Is U.S. prepared to care for more casualties from troop buildup?

McClatchy NewspapersDecember 7, 2009 

WASHINGTON — As the Obama administration ramps up the war in Afghanistan, veterans advocates say the government must develop a better plan to handle the wounded when they come home.

Eight years of war have overtaxed the health care systems that treat service members and veterans, several said, and President Barack Obama's decision to deploy 30,000 to 35,000 more troops in Afghanistan will compound the stress.

Treatment at medical facilities that the military and the Department of Veterans Affairs operate is viewed as world class despite its well-publicized lapses. However, both often struggle to care for large numbers of soldiers and Marines with devastating physical and mental injuries.

Coordination between the military and the VA is often slow, veterans groups say, and waiting times to see doctors and process benefit claims are long. A recent VA investigation found that 11,000 claims filed at offices around the country were still unresolved after more than a year.

More disturbing still is that suicides by combat veterans are at record levels.

"A war plan has to include the care of vets on the back end," said Paul Rieckhoff, the executive director of Iraq and Afghanistan Veterans of America. "What was lacking in the Iraq war was a plan for all the resources. We're going to encourage them to not just think about bombs and bullets, but social workers and hospital beds."

A spokesman for the U.S. Army Medical Command couldn't be reached for comment. A VA spokeswoman declined to speak on the record, but said the Obama administration already had taken several steps to improve the delivery of health care to veterans.

These include new programs to reduce homelessness and expand access to health care through more outpatient clinics and telemedicine. Obama has proposed the single largest increase in VA funding over the next five years, which would, among other things, be used to improve community-based primary care to avoid the need for hospitalization.

However, Rick Weidman, the director of government relations for Vietnam Veterans of America, said the troop buildup in Afghanistan meant that advocacy groups needed to press the administration and Congress for additional money for military health care.

"It will result in ... people torn up," he said. "If you're going to throw more people into harm's way, you better appropriate money."

Almost since 2001, when the U.S. invaded Afghanistan after the 9/11 attacks, veterans groups have been at war with the VA over the treatment of the wounded. They alleged that the Bush administration ignored or misread the impact that the war and repeated deployments would have on the troops. They said the system was unprepared.

Nearly half a million veterans of Iraq and Afghanistan have used the VA. That's almost half of all the combat troops who are eligible for benefits, and it includes 80,000 new vets in the first nine months of this year alone.

When the president announced the new Afghanistan strategy Tuesday during a speech at West Point, he praised the valor and sacrifice of the troops but said nothing about the importance of ensuring that they don't endure a second struggle, this time for health care.

"That's always our concern," said Steve Smithson, the deputy director of veterans affairs and rehabilitation for the American Legion. "We haven't heard of anything specific to address any surge in Afghanistan."

White House spokeswoman Amy Brundage said that Obama "is determined to fulfill America's responsibility to those who have served and sacrificed on our nation's behalf. Any decision that the president makes in regard to military action will always ensure that our military and our veterans get the care they deserve and the benefits they earned."

That was clearly the message behind the decision to have VA Secretary Eric Shinseki, a retired four-star general, accompany the president on Air Force One to West Point. Shinseki, who was badly wounded in Vietnam, also met this week with the heads of several leading veterans organizations.

While they're encouraged, veterans remain skeptical.

"We're pleased the president made a symbolic gesture, but where is the plan?" said Paul Sullivan, the executive director of Veterans for Common Sense, a nonpartisan advocacy group. "What is the military doing to monitor casualties so the VA knows what to expect?"

Mental health is a big problem. Even before the recent Fort Hood massacre, the Army was concerned about its lack of mental health professionals. It has just more than 400 psychiatrists for a force of more than half a million soldiers.

Traumatic brain injury and post-traumatic stress disorder have become the signature wounds of the wars. Through last June, the VA saw 134,000 Iraq and Afghanistan veterans for potential cases of PTSD, according to a department report prepared for the Government Accountability Office.

The problem could be much more widespread. A Stanford University study estimated that the PTSD rate among deployed troops could be as high as 35 percent.

The VA is "under a tremendous amount of pressure" and the troop buildup in Afghanistan will make it worse, said Joy Ilem, the deputy national legislative director for Disabled American Veterans.

"This is just the tip of the iceberg," Ilem said. "If people are still in the service and still not getting help or don't feel like they can, and keep redeploying, that could really impact the VA in the coming years."

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