The Fight on the Homefront

Tim Sanders is home from the war, but he is still fighting. Now he is fighting for himself, and his foe is the system that promises to stand up for those who stand up for us.

Walking up and down the sidewalk near the Colmery-O'Neil VA Medical Center, Tim Sanders looks like a model for the "Army Strong" ad campaign.

Except, that is, for the placard he is holding high proclaiming, "Vets are losing their benefits."

Sanders, an imposing 6-foot-3 inches tall, isn't the picture of health he appears to be. After tours of duty in Iraq and Afghanistan, he is considered 50 percent disabled by the Department of Veterans Affairs. He suffers physical, emotional and now bureaucratic problems.

For starters, he suffers from post-traumatic stress disorder. He also has back and knee problems from paratrooper duty.

"The transition from combat veteran to civilian was very difficult for me," he said.

Now 32, he is entitled to care at the VA medical center and normally receives a VA check for $730 each month. This month his check was reduced to $196. He can't pay his rent or other bills.

The VA asserted he owed money for medical expenses he incurred in 2006. The VA began retrieving the money from his monthly allotment. But Sanders insists he doesn't owe the money and believes the error is being corrected, thanks to the efforts of a Veterans of Foreign Wars representative who went to bat for him.

Sanders still hasn't seen the missing money, but even if it arrives soon, he is on a mission to bring public attention to what he considers the VA's insensitivity to the needs of veterans like himself.

So, he continues picketing at S.W. 21st and Gage as a matter of principle.

"I believe our government is being a tyrant. I'm proud of my country. I'm not proud of my government," he said.

Because of the toll that his service has taken on his body, some days he can only picket for two hours, but he makes sure that he is out for those two hours, waving to friendly motorists and holding his sign. "I've had it," he said. "I've been passive. I'm not going to be passive anymore."

I have a long track record of being pissed off over the hosing our veterans have been getting. I have watched in horror as the VA, rebuilt from the ashes to become a model system, has been destroyed by underfunding and the stresses of treating the veterans of two wars that have ground on for over five years.

If it were up to me, all veterans would have their benefits approved provisionally and vetted later, since over 90% are eventually approved anyway. I would also cease and desist in collection efforts. If a Veteran who receives a monthly stipend is found to be in arrears, if the veteran is not at fault and did not commit fraud, the balance should be written off. No veteran should ever open an envelope expecting to see seven hundred bucks and instead see less than two. That's just wrong - no one can live on that, and it is callous to expect it. If overpayments absolutely must be recouped, and the veteran is going to be getting benefits the rest of his or her life, for Christ's sake, take twenty bucks a month! We can tighten a hell of a lot of other belts before we get down to the point we take VA benefits from people who served in combat because some 702 somewhere made a clerical error.

With the V.A. overwhelmed, Veterans suffer needlessly

The Department of Veterans Affairs has produced it's annual year-end report to the congress, and for the third year running, the rate at which the V.A. acts to render decisions on disability claims fell further behind.

While the goal is to make determinations within 125 days, the reality is, on average it takes a claim 183 days to be acted on.

When a claim is rejected and appealed, the goal is to act on that appeal within one year, or 365 days. In reality, rejected claims take on average 660 days to be acted on; just under two years.

The VA has responded to this backlog by hiring new personnel, but it takes a reviewer two to three years to become efficient at their job, and the backlogs had a huge head start. While new personnel have been hired, and are being trained and gaining the acumen to do their jobs efficiently, veterans continue to be caught in limbo.

And when it is all said and done, just under 90% of all claims are found to be reasonable and valid, and the veteran receives the benefits he or she is due.

Very few wounded veterans have the ready resources that politicians seem to take for granted, and virtually none have the resources of the Bush clan. While they wait for their benefit determinations, they often face poverty, destitution and homelessness. No returning soldier should face homelessness, and no soldier should be relieved that they lost both arms because then the VA will have to give them a 100% disability rating!

That is why I favor the heartbreakingly simple approach advocated by Linda Bilmes of the Kennedy School of Government at Harvard: Give the Veteran the benefit of the doubt. Provisionally approve all claims made by Veterans for disability benefits, and don't withhold health care benefits while the claim is under review by the Department of Veterans Affairs.

