The VA nor our country was prepared for anything of this magnitude, and it has put a strain on the VA system.
BIRMINGHAM, Alabama -- The disability claims continue to add up for America's newest veterans, with nearly half of all Iraq and Afghanistan troops filing for benefits. Based on those numbers, they are America's most medically and mentally troubled generation of soldiers.
Nathaniel Bass, a Vietnam vet, sees the frustrations these troops encounter. Day after day, he helps veterans in Alabama, Florida and Mississippi file disability claims with the Department of Veterans Affairs.
"The VA nor our country was prepared for anything of this magnitude, and it has put a strain on the VA system," said Bass, chairman of the Gulf Coast Veterans Advocacy Council. "Employees at the VA, they're burning out because they're overwhelmed, and then a domino effect goes into play. It's bad, it's really bad."
Nationally, 45 percent of the 1.6 million veterans from the Iraq and Afghanistan wars are now seeking compensation for injuries they claim are service-related, The Associated Press reported last April. That's more than double the estimated 21 percent who filed claims after the Gulf War in the early 1990s.
New veterans are claiming eight to nine ailments on average, and the most recent ones claim 11 to 14, according to the AP. Vietnam vets have fewer than four ailments, and it's just two for World War II and Korea vets.
In Alabama, about 20,000 Iraq and Afghanistan troops are? treated at the four VA medical centers in Birmingham, Tuscaloosa, Montgomery and Tuskegee. That figure does not include Mobile-area troops, who are part of the Gulf Coast Veterans Health Care System and report to the Biloxi (Miss.) VA Medical Center.
Data obtained from the Alabama hospitals paint a picture of the average vet at an Alabama VA: male, under 35, battling mental health problems, and almost as likely to have been deployed multiple times as he is one tour.
Several factors contribute to dramatically higher U.S. claims, including two long wars being fought simultaneously. Other reasons: advanced medical treatment keeps more troops alive, a down economy, more outreach by veterans' advocates, and greater awareness of mental health.
Fifty-three percent of the VA's diagnoses for new veterans are mental disorders. That makes mental health the second-most common problem behind musculoskeletal ailment.
Alabama VA hospitals have made 30,000 diagnoses of mental disorders, counting multiple issues for the same patient.
Many of the psychological wounds from Iraq and Afghanistan are more severe than past U.S. wars, said Dr. Bill Beidleman, assistant chief of mental health at the Birmingham VA.
"One of the consequences of people surviving is the treatment must be sophisticated," Beidleman said. "We expect to see about 20 to 30 percent of returning Iraqi and Afghanistan veterans will require some sort of mental health case."
That is, if these new veterans even show up in the system.
Backlogged claims
Within the VA, there's a health-care side that treats patients and there's a benefits side that addresses claims. They don't always speak the same language.
An Alabama veteran typically waits six to 12 months for an initial response from the Veterans Benefits Administration (VBA) in Montgomery over a claim, Bass said. Processing can take longer than that once more information is requested.
"Sometimes the information they are requesting has a tendency of discouraging a veteran from processing his claim further," Bass said. "A lot of them feel they're not being taken care of properly."
Across the country, there are 896,000 VA claims pending for veterans of all wars, according to the most recent VA workload report. Sixty-seven percent of those are considered backlogged claims, which the VA defines as more than 125 days.
The VA's Montgomery regional office has 15,000 claims pending, with 67 percent lasting more than 125 days.
The VA says the backlog is a decades-old problem and cites several factors:
> Outdated systems. The VA is switching to electronic records but has millions of case files throughout the country. Paperless technology has reached 16 of the 56 regional offices and will be in all of them by the end of 2013.
> Volume of claims. A recent change in considering problems related to Agent Orange brought more claims from Vietnam vets. Handling those cases has cut into the VA staff workload. Disability claims for all vets soared from 888,000 in 2008 to 1.3 million in 2011.
> Finishing older cases first. A mandate to complete older claims first pushed back the VA's processing time on new cases.
> Number of ailments per claim. The more problems a vet claims, the longer it takes the VA to get medical evaluations and proof that the ailments exist and are service-related.
