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!

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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.

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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.



[Cross-posted from Blue Girl, Red State]

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A Radical Notion

The Veterans Administration is staggering under the burden of caring for those wounded and/or psychically damaged by the wars in Afghanistan and Iraq. Currently, the VA has a backlog of over 600,000 cases (Air Force Times) pending determination of disability and benefits.

Tuesday Harvard Professor Linda Bilmes testified before the House Veterans Affairs subcommittee on disability assistance, where she asserted that all claims filed by veterans of the conflicts in Afghanistan and Iraq should be immediately accepted at face value.

Bilmes, of Harvard’s Kennedy School of Government, has been studying veterans’ medical care and disability benefits and said the current backlog overwhelmed a system that was already struggling under budget cuts before the wars started; and that now things only stand to get worse. She predicts 250,000 to 400,000 claims will be filed over the next two years alone by veterans of the wars in Iraq and Afghanistan, creating a situation that she said “will rapidly turn the disability claims problem into a crisis.”

This just makes sense. Since 88 percent of disability claims are approved, spot-checking and audits would be enough to ensure the fairness of the system. In fact, the system she proposes would be better for those who apply for benefits.

Bilmes also proposes changes to the disability rating system. The current system ranks disability between zero and 100 percent, in 10-percentage point increments. Bilmes proposes dividing disability into four rankings: zero, low, medium or high disability. “This would immediately streamline the process, reduce discrepancies between regions and likely cut the number of appeals,” she said.

The ideas offered by Bilmes are definitely worth considering. If there is one thing that we know, for certain, novel thinking is how challenges get met and how problems get solved. In other words, don't stay the course. Instead, try steering away from the iceberg. The Bilmes Protocol offers steering away from the iceberg.

Rep. John Hall, D-N.Y., chairman of the House Veterans’ Affairs subcommittee on disability assistance, said the recommendations might help.

“The idea of giving veterans the benefit of the doubt sounds good to me,” Hall said at the hearing.

Brady Van Engelen, a wounded Iraq war veteran, said veterans and their families are suffering. “We may end up with an entire generation of veterans who have no faith in our VA because those running it — as well as those overseeing it — were unable to hold up their end of the bargain,” he said.

“We did not prepare for this, and it is painfully evident,” said Van Engelen. “My generation is going to have to pay for this, and we will be paying for years and years.”

As the wars grind on and the flood of wounded shows no sign of abating, and the DoD health system continues to dump patients into the VA system it negatively impacts all veterans who use the system.

It is incumbent on our nation that we take care of those who serve.

It is time to fully fund the VA, and the Bilmes Protocol should be accepted and enacted immediately. Enact it with the caveat of oversight by the Veterans Affairs Committee and an Inspector General. But enact it. The VA Health system stands at a critical juncture, and bold, decisive action is needed. While the system bogs down, veterans suffer. The stories of eviction and homelessness as cases wend through the system are starting to appear.

Decency mandates that we give these men and women who volunteer to serve the benefit of the doubt when they claim they were damaged by war. To not do so is downright disgraceful.

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