Is the VA benefits system broken beyond repair?

To follow is the "Overview" section of this week's CQ Researcher report on "Caring for Veterans" by Peter Katel, April 23, 2010.
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The car bomb exploded at dusk. Its target – a seven-ton U.S. Army personnel carrier – was blown about six feet by the force of the blast. Infantryman John Lamie came out alive, thanks to armor plating around his machine-gunner’s cupola, but three of his buddies died in the Aug. 3, 2005, attack in Baghdad. Lamie went to Iraq a second time in 2007-2008, before the cumulative effects of combat eventually pushed him out of the Army.

Now he’s fighting another kind of battle – with the Department of Veterans Affairs (VA). “I did two tours in Iraq and half my squad died,” he says from his home in Cecil, Ga., only to “come home and get treated like a piece of crap in my own state.”

Because of a series of complications over the validity of disability exams Lamie took for post-traumatic stress disorder (PTSD), traumatic brain injury (TBI) and other conditions, Lamie’s most recent disability check amounted to $83.19. He and his wife have three children, and he’s paying child support for a fourth child with his ex-wife.

Lamie says that when he tried to straighten out his case with staff of the VA’s Veterans Benefits Administration (VBA), he ran into a wall of indifference. “The vet has no power, you are left to the wind,” Lamie says. “You have to call and beg – I don’t mean ask nicely, I mean beg – and I don’t feel any vet should have to beg somebody to do their damn job.”

However, by late April, Lamie had found a VA staffer who was trying to straighten out bureaucratic confusion involving multiple files shipped among multiple offices. “Fingers crossed,” Lamie says. “Within another two months something might work itself out.” He emphasizes “might.”

Veterans’ advocates, the Government Accountability Office (GAO) and the VA’s own inspector general have all reported similar communications breakdowns and wildly varying standards for evaluating disability claims among VBA regional offices, even as a steady stream of new claims pours into the VA.

Soldiers wounded while serving their country “are waiting – and waiting – for the help they have been promised,” said Rep. Bob Filner, D-Calif., chairman of the House Veterans’ Affairs Committee, after meeting with agency officials and veterans’ organizations in March. “Frankly, it’s an insult to our veterans and their service.” [Footnote 1]

About 1 million claims of all kinds are backlogged at the VA, according to veterans’ organizations, some of which help veterans on behalf of the VA, which says the backlog of initial claims alone totals 500,000, using a different calculation method.

While VA medical care, delivered through the Veterans Health Administration, tends to earn high marks from vets, the VBA presents a different picture. In 2007-2008, staff at VBA regional offices compiled an overall accuracy record on initial claims decisions of only 77 percent, Belinda J. Finn, VA deputy inspector general, told the House Veterans’ Disability Assistance and Memorial Affairs Subcommittee in early March. “This equates to approximately . . . 203,000 total claims where veterans’ monthly benefits may be incorrect,” Finn told the subcommittee. [Footnote 2]

The VA’s scramble to meet mounting demand for its services is occurring amid continuing warfare on two fronts: Since U.S. forces entered Afghanistan in 2001, at least 5,190 service members have been wounded, 425 of them this year. Since the 2003 U.S. invasion of Iraq, 31,176 service members have been wounded there. [Footnote 3]

Yet the VA’s difficulties providing adequate care for veterans got only sporadic attention until 2007, when a prize-winning Washington Post series pushed them to the top of the national agenda. With the issue in the spotlight, Congress in 2008 authorized free medical care for all Iraq and Afghanistan veterans for five years after leaving the military. And GI Bill educational benefits were expanded for veterans who entered the service after the Sept. 11, 2001, terrorist attacks.

Vets welcomed the new benefits, but questioned the VBA’s ability to process all the new claims. The VA’s new boss, retired Gen. Eric K. Shinseki, is vowing to shake up the agency. “2010 is my year to focus on finding and breaking the obstacles that deny us faster and better processing and higher quality outcomes,” he told the Veterans of Foreign Wars in early March. To break the backlog while dealing with a rush of expected new claims, he proposes adding 4,000 claims examiners in the 2010-2011 fiscal year. [Footnote 4]

His appointees aren’t mincing words about what they found when they took over. “In my judgment, it cannot be fixed,” Peter Levin, the VA’s chief technology officer, said of the benefits claims system during a March meeting on Capitol Hill with veterans’ organizations. “We need to build a new system, and that is exactly what we are going to do.” [Footnote 5]

Veterans’ advocates cheered Levin’s comments and praise Shinseki’s vision, but some wonder if he can put his stamp on the VA. A West Point graduate who lost most of a foot in Vietnam combat, Shinseki has earned a reputation for speaking out regardless of consequences. As Army chief of staff, he told the Senate Armed Services Committee in 2003 that securing Iraq after invading it would require “something on the order of several hundred thousand soldiers.” Shinseki’s civilian boss, Defense Secretary Donald Rumsfeld, contemptuously brushed that assessment aside and marginalized its author. But time proved Shinseki more accurate than Rumsfeld, who endorsed a forecast of 30,000-50,000 troops in Iraq after the invasion. By fiscal year 2008, U.S. troop strength had reached nearly 160,000. [Footnote 6]

Now, Shinseki’s leading an agency trying to adjust to the special demands created by 21st-century warfare. Vast advances in battlefield care are enabling thousands of vets to survive injuries that would have been fatal in the past. But those injuries, often caused by homemade bombs, or so-called improvised explosive devices (IEDs), can be crippling.

