Saturday, March 15, 2008

War's legacy: Its human toll

Congressman Filner on Iraq war veterans benefits

By Philip Dine

MARCH 13, 2008 --Brad Trower of High Ridge (center) displays the pain he suffered in his arm to Polytrauma Occupational Therapist Tracy Beardsley during a therapy session.
(Erik Lunsford/P-D)

WASHINGTON --As the Iraq war ends its fifth year, a dominant legacy of the conflict has turned out to be the human toll on those who have fought it.

The nature and sheer extent of American casualties — officially in the tens of thousands, but hundreds of thousands have sought medical help — has caught the U.S. government off guard.

From wounded soldiers who faced dilapidated conditions at Walter Reed Army Medical Center to troops whose mental problems have been overlooked, Iraq veterans have paid the price.

"The government was not ready for the casualties to come home," says Brad Trower, 29, a Marine Corps veteran from High Ridge who was injured twice in his tour in Iraq.

When Trower returned to St. Louis in 2005, suffering from traumatic brain injury after two vehicles he was riding in were blown up within a month of his arrival, he got "zero response" initially from local Veterans Affairs officials, though he is now doing well.

Rep. Bob Filner, D-Calif., chairman of the House Armed Services Committee, says the nation has failed to heed the lessons of Vietnam, a war whose veterans constitute half of the 400,000 people sleeping on America's streets tonight.

Though the number of veterans today is smaller, the percentage of veterans who become homeless, commit suicide or face other social problems, partly because of a lack of treatment, is similar to that of the Vietnam era, Filner says.

"We know how to deal with it," he says, "but we apparently don't want to deal with it."

Many of today's veterans, especially reservists, are married, complicating the situation.

"The Vietnam conflict was primarily a single soldier's conflict, but the impacts now are greater because you have entire families that are impacted by how this gets handled," says Matthew Cary, president of Veterans & Military Families for Progress.

The backlog of disability claims has jumped to 600,000 from 300,000 with the surge of Iraq injuries, Carey says. And the Army says suicides are at their highest since it began keeping figures in 1980.

It wasn't supposed to be this way.

The Pentagon's "shock and awe" doctrine featuring hi-tech precision bombs was supposed to stun the Iraqis into quick submission while limiting the toll on American soldiers. The confidence only grew after Saddam Hussein's regime fell with little resistance.

In the war's early months, President George W. Bush was so confident that American forces faced little danger that he famously dared Iraqi insurgents to "bring it on."

They did, with suicide bombings and improvised roadside explosives that killed or maimed thousands, extended the U.S. occupation and frustrated U.S. and Iraqi attempts to establish a stable replacement for Saddam.

Five years later, Sen. Patty Murray, D-Wash., of the Senate Veterans Affairs Committee, says she's seeing "particularly severe and complicated injuries" among returning soldiers. Murray spoke at a news briefing late last week featuring a handful of legislators who want to raise public awareness.

Officials have begun, if in fragmented fashion, to acknowledge the need for change. Recent steps already are helping some Iraq veterans and may mean better treatment for veterans of the next battle in the war on terrorism.

"There have been shameful lessons learned over the treatment of our military," says Sen. Claire McCaskill, D-Mo., a member of the Senate Armed Services Committee. "Regardless of how you feel about the war in Iraq, progress we have made in the treatment of those heroes has to be embraced as positive."

A Pentagon official adds, "As much a tragedy as Walter Reed was, it's spawned debate and action, and helped us cut the red tape for soldiers."


Three factors are generally viewed as having combined to produce problems in care for U.S. veterans of Iraq:

— Strategic mistakes that made the war longer and more lethal, including sending too few troops, not sealing Iraq's borders or arms depots, failing to recognize the insurgency early on and not planning how to secure the peace.

— The nature of the war. The lack of front lines made everyone vulnerable at any time, increasing the danger and stress. The insurgents' use of improvised explosive devices has produced devastating injuries. Multiple deployments and the unprecedented use of the National Guard and Reserves increased the risks, especially of stress-related problems.

— A lack of preparedness for the volume of casualties, which overwhelmed the system. Additionally, the military missed many cases of post-traumatic stress disorder or traumatic brain injury by relying on soldiers to come forward. Of the 1.7 million service members with recent combat experience, some 800,000 are now veterans entitled to VA health care and benefits. Of those, 300,000 have had treatment; 40 percent were diagnosed with a mental health problem, more than half with PTSD, according to Veterans Affairs figures released as a result of a lawsuit by Veterans for Common Sense, a nonpartisan veterans advocacy group.

