Washington – The U.S. Department of Veterans Affairs – blasted by Congress last week for underestimating the cost of veterans’ health care by as much as $2.7 billion through 2006 – faces growing patient loads and stretched services as troops return from Iraq and Afghanistan.
About 103,000 veterans from the wars will have used VA medical care by the end of September – four times what the agency predicted when it budgeted for 2005. And with about 145,000 U.S. military personnel in Iraq and 16,700 in Afghanistan, thousands more veterans can be expected to need medical care.
The VA insists that it is fulfilling its mission, while others are criticizing the way it has planned for veterans’ needs.
“Veterans are being served,” Veterans Affairs Secretary Jim Nicholson told The Denver Post last week. “Our veterans are getting world-class care.”
In a system with more than 5 million patients, the VA believes it can absorb and care for those injured in the Iraq war, whatever the number, said VA spokesman Phil Budahn.
Yet many veterans fresh from the Iraqi battlefield say agency services already are overwhelmed.
Doctor-to-patient ratios are climbing, waiting periods to see specialists are growing, and the time that psychiatrists spend with the most troubled patients – those with post-traumatic stress disorder, or PTSD – is shrinking.
Many are asking whether the Bush administration failed to adequately plan for treating the wounded as part of the cost of the more than 2-year-old Iraq war.
“The number of cases the VA has seen (from Iraq) is still only a fraction of what’s going to arrive,” said Charles Sheehan- Miles, executive director of Veterans for Common Sense. “The system’s not going to be able to handle that.”
” The VA does not project out for years to come the cost of providing medical care specifically to Iraq and Afghanistan veterans. While it does predict use of VA services over a 20-year-period, it develops budgets only for each fiscal year. Those are started 30 months in advance, using modeling methods that came under attack in Congress last week for being inaccurate.
Counting veterans from all eras, use of VA services in 2005 more than doubled over what the agency predicted.
In 2000, systemwide, the VA’s patient-to-doctor ratio was about 335 patients for every one doctor. For the fiscal year ending Sept. 30, 2004, it was 531 patients for every one doctor, according to the VA and congressional testimony.
Veterans returning from Iraq and Afghanistan normally have to wait six months or more to get into the health care system, said Paul Rieckhoff, executive director of Operation Truth, the largest group for war veterans from Afghanistan and Iraq.
At the VA hospital in Grand Junction, appointments are being canceled and rescheduled further out, said Ronald “Doc” Ross, chief service officer for the Colorado chapter of Vietnam Veterans of America.
In Portland, Ore., the minimum wait for non-emergency surgeries is six months.
Mike Lemke, 46, served in Iraq with the National Guard’s military police unit out of Denver. He came back on Aug. 14, 2003, unable to sleep more than 90 minutes at a time. It took more than three months to see a VA psychiatrist.
He used to see a psychiatrist at the Colorado Springs VA once a week or every other week for an hour-long session. Now, it’s once a month for 30 minutes.
“You just start getting into the meat of your stuff, and it’s over,” he said of the sessions.
The severe wounds suffered by those serving in Iraq and Afghanistan have created demand the VA doesn’t have the manpower or facilities to meet, Rieckhoff of Operation Truth said.
For example, he said, many returning soldiers have had limbs amputated, yet the VA doesn’t have enough clinics or staff needed to fix prosthetics, even though “you don’t have to be a mind reader or have a crystal ball to see this was coming.”
In particular, questions are being raised about VA’s ability to care for vets suffering from PTSD, the symptoms of which can include combat flashbacks, emotional problems, anger and sleep disturbances. The disorder can lead to alcohol and drug abuse, depression and increased risk of suicide.
Of the 103,000 Afghanistan and Iraq veterans who will have used a VA medical service by September, about 25,000 will be suffering from mental and emotional disorders, including 10,000 cases of PTSD.
The kind of guerrilla warfare being waged in Iraq could lead to rates of PTSD as high as 30 percent to 40 percent, similar to the Vietnam War, Sheehan- Miles said. The character of the war has brought ominous predictions from Vietnam veterans, who call Iraq a “Vietnam without water.”