“IED blasts alone often cause multiple wounds, usually with severe injuries to extremities, and traumatic brain and other blast injuries, and they leave many . . . with serious physical, psychological and cognitive injuries,” the government-funded Institute of Medicine (IOM) reported to Congress in a lengthy study published in March. [Footnote 7]

Today’s all-volunteer military is far smaller than past draftee-fed forces, requiring troops to be repeatedly recycled through combat zones. About a third of those who have been deployed to combat more than once have suffered from PTSD, TBI or major depression, and about 5 percent suffered from all three, according to the RAND Corp, a California think tank. Multiple deployments can double the risk of PTSD and other psychological problems, the Army surgeon general concluded in a 2008 report, which found mental health problems in 12 percent with one deployment and 27 percent with three or more deployments. [Footnote 8]

Retired Army Capt. Anthony Kennedy, who attempted suicide after two tours in Iraq, described the nature of the fighting there and the psychological effects of the constant threat of being blown up by an IED. “One of my friends . . . had a friend whose arms and legs were blown off,” Kennedy says. “All of us combat guys are thinking, ‘Why do I want to go through life with no arms and no legs?’ Our consensus: ‘Can my battle buddy just put a bullet in me?’ We talk about that.”

Kennedy has had problems with the VA benefits system as well, but obtained a volunteer lawyer’s help in pushing his PTSD rating from 30 percent to 70 percent disability. He says his 17 years in the service taught him how to deal with military-style bureaucracy. “I have the maturity and the knowledge to know that there’s 100,000 applications out there, and I’m just one cog in the wheel,” he says. “But I can imagine that if someone is completely disabled, and their father or mother comes in, the system can be a shock.”

Even military reservists, accustomed to part-time service, can be taken aback by the VA system they encounter after active duty. Naval reservist Richard Sanchez of New York, a former paralegal for a Wall Street law firm, was discharged after his second deployment, which took him to Kuwait, where he was injured when an ammunition and weapons container fell on him in 2005.

After discharge, Sanchez began to suffer intense back pain, failing memory and depression. In his confused state, the VA system overcame him, he says. Eventually, he encountered a VA counselor who helped him straighten out a long series of bureaucratic complications, and in March received a letter from the VA apologizing for erroneous ratings and promising to reevaluate claims for PTSD, TBI and depression.

“I don’t hate the VA,” says Sanchez, who is attending college thanks to VA education benefits. “There are some faults there, but you can’t blame the whole system.”

That system is about to be tested even more forcefully. The VA is predicting that its claims workload will rise 30 percent next fiscal year, to about 1.3 million, in part because the department added three new ailments to the list of illnesses presumed to result from exposure to the Vietnam-era defoliant known as Agent Orange. And more “presumptive” illnesses associated with exposure to other battleground chemicals in more recent wars may be added later this year. [Footnote 9]

Still, it won’t be easy to convince veterans that the VA has turned a new page. In Georgia, Iraq vet Lamie is trying to keep his family fed, his lights on and his car running on the small checks he receives now. “I’ve still got no faith in VA” – for now, he says.

The Issues:
*Is the VA benefits system broken beyond repair?
*Is the VA adjusting to the needs of 21st-century combat and technology?
*Is the VA improving rapidly enough?

For more information see the CQ Researcher report "Caring for Veterans" [subscription required] or purchase the CQ Researcher PDF.

Footnotes:
[1] “Radical Change Needed for Veterans Disability Claims Process,” House Committee on Veterans Affairs, press statement, March 18, 2010.
[2] “Statement of Belinda J. Finn, Assistant Inspector General for Audits and Evaluations, Office of Inspector General, Department of Veterans Affairs,” VA Office of Inspector General, March 24, 2010.
[3] Icasualties.org, updated regularly.
[4] “Remarks by Secretary Eric K. Shinseki,” Veterans of Foreign Wars National Legislative Conference, March 8, 2010; “Fiscal 2011 Budget: VA,” Committee Testimony, Senate Veterans' Affairs Committee, Feb. 26, 2010; “FY 2011 Budget Submission,” Department of Veterans Affairs, pp. 2B-4, 2C-2.
[5] Quoted in Rick Maze, “VA official: Disability claims system ‘cannot be fixed,’” Federal Times, March 18, 2010 .
[6] Quoted in Philip Rucker, “Obama Picks Shinseki to Lead Veterans Affairs,” The Washington Post, Dec. 7, 2008; Bernard Weinraub and Thom Shanker, “Rumsfeld's Design for War Criticized on the Battlefield,” The New York Times, April 1, 2003, p. A1; Amy Belaso, “Troop Levels in the Afghan and Iraq Wars,” Congressional Research Service, July 2, 2009, Summary page; “US Forces Order of Battle,” GlobalSecurity.org, undated.
[7] “Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families,” Institute of Medicine of the National Academies (2010), p. 52.
[8] Terri Tanielian and Lisa H. Jaycox, eds., “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery,” RAND Center for Military Health Policy Research, 2008, p. xxi; U.S. Army Surgeon General study cited in Kline, Anna, et al., “Effects of Repeated Deployment to Iraq and Afghanistan on the Health of New Jersey Army National Guard Troops: Implications for Military Readiness,” American Journal of Public Health, February 2010.
[9] The three are Parkinson's Disease, ischemic heart disease and B-cell leukemias. “FY 2011 Budget Submission,” op. cit., p. 1A-3; Gregg Zoroya, “VA to automate its Agent Orange claims process,” USA Today, March 9, 2010, p. 4A.