As the nine-year “War on Terror” rages onward, high suicide rates, multiple deployments and lack of psychological treatment for Post Traumatic Stress Disorder (PTSD) alarms military personnel and many point to the real cost of the Middle East offensive will be health care after the war has ended. This disparity will likely exact a large toll on the nation’s military readiness in future conflicts.
Several reports including the Rand Study, Harvard Study and Dole-Shalala Commission find that the real cost of the war effort will come long after the fighting has ended and soldiers seek treatment for a myriad of injuries they suffered on the battlefield.
The signature injuries and perhaps the hardest to document are the elusive and well-hidden Traumatic Brain Injury or TBI and PTSD.
When soldiers return from the Middle East they are subjected to a plethora of details that need to be taken care of so they are able to receive adequate treatment, make their adjustment to life outside the battlefield and return to their families.
Since most deployments last months if not more than a year, most returning service members hastily scan through the mountains of paperwork in an effort to get home quickly.
Among the forms each soldier receives is a self-assessment for PTSD. When asked what the questions consist of and how many questions are on the PTSD evaluation form, Walter Reed Army Medical Center, Gigail "Gail" Cureton media relations said, “That’s not information we release.”
However, the question doesn’t lie with how many or what the content of the questionnaire contains, but the fact it is a self-assessment. Many soldiers may not show signs of TBI/PTSD until weeks or even months after they return home and as many reports cite there are simply not enough military trained staff to adequately take care of the men and women who serve in conflict zones overseas.
The Harvard Study concluded that the Veterans Health Administration (VHA) is already overwhelmed by the volume of returning veterans and the seriousness of their health care needs, and it will not be able to provide high quality of care in a timely fashion to the large wave of returning war veterans without greater funding and increased capacity in areas such as psychiatric care.
The study also pointed out the Veterans Benefits Administration (VBA) needs structural reforms
to deal with the high volume of pending claims and that the present claims process is unable to handle the current volume and will be completely inadequate to cope with the high demand of returning war veterans once the troops come home next summer.
With regard to the budgetary costs of providing disability compensation benefits and medical care to the veterans from Iraq and Afghanistan over the course of their lives the estimates range from the $350 - $700 billion and this scares many in Congress.
The Harvard Study concluded that the money needed to care for the soldiers depends on the length of deployment, the speed they claim disability benefits and the inflation rate of pending health care costs.
This staggering cost of medical treatment threatens to further bankrupt the Department of Defense and VA agencies and cause grave concern to some on Capitol Hill.
Yet, the summer offensive in Afghanistan rolls onward and injuries and death tolls continue to mount.
Key recommendations the Harvard Study suggests include more staffing in preparation for the influx of soldiers, increased funding especially in the mental health care treatment, funding of “Vet Centers” and perhaps the toughest is the need to restructure the benefit and claim process the VA uses.
Currently there are 37 bills, two resolutions, and two amendments to bills relating to Post Traumatic Stress Disorder and/or Traumatic Brain Injury somewhere in the legislative process. At least 11 of these deal with both issues. Of these bills, resolutions and amendments, three are now law (H.R. 2647, H.R. 3288, S. 1963), but none solves the problems facing returning veterans.
In a recent Military Times article the Veterans Affairs Department was asked how they should handle the tsunami of soldiers headed their direction. “In my judgment, it cannot be fixed,” said Peter Levin. “We need to build a new system, and that is exactly what we are going to do,” said the Veterans Affairs Department’s chief technology officer.
Among the plethora of issues facing the VA is the current backlog of 1.1 million claims that are awaiting decisions and how to best fix the error rate that hovers around 17-25 percent margin.
While veterans are waiting for their claims to be processed or reprocessed they run into all kinds of problems with managing their daily expenses which can lead to the loss of their cars and homes.
“It looks like we are going backwards rather than forward,” Congressman Bob Filner (D-CA) said. “No matter how much we raise the budget, no matter how many people we hire, the backlog seems to get bigger. People die before their claim is adjudicated. They lose their home. They lose their car,” Filner explains in the same Military Times article.
Solutions, however, are harder to come by in the bureaucratic quagmire of Washington DC. The VA Secretary
Eric Shinseki suggests the VA needs to hire more people to process claims. But what the VA really needs is more medical staff to treat the influx of soldiers suffering from TBI/PTSD and this process takes years to train workers something the VA does not have.
The VA hierarchy is looking at a three-to five-year range to fully train medical professionals to take care of the “War on Terror” veterans.
In the meantime, soldiers will be asked to wait.
The Rand Study titled “Invisible Wounds of Wars – Psychological and Cognitive Injuries, their consequences and services to assist recovery,” further delves into the serious problems returning soldiers face when it comes to treatment.
The study focuses on post-traumatic stress disorder, major depression and traumatic brain injury. These injuries were at the forefront “not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other service members, family members and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it,” the report summarized.
In July of 2007, President Bush received a report on a study his administration requested. Oftentimes when reports are commissioned, facts are dissemination, parties questioned and recommendations made. However more often than not these commissioned reports are read, talked about and put away in a drawer with no further thought of change.
Nowhere is this more true than the bipartisan report the Bush Administration requested from Bob Dole and Donna Shalala; “Serve, Support, Simplify Report of the President’s Commission on Care for America’s Returning Wounded Warriors” dated, July 2007.
The 40-page report suggested the Department of Defense and VA should develop integrated care teams of physicians, nurses, and allied health professionals from relevant specialties like, social workers and vocational rehabilitation staff.
