The Washington Post’s stories about the Walter Reed Army Medical Center raised the visibility of a topic that others have been persistently following and reporting on. Our military medical and Veterans Administration health care systems are stretched to capacity and beyond in some areas. The VA is scheduled for budget cuts after 2008 despite indications that the need for services is high and going higher.

Let’s start with this item from the Boston Globe about a recent Harvard University study done by Linda Bilmes:

Due to improvements in battlefield medicine and equipment, there are now about 16 “nonmortally wounded” soldiers for every death, far more than the 2.6 soldiers wounded per death in Vietnam, the [Harvard Univerity] study said, citing Department of Veterans’ Affairs data.

The potential costs include medical care, disability payments and other benefits paid to injured veterans and assume that 44 percent of veterans eventually claim disability. That was the percentage of claims from the first Gulf War. [Linda] Bilmes’ calculations assume that by 2016, 2 million soldiers will have participated in these wars.

From a NY Times discussion (subscription) of the study:

About 1.4 million troops have served in Iraq or Afghanistan, and more than 205,000 have sought care from the veterans’ agency, according to the government. Of those, more than 73,000 sought treatment for mental problems like post-traumatic stress disorder.

Large numbers. Note the large numbers. <!-more-> Newsweek has just published its own review of the health care offered to our wounded soldiers:

A NEWSWEEK investigation focused not on one facility but on the services of the Department of Veterans Affairs, a 235,000-person bureaucracy that provides medical care to a much larger number of servicemen and women from the time they’re released from the military, and doles out their disability payments. Our reporting paints a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA’s arcane system of rights and benefits.

...

Yet, as the number of veterans continues to grow, critics worry the VA is in a state of denial. In a broad sense, the situation at the VA seems to mirror the overall lack of planning for the war. “We know the VA doesn’t have the capacity to process a large number of disability claims at the same time,” says Linda Bilmes, a Harvard public-finance professor and former Clinton administration Commerce Department official. Last month Bilmes released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan. She projects that at least 700,000 veterans from the global war on terror (GWOT) will flood the system in the coming years.

In a background piece about the article, Newsweek publicists wrote:

A jump in disability claims in recent years has created a bottleneck. Daniel Cooper, the VA’s under secretary for benefits, confirmed his department was coping with a backlog of 400,000 applications and appeals; 75 percent of them were still within a “reasonable” reviewing time frame, he says. As more servicemen and women return from Iraq, the backlog is likely to increase.

Cooper says the average waiting time for a benefits claim is about six months. But Newsweek turned up a number of veterans who’d waited longer. Patrick Feges, an Eagle Scout from Sugar Land, Texas, who was injured in Ramadi in October 2004, finally got approval last month, 17 months after filing his claim: after Newsweek and the advocacy group Veterans for America began looking into his case, he got a call from a VA official in Waco, Texas, with the news that his claim had been approved. Last week he received back pay to the date of his application.

And then we get to the reporting by the Army Times. If you want to see some clear reporting on the matter, do a search on Army Times and Kelley Kennedy.

Published on Monday Feb 26, 2007, Critics: Army holding down disability ratings

The Army is deliberately shortchanging troops on their disability retirement ratings to hold down costs, according to veterans’ advocates, lawyers and services members, and the Inspector General has identified 87 problems in the system that need fixing.

...

But in the Army — in the midst of a war — the number of soldiers approved for permanent disability retirement has plunged by more than two-thirds, from 642 in 2001 to 209 in 2005, according to a Government Accountability Office report last year. That decline has come even as the war in Iraq has intensified and the total number of soldiers wounded or injured there has soared above 15,000.

While the number of soldiers placed on permanent disability retirement has declined in the past five years, the number placed on temporary disability retirement...has increased more than fourfold, from 165 in 2001 to 837 in 2005.  [...]

Along with paying them reduced wages during that time, the eventual reevaluation often leads to downward revisions in their disability ratings — and lower disability payments.

Only 209 permanent disability retirement ratings given in 2005? Really? After 642 given in 2001?

More from the Army Times on the Inspector General’s report referenced above:

And what about that Inspector General’s report that identified 87 problems that needed to be fixed? It was from a year long probe that found, “inconsistent training for counselors helping soldiers through the system, inadequate record keeping and a failure to follow policy pushed down from the Defense Department,”

The Inspector General, according to Army spokesman Paul Boyce, found inconsistent training for counselors helping soldiers through the system, inadequate record keeping and a failure to follow policy pushed down from the Defense Department — all findings that Army Times has reported on since June 2006.

From the Army Times in June, 2006 comes an article that contrasts the experience of Lt. Col. Mike Parker versus the GAO report of a review of the Army Medical and Physical Evaluation process. Parker’s story and his effort to help others is engaging but here are the basics from the article.

From 2001 through 2004, the number of active-duty and reserve claims made with the Army Medical Evaluation and Physical Evaluation boards nearly doubled from 7,218 in 2001 to 13,748 in 2005

A soldier goes before a physical evaluation board if a medical evaluation board determines he is not able to do his job. The physical evaluation board then determines how much the Defense Department will compensate the soldier.

A report by the Government Accountability Office released in March found that no one is checking the consistency of the boards? decisions ? whether some soldiers? claims are rejected as others with similar disabilities earn benefits, for example.

... In its March report, the GAO pinpointed several problems in the medical evaluation process:

• The Defense Department and the services do not have a consistent system in place to monitor the way cases are handled.

• The services do not have a formal training system set up for the people who help troops through the physical evaluation board process.

• The Army does not keep good statistics on how long it takes to process soldiers’ physical evaluation boards, so it can’t be determined whether they are handled in a timely fashion.

...

[Parker] points out that to receive retirement pay, a service member has to be rated at 30 percent disability or higher. That qualification is important for the monthly stipend, and more important, the lifelong medical benefits.

As you read the stories of individuals who are trying to find their way through the medical eval process, remember that number: 30% disability. It will have critical impact in what ongoing care a wounded soldier will receive.

I want to return to a sidebar article that Newsweek included with its coverage. They held a Q&A with Sen. Patty Murray of Washington who highlighted these points:

The VA, last year, was under-projecting how many men and women would come into the VA system from Iraq and Afghanistan. They expected 45,000 and ended up with over 100,000. Now they are projecting 263,000 Iraq and Afghan vets next year. But we’re hearing from independent sources that the figure will be over 300,000. Without being a budget or numbers guru, you can realize that 1.5 million men and women have served in Iraq and Afghanistan and are coming home with everything from minor injuries to cases of TBI [traumatic brain injury], lost arms and limbs, and PTSD [post-traumatic stress disorder]. You know the number is going to be high. But they seem to want us to believe that the number is going to be lower. Which means we don’t fund VA adequately. ...

We have a backlog of patients that cannot get in. The VA likes to say that everyone gets an appointment within the first 30 days. Great, that’s better than it was. But I come home and talk to veterans who say, sure, after calling three times, 30 days into it, they get an appointment—for nine months later. That just doesn’t cut it. Many of them can’t start working until they’ve had their medical problems cleared. But they are sitting at home for nine months waiting to get into the VA. ...

They don’t have enough people tracking claims, they don’t have enough processing paperwork, they don’t have enough physicians, and therefore they deny care because they don’t have the people to offer it. It keeps the budget down, but it keeps people out of the system.

Looks like there’s some serious work to be done to take care of our veterans. JK will be speaking out about addressing some of those needs today in the Senate. Look for an update here after his statement.