Bilmes has been studying veterans’ medical care and disability benefits for years, and it is her considered and esteemed opinion that the current backlog simply overwhelmed a system that was already struggling under budget cuts before the wars started and created a whole bunch of new veterans needing services. Now things only stand to get worse. Last spring, in testimony before a congressional subcommittee, she predicted 250,000 to 400,000 claims will be filed over the next two years alone by veterans of the wars in Iraq and Afghanistan. This, she maintained, would create a situation that she said “will rapidly turn the disability claims problem into a crisis.” The problems of the VA are exacerbated as the wars in Iraq and Afghanistan grind on and on with no end in sight, and and the flood of wounded shows no sign of abating. And the DoD health system continues to dump patients into the underfunded VA system. This negatively impacts all veterans who use the system.

Keep in mind that Bilmes offered this testimony nearly a year ago, before the latest information on TBI was publicized.

The most recent findings are the result of percussive experiments conducted on animals, then the animals were sacrificed and the brain tissue examined microscopically. In the animal studies, scientists have discovered a fundamentally different injury than the “concussion” wound that has traditionally been ascribed to exposure to explosions. A concussion is essentially a bruise on the brain that generally heals with time.

Brain damage at the cellular level is likely permanent – and will almost certainly lead to further neurological degradation over time. Put bluntly, G.I.’s afflicted by TBI are not likely to get better, and in fact will get worse. How much worse is still unknown, but this will strain the system even further.

When the V.A. falters, it is the Veterans who stepped up and served who pay the price - again! - and who suffer as a result. That is a situation I find wholly intolerable. And frankly, anyone who professes unflagging support for the troops, but isn't hopping mad about the way our veterans are being treated once back home, should probably not profess their patriotism in direct proximity to me.

They gave the government the benefit of the doubt that they would not be sorely used when they joined up - the government owes them the same courtesy in return.

Vindication for a long-running hissy-fit

I have a long history of writing about mental health issues and repatriated soldiers. (More here, here, and here)

Sometimes it has felt like I was shouting down the well. Thank goodness these issues are finally getting some traction. Yesterday I got one more bit of vindication when the Institute of Medicine, which advises the federal government on issues of medical science, released their long awaited report on the treatment returning soldiers are not getting.

The report suggested changes to VA policies, but the panel could not say whether those changes would result in more or fewer PTSD diagnoses, or in greater or lesser expense for taxpayers. "PTSD has become a very serious public health problem for the veterans of current conflicts and past conflicts," said psychiatrist Nancy Andreasen of the University of Iowa, who chaired the panel. Noting the shortcomings of the VA system, Andreasen added that "a comprehensive revision of the disability determination criteria are needed."

She said the current VA system, in which PTSD compensation is limited to those who are unable to hold a job, places many veterans in a Catch-22.

"You can't get a disability payment if you get a job -- that's not a logical way to proceed in terms of providing an incentive to become healthier and a more productive member of society," she said.

The practice is especially wrong, she added, because it is at odds with VA policies for other kinds of injuries. To determine the compensation a wounded veteran should get, the government assigns one a disability score. Veterans who are quadriplegic, for example, can be assigned a disability level of 100 percent even if they hold a job, whereas veterans with PTSD must show they are unable to work to get compensation.

Andreasen said the policies are "problematic, in the sense that they require the person given compensation to be unemployed. This is a disincentive for full or even partial recovery."

I personally favor adopting the suggestions offered by Linda Bilmes of Harvard. She has offered the most troop-centric approach to offering services to those who need and deserve those services. Her notion is so simple it hurts: Give the troops who apply for benefits the benefit of the doubt!

The Institute of Medicine panel said the scale used to evaluate veterans is outdated and largely designed for people who suffer from other mental disorders. Andreasen and other members also said they had heard from veterans who had received wildly different kinds of evaluations -- some lasting 20 minutes while others took hours. The scientists said VA should standardize the evaluations using state-of-the-art diagnostic techniques.

While VA requires its experts to determine what proportion of a veteran's disabilities were caused by particular traumatic experiences, and to what extent overlapping symptoms are related to particular disorders, the IOM said there is no scientific way to classify symptoms in this manner.

Frankly, if you aren’t mad as hell about the way our troops are being treated – if you aren’t pissed off about the fact the VA is still not fully funded – don’t be mouthing platitudes about supporting the troops around me.