These teams would be able to create injured service members’ initial ‘Recovery Plans,’ which would start with a comprehensive clinical evaluation upon return from the war theater.
The DoD and VA would direct staff at military medical facilities to complete these Recovery Plans and a plan be created for all service members who have been seriously injured since the beginning of the Afghanistan and Iraq conflicts. This would make future treatment of wartime injuries easier to document and get benefits to those who served in a time efficient manner.
The Dole-Shalala report also drove home the point that DoD and VA needs to work with the Commissioned Corps of the Public Health Service and Department of Health and Human Services to develop a cadre of well-trained, highly-skilled Recovery Coordinators (however these coordinators only added another layer of bureaucracy and their results have been negligible).
At the conclusion of the Dole-Shalala report they included results from an Operation Enduring Freedom and Operation Iraqi Freedom survey. The numbers were not encouraging.
It is thought that many young people join military service as a way to earn money for a college education, but the report found that only 21 percent of demobilized reservists and 31 percent of retired/separated service members actually enrolled in an educational program leading to a degree. It is also worth pointing out that OEF/OIF soldiers are suffering from unemployment numbers in the 20-30 percent range.
When it comes to understanding the claim and benefit process the numbers were even more disturbing.
Approximately 38 percent of active duty, 34 percent of reserve component and 38 percent of retired/separated service members are “very” or “somewhat” satisfied with the disability evaluation system. Only 46 percent of active duty, 36 percent of reserve component, and 40 percent of retired/separated service members say they “completely” or “mostly” understand the military’s disability evaluation process. While 42 percent of retired/separated service members who filed a VA claim report that they “completely” or “mostly” understand the VA claims process. All of these numbers give the DoD and VA a failing grade.
Dole-Shalala also believe the DoD and VA needs to create a single, comprehensive, standardized medical examination and that it be administered by the DoD. The single examination would serve Department of Defense’s purpose of determining fitness so the Veteran Affairs’ can determine the initial disability rate.
If service members are found unfit because of their combat-related injuries Dole-Shalala say they should receive comprehensive health care coverage and pharmacy benefits for themselves and their dependents through DoD’s successful TRICARE program.
When it comes to TBI and PTSD many see psychological problems as nonsense. It is up to the DoD to intensify its efforts to reduce the stigma associated with PTSD and ensure they question all returning war-theater soldiers to set benchmarks for future treatments.
Part of this process could include strengthening family support programs; expand DoD respite care and extending the Family and Medical Leave Act for up to six months for spouses and parents so they can care for their seriously injured soldiers.
Now that Congress has passed a health care reform bill, private insurance companies will begin the arduous task of transferring all medical records onto a new electronic data base. However, it may make sense for the Department of Defense and Veteran Affairs to ‘jointly’ develop an interactive “My e-Benefits” website that provides a single information source for all service members to access. Most agree that the DoD and VA is a small microcosm of the American population making it the perfect organization to integrate the electronic medical record keeping program.
The consolidation of electronic medical records should be tied to a Social Security number, similar to how the Social Security retirement program is currently operated. Military experts say this process would cut red tape for veterans when it comes to receiving services in either the DOD or VA.
Currently the military medical programs operate on entirely different systems causing unnecessary delays in care and headaches for those attempting to navigate the complex DoD/VA benefits system. The creation of an e-benefits page would allow soldiers to have a one-stop site to chart their benefits and be reminded of important deadlines and treatments.
Lastly, understanding the unquantifiable problem of Post Traumatic Stress Disorder requires an immense amount of work something the military has been reluctant to embrace.
The self-assessment for PTSD must be changed and it has been suggested an in-depth test administered by psychological health care professional that is better qualified to determine the PTSD problems the returning war veterans may or may not have.
The 2007 estimates on soldiers suffering from PTSD of varying degrees of severity affects approximately 12 to 20 percent of returnees from Iraq and six to 11 percent of returnees from Afghanistan. However, most psychological medical professionals believe that number to be much higher as many don’t return with symptoms right away and a future event could trigger the PTSD at anytime.
Through 2007, 52,375 soldiers have been seen in the VA for PTSD symptoms. Severe and penetrating head injuries or TBI can be readily identified, but cases of mild-to-moderate TBI can be more difficult to identify and their incidence is much harder to determine.
A recent report indicated that approximately 35,000 returnees were believed to be healthy after a screening test; however 10 to 20 percent had apparently experienced a mild TBI during their deployment. Medical experts agree that those soldiers who suffer from TBI will most likely have PTSD. Multiple deployments automatically increase the odds of soldiers getting both TBI and PTSD during the Middle East conflict.
Once a soldier is severely injured in the ‘War on Terror’ their life will be forever changed. However, what remains unchanged is the quality of life issue. The earning ceiling for those who survive amputations, serious head trauma and other debilitating injuries will be in play the moment the injury occurs.
The earnings/loss payments are supposed to make up for any reduced earning capacity and quality-of-life issues. Nevertheless these payments that are meant to compensate for permanent losses of various kinds of injuries needs to be reviewed to provide better reimbursements for those who will have trouble reentering the civilian workforce.
If service members are found unfit because of their combat-related injuries they should receive lifetime, comprehensive health care coverage and pharmacy benefits for themselves and their dependents through DoD’s favorable TRICARE program.
Daily stressors will continue to plague soldiers the rest of their lives, at the very least the government can ensure money matters are not a part of the equation for the injured soldier and their families. Americans would do well to remember that these soldiers made a life-long sacrifice to ensure the freedom and safety of all - as a result they need to be honored with integrity and respect.
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