show that veterans leaving the military in recent years are filing for and receiving compensation for more injuries than did their fathers and grandfathers.
At the same time, McClatchy found, the VA is losing ground in efforts to provide fast, efficient and accurate disability decisions. And the agency has yet to get control of a problem that has vexed it for years: The wide variation in disability payments by state and region, even for veterans with the same ailments.
For soldiers now coming home from Iraq and Afghanistan, this ongoing variation in an already-clogged disability system means the size of monthly compensation checks might be a quirk of geography.
Given the nature of today's disabilities, it's difficult to calculate how much it all might ultimately cost. "We're in somewhat uncharted waters," said Linda Bilmes, a Harvard University professor who has conducted an exhaustive study on the long-term costs of the wars.
Her most recent estimates, from 2010, indicate that providing disability payments to Iraq and Afghanistan war veterans could range from $355 billion to $534 billion over the next 40 years; on top of that, costs to the VA's medical system could range from $201 billion to $348 billion to treat veterans of the current wars.
For the VA system, that means costs will grow for years to come — even as the country is entering a period of belt-tightening that could reduce the size of government and put a damper on the agency's ability to find the money to pay these expenses.
The fatalities in war are only a small portion of its ultimate human cost. Soldiers back from the war in Afghanistan, which began in 2001, or the war in Iraq, which began in 2003, carry with them a lifetime of physical and mental reminders.
According to VA and Department of Defense information compiled by the advocacy group Veterans for Common Sense, 2.2 million service members have deployed to one of the wars since Sept. 11, 2001; 942,000 have deployed two or more times.
Of those, 6,300 service members have died, and 46,000 have suffered non-fatal wounds in action. But more than 600,000 veterans have filed for VA disability benefits, and more than 700,000 have been treated in the VA's medical system.
"Right now, VA is getting about 10,000 new Iraq and Afghanistan claims and patients per month," said Paul Sullivan, executive director of the National Organization of Veterans' Advocates, which helps veterans file their disability claims. "The numbers are devastating."
Compensating veterans for those injuries is the duty of the VA. The department has long been guided by the words of President Abraham Lincoln, who vowed "to care for him who shall have borne the battle, and for his widow and his orphan."
The VA's ability, or willingness, to do so has long been questioned by veterans who felt the agency tangled them in red tape. Those complaints are still aired, but outside observers say the VA has made changes in recent years to improve both its medical and disability systems.
But the department is fighting a huge tide of new veterans back from Iraq and Afghanistan. With them comes a range of mental and physical ailments that generally worsen as a veteran ages.
McClatchy analyzed the VA's compensation database, which includes 3.2 million records documenting each veteran and his or her mental or physical disabilities; information that could identify a specific veteran was blacked out.
The VA doesn't actually specify whether somebody was in Iraq or Afghanistan, instead lumping all veterans from the first Iraq war in 1990 into a "Gulf War" category. McClatchy zeroed in on veterans who left active duty in 2003 or later, an approximate cohort of Iraq and Afghanistan veterans.
Among the findings:
Recent veterans are filing claims at a far higher rate than veterans from previous wars or generations. That could make the eventual payout for the VA far higher than it has been for previous wars.
The VA's disability payments are still wildly uneven, despite years of attempts to improve consistency to the regional offices that process veterans' claims. It means, for example, that a veteran who lives in Kentucky is likely to have a higher disability payment than one who lives in South Dakota, often for the same ailment.
The speed at which the VA processes disability applications has gotten worse, and the percentage of claims with an error in them has worsened as well. In fiscal 2011, 16 percent of VA disability decisions contained an error, the VA's own review shows, far higher than the 2 percent error rate the VA is aiming for.
The VA said that it is working to do better and that it has hired 2,700 new workers. "We think we've got the problem identified and we think we have the right disciplines in place," said Thomas Murphy, who directs the VA's compensation program.
