Iraq war veterans face long-lasting mental health issues, official says

WASHINGTON—U.S. Secretary of Veterans Affairs Anthony J. Principi said Tuesday that the violent guerrilla tactics used by insurgents in Iraq will take a considerable toll on the mental health of troops, resulting in a lifetime of disability payments for many of those who return from war.

So far 20 percent of returning Iraq veterans who've sought VA care have done so for mental health issues. While the exact cost of compensating those injured in the Iraq war is uncertain, the VA already expects to pay $600 billion over the next three decades in disability payments to veterans of earlier wars.

Principi said the VA is readying itself for an influx of veterans with mental illnesses and post-traumatic stress disorder (PTSD).

"This type of war—insurgency warfare—where you don't know whether you're going to be the next victim of a car bomb or roadside bomb or (rocket-propelled grenade). It's like fighting in Vietnam when I was in the Mekong Delta," Principi said. "You don't know whether you're getting into an ambush with guerrillas."

Of 168,000 service members who had served in Iraq and been discharged as of July 22, 28,000 had sought medical care from the VA, according to the department's most recent statistics. Of those, about 5,400 had mental health issues and nearly one in three of those suffered from PTSD, which results from a serious traumatic event and can cause debilitating flashbacks, nightmares, anxiety and uncontrollable anger. The disorder may not show itself for years.

Dr. Matthew J. Friedman, the executive director of the VA's National Center for Post-Traumatic Stress Disorder, said the insurgency's ambush tactics potentially expose a greater percentage of soldiers to the kinds of stress that causes PTSD.

"Whether you drive a truck or are medical personnel or a Special Forces person, the risks are more evenly distributed. So the likelihood of being exposed to war-zone trauma is greater," he said.

Only time will tell, he said, exactly how many veterans of Operation Iraqi Freedom will be afflicted.

A major study of Vietnam veterans found that about 31 percent of men and 27 percent of women had suffered from PTSD at some point after returning from the war. An additional 22 percent of them had some symptoms of PTSD. Studies of veterans of other wars have found the prevalence of PTSD ranging between 8 percent and 12 percent, Friedman said.

A study published in July found that during early major combat in Iraq, the rate of depression, anxiety or PTSD was about 16 percent to 17 percent. The study found that few soldiers got treatment.

The injuries of war—whether mental or physical—have implications for the VA's systems that provide health care and compensation to the disabled.

As of Tuesday morning, 7,532 service members had been wounded in action in Iraq and 1,051 had been killed, according to Department of Defense statistics.

Principi noted that the number of troops serving in Iraq is small compared with those who served in Vietnam or World War II. But these newest veterans will add to the bill already incurred by the VA to compensate veterans disabled in previous wars.

"Our unfunded liability for the disability compensation program is $600 billion over the next 30 years," Principi said. The program, an entitlement that Congress must fund each year, provides monthly payments to compensate veterans injured in the service of their country. The payments generally last for the life of the veteran and sometimes for their spouses and children.

"Wars may be of a relatively short duration," Principi said, "but there's a lifetime of benefits that goes with them. And it's not a reason not to go to war when the war is just and is a good cause. But the fact of the matter is that policy-makers on both sides of the aisle need to understand that there is a price."


Veterans seeking health care or disability compensation can contact the VA at 800-827-1000 or go to