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Until They All Come Home

A soldier of the 4-19th Agribusiness Development Team makes his way home through the Indianapolis International Airport from a yearlong deployment to Afghanistan, Sunday, June 10, 2012. (Photo: Sgt. John Crosby / The National Guard / flickr)

For reasons beyond my personal control, I recently found myself snarling through the long and winding bowels of the Hartsfield-Jackson Atlanta International Airport …which, if you haven’t had the pleasure and so are unaware, is quite possibly the most preposterous travel hub north of the equator. As I finally managed to stagger my way to the end of another endless hallway that led, allegedly, to the ‘Exit’ doors, I came upon an impromptu party.

There were maybe fifty people standing behind the security perimeter, some holding American flags, some holding “Welcome Home!” signs, some in uniform. All of them were looking down the hallway I had just emerged from. About ten strides behind me was an Army sergeant in camo carrying a duffel. I stopped to analyze this crowd, he walked past me, and the crowd erupted in cheers and applause. Ah, I thought. This is a welcome-home party for that sergeant … but the sergeant only tipped the applauding crowd a wave before continuing on his way.

Another man in uniform emerged from the hallway, and the assembled crowd lit up again.

And then another. And another. And another.

Each person in uniform who passed that crowd received the same adulation, the same calls of “Thanks!” and “Welcome home!” I asked a person holding an American flag what the story was, and she told me she and the others came to the airport as often as they could to greet soldiers returning home. One small cluster within the group was actually waiting for a specific person. The rest were just there, to be there for every living thing in uniform that emerged from that hallway.

American history textbooks, along with American “news” media outlets, tend to focus on large martial events – World War II, Korea, Vietnam, Desert Storm – as specific, defined moments in time. That they are is beyond question; that the spaces between them have been times of peace is, however, laughable. The United States has been in a state of permanent, global war since Pearl Harbor. Involved in conflicts large and small, known and unknown, a moment has not passed in the last 71 years that has not involved American military personnel killing and dying somewhere in the world.

That is fact.

This reality has accelerated to an extreme and lethal level over the last twelve years; we have been at war in Afghanistan since 2002, and at war in Iraq since 2003 (if you think we’re not still at war in Iraq, I can introduce you to some military families who are still posting love-you-be-safe letters to that particular delivery code), and the operational tempo that has defined the last 4,000 days has taken a savage toll on the men and women tasked to carry the burden placed upon them by those who have been allegedly leading this country.

This is not a story about America’s insanely bloated “defense” budget. It is not a story about the bent priorities this nation has come to accept; to wit: more than half of every dollar collected in taxes goes to warfare and spying, a multi-trillion dollar industry, while we reel through national “debates” about cutting health care benefits for old people and closing schools because “we can’t afford it.”

This is a story about the people who have most recently endured what it means to serve in America’s military, and what they are dealing with right now as a consequence of that service.

Those people waiting to welcome returning service members in the Hartsfield-Jackson International Airport in Atlanta are very special in the current American experience, in that they are acutely aware of the fact that we are, in fact, at war. For most of the country, our ongoing wars are less than an afterthought, a reason to buy Bounty paper towels or Miller High Life beer because the packaging makes mention of “Supporting Our Nations Heroes & Their Families” (with an asterisk, because there’s always an asterisk).

For men like Paul Sullivan – former Cavalry Scout for the Army’s 1st Armored Division and veteran of the 1991 Gulf War – our ongoing wars and the plight of the veterans who have fought them is an abiding passion, and the focus of a singular mission.

Between 1995 and 2000, Mr. Sullivan worked for the National Gulf War Resource Center in Washington, DC, where he led the national effort to pass the “Persian Gulf Veterans Act of 1998,” a law significantly expanding health care, disability benefits, and scientific research for 250,000 ill Gulf War Veterans. From 2000 to 2006, Mr. Sullivan worked at the VA, where he produced reports about the health care use and disability benefit activity of Gulf War, Afghanistan War, and Iraq War veterans. From 2007 until 2012, Mr. Sullivan served as the Executive Director at Veterans for Common Sense. He regularly testifies before Congress and frequently appears in the media speaking about veterans’ health care and disability benefits, especially Gulf War illness and post traumatic stress disorder. He works today for the law firm of Bergmann & Moore, whose website carries a bold banner that reads, “Aggressively Representing America’s Veterans.”

I recently interviewed Mr. Sullivan about the current state of affairs for veterans in America.

WRP: Approximately how many veterans of the Iraq and Afghanistan wars will there be in America if/when these wars are wound down to a conclusion?

