For years, the Defense Department and the Department of Veterans Affairs have been assuring a "seamless transition" in medical care that would eliminate myriad obstacles for service members who leave active duty and return to civilian life.
Gone would be frustrating delays in becoming qualified for VA treatment after a person leaves the military. And no more lost records that ordinarily should have been transferred quickly to help make the process fast and easy.
Today, despite some efforts to meld the two systems, the transition still is hardly seamless, and the problem is being intensified by the flood of wounded returning service members, according to panels of experts at the 2007 Defense Forum Washington, held on 18 September and sponsored by the U.S. Naval Institute and the Military Officers Association of America. The theme was "Keeping Faith With Those Who Serve."
"We're doing better, but the two departments [DOD and the VA] must do more," said Representative Steve Buyer (D-IN), ranking member of the House Veterans Affairs Committee, who was the luncheon keynote speaker at the conference. He urged both agencies to speed up their efforts immediately to prevent situations in which veterans suffer lapses in treatment. "It's got to happen, and it's got to happen now," he said.
Panelists also called for earlier screening to diagnose traumatic brain injuries, which has proved to be one of the most important issues facing wounded veterans of the Iraq and Afghanistan campaigns. "These are young guys?when they get booted out, they get lost," said Commander Rich Jadick, who earned a Bronze Star while serving as a Navy physician in Iraq. "Nobody's out there trying to pick these guys up."
They also called on the services to take steps to eliminate the stigma now surrounding post-traumatic stress disorder. Instead, PTSD should be treated like other diseases, they said, so veterans suffering from its symptoms can feel free to report them and seek treatment without fear that such a step will ruin their military careers. They labeled the issue an important leadership challenge for the coming decade.
And they urged DOD to relax its policies so that service members who lost arms or legs during the conflicts in Iraq and Afghanistan can return to active duty, despite their handicaps. Many who have lost limbs want to stay in the military, and some even want to return to Iraq, said Army Major David Rozelle, a cavalry officer who won a fight for redeployment to Iraq after his leg was amputated during an initial tour.
Medical Care Needs Are Crucial
The medical care issue is now more crucial than ever, panel members told the group. The advent of improved body armor, combined with faster medevac procedures and medical breakthroughs, has enabled more wounded warriors to survive than was the case in Vietnam or Korea. And new technology in prosthetics is promising to make them able to lead productive lives even after losing arms or legs.
Yet, anecdotal evidence shows that veterans still are facing formidable problems when their cases are transferred from the DOD military health-care system to the civilian medical organization run by the VA. The two departments use separate computer and record-keeping systems and often have far different criteria for declaring a person eligible for specific benefits.
The conference followed a report in July by a blue-ribbon presidential commission headed by former Senator Robert J. Dole (R-KS) and former Health and Human Services Secretary Donna E. Shalala that recommended a spate of far-reaching changes in the healthcare programs of both DOD and the VA designed to modernize the veterans disability system.
Among 35 recommendations, the nine-member commission called for appointing special recovery coordinators who would be assigned to help each seriously injured service member cope with the system. It also recommended giving the VA sole authority to determine payments for wounded veterans. And it urged moving more aggressively to treat PTSD and traumatic brain injury.
President Bush has ordered top officials in both departments to look closely at the recommendations and to implement them as quickly as possible.
At the conference, Assistant Secretary of Defense for Health Affairs Dr. S. Ward Casscells said the military was moving to improve its medical care, both in boosting the quality of treatment and in streamlining the bureaucratic system.
"The events at Walter Reed show that we can do better," he said, referring to a series of articles the Washington Post published earlier this year uncovering delays and poor living conditions experienced by returning Soldiers being treated at the Walter Reed Army Medical Center in Washington. "We have pushed our wounded warriors to the point of exasperation," he said.
The VA already keeps the medical records of its patients on electronic files, making them easily accessible to healthcare professionals throughout the VA system. VA Secretary R. James Nicholson, who is leaving office after two and a half years on the job, agreed that making his own agency's policies and recordkeeping compatible with those of DOD will be one of the most important issues his successor will face. "One of our goals is to make sure that this is a hassle-free transition" for veterans, Nicholson told the group.
The panels included a presentation by retired Air Force Colonel Peter Bunce, who chronicled the bureaucratic difficulties faced by his son, Marine Corporal Justin Bunce, in obtaining medical care from the VA. Corporal Bunce received a severe brain injury from an improvised explosive device that seriously incapacitated him during a second tour in Iraq in March 2004.
Colonel Bunce said that, because of bureaucratic glitches, his son several times received conflicting letters about whether his benefits would be cut off. He said the young man wasn't able to cope with these challenges, and it took hours for the colonel to straighten things out. "Just to be able to handle the VA bureaucracy is sometimes daunting?and I live in the [nation's] capital," Colonel Bunce told the conference.
Merideth Beck, national policy director for the Wounded Warrior Project, an advocacy group for veterans, said such bureaucratic difficulties existed in the Defense Department as well. "You see it so often?the family gets so frustrated with DOD and the [benefits evaluation] process that by the time the veteran gets transferred to the VA, he's ready for a fight," she said.
Post-Traumatic Stress Disorder
Panelists also urged that the Defense Department take steps to remove the stigma from PTSD to encourage service members to report it to authorities so it can be treated properly. They also recommended that the military change its attitude toward the disorder so it needn't preclude service members from returning to duty or from embarking on civilian careers.
"Our top challenge is going to be breaking the culture" in which combat stress is viewed as a career-stopping stigma, said Paul Rieckhoff, a former Army infantry officer who serves as executive director of Iraq and Afghanistan Veterans of America, a nonprofit group. The author of last year's provocative Chasing Ghosts, Failures and Facades in Iraq: A Soldier's Perspective, he called the problem of dealing with combat stress "one of the most important issues facing our generation of veterans."
Rieckhoff said attaching a stigma to PTSD during the Vietnam War era led to a raft of misplaced veterans and homeless people who eventually became a burden to society. "We don't have to go down the road of Vietnam again," Rieckhoff said. "We've seen how a helping hand and motivated people can make a difference." He told the group that the nation was "at a crossroads" in deciding whether to repeat past mistakes.