"The VA has completed a record-breaking 1 million claims per year the last two fiscal years, and we are on target to complete another 1 million claims in 2012," the VA said in a statement. "Yet too many veterans have to wait too long to get the benefits they have earned and deserve. That's unacceptable, and VA is building a strong foundation for a paperless, digital disability claims system -- a lasting solution that will transform how we operate and eliminate the claims backlog."
Alabama had an estimated 400,000 total veterans -- not just those from Iraq and Afghanistan -- during fiscal year 2011. That's 8 percent of the state's population.
Nineteen percent of all Alabama veterans received disability benefits from the VBA. That was the sixth-highest rate in the country.
Disability pay for veterans ranges from $127 a month for a 10 percent disability to $2,769 for a full one, according to the AP. To be eligible, a veteran must have served under conditions other than dishonorable and the disability cannot be the result of misconduct by the veteran.
The compensation rate ranges from 10 percent to 100 percent and increases by increments of 10 percent, depending on the degree of disability and the number of dependents. Disabilities that are due to service but not disabling are rated 0 percent. A veteran with that rating doesn't get compensated unless he or she suffers from two or more permanent service-connected disabilities rated at 0 percent that interfere with normal employability.
"I know at least when I got here five years ago, the claims process was something that could take up to a year to get a claim decided, and they've lessened it," said Jeff Bloch, Birmingham VA program manager for the newest veterans. "But it's still a pretty long time."
Bass said the VA deserves credit for creating a new claims process -- but even that gets bogged down by bureaucracy.
"For some strange reason the health care side is not recognizing some of the forms and paperwork needed to help speed up the claims process," he said. "If we can get everybody to communicate, perhaps that will help everybody go a little faster."
Treating mental health
For Iraq and Afghanistan troops who need help, one of the greatest challenges is post-traumatic stress disorder (PTSD). Almost 8,000 PTSD diagnoses have been made at Alabama's VA medical centers, making PTSD the No. 1 mental-health problem in the state.
Beidleman, the assistant chief of mental health at the Birmingham VA, finds that the most effective treatment of PTSD is combining medication with psychotherapy. During psychotherapy, veterans are exposed to the trauma they experienced but in a controlled setting and never alone, Beidleman said.
"We don't think we're curing PTSD as much as relieving the symptoms," he said. "People will remember their combat experiences. Those memories will always cause some discomfort."
Over the past 15 years, the mental health staff at the Birmingham VA has increased from about 30 to 160. Beidleman said there is enough staff for veterans to be treated immediately.
The Birmingham VA is in the second year of a "Connect to Recovery" program, which gives away 100 cell phones to high-risk veterans who frequently visit emergency rooms or who struggle with treatment. The goal is to keep veterans and medical staff members in touch.
"If they miss an appointment, it's incumbent on the mental health provider to call them and see what's going on," Beidleman said. "We found we've been able to get in touch with our veterans, they decreased their ER usage and they're seeing their regular doctor."
Although there are almost 33,000 unique Iraq and Afghanistan veterans enrolled at Alabama's VA medical centers, 36 percent don't currently receive VA health care. Many troops enroll and use it later.
Combat veterans have five years of free health care related to their service and five years to enroll after leaving the military. After five years, veterans can continue to be treated by filing for service-related ailments.
One future problem: The cost of caring for veterans tends to rise many decades later, but America has no long-term funding set aside. Economists estimate the medical costs of the Afghanistan and Iraq wars at $600 billion to $900 billion.
Compounding the issue is the VA struggles to get an adequate count of the number of veterans who need help, said Bass, the Gulf Coast Veterans Advocacy Council chairman.
Some veterans don't want their job impacted by the stigma of getting help, Bass said. Some veterans simply don't trust the VA.
"If you don't trust 'em, then it's hard to get them in there to get anything done, which they need because a lot of them have been affected by the situations they were in over there," Bass said. "If you have an issue, come on in. You're entitled to help."
E-mail: jsolomon@al.com.?
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Source: http://blog.al.com/spotnews/2012/11/americas_newest_veterans_claim.html
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