Ever been to war? Mine was in the last century and that’s hard to admit. The fact we lost is even harder. Being shot at tends to focus you, and things experienced stay with you. No one hates war more than those who have lived it, yet we send our children to go and peer into hell. They come back with scars, some physical, more mental. You can’t take someone from a normal ordered society and drop them into a combat zone, a year later pull them out, put them back on Main Street, and expect them not to have some baggage. In a strange way the lucky ones with all their fingers and toes can carry deeper scars. As scary as it is, you’re never more alive then in combat. Your senses are on overload, pores wide open, adrenalin coursing. But you will pay for this dance with the devil, in the silence of a future midnight when the demons return to collect. Old soldiers have passed many such midnights. For us it’s normal. The mission is to let this generation know that it can and must be dealt with or it will deal with you. This mission for some has become a career.
Fifty-four counties across this state have Veterans’ offices. These were put in place by the State of New York in 1945 to inform returning war veterans of their rights and benefits. Makes sense because dealing with the State and Federal bureaucracies is daunting. They’re hard to deal with, so hard in fact that they won’t release discharges and contact information on veterans returning to their counties. When questioned ,we’re told it’s to protect the privacy of the returning veteran…Yep, that was my question. If we don’t talk to them, who will? And do you really believe we aren’t going to protect their privacy? We are of the same faith. We’ve shared the same baptism of fire…
Might be that we are too good at what we do. And giving us the contact information would allow us to reach all the returning vets in our county, that would lead to more claims, therefore and even the larger backlog. Maybe that’s the problem. Well we shouldn’t worry because these new veterans are above average. They’re above average in unemployment, alcoholism, divorce, foreclosures, Post Traumatic Stress.
This year the Army set a record. Some say the highest in 26 years, others say the highest since Vietnam. The record is for suicide. But I digress. We don’t have to worry about them filling out claims, but it may be a barometer. However, keeping the claims process long and frustrating saves money. First, by not having to hire more and competent people. Second, by frustrating veterans to the point where they drop their claims, there’s another savings. Third, is the truly uncooperative veteran who dies while waiting for a settlement, sad, but yet another savings.
So let’s get this straight. We have a government agency that’s figured out that by spending less money they can make or at least keep more money. The bean counters love this stuff. So where is the motivation for change unless money in the VA budget is specifically targeted? How did we get here? Wasn’t hard. We’re about where we were in Vietnam. Then the VA Hospital System was gearing up to handle the geriatric population of WW I. When it was hit with thousands of young veterans with nasty wounds that had never been seen before. But due to advances in medical technology and speed of evacuation from the field, more of them were coming home. At that time for every person killed, 3 to 4 were wounded. If you were wounded and made it to a dust off chopper, odds were that you had a 95% chance of living. They didn’t know what to do with them, but they did have bed space as did the Department of Defense so they could hang onto them longer until they figured it out.
What happens after a war in general, is military and VA budgets tank. The people are tired of war, the economy is in need of transition. However, after Vietnam you could square that. It’s kind of like the ‘perfect storm’ in the way those three elements came together. It was a lousy war that we lost. The public was suffering not from war fatigue, they were genuinely angry and the economy was going over the falls. Remember the gas lines? So a new phrase came into our lexicon, “base closures”. However, with every base at least one hospital was lost. At the same time, the VA hospitals began following the medical trend of the private sector - going into shorter hospital stays, more out patient, therefore they too, were eliminating beds and opening community clinics, the first of which was in Rockland County.
Then there was Desert Storm. That showed America we could go to the other side of the world, win a war in a hundred hours, take only 168 killed and come home. Perfect, we avenged Vietnam and proved the bean counters right, all in one shot. It was then that the bed letting began. From the time of Desert Storm to the beginning of Iraqi freedom, the Department of Defense and Veterans Affairs beds went down 65%. So now we’ve got fewer beds especially in the Department of Defense, and now the killed to wounded ratio has gone off the map. For every one person killed, 15 are wounded. We are approaching 4,000 killed in Iraq and Afghanistan. That translates to 60, 000 wounded. With that number of wounded in Vietnam, we would have had 20,000 killed.
So you can see the volume has been turned way up. The wounds are more grievous and are taking longer to recover as well. Now what happens is the wounded come back to Walter Reed, Bethesda or other DOD hospitals. They can’t handle the load. If DOD determines that the vet is too badly wounded to return to duty, the vet is in fact no longer of any value to the military, and he is retired. This hands the veteran off to the Department of Veterans Affairs. Not only getting them off their hands, but off their books. The VA is not in that much better shape in terms of beds and has only one-tenth of DOD’s budget. Also this is the point at which VA claims begin, again adding to the backlog. VA only has so much space and so many people in terms of rehab. When new wounded come in to begin rehab, the old have no place to go. So they are sent either home to ill-equipped parents or spouses, or move to nursing facilities.
In either case, rehabilitation effectively stops or at least considerably slows. The fact that the veterans aren’t rehabilitated to the highest point possible, they become more of a burden to the VA. Again, more claims and for a longer period of time, not to mention that the veterans are left with a poorer quality of life. What could happen is DOD could hold onto these people on active duty. They would then still have “Tri-care” military health insurance. The veteran then could be outsourced to a state of the art private rehab facility near their home. Tri-care would be used to cover the cost. No new hospitals would need to be built or medical staff hired. And that rehab could start today and continue ‘til it was determined by a medical professional, not an administrator, that as much as possible had been done for the veteran. On the claims backlog side, we could rehire recently retired claims adjudicators on a per diem or contract basis, possibly even with an incentive for more than average number of claims cleared. These people already know the system. They already have the training. There’s no adjusting period. They could start tomorrow. Four of such people working full-time in each VA Regional Office could clear the back log in 2 years.
The second idea would allow regular VA doctors in hospitals and clinics to diagnose vets beginning their claim, and have that diagnosis be adjudicated. The way it works now is, in order to file the claim the veteran has to have a diagnosis. That diagnosis is submitted with the claim. Months go by, the veteran is then sent for another physical examination and diagnosis. In many cases they are sent back to exactly the same medical facility and the same doctor who examined them in the first place. Therefore if the original doctor is a VA doctor, let them submit their findings directly to the adjudication board. This may necessitate an increase in doctors on the clinic level, however one doctor could serve several clinics. That in itself should take a couple of months out of the claim process. It’s not perfect, or may not work in all circumstances, but I’ll take a bite. These people, facilities, and systems, are all in place as we speak. This could begin tomorrow if there is a political will to do so.
Lastly, appoint someone to head up the transition, who would report back to Congress in 6 months. Max Cleland would be my suggestion. As a former senator he knows the beltway. As the former Director of the Veterans Administration under President Carter, he knows the VA. As a wounded Vietnam veteran he has seen the system from both sides.