On Veterans Day 2009, President Barack Obama walked through the headstones in Arlington National Cemetery outside Washington, DC. He was deliberating his impending decision to escalate and then terminate the Afghanistan war.
On December 1, Obama announced his temporary escalation of the Afghanistan war with the deployment of 30,000 new troops, to the dismay of both pro-war neoconservatives and antiwar activists. On December 6, 2009, The New York Times quoted a presidential adviser as saying Obama was “totally at peace,” as troops would begin returning home by July 2011.
Veterans for Common Sense (VCS) remains deeply concerned about the escalation. While Obama and his top advisers gathered facts, weighed options, carefully planned the escalation on the front end, there appears to be no plan for the back end – caring for the expected flood of tens of thousands more casualties, defined as deaths, wounds, injuries and illnesses among our troops and veterans.
VCS appreciates that Veterans Affairs (VA) Secretary Shinseki attended the president’s speech at West Point, Shinseki’s alma mater, symbolizing former President George W. Bush’s precipitous Iraq war as well as the need to care for our veterans.
However, Obama offered no words about the VA or veterans, a significant oversight not missed by veterans’ advocates, including VCS. In addition to military preparations for a wider war, our nation needs increased military and VA efforts to handle tens of thousands of new casualties, especially for the unseen wounds of war: traumatic brain injury (TBI), depression, post-traumatic stress disorder (PTSD) and suicide.
Last week, VCS publicly demanded that the administration implement a casualty plan. After all, these are now Obama’s wars, these are Obama’s casualties and they are Obama’s full personal responsibility. There is still no casualty plan, a serious problem first raised by VCS on CNN in October 2006, months before the Walter Reed scandal was widely exposed.
While there continues to be outstanding emergency medical services on the front lines saving many lives every day, let us be very clear: our Nation shall not repeat the mistakes after the Vietnam War, the Gulf War and the first eight years of the Iraq and Afghanistan wars, where the long-term medical needs of our service members and veterans were neglected.
Based on lessons learned, VCS describes the current challenges for our service members and veterans, and then we list policy objectives that can be easily implemented by Obama, the military and the VA.
Current Challenges for the Military and the VA
1. Half-Million VA Patients. Every month the war continues, the number of veteran patients grows sharply. Two million US service members have deployed overseas, and the count keeps climbing. After returning home, more than 480,000 veteran patients have already flooded into VA hospitals and clinics. In the long term, VCS estimates as many as one million total veteran patients from the two wars as soon as the end of 2013.
2. Severe Doctor Shortage. Last month, Army Vice Chief of Staff Peter Chiarelli confirmed the dire situation when he told The Washington Post that the Army continues to be short an estimated 800 behavioral health specialists – an appalling leadership failure after eight years of war. In simple terms, the supply of mental health professionals remains woefully insufficient to meet the tidal wave of demand by service members and veterans for medical exams and prompt treatment.
3. Escalating Suicide Epidemic. Sadly, the year 2009 will set another record for suicides among our service members. The suicides are caused by deployment to war, multiple deployments back into combat, a lack of mental health providers, self-discrimination by service members to avoid treatment, and discrimination by officers who downplay mental health conditions or who refuse soldiers’ requests for care. The situation would have been far worse if not for several new military and VA programs, such as the VA’s toll-free suicide prevention hotline (800-273-TALK) that received more than 180,000 calls and then provided urgent medical care to more than 5,000 distraught veterans, clearly saving many lives.
4. Soaring Financial Cost. The staggering financial expenditures of the two wars continue increasing into the trillions of dollars. Harvard University Professor Linda Bilmes, co-author of the book “The Three Trillion Dollar War” with Nobel laureate Joseph Stiglitz, estimated a $100 billion price tag for the Afghanistan war escalation. In an interview with the Christian Science Monitor, Bilmes included the costs of health care and disability benefits for veterans, something not mentioned by President Obama. Americans deserve to know both the short-term war costs and the long-term VA health care and disability costs.
Scientific and Legal Evidence of Urgent Need
The Institute of Medicine (IOM), the agency that provides independent scientific advice to the administration, thoroughly studied the psychological impact of war deployment on veterans. In 2008, the IOM reached this very strong conclusion leaving no doubt the consequences are very serious:
The epidemiologic literature on deployed vs nondeployed veterans yielded sufficient evidence of an association between deployment to a war zone and psychiatric disorders, including post traumatic stress disorder (PTSD), other anxiety disorders, and depression; alcohol abuse; accidental death and suicide in the first few years after return from deployment; and marital and family conflict, including interpersonal violence.
Court testimony also linked war deployment to significant mental health conditions, according to a top VA official subpoenaed and placed under oath:
Dr. Gerald Cross, the deputy under secretary for health in the VA, testified that the high rates of PTSD among Iraq veterans are the result of various factors, including multiple deployments, the inability to identify the enemy, the lack of real safe zones and the inadvertent killing of innocent civilians (page 17, line 22, Veterans for Common Sense v. Peake, June 25, 2008).
In the same court case, one of the nation’s top suicide experts linked veterans’ mental health conditions with suicide:
Dr. Ronald Maris, an expert witness for Plaintiffs [Veterans for Common Sense and Veterans United for Truth] in suicidology, testified that depression and PTSD are two of the leading risk factors for suicide (page 20, line 26).
