WASHINGTON (AP) — Two years after Congress passed a high-profile law to improve health care for military veterans, lawmakers and advocates are again raising alarms that the sprawling Department of Veterans Affairs is not expanding help for the nation's former fighters and their families as quickly or widely as intended.
This time the dispute is over two mental health measures: one to establish a network of peer counselors so that Iraq and Afghanistan veterans have someone to consult with who shares their war experience, the other to give the families of National Guard and reserve members temporary access to mental health services at VA facilities.
Veterans Affairs, the second largest federal agency after the Defense Department, says it was already providing the help that Congress wrote into law in May 2010. Advocates for veterans, though, say the VA is effectively ignoring the law's demand for those two steps.
"The VA does some wonderful stuff, don't get me wrong, but they seem to be ignoring their obligations under this law, almost to the point of being a scofflaw," said Peter Duffy, deputy director for legislative programs at the National Guard Association of the United States.
The VA says it already offers peer support and family counseling at about 300 vet centers around the country. The vet centers are located in strip malls, downtown stores and in office buildings around the country. About two-thirds of the workers are veterans. So, rather than create an entirely new program, the department has told lawmakers that it's meeting the bill's requirements through existing services.
"I think we need to use the legislation in a positive sense to reinforce what we're already doing," said Dr. Jan Kemp, director of the VA's suicide prevention program. "As the need increases, which it inevitably will, we've got the legislation now to help us move resources in that direction. It's an evolving sort of process."
The VA's response has upset those who fought to get the legislation passed. They expected the VA to establish a peer support network consisting of Iraq and Afghanistan vets at each of its 152 hospitals. They also expected family members of guardsmen and reservists to temporarily have access to the full range of mental health services available at the VA's hospitals and its nearly 800 outpatient clinics.
"The language in the bill was not written with the precision that you would like to see, but you can't read a provision of law and say it has no meaning, which is essentially what the VA is doing," said Ralph Ibson, national policy director for the Wounded Warrior Project, a nonprofit group that assists injured service members and veterans. "To say we're already doing this is to say Congress is an ass."
Ibson said the conflict reminds him of an earlier disagreement over the bill's provision of financial aid to caregivers of wounded vets. When the department announced in early 2011 how the program would work, lawmakers and advocacy groups complained that it would help fewer families than expected. The department subsequently expanded the program's reach to about 3,500 families.
Proponents of the legislation said that establishing a strong peer network throughout the VA system would supplement the care veterans get from doctors. Many veterans report feeling more comfortable talking with somebody who has shared similar experiences. The rapport that a veteran counselor develops with clients could encourage more vets to access and stick with their care.
A Rand Corp. study has indicated that accessing care is a significant problem. Researchers found in a 2008 study that barely more than half of those veterans exhibiting symptoms of major depression or PTSD had sought help from a physician or mental health provider in the previous year.
Ryan Alaniz, 32, who suffered from post-traumatic stress disorder after serving in Iraq, said he can attest to the benefits of having fellow veterans to turn to when coming back from war. Alaniz, a specialist in the Army, said he essentially became a shut-in after returning. He drank a lot, felt stressed and had frequent flashbacks to his time in Baghdad, where he helped stabilize and load seriously wounded soldiers for evacuation. One day, while on guard duty, he watched as a chain of bombs killed or maimed dozens of Iraqi civilians.
Alaniz received treatment for post-traumatic stress disorder at the VA's medical hospital in Houston and has praise for the psychologist who worked with him. But he said he made important strides after linking up with fellow veterans at a program in San Antonio administered by the Wounded Warrior Project. One aspect of the program involved spending a week with about 10 of his peers in the Utah countryside. Another helped improve his focus and reduce anxiety during stressful situations. He said there is a comfort that comes from talking to people who have been through a similar experience.
"People don't understand that vets don't actively like to share our stories with someone who hasn't been there," Alaniz said.
Veterans groups and lawmakers are big backers of the peer support work done at vet centers.
"Congress has spoken on this issue and it's time for the VA to move forward and implement these provisions," said Sen. Jon Tester (D-Montana), who led the effort to get the two programs into law after the original authors of the provisions — Republican Pete Domenici and Democrat Barack Obama — had left the Senate.
The VA operates a vast health care system. It started opening vet centers after the Vietnam War as a one-stop clearinghouse that vets could turn to when they needed help and lived far away from a VA hospital. About two-thirds of the workers are veterans. They screen visitors for drug and alcohol abuse. They help the homeless find a shelter or apartment, and the unemployed find a job.
"Our approach is a personal approach. It's another veteran looking you in the eye, establishing a contact and then getting you to the support services that you need," said Dr. Alfonso Batres, who oversees the vet centers as director of the VA's Readjustment Counseling Service. "Our job is to get them to the right individuals, but we do have the capacity to provide a fair amount of counseling at the vet centers."
The proponents also view mental health care for family members as a temporary service that would help more veterans take advantage of treatment: If a spouse or child can get help for depression that stems from the soldier's war experiences, then the veteran may also seek care.
Yet, the clock is already ticking for many families eligible for that benefit because it only applies to a three-year period that begins once a veteran returns from deployment.
On the House side, lawmakers serving on the House Committee on Veterans Affairs have been pressing the VA for details about the legislation's implementation. Rep. Jerry McNerney, D-Calif., and Rep. Ann Marie Buerkle, R-N.Y., both said they believe the VA has fallen short of requirements.
"I don't think they're stalling. I think they're failing to communicate, failing to coordinate and failing to understand that there was a significant attempt to give our veterans and their families what they needed, and I don't think they're getting it done," said Buerkle, the Republican chairwoman of the Committee on Veterans Affairs' health subcommittee.
Kemp insisted that there is no resistance to the legislation. She said the VA also has some veterans who work as peer counselors at the medical centers and that it's conducting site visits that could lead to more hiring. The department is also entering into a contract later this year with an organization that would train the department's peer counselors. She wants the first training program to be completed by the end of September. VA officials said that the timeframe is appropriate because it wanted to give multiple bidders the chance to compete.
"It's a big responsibility to bring peers in and get them trained and up and going," Kemp said. "Getting there is harder than it sounds."