PS: As of May 2012, the United States Department of Defense (DoD) deployed approximately 2.4 million individual active duty service members to the war zones in and around Iraq since September 2001. Of those, more than 1.6 million were discharged from active duty and are now veterans. As veterans, they are eligible for healthcare and disability benefits provided by the U.S. Department of Veterans Affairs (VA). Specifically, our recently deployed veterans receive five years of free VA medical care starting from the date of the veteran’s discharge from active duty, a new benefit that began in 2009. For comparison, the U.S. deployed 700,000 to the 1990 – 1991 Gulf War, 3.4 million to the Vietnam War, and 1.8 million to the Korean War, and there were few re-deployments for those three prior wars.

How many deployments have these veterans experienced? The current wisdom says the Afghanistan war won’t be finished until the end of 2014, a full two years from now; how many more deployments will that involve?

According to DoD, nearly one million troops, or more than 40 percent, deployed twice or more to the war zones in and around Iraq and Afghanistan since September 2001. I don’t have access to DoD’s troop deployment plans for 2012 – 2014. Based on history, a reasonable estimate is that a total of 2.5 million U.S. troops will have deployed to the Iraq and Afghanistan wars by the end of 2014.

Describe the average situation of a veteran of these multiple deployments for those who are home and finished with their service? The experience of those who have been wounded? The experience of those who have not?

The situation has improved significantly. The George W. Bush Administration had no plan to care for massive casualties. For example, in August 2003, the Wall Street Journal exposed serious problems at Walter Reed Army Medical Center. However, that story was ignored (except for reporter Mark Benjamin) by the mainstream press. However, the Washington Post suddenly “discovered” what was going on down the street from the U.S. Capitol in February 2007, causing widespread national coverage and condemnation of the poor treatment of our wounded, injured, and ill. I was one of the first former government employee witnesses called to testify before Congress in March 2007 and describe in detail how VA and DoD knew all about the Walter Reed scandal, yet the government failed to act. Without a doubt, the Walter Reed scandal was the watershed event that changed the paradigm and prompted VA and DoD to begin improving. Frankly, we could write a book about that sordid affair.

Overall, the veterans of our current wars are more likely to seek VA healthcare and file a disability benefit claim against VA than prior wars. Veterans with multiple deployments, injuries, or illnesses use VA care and benefits at even higher rates. Service members wounded in the war zone are far more likely to survive due to tremendous advances in science and medicine as well as the placement of additional experienced trauma professionals inside the war zone, where the most effective treatment can be provided quickly. For comparison, during the Civil War, a wounded U.S. soldier was more likely to die than survive. For the current Iraq and Afghanistan Wars, there are more than 6,600 deaths, yet 834,000 veteran patients treated at VA hospitals, a ratio of more than 125 to 1 when both physical and mental health conditions are counted.

On another issue, unemployment for returning veterans is now 10 percent, or two percentage points higher than the general population, according to the Department of Labor, as of early November 2012.

For the most serious issue, there is one active duty suicide per day. Among all veterans of all wars and peacetime, there are 18 suicides per day. Nationwide, each year, three thousand veterans die while their VA disability claim languishes at VA.

VA’s beleaguered disability claims processing system remains mired in severe crisis. As of November 2012, nearly 900,000 veterans were waiting an average of eight months for an initial decision from VA on a disability benefit claim. An additional 250,000 veterans are waiting an average of four more years for an answer from VA on an appealed disability claim. And in April 2012, VA’s Office of the Inspector General reported VBA makes errors in 30 percent of the claims VA’s OIG audited. Even worse, the situation continues deteriorating. The Bay Citizen reported in November 2012 that VBA’s error rate fell further, to 38 percent, for VA OIG audits during the past year. In January 2010, I appeared on “60 Minutes” and described the plight of our veterans. Too many veterans are waiting too long for VA health care and benefits, and that’s a national disgrace.

For our veterans with PTSD, the VA legal landscape improved substantially in favor of veterans. Prior to 2010, veterans were required to provide evidence to VA of a current diagnosis of PTSD plus evidence of an “event” or “stressor” that caused the veteran to develop PTSD. Finding documents about the “event” often was impossible or required lengthy searches and endless VA appeals. Fortunately for our war veterans, based on a 1998 law and a 2008 Institute of Medicine review of scientific studies on PTSD, VA changed the regulation, effective as of July 2010. Now a veteran must show the diagnosis of PTSD and deployment to a war zone.

Veterans with concerns about the change should seek professional assistance about their VA disability claim. Veterans for Common Sense filed the first petition to change VA’s PTSD regulations in January 2009, shortly after President Barack Obama became President. I appeared live on CNN immediately after President Barack Obama made the announcement about the new VA regulations in July 2010.