Two recent studies, one by RAND and the other by Stanford University, estimated a range of depression and PTSD between 18 percent and 35 percent. Among the two million service members deployed to the two current wars, that means the VA faces between 360,000 to 700,000 serious mental health cases. The estimates are reasonable, as the VA has already treated more than 227,000 mental health cases from the Iraq and Afghanistan wars, and 40 percent of our troops have deployed twice or more.
The landmark court case concluded that the VA’s systemic delays in processing veterans disability claims – six months for an initial claim and up to five years for an appeal – cause tremendous hardships for veterans and families, often exacerbating veterans’ already severely strained lives:
It is beyond doubt that disability benefits are critical to many veterans and any delay in receiving these benefits can result in substantial and severe adverse consequences, including the inability to make mortgage or car payments (page 46, line 21).
Our VCS Five-Point Plan
Here are five major policy initiatives that should comprise the framework of a casualty plan for President Obama, Defense Secretary Robert Gates and VA Secretary Eric Shinseki:
1. Fill Medical Vacancies. VCS asks Obama to direct Gates and Shinseki to quickly fill all of the hundreds of mental health care provider vacancies at both the Department of Defense (DoD) and the VA in order to meet the expected increase in mental health casualties from the wars for conditions such as TBI, depression, PTSD and suicide. Hiring additional medical professionals to treat our service members’ and veterans’ physical wounds, injuries and illnesses is also urgently warranted.
President Obama can complete this task by ordering up more doctors from the Reserve and National Guard. He can work with nonprofit organizations, such as Give an Hour, that will provide free mental health care to service members and their families. And Obama, as a last resort, should begin a review of reinstituting the draft to conscript doctors to care for our casualties.
2. Conduct Exams and Provide Care. The new mental and physical health care professionals are urgently needed to perform the universal pre- and post-deployment exams mandated by the Force Health Protection Law (PL 105-85). The increase in new hires should also allow for earlier access to treatment for our service members and veterans, when treatment is more effective and less expensive.
President Obama can complete this task when he orders Secretary Gates to see to it that every soldier is examined by a doctor before and after going to war, as required by law, but not yet fully implemented. This also means no soldier ever waits to see a doctor for any physical or mental condition that may impact the soldier’s ability to fight. And it means that no veteran, especially veterans with mental health conditions, is ever told by the VA to return in 14 days, as is the current policy. Mental health conditions, such as TBI and PTSD, must be treated as they are equal to and just as important as visible physical conditions.
3. Fight Stigma. Discrimination remains the leading obstacle blocking mental health care for service members and veterans. Implementation of an anti-stigma effort remains half-hearted and incomplete, at best, a sign that comments by our top military leaders at press conferences are not filtering down through the ranks.
President Obama can improve the situation by ordering the DoD and the VA to expand their anemic anti-stigma campaign. Our government can and must encourage service members and veterans to seek care without fear of damaging their careers. Similarly, DoD must train officers to promote exams and treatment, and the VA should educate employers and the public about veterans’ needs. One bright example is the Department of Labor web site, America’s Heroes at Work.
4. Quickly Process Claims. The VA should also anticipate an increase in disability claims due to the increased number of service members deployed. The VA should begin planning to hire any needed additional staff for the Veterans Benefits Administration (VBA), already facing a backlog of nearly one million claims. VCS eagerly awaits VA’s final rules on handling PTSD claims, a very strong move in the right direction designed to expedite delivery of benefits to disabled veterans in need.
5. Expand Monitoring and Reporting. The DoD and the VA must work closely together to understand the expanding scope and depth of our casualties so they are not caught off guard again. After eight years of war, the DoD and the VA still have no published reports detailing the total human and financial costs of the conflicts, a shocking and deliberate attempt to hide the consequences of the wars from the American public. The VA should collect data, prepare reports and share the information with Congress, journalists and the public. The VA should stop forcing reporters and the public to use the Freedom of Information Act to obtain information about the human and financial costs of the wars.
There are now 480,000 new Iraq and Afghanistan war veteran patients at the VA – and the number is rising sharply at an average rate of 300 new veteran patients every day. Therefore, planning for the long-term care of casualties remains a very urgent issue that should concern all Americans.
The lesson here is that former President George W. Bush lied to start his Iraq war fiasco. Bush also botched the job in Afghanistan, according to a new Senate Foreign Affairs investigative report, by failing to capture Osama bin Laden and secure Afghanistan for seven years. Bush also failed to plan for significant numbers casualties, as shown by the Walter Reed scandal. Some of Bush’s political appointees even sought to block veterans’ access to care and to conceal official VA casualty reports by denying their existence.
We can and must do better under President Obama.
This year, Obama performed reasonably and admirably in how he approached the Afghanistan war. He obtained facts, deliberated with top advisers and then acted to repair the crisis in Afghanistan caused by Bush’s negligence. However, Obama, Gates and Shinseki still have no detailed plan to care for our veterans – our family members, friends and neighbors who defended our Constitution.
According to a December 7 report by McClatchy News, White House spokeswoman Amy Brundage said Obama “is determined to fulfill America’s responsibility to those who have served and sacrificed on our nation’s behalf.”
All of America is waiting for President Obama to fulfill his obligation by implementing a plan and making certain that no service member or veteran ever waits for medical care or benefits.