The true cost of war can't be known for years and decades after the last bullet has been fired and the final base torn down. A disability tied to military service might take years to emerge and or might steadily worsen after it does.
Bilmes, the Harvard professor who co-wrote "The Three Trillion Dollar War" with Nobel laureate Joseph Stiglitz, said the peak for paying out claims from World War II didn't come until the 1980s. The peak for the Vietnam War, which ended nearly four decades ago, hasn't yet been reached.
"We expect to see the same kind of lag this time around," said Bilmes.
In addition to aging, the wars fought this time around have been different. Beyond that, there's been a cultural shift among veterans and the VA.
Veterans file disability claims with the VA if they've been injured during military service — whether in a combat zone or stateside. Based on the severity of the disability, the VA pays veterans compensation checks that range from $127 to $2,769 a month.
Veterans today are applying with greater frequency and greater urgency than in years past.
Part of that, Bilmes said, is the nature of these wars. In previous wars, a general seeing a brigade under stress might have pulled it back — putting the soldiers on kitchen duty for a while, she said. Now, those functions are being handled by contractors, eliminating that relief valve.
"The guys who are out in the field are relentlessly out in the field," she said.
Beyond that, far more soldiers in this all-volunteer military have been back for two, three, four or five tours, and the long-term impact on hearing and on traumatic brain injuries caused by improvised explosive devices will be felt for years.
Other factors are at play: Better war zone medical treatment means more injured soldiers come home alive. Veterans are more willing to claim their disabilities than were vets of previous generations, and the VA is more accommodating than it once was.
According to VA data, the average Vietnam veteran in the VA system has 3.5 documented disabilities — more than those from the Korean War or World War II, but less than those in the Gulf War era. Veterans who have left military service since 2003 have an average of six disabilities on file, VA data show.
These recent veterans have a combined total of 3.5 million disabilities on file, compared with 3.9 million from Vietnam, McClatchy's analysis shows. While the annual cost of those Vietnam disabilities is higher, recent vets will see their monthly checks go up as they age.
As it deals with the rush of new veterans, the VA also is contending with an overwhelmed system that is getting slower and sloppier — despite years of promises and efforts to fix it.
The VA received a record 1.3 million disability claims in fiscal 2011. The time to decide those rose to an average of 188 days — far above the goal that no claim take longer than 125 days, and going in the wrong direction.
That should change, the VA's Murphy said. Workers hired in the past three years are now experienced enough to handle the complex claims coming in.
While some award decisions are relatively straightforward, McClatchy found that others — particularly those involving mental illnesses — are subject to wide variation among the VA's regional offices that decide claims.
The VA first confronted this problem in 2005, when news organizations reported that veterans' monthly checks varied widely depending on where they lived. The VA pledged to improve its training to ensure consistently among its 57 regional offices.
That wide variation still exists, McClatchy found — and particularly for post-traumatic stress disorder, one of the costliest disabilities of the war.
For recent veterans who are part of the Louisville, Ky., regional office, 67 percent have a high PTSD rating; 17 percent have the highest rating of 100.
For veterans who are part of the Sioux Falls, S.D., regional office, 42 percent have a high rating, and just 1 percent have the highest rating of 100.
For "chronic adjustment disorder" — not as big a condition as PTSD but still involving 12,700 recent veterans — the spread was even more dramatic: 24 percent with a high rating in one office, just 4 percent in another.
The reasons for the variation are many, but much of it goes to training — or the lack of it — at regional offices, as well as differing attitudes toward some of the big-ticket disabilities such as PTSD.
Sullivan, from the veterans' advocacy group, said that the VA falters because of demands to "rush decisions, causing too many mistakes," a "lack of thorough training for thousands of new claims processors" and "overly complex and adversarial regulations," among other reasons.
McClatchy's analysis shows little change since 2005, and it shows some regional offices are consistently high while others are consistently low.
The VA's Murphy said the agency put in place a new system to guide the regional offices through their disability decision process. That, he said, should help improve consistency.