Paul Sullivan, the group's executive director, says the patient figure could eventually reach 700,000.

Dr. Michael Kilpatrick, a top Pentagon official overseeing care for combat troops, says that by helping reduce the stigma associated with mental problems, the military has increased the number of cases to handle. In terms of physical wounds, Kilpatrick says the military was prepared for the initial acute care but less so for the long-term rehabilitation of soldiers to return to service while dealing with family issues and spouses' lost incomes.

Thirty-one percent of the veterans have filed disability claims, waiting on the average more than six months for them to be processed. Delays are pronounced for those who returned to small towns or rural areas in the Midwest or South far from VA facilities, as happens with many reserve troops.

A recent Harvard University study says taxpayers' cost for the care of injured veterans will run up to $700 billion.

"Unfortunately, we are too often falling short in meeting our duty to our warriors here at home," says Sen. Christopher "Kit" Bond, R-Mo., who has pushed for improved treatment of mental health injuries.

The military is paying the price, a Pentagon official contends, for being "so good" in saving lives that would have been lost in previous wars. In Iraq, if a wounded soldier gets medical attention within a few minutes, the survival rate is 97 percent, he says. But he concedes that mental health care remains "in its infancy. If we're moving slowly in treatment, it's because we're just starting to have the technology to understand how to treat PTSD and especially TBI."

Critics contend that officials have compounded the situation. Among the most egregious actions, Filner asserts, has been diagnosing 22,000 veterans with "pre-existing personality disorders," as reported late last year by the Post-Dispatch.

"We mess them up, then we say, 'We didn't mess you up, it's your fault,' and we hand them a bill," Filner says.

Trower, who spent four years on active duty in the Marines before rejoining in 2004 to go to Iraq, was injured on his first day of action, when his light-armored vehicle ran over a land mine.

A month later, an explosive device hit the 14-ton vehicle he was commanding and threw it 20 feet. Trower awoke with smoke all around and men badly hurt. He was hospitalized for a week with a concussion.

He finished his tour and headed back to St. Louis. It wasn't until 18 months later, after news stories critical of the treatment given veterans, that he began to get phone calls from officials offering help, "because they realized I hadn't been seen by anyone."

Now working as an EMT for a private ambulance company and serving as a volunteer firefighter, Trower hopes to become a professional firefighter.


After what many experts describe as a chaotic few years marked by too few resources — though Walter Reed and other institutions have done remarkable work in areas such as prosthetics — the past year or so has seen some progress. Congressional legislation, pressure from veterans advocacy groups, continued efforts by veterans services groups and greater urgency by officials in the VA and Pentagon have moved things along.

Since August, military officials have encouraged soldiers who were near an explosion to get checked for traumatic brain injury, and Illinois and some other states have filled gaps for their own veterans. The transition between the Pentagon and VA is smoother, with record transfers being done electronically, and VA care has been extended for combat veterans.

A handful of key bills passed last year. They include efforts to prevent suicides, give wounded veterans cost-of-living adjustments, unify the disability rating system between the Pentagon and the VA and compel the military to examine personality-disorder discharges.

Much remains to be done to get mental health treatment to rural veterans or provide home care for disabled veterans, Cary says. More generally, what's needed is a comprehensive approach to treating veterans and families, as well as better funding mechanisms. One idea, he says, would be to sell war bonds to fund care, so the public could help.

Assessments vary as to where things stand. American Legion spokeswoman Ramona Joyce says that the unconventional nature of the war led to early problems but that officials are doing better now.

"I think you learn from your mistakes as time goes on," she says. "Yes, as far as PTSD and TBI, they didn't catch it in the first couple of years of the war, but better late than never."

Filner is less optimistic.

He cites a small program in his home district of San Diego, in which 30 wounded Marines were taught moviemaking. "They say, 'Now I have a life. I was sitting around doing nothing, thinking of committing suicide.'" But it took two years to get the program approved, he says. Now he's seeking support for a "de-boot camp" to help troops re-adjust to civilian life, but "nobody at DOD wants to talk about it."

"It doesn't seem like we've learned the lesson," Filner says.

And Cary worries that financial concerns could impede the current progress, given the mounting war costs and the looming recession. | 202-298-6880

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