Wounded veterans suffering financially

VA challenged by prolonged injury costs

By Jeff Donn and Kimberly Hefling
The Associated Press
Sunday, September 30, 2007

TEMECULA — He was one of America's first defenders on Sept. 11, 2001, a Marine who pulled burned bodies from the ruins of the Pentagon. He saw more horrors in Kuwait and Iraq.

Today, he can't keep a job, pay his bills, or chase thoughts of suicide from his tortured brain. In a few weeks, he may lose his house, too.

Gamal Awad — the American son of a Sudanese immigrant — exemplifies an emerging group of war veterans: the economic casualties.

More than in past wars, many wounded troops are coming home alive from the Middle East, a triumph for military medicine.

But they often return hobbled by prolonged physical and mental injuries from homemade bombs and the anxiety of fighting a hidden enemy along blurred battle lines.

These troops are just starting to seek help in large numbers, more than 185,000 so far. The cost of their benefits is already testing resources set aside by government and threatening the future of these wounded veterans for decades to come, say economists and veterans' groups.

"The wounded and their families no longer trust that the government will take care of them the way they thought they'd be taken care of," said veterans advocate Mary Ellen Salzano.

How does a war veteran expect to be treated? "As a hero," she said.

Two years of free care

Afghanistan seemed quiet and Saddam Hussein still ruled Iraq one year after the Sept. 11 attacks. That's when the U.S. Department of Veterans Affairs guaranteed two years of free care to returning combat veterans for virtually any medical condition with a possible service link.

Later, few predicted such a protracted war in Iraq, one in which Iraqi insurgents would rely on disfiguring bombs and bombardment as chief tactics. Better armor and field medicine have kept U.S. soldiers alive at the highest rate ever, according to one study based on government data.

However, many are returning with multiple amputations or other disabling injuries.

The Pentagon counts more than 29,000 combat wounded in the Middle East since the terrorist attacks on New York and Washington. Tens of thousands more got hurt outside of combat or in ways that only surface later.

Of 1.4 million U.S. forces deployed for Iraq and Afghanistan, more than 185,000 have sought care from the VA, a number that could easily top 700,000 eventually, predicts one academic analysis.

Iraq veteran John Waltz, of Hebron, Ky., sought treatment for post traumatic stress disorder but ran up about $12,000 worth of medical bills while his condition and claim were evaluated, he says.

"We have to be really frugal, as far as what groceries we buy," Waltz said.

Another mouth to feed

On a national scale, the costs of caring for the wounded certainly won't crush the immense American economy or the VA. But the price tag will challenge budgets of governments and service agencies, adding another hungry mouth within their nests.

Economic forecasts vary widely for the federal costs of caring for injured veterans returning from the Middle East, but they range as high as $700 billion for the VA. That would rival the cost of fighting the Iraq war. In recent years, the agency has repeatedly run out of money to treat sick veterans and had to ask for billions more before the next budget.

"I wouldn't be surprised if these costs per person are higher than any war previously," said Scott Wallsten, of the conservative think tank Progress and Freedom Foundation.

Federal officials generally defend the quality of care. At a recent ribbon cutting, the Army's vice chief of staff, Gen. Richard Cody, trumpeted a new rehab center for amputees as "proof that when it comes to making good on such an important promise, there is no bottom line."

White House budget spokesman Sean Kevelighan says medical spending for all veterans has risen by 83 percent during President Bush's time in office. "The president has made his dedication very clear to troops in the field and after," Kevelighan said.

Rehabilitation restrictions

VA officials didn't respond to several requests for comment. Recently, though, outgoing chief Jim Nicholson acknowledged trouble keeping up with the pace of disability claims. Earlier this year, he also insisted that veterans "will invariably tell you they are really getting good care from the VA."

Not invariably.

The VA takes the lead in treating wounds and paying for disabilities of veterans, and it usually does a good job of handling major, known wounds, especially in the early months, by many accounts.

However, many veterans and families say the agency often restricts rehabilitation or cuts it off too quickly.

Denise Mettie, of Selah, Wash., says she fought successfully for VA funds to rehabilitate her brain-damaged son, an Iraq veteran, in a private hospital where he was given five times more therapy. She's been living "paycheck to paycheck" to cover travel to his bedside and other costs of his care.

A presidential commission has also recommended broader disability compensation for lost quality of life.

Some wounded veterans turn to private health insurance and other programs outside the federal government, swelling costs also for states and towns. Service nonprofit organizations also pay for housing, food, clothing and transportation for wounded veterans.

Veterans groups sued the VA a few months ago, seeking quicker care and disability payments for those with post traumatic stress disorder. They claim that the crush of shattered troops has sent the agency into a "virtual meltdown."

Last week, the VA challenged the lawsuit on technical grounds. Its lawyers also argued that even though agency rules commit to two years of free care, that depends upon Congress setting aside enough money.

Many recommendations for fixes involve quicker and heftier disability benefits. Nearly everyone begs for more VA money and staff members for medical treatment.