April 25, 2008

More Must Be Done to Ensure Our Wounded Warriors Receive The Care They Deserve.

Yesterday’s passage of the Veterans’ Benefits bill makes important changes to help our nation’s veterans. But more must be done to ensure that our wounded warriors receive the care they deserve. Nearly 20 percent of those who have served in Iraq or Afghanistan suffer from PTSD or major depression. Another 19 percent have TBI. Yet they are not receiving the care that they deserve. Our military medical facilities are short-staffed and our veterans are suffering through a bureaucratic nightmare. Instead of hiding the facts, the Bush Administration should work with Congress to improve the care our wounded warriors receive.

In this document:

Report found 300,000 Iraq and Afghanistan veterans have suffered from serious mental health conditions.
Report found 320,000 Iraq and Afghanistan veterans suffer from Traumatic Brain Injuries, but few receive treatment.
Department of Defense medical care continues to be short-staffed.
Veterans’ advocates and family members say some Iraq and Afghanistan veterans have not received the care they deserve.

Report found 300,00 Iraq and Afghanistan vets have suffered from serious mental health conditions:

Prolonged Periods of Combat Have Taken Serious Psychological Toll on Vets. “Since October 2001, about 1.6 million U.S. troops have deployed to the wars in Iraq and Afghanistan, with many exposed to prolonged periods of combat-related stress or traumatic events. Early evidence suggests that the psychological toll of the deployments may be disproportionately high compared with physical injuries.” [Rand Corporation, 4/17/08]

Comprehensive Study Found 300,000 Veterans of Iraq and Afghanistan Suffered From PTSD or Major Depression. “Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have sought treatment, according to a new RAND Corporation study. In addition, researchers found about 19 percent of returning service members report that they experienced a possible traumatic brain injury while deployed, with 7 percent reporting both a probable brain injury and current PTSD or major depression.” [Rand Corporation, 4/17/08]

Many Vets Received ‘Minimally Adequate’ Treatment for PTSD. “But even among those who do seek help for PTSD or major depression, only about half receive treatment that researchers consider ‘minimally adequate’ for their illnesses. In the first analysis of its kind, researchers estimate that PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment — an amount that includes both direct medical care and costs for lost productivity and suicide. Investing in more high-quality treatment could save close to $2 billion within two years by substantially reducing those indirect costs, the 500-page study concludes.” [Rand Corporation, 4/17/08]

Half of Veterans Being Treated for PTSD Reported Inadequate Treatment. “Researchers found many treatment gaps exist for those with PTSD and depression. Just 53 percent of service members with PTSD or depression sought help from a provider over the past year, and of those who sought care, roughly half got minimally adequate treatment. ‘If PTSD and depression go untreated or are under treated, there is a cascading set of consequences,’ Jaycox said. ‘Drug use, suicide, marital problems and unemployment are some of the consequences. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general.’” [Rand Corporation, 4/17/08]

VA Officials Concealed Actual Numbers of Veteran Suicide Attempts from Congress. “The Department of Veterans Affairs has lied about the number of veterans who have attempted suicide, Sen. Patty Murray said Wednesday, citing internal e-mails that put the number at 12,000 a year while the department was publicly saying it was fewer than 800… Deputy Secretary of Veterans Affairs Gordon Mansfield apologized during a Senate Veterans' Affairs Committee hearing, saying he did not think there was a deliberate attempt to mislead Congress or the public.” [McClatchy, 4/24/08]

Study found 320,000 Iraq and Afghanistan veterans suffer from TBI, but few receive treatment:

Study Found 320,000 Iraq and Afghanistan Veterans Have Experienced TBI. “The RAND study also estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment — the term used to describe a range of injuries from mild concussions to severe penetrating head wounds. Just 43 percent reported ever being evaluated by a physician for that injury.” [Rand Corporation, 4/17/08]

GAO Found Clinical Validity of VA’s TBI Screening Tool Has Never Been Evaluated. “While VA’s screening efforts depend on its TBI screening tool, VA is planning to but has not yet begun to evaluate the clinical validity and reliability of the screening tool—that is, respectively, how effective the tool is in identifying those who are and are not at risk for mild TBI, and whether the screening tool would yield consistent results if administered to the same veteran more than once… However, until such an evaluation takes place, VA providers will continue to use the screening tool without knowing how effective the tool is in identifying which OEF/OIF veterans are and are not at risk for a mild TBI.” [GAO, “Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF/OIF Veterans, But Challenges Remain,” 2/08]

GAO Found Some VA Facilities Had Difficulty Following Protocol for Evaluating TBI. “VA has established training for its providers to help ensure veterans are evaluated and treated for mild TBI. Although VA has implemented the protocol nationwide, we found that some medical facilities had difficulty fully following some of the protocol requirements.” [GAO, “Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF/OIF Veterans, But Challenges Remain,” 2/08]