A VA doctor in the March issue of the New England Journal of Medicine put the PTSD rate in vets at closer to 15 percent.
Whatever the rate, the VA already has trouble meeting the demand of its PTSD patients. In a September 2004 report, the Government Accountability Office, the investigative arm of Congress, said the VA “does not have sufficient capacity to meet the needs of new combat veterans while still providing for veterans of past wars.”
VA officials at six of seven medical facilities contacted by the GAO said that “they may not be able to meet an increase in demand for PTSD services.”
In the past few months, in Denver, Grand Junction, Salt Lake City and at other hospitals, patient appointments with psychiatrists, held once every four months, have been cut from 60 minutes to 30 minutes or eliminated altogether.
In an April 2005 report on PTSD, the GAO found that the VA had failed to fully meet 24 recommendations, which the GAO said raises “questions about VA’s capacity to identify and treat veterans returning from military combat who may be at risk for developing PTSD, while maintaining PTSD services for veterans currently receiving them.”
In Kansas City, Mo., the clinic treating veterans with PTSD has seen patient levels rise from 55 people four years ago to nearly 1,000 currently, said Randy “Doc” Barnes, a board member for Vietnam Veterans of America national group and the Kansas City, Mo. Chapter.
That’s as the number of full-time mental health professionals has fallen from 4.5 to 2.5, with one more scheduled to leave Aug. 1.
“I have nothing but disdain for the president and the administration for the way they have treated active duty military and the troops returning from the Middle East,” Barnes said. “There’s no way they could not have known (that the Afghanistan and Iraq wars) would create this many problems.”
The overload affects people like Abbie Pickett, 23, of Madison, Wisc., who spent 11 months in Iraq with the National Guard. A combat support engineer, she rushed to help a wounded soldier when a military base came under attack.
The soldier was bleeding profusely. She later heard that the man had lost his arm. She felt guilt wondered if she had done everything right.
After returning home, she couldn’t sleep, waking every 45 or 50 minutes. She had nightmares. She relived the attack. While driving she saw debris in the road she thought was improvised explosive devices, the bombs that wounded so many in Iraq. She couldn’t see a VA psychiatrist for four months.
After getting in, she missed an appointment and now has not had access to a VA doctor since January. Her medications no longer work.
“I just find it kind of odd that there was funding to get us over there, but there wasn’t funding to get me what I needed when I was there. I didn’t have a flak jacket,” she said.” Now they can’t find funding to take care of what I see is a war wound, post traumatic stress.”
At a Senate hearing last week, senators asked Nicholson why he didn’t know about the $2.7 billion shortfall earlier, and what could be done to prevent a recurrence.
He insisted that the shortfall was not a “crisis,” hesitating to even call it a problem.
To the surprise of many lawmakers, Nicholson explained that the VA didn’t factor in Iraq when it computed its 2005 budget. The agency’s 2005 budget was based on numbers from 2002 and did not include any projections for Iraq because the conflict had not started.
The VA in 2002 predicted it would see just 23,523 veterans as a result of the war on terror. The number came from what the Defense Department said to expect, said VA spokesman Terry Jemison. The administration never revised the budget to include those numbers.
“It just strikes me, for our veterans administration to somehow not include … this reality that we were going to have a significant number of veterans to take care of coming out of (the Afghanistan and Iraq wars) is something that should not have happened,” Sen. Ken Salazar, D-Colo., told Nicholson.
In preparing its budgets, the VA contracts with a company that forecasts system usage and costs. The model accounts for the age of veterans and the severity of their illnesses, using data from the Defense Department each time the model is updated. The Defense Department estimates how many people will leave the armed forces each year, and gives that to the VA.
Though the budget is started 30 months in advance of the end of a fiscal year, it is updated at several points. However, that model was not updated enough to prevent the surprise shortfall of $2.7 billion by the end of fiscal year 2006.
Senators voted to add $1.5 billion to the VA’s budget. The House voted to add $975 million. A conference committee will work out the differences.
Veterans advocates predict it’s not nearly enough, and say the scenario of the VA asking Congress for funds over its projected budget will be repeated many times in the next few years.
This is an enhanced version of an article that appears in the July 3 print editions of The Denver Post.
