The glib assurances of politicians, that those who volunteer for service receive the best care possible, ring hollow for too many of the 1.7 million Americans who fought in Iraq or Afghanistan, or both.
That theme ran through an intense, daylong gathering on 17 September 2008 of hundreds of military caregivers, Department of Defense (DOD) and Veterans Affairs (VA) officials, family members, and veterans. The panels, discussions, and networking, sponsored by the U.S. Naval Institute and the Military Officers Association of America, seemed to offer this progress report: Better. Not good enough for wounded troops.
Despite the selfless dedication of caregivers and policymakers, the treatment of wounded veterans tragically reflects neither America's ability nor its heart.
For veterans in need, services often fall short. Maddening red tape frustrates those seeking help, and institutional indifference or hostility baffles their families. For every wounded veteran who receives loving and technically advanced rehabilitation, it seems there is one who, like his veteran father and grandfather before him, fights months just for attention.
And then there are the unknown veterans in need, more than half a million whose eventual diagnoses, researchers believe, will fall along the scale from psychological wounds to traumatic brain injury (TBI). How they will be identified, how they will be provided care, and what they will need to resume productive lives is not now known.
"These young Americans have written a blank check that includes giving their life if necessary," said retired Marine Corps Major General Thomas L. Wilkerson, chief executive officer of the U.S. Naval Institute. "And Americans write a blank check that we will care for them and their families for the balance of their lives.
"That is a moral obligation but also a practical one: if we allow the perception to go forward that veterans cannot return to a meaningful life that they can sustain, when we ring the bell we might not find the volunteers we need to defend this democracy," Wilkerson said.
With the passage of the Wounded Warrior Act, part of the Fiscal Year 2008 Defense Authorization bill, much has been done toward that goal, said Senator Carl Levin (D-MI), chairman of the Senate Armed Services Committee. The legislation mandated reforms of the DOD and VA disability rating standards policies and required an increase in severance pay for members injured in combat or combat-related activity. It required DOD to establish TBI and Post-Traumatic Stress Disorder (PTSD) centers of excellence and for DOD and the VA to jointly develop comprehensive policies on care management to achieve a "seamless transition" from military to veterans care.
Continuing Shortfalls
But, as Levin observed, "When it comes to implementation, there have been shortfalls. We can pass all the laws that we possibly can and should, but unless they are implemented fully, then we have not carried out our missions and we have not done our duty."
The Pentagon has acted on many of these requirements. Army Brigadier General Loree K. Sutton directs the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. Among its initiatives, she said, are establishing the Defense and Veterans Brain Injury Center, the Center for Deployment Psychology, the Deployment Health Clinical Center, a Center for the Study of Traumatic Stress, and the National Intrepid Center of Excellence, which is due to open next fall.
At a higher level, the Wounded, Ill, and Injured Senior Oversight Committee, chaired by the deputy secretaries of Defense and Veterans Affairs, is working to streamline coordination between the two agencies and to improve case management, said Dr. Lynda Davis, the deputy assistant secretary of the Navy who supervises joint DoD-VA case management. The committee oversees the work of each service's wounded warrior programs with its own recovery coordinators who work at Walter Reed Army Medical Center, Brooke Army Medical Center, the National Naval Medical Center at Bethesda, and elsewhere.
Although many of these programs and initiatives had their genesis before 9/11 and the wars in Afghanistan and Iraq, there has been impressive progress since then. "There are double amputees on active duty. That's profound," said Lieutenant General Ronald Coleman, deputy commandant of the Marine Corps for manpower and reserve affairs.
But even with these achievements came the acknowledgment of shortfalls.
Many community-based organizations want to help wounded troops but cannot find a way to do it. "We have an awful lot of families who call and want to help,'' said Lieutenant Colonel Nikki Butler, of the U.S. Army Surgeon General's Office. But they are often bewildered by the alphabet soup of offices within DOD and the VA.
One problem is a Defense Department ethics regulation that forbids the gift of more than $1,000 to any active-duty service member. Jerry Kerr is a 53-year-old disabled civilian who runs a nonprofit organization that provides Segways, the two-wheeled mobility platform, to injured service members. His organization, Segs4Vets, obtained a blanket waiver from the Pentagon allowing it to donate the Segways, which cost about $5,000 each. If the ethics rule was amended, he said, "people would come out of the woodwork to help."
"There's a lot of guys out there who want to assist," said Marine Colonel Gregory A. D. Boyle, who commands the Marine Corps Wounded Warrior Regiment, but there is no organized way to include them. "There is a lack of command and control," he said.
Meredith Beck, a senior adviser on community reintegration at the VA, acknowledged that it had been "somewhat insular" in not reaching out to community organizations and individuals. She agreed that reforming ethics and other regulations are needed "not because the government is not doing its job, in many cases, but because these communities want to help."
There is a shortage of caregivers, acknowledged Colonel Jim S. Rice, director of the Army's Wounded Warrior Program. His goal is one case manager for every 30 patients, but at present the program can only manage one for every 37 patients. One problem is the high turnover among case managers, he said, and there is competition among Pentagon and VA agencies for experienced case managers. And the workload is growing: his program is absorbing 91 new Soldiers per week and is currently caring for more than 3,200 Soldiers.
Among those not receiving help are tens of thousands of former service members who are not in contact with their former service or the VA. Colonel Boyle said there are an estimated 8,000 former Marines in this category, and his office is making an effort to reach each one of them by phone.
Families Must Be the Squeaky Wheel
Families of wounded service members were not hesitant to speak up.
"I have to pester the VA" to get assistance, said Cynthia A. Lefever, whose son, Army Specialist Rory Dunn, was badly wounded by an IED blast in Iraq. "You have got to get rid of your big roll of red tape," she told a VA official. She said she and her son had not had any contact from their VA case manager since February 2007. She said it took 18 months to arrange for the automatic deposit of her son's checks.
"As far as getting contact with the VA, it's always, we're understaffed, we're understaffed!' All these programs sound great, but we don't get access to them because of understaffing,'' she said.
She said VA staff, including receptionists, need to be trained in how to handle patients with TBI or PTSD. "We need your staff to know how to de-escalate a confrontation, how to treat patients with dignity and respect—just those two things—please! Sometimes when I come into the VA, I want to hit somebody I get so frustrated!''
Andrea Sawyer, the wife of a Soldier who served in Iraq in mortuary affairs, also sounded bitter about the VA. Her husband, Sergeant Loyd Sawyer, waited at Fort Lee, Virginia, for eight months before he could get a referral from the base psychologist for help with PTSD, which he says he developed after handling 40 to 50 bodies a day and "being mortared constantly." He is now being treated at the Portsmouth Naval Medical Center.
"There are so many people working so hard on these problems—and not talking to each other," said Beck, who has served as national director of the Wounded Warrior Project and who has a brother deployed as a Marine in Iraq. "A lot of progress has been made but there is a long way to go," she said. "I know the worst thing you can say to the family of an injured member is to be patient. They have been patient!''