GAO Found 2 VA Facilities Were Not Using TBI Symptom Checklist. “At two facilities we reviewed, providers were not using the symptom checklist to evaluate a veteran at the time of our visit in July 2007, though the providers were using the symptom checklist several months later.” [GAO, “Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF/OIF Veterans, But Challenges Remain,” 2/08]

Dr. Bristow Testified the VA is Not Properly Evaluating Soldiers with TBI. “In Iraq, many service members have been subjected to multiple improvised explosive device blasts…It is time to review how to properly evaluate and rate TBI in light of current medical knowledge, along with the rest of the neurological conditions, most of which have not been revised since 1945.” [Dr. Bristow’s Testimony to the Senate Committee on Veterans Affairs, 2/27/08]

DOD medical care continues to be short-staffed:

Army Failed to Reach Goals in Care For Servicemembers in “Both Hiring and Meeting Current Demands.” “Although the Army has made significant progress in staffing its Warrior Transition Units, several challenges remain, including hiring medical staff in a competitive market, replacing temporarily borrowed personnel with permanent staff, and getting eligible servicemembers into the units. With respect to supporting servicemembers as they navigate the disability evaluation process, the Army has reduced caseloads of key support staff, but has not yet reached its goals and faces challenges with both hiring and meeting current demands of servicemembers in the process.” [GAO, “Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for Servicemembers,” 2/27/08]

Warrior Transition Unit Staffing Insufficient, GAO Report Shows. “The Army is facing several challenges in fully staffing the Warrior Transition Units and ensuring all eligible servicemembers can benefit from the care provided in these units. For example, the Army established a goal of having at least 90 percent of Triad staff positions filled to meet the staff-to-servicemember ratios that the Army had established for its Warrior Transition Units.” [GAO, “Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for Servicemembers,” 2/27/08]

Noncompetitive Salary Levels Blamed for Health Care Professional Shortage. “Army officials cited challenges in staffing Triad positions, including difficulties in hiring physicians and other medical personnel at certain locations because salary levels do not provide the necessary incentives in a competitive market.” [GAO, “Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for Servicemembers,” 2/27/08]

11 Major Treatment Facilities Lack Sufficient Board Liaisons Who Help Wounded Warriors Navigate the Disability Evaluation Process. “11 of 35 treatment facilities continue to have shortages of board liaisons and about half of all servicemembers in the disability evaluation process are located at these 11 treatment facilities. Due to their caseloads, liaisons we spoke with at one location had difficulty making appointments with servicemembers, which has challenged their ability to provide timely and comprehensive support.” [GAO, “Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for Servicemembers,” 2/27/08]

Vets advocates and family members say some Iraq and Afghanistan vets have not received the care they deserve:

Adrian Aitzado, Assistant Director of Disabled American Veterans Said Quality of Veterans Medical Support Is Subpar. “Staffing problems for the Disability Evaluation System persist where board liaison, legal staff and board physicians are not being filled and the quality of support is not where it should be… Meeting staff goals of the Army's warrior transition units also have not been met, despite recent significant increases. In particular, staffing targets for the triad, the nurse case manager, squad leader, and primary care providers who are the backbone of these units remain unfulfilled.” [Testimony before Senate Committee on Veterans Affairs, 4/23/08]

Father of Wounded Veteran Said VA Care Falls Extremely Short. “But, what I learned immediately upon leaving there, however, was they didn't know what they didn't know. And that is, their skills, capabilities, resources, staffing, treatments, therapies and therapy techniques all fell extremely short.” [Testimony before Senate Committee on Veterans Affairs, 3/11/08]

Father of Wounded Vet Says VA is Unresponsive and Unable to Meet Needs. “My experience with the Philadelphia V.A. is they are unresponsive. They ignore primary physician's orders regarding in- home care and assistance. They are unable to provide newly prescribed medications, they're unable to establish and execute action plans, and they're unwilling to fund his therapy needs.” [Testimony before Senate Committee on Veterans Affairs, 3/11/08]

Father Of Wounded Iraq War Vet Described VA Shortcomings In Treating TBI. “…due to the inadequacies of the VA’s ability to provide tailored and consistent traumatic brain injury (TBI) therapy, case management or even basic transportation to and from the hospital, we have become ever more reliant on state and community based brain injury resources to facilitate continued rehabilitative care… The multitude of bureaucratic hoops that families are expected to jump through for services, can be the breaking point for that veteran’s support system. Most families who are dealing with a veteran with TBI also have demands and responsibilities elsewhere. They often have other family members who need their attention and energy, they must hold down full time jobs and manage households. The stress of dealing with the TBI afflicted veteran cannot be understated. Without clear direction and support for both the veteran and the family, it is unrealistic to expect the best long term outcome for the TBI veteran.” [Peter Bunce’s Testimony to the Senate Committee on Veterans Affairs, 3/11/08]

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