| | Speaking generally, Dr. Michael Kussman, the VA's acting under secretary for health, tells NEWSWEEK that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely. "The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it."Still, 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. Yet, most of those claims were filed by veterans of previous wars (a veteran can file or appeal a claim even decades after discharge). 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. NEWSWEEK turned up a number of veterans who'd waited longer. Keri Christensen, a National Guard veteran and a mother of two, says the VA in Chicago took 10 months to process her application. Rory Dunn, who nearly died in an IED attack outside Fallujah, says his application was delayed because, among other things, the VA mixed up his file with that of a Korean War veteran.
Feges's claim was finally approved last month: 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 money would come through. Last week he received back pay to the date of his application.
The compensation is not huge. A veteran with a disability rating of 100 percent gets about $2,400 a month—more if he or she has children. A 50 percent rating brings in around $700 a month. But for many returning servicemen burdened with wounds, it is, initially at least, their sole income. "When I started school, that's when it became really hard not to have that money," says Feges.
One reason to worry about a crush of new vets at the VA has to do with the proportion of wounded to dead Americans in Iraq. Though we tend to mark the grim timeline of the war by counting fatalities, what really distinguishes this conflict is how many soldiers don't die, but suffer appalling injuries. In Vietnam and Korea, about three Americans were wounded for every one who died. The ratio in WWII was nearly 2-1. In Iraq, 16 soldiers are wounded or get sick for every one who dies. The yawning ratio marks progress: better body armor and helmets are shielding more soldiers from fatal wounds. And advanced emergency care is keeping more of the wounded alive. The VA's Kussman says that soldiers who survive the first few minutes after an explosion have a 98 percent chance of surviving altogether. But that means an increased burden on the VA's health-care system.
Two such survivors are Albert and Connie Ross. Albert lost a leg when a rocket-propelled grenade landed close to him in August 2004 while he was on patrol in Baghdad. Connie lived through a 2004 suicide bombing in Mosul but suffered multiple fractures and burns. When the two met in a hallway at Brooke Army Medical Center in San Antonio, Texas, Connie thought she noticed a certain swagger in Albert's walk. "He had this weird dip in his walk, so I asked him, 'Why are you pimp-walking in a hospital?' And he said: 'I'm not pimp-walking, I'm an amputee.' I was so embarrassed." The two married earlier this year and are expecting a child.
Though he's been in the VA system for more than two years now, Albert still doesn't have a primary-care doctor. Without one, getting appointments with specialists can be difficult. "You're supposed to be assigned one right away," says Albert, who now lives in San Antonio. "I'm not frustrated so much as worried—worried if and when something does go wrong, something will happen with one of my legs ... They [primary-care doctors] are the ones who have to fill out a work-order form; it's impossible to do anything without them."
One thing Albert desperately wants to do: get a new prosthetic. He's one of the early African-American amputees of the war. But the fake limb he's been given matches the skin tone of a Caucasian. It so embarrasses Albert that he always wears a sock over it—even if he's in sandals. "He's very self-conscious about it," says Connie. "It really bothers him."
Albert's situation is probably atypical. The VA says a huge majority of veterans get primary-care doctors within 30 days. But people inside the system do concede there's a shortage of mental-health workers at many of the VA's hospitals and clinics across the country. And Schulze is not the only veteran to commit suicide after being turned away. In a similar case in 2004, the VA twice neglected to treat Iraq veteran Jeffrey Lucey for posttraumatic stress disorder (the second time because he was told alcoholics must dry out before being accepted to an inpatient program). By the time a VA counselor tracked down a bed in a New York facility with a built-in detox program, Lucey had already hanged himself. "The system doesn't treat mental health with the same urgency it treats general health care," says a senior VA manager who did not want to be named talking about shortcomings in the agency.
Even when veterans get to the right doctors, understanding how to leverage what they need from the system can be mind-bending. Tonia Sargent, whose husband, Kenneth, nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don't ask, don't tell system," she says.
Kenneth is a Marine master sergeant who'd been in the Corps for nearly 18 years. He was on his second tour in Iraq when a sniper bullet ricocheted off the metal hatch on his vehicle and hit him directly below the right eye, grazing the front of his brain and exiting near his left ear. Among other things, he was diagnosed with traumatic brain injury, which has become the signature wound of the Iraq war. Tonia had to fight the Marine Corps to keep him from being discharged, figuring he'd get better medical care if he remained in active service. But some of his treatment has been outsourced to the VA.
One of the tricks she learned early on was to demand photocopies of her husband's records—every exam, every X-ray, every diagnosis—and personally carry the file from appointment to appointment. "I don't know if there is a more formal protocol for transferring documents, but I know that what I brought ... was definitely put to use." When Sargent was transferred to the VA's lauded Polytrauma Center in Palo Alto, Calif., doctors there encouraged her to go home to Camp Pendleton near San Diego and treat his stay at the hospital as if it was a deployment. "After two weeks, they asked me how long I was planning to stay with my husband," she says. "They said it was his rehab, not mine. But I needed to learn how to care for him, and he suffered from extreme anxiety without me." She pushed back, staying in Palo Alto until he completed his care.
How can the system improve? Bilmes, who authored the Harvard study, proposes at least one drastic change—automatically accepting all disability claims and auditing them after payments have begun. (The VA says that would be an irresponsible use of taxpayer money.) Other critics have focused on raising the VA's budget, which has been proposed at $87 billion for 2008. More money could go toward hiring more claims officers and more doctors, easing the burden now and preparing the VA for the end of the Iraq war, when soldiers return home en masse.
But veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war. (All told, Bilmes projects it could cost as much as $600 billion to care for GWOT veterans over the course of their lifetimes.) That reluctance, they say, trickles down to the VA, where top managers are politically appointed. Secretary Jim Nicholson, a decorated Vietnam War veteran who was chosen by Bush in 2005, tends to be the focus of this criticism.
The senior VA manager who did not want to be named criticizing superiors told NEWSWEEK: "He's a political appointee and he needs to respond to the White House's direction." Steve Robinson of Veterans for America levels the accusation more directly. "Why doesn't the VA have a projection of casualties for the wars? Because it would be a political bombshell for Nicholson to estimate so many casualties." The VA denies political considerations are involved in its budgeting or planning. Nicholson declined to be interviewed but Matt Burns, a spokesman for the VA, called Robinson's comments "nonsensical and inflammatory," adding: "The VA, in its budgeting process, carefully prepares for future costs so that we can continue to deliver the quality health care and myriad benefits veterans have earned."
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