Stiffing veterans

The underfunded V.A. is being overwhelmed by injured soldiers -- and the administration that sent them to war won't pay to take care of them.

By Judith Coburn

Read more: Politics, News, Iraq

May 1, 2006 | On the eve of his Marine unit's assault on Fallujah, Iraq, in November 2004, Blake Miller read to his men from the Bible (John 14:2-3): "In my father's house, there are many mansions: if it were not so, I would have told you. I leave this place and go there to prepare a place for you, so that where I may be, you may be also."

A photograph of Miller's blood-smeared, filthy face, so reminiscent of David Douglas Duncan's photos of war-weary Marines in Vietnam, is one of the Iraq war's iconic images. Over a hundred newspapers ran it. But as the San Francisco Chronicle reported recently, Miller, a decorated war hero, has been shattered psychologically by Iraq. Disabled by flashbacks and nightmares, he continues to pay daily and dearly for his service there.

His eloquent commitment to his fellow Marines is the highest value in military life. But the Bush administration, which sent Blake Miller, his fellow Marines and 1.3 million other Americans (so far) to war in Iraq and Afghanistan, apparently does not share this commitment.

Much has been written about how President Bush and Secretary of Defense Donald Rumsfeld waged war on the cheap, sending too few ill-equipped young soldiers -- 30 percent of them ill-trained Reservists and National Guardsmen -- into battle. But little has been reported about how shockingly on the cheap the homecomings of these soldiers have proved to be. The Bush administration awarded Miller a medal, but it has fought for three long years to deny soldiers like him the care they need. While Miller and his men were being thrown into the fire in Fallujah, the White House was proposing to cut the combat pay of soldiers like them. (Only an outburst of outrage across the political spectrum caused the administration to back off from that suggestion.)

The Department of Veterans Affairs, now run by a former Republican National Committeeman, has been subjected to the same radical hatcheting that the White House has tried to wield against the rest of America's safety net. Cutbacks, cooking the books, privatization schemes, even a proposal to close down the V.A.'s operations have all been in evidence. The administration's inside-the-beltway supporters, such as the Heritage Foundation and famed antitax radical Grover Norquist, like to equate veterans care with welfare. Traditionally, however, most Americans have held that the V.A.'s medical care and disability compensation were earned by those who served their country.

Unfortunately, in our draft-free country, the fight to protect the V.A. and to fully fund it has gone on largely out of public sight. Other than the Washington Post and the Associated Press, relatively few journalistic organizations have bothered to regularly cover the department. The fight over it that White House hatchetmen, V.A. political appointees and their allies in Congress have had with congressional critics (Democratic and Republican) along with veterans organizations has been monitored closely only by veterans' Web sites like Larry Scott's VA Watchdog.org, Veteransforcommonsense.org and Military.com.

While national deficits soar, thanks in part to skyrocketing war costs, veterans of Iraq and Afghanistan are flooding into the increasingly underfunded V.A. system. As of April 28, the Pentagon says that 2,401 Americans have died and 17,762 have been wounded in combat in Iraq (and 281 more have died in Afghanistan). But these casualty figures seem to be significant undercounts. After all, 144,424 American veterans have sought treatment from the V.A. system since returning from those wars, not including soldiers actually hospitalized in military facilities.

These figures were wrested only recently from the V.A. after years of fruitless demands from Democrats on the House Veterans' Affairs Committee. The 144,424 figure includes not only many of the 17,762 reported wounded in combat by the Pentagon -- if that figure is, in fact, accurate -- but those wounded psychologically, those injured in accidents and those whose ailments were caused or exacerbated by service in the war. (Think of war, in this sense, as an extreme sport in its toll on the body.) Of course, neither Pentagon nor V.A. figures for the wounded include estimates of soldiers or veterans who don't show up at a Department of Defense or V.A. facility. Among these casualties are post-combat-tour suicides (who obviously can't show up) and the victims of diseases like leishmaniasis, caused by the ubiquitous sand flies in Iraq, who often suffer on their own.

Nonetheless, the V.A. has admitted -- and it has been confirmed by an Army study -- that a staggering 35 percent of veterans who served in Iraq have already sought treatment in the V.A. system for emotional problems from the war. Add this to the older veterans, especially from the Vietnam era, pouring into the system as their war wounds, both physical and emotional, deepen with age or as, on retirement, they find they can no longer afford private health insurance and realize that V.A. healthcare is -- or at least was -- more generous than Medicare.

Just as the Pentagon failed, after its March 2003 invasion of Iraq, to plan for keeping the peace, guarding against looting, fighting a resilient insurgency or handling a civil war, so has the Department of Veterans Affairs failed to plan for caring for casualties of the war. The V.A. admitted recently that 33,858 more vets showed up for treatment in just the first quarter of fiscal year 2006 than were expected for the entire year. Do the math yourself. Multiply times 4, assuming that the war goes on injuring Americans at current levels, and you get a possible underestimate of about 135,000 casualties for the year.

Even more distressing, the San Diego Union-Tribune recently reported that mentally ill soldiers are being sent back to war armed only with antidepressants and anti-anxiety drugs. The Union-Tribune quotes Sydney Hickey of the National Military Family Association as saying that "more than 200,000 prescriptions for the most common antidepressants were written in the last 14 months for service members and their families." According to the Union, an Army study also found that 17 percent of combat-seasoned infantrymen suffer from major depression, anxiety or post-traumatic stress disorder after a single tour in Iraq. California Sen. Barbara Boxer has called for an investigation.

Are such chronic underestimates merely the result of incompetence? Not according to the Government Accountability Office, Congress' investigative arm. In a series of reports on the V.A. over the past three years, the GAO found that the department's top officials submitted budget requests based on cost limits demanded by the White House, not on realistic expectations of how many veterans would actually need medical care or disability support.

In repeated testimony before Congress, top V.A. political appointees have opposed demands by veterans groups like the American Legion and the Disabled Veterans of America to increase significantly funds for medical care and disability payments for the new patients now flooding the system. Top V.A. officials assured Congress that more money wasn't needed because the agency had stepped up "management efficiencies." But the GAO found that from 2003 to 2006, there were no obvious management efficiencies whatsoever to offset the increased treatment costs from the Iraq war, nor did the V.A. even have a methodology for reporting on such alleged efficiencies.

While the GAO's findings, when describing the V.A.'s budget manipulations, were couched in such relatively polite bureaucratic euphemisms as "misleading," "lacked a methodology" and "does not have a reliable basis," the conclusions nonetheless were striking. "The GAO report confirms what everyone has known all along," American Legion national commander Thomas L. Bock commented. "The VA's health-care budget has been built on false claims of 'efficiency' savings, false actuarial assumptions and an inability to collect third-party reimbursements -- money owed them. This budget model has turned our veterans into beggars, forced to beg for the medical care they earned and, by law, deserve. These deceptions are especially unconscionable when American men and women are fighting in Iraq and Afghanistan."

Some veterans are calling it fraud. Rep. Lane Evans, D-Ill., of the House Veterans' Affairs Committee calls it "Enron-styled accounting."

Next page: Even before recent veterans began flooding the system, the V.A. was underfunded and criticized for poor services