After the Vietnam War, there were increases in veterans going to jail and veterans living on the street. Those problems are being addressed forcefully today, a sharp improvement over prior failures. One new development with only limited press exposure are new “Veteran Treatment Courts.” In October 2012, the news show “60 Minutes” broadcast describes how these specialty courts reduce incarceration, increase treatment, and reduce recidivism. An additional VA program seeks to prevent homelessness among new veterans. Again, in July 2011, “60 Minutes” aired a news segment describing VA’s aggressive outreach efforts to both reduce and prevent homelessness. Credit goes to advocates who pushed VA, Congress, and local governments to cooperate and address these major social issues. [Full disclosure, I provided background materials and statistics for both segments.]

A recent very un-heralded VA report pegged the number of veterans who are now dealing with PTSD at 30%. How many people is that, and what does that mean for them physically and mentally?

According to an internal VA report, as of June 30, 2012, VA treated 834,000 veterans after deployment to the Iraq and/or Afghanistan wars, or more than half of the eligible veterans. Among the 834,000 veteran patients, there are 445,000 diagnosed with at least one mental health condition, more than 50 percent of the patients. Among the veterans treated by VA, 247,000 are diagnosed with posttraumatic stress disorder (PTSD), or nearly 30 percent of the patients. According to a Stanford University study, scientists expect a long-term PTSD rate as high as 35 percent.

So what can we expect? If the rates of 30 percent to 35 percent are applied to all 2.5 million deployed veterans, VA can reasonably expect between 750,000 and 875,000 total veteran patients diagnosed with PTSD over the next few decades. Please note this estimate excludes military retirees who often use military doctors (and not VA) after leaving the service. This estimate also excludes veterans who use private doctors or non-Federal medical care.

VA now provides a reliable and easy-to-use set of resources for the public to learn about combat-related PTSD. While VA struggles to provide timely care at hospitals and clinics, VA did start a suicide prevention hotline after VCS sued VA. Here are details about VA’s “Crisis Line,” including a recent White House announcement to increase funding for it.

What is the average experience for a soldier who seeks help from the VA?

There is no average experience; the return home is a unique experience for each new war veteran. In most cases, veterans are seen promptly by competent VA professionals. However, VA’s inconsistent ability to provide both timely access and quality care remain very serious problems for too many veterans. Specifically, in April 2012, VA’s Office of the Inspector General concluded VA has a nationwide systemic inability to meet demand for care. VA “does not have a reliable and accurate method of determining whether [VA is] providing patients timely access to mental health care services. VHA did not provide first-time patients with timely mental health evaluations and existing patients often waited more than 14 days past their desired date of care for their treatment appointment. … [The VA OIG] analysis projected that VHA provided only 49 percent (approximately 184,000) of their evaluations [to veterans seeking mental healthcare] within 14 days. On average, for the remaining patients, it took VHA about 50 days to provide them with their full evaluations.”

Someone once said, “A nation that does not care for its veterans has no business making new ones.” How do you feel about that statement?

There are other more salient quotes regarding war and veterans.

In 1789, President George Washington, a retired Army General, said, “The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional as to how they perceive the Veterans of earlier wars were treated and appreciated by their country.”

In November 1863, President Abraham Lincoln dedicated the Gettysburg battlefield with these timeless and poignant words: “It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us-that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion-that we here highly resolve that these dead shall not have died in vain-that this nation, under God, shall have a new birth of freedom-and that government of the people, by the people, for the people, shall not perish from the earth.”

At his second inaugural address in March 1865, Lincoln said, “…let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan-to do all which may achieve and cherish a just and lasting peace among ourselves, and with all nations.”

More importantly, when dealing with VA, I firmly agree with retired Army General Omar Bradley’s statement in 1947, after he was sent to clean up a scandal-ridden VA: “We are dealing with veterans, not procedures – with their problems, not ours.”

Finally, there is retired Army General William T. Sherman, who said to young military prep students in June 1879, “I’ve been where you are now and I know just how you feel. It’s entirely natural that there should beat in the breast of every one of you a hope and desire that someday you can use the skill you have acquired here. Suppress it! You don’t know the horrible aspects of war. I’ve been through two wars and I know. I’ve seen cities and homes in ashes. I’ve seen thousands of men lying on the ground, their dead faces looking up at the skies. I tell you, war is Hell!”

What does “Until they all come home” mean to you?

Coming home means far more than bringing our troops home, ending the war with an official declaration, holding a parade, and promising care. In my view, we must uphold President Lincoln’s powerful words from March 1865. For we as individuals, communities, and a nation have a solemn duty to make certain our veterans receive prompt and quality health care, disability benefits, and other VA transition assistance, including full due process legal rights to obtain care and benefits.

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