The Never-ending Battle

A THREE-PART SERIES: PART I

Government care for injured troops and disabled veterans has commanded public attention since a 2007 Washington Post series exposed the plight of wounded warriors awaiting medical discharge in unsanitary conditions at the nation’s flagship military hospital. The revelations struck such a nerve that transition care for wounded warriors remains a high-priority issue two years later. No matter where they stand on Iraq and Afghanistan, Americans in general – and veterans in particular – are passionate about the government’s sacred responsibility to care for those who have borne its battles. In the aftermath of the Walter Reed Army Medical Center scandal, the military urgently rewired its approach to helping severely injured servicemembers return to their civilian lives. Each branch now has its own transition assistance program. The Pentagon is working more closely than ever with VA to help those in transition. And veterans service organizations like The American Legion have launched programs to assist with the adjustment process in local communities. This isn’t new territory for the Legion, which for nine decades has been helping veterans cut through the red tape of VA benefits, health-care eligibility laws, and other transition services they are due. In this first of a three-part series, The American Legion Magazine examines the root cause of the problem: a backlog of unresolved benefits claims that has plagued administrations for decades and continues today, as fewer than 10,000 VA claims workers try to resolve upwards of 800,000 unique cases of veterans who simply want definitive answers.

On the Sunday morning in February 2007 when Washington Post reporters Dana Priest and Anne Hull broke their story about severely wounded soldiers recovering in a mold-infested outpatient building attached to Walter Reed Army Medical Center in Washington, they were at the newspaper’s downtown office, polishing the second installment of their series. They tuned in to NBC’s “Meet the Press” to see if the first piece would be mentioned. Host Tim Russert had a copy of the Post in his hand – article and photos prominently displayed on the front page – while he discussed the war in Iraq with Sens. Harry Reid and John McCain. The article about Walter Reed never came up. The reporters were discouraged. After months of interviewing patients and families, and documenting problems at the nation’s top military medical center, they had hoped the report would catch the attention of top officials in Washington. The White House, Congress and the Pentagon were not the first to respond. Ordinary Americans from across the country, led by a massive wave of veterans, bombarded the newspaper with phone calls, letters, e-mails and Web-site postings. Two weeks later, the Post published a follow-up article, detailing similar problems wounded troops and disabled veterans face at DoD and VA medical centers across the United States. “That’s when the story went galactic, because it showed it wasn’t just Walter Reed, and it wasn’t just other Army bases,” Hull says. “This wasn’t just the active-duty guys. It became this catharsis for everybody who dealt with – and had been neglected by – their own VA. (It was) a great moment for them. At last, someone’s going to care.” It was also a story that was not going to burn hot, short and out. “There was this grass-roots movement that wasn’t going to let go of the problem,” Priest explains. “It was the retired community. And they were outraged.”  Walter Reed made headlines across the United States well into the presidential campaigns of 2008. Army Secretary Francis Harvey and Maj. Gen. George W. Weightman – in charge at the medical center – both resigned after the story broke. The scandal led President Bush to assemble a special commission (led by former U.S. Sen. Bob Dole, R?Kan., and former U.S. Health and Human Services Secretary Donna Shalala) to craft recommendations to repair the problems and assure they never happen again. The American Legion was granted office space at Walter Reed to help troops in transition. Soon, no fewer than 25 U.S. departments and agencies had wounded-warrior programs of some kind. The issue climbed the priority lists of every military branch and the Pentagon. Politicians conducted press conferences outside Walter Reed and convened hearings on Capitol Hill. The Army deployed rapid-reaction teams to assess problems at the nation’s other military hospitals. Congress began appropriating billions of dollars to address the problem. DoD and VA hired more than 4,000 new employees to help smooth the transition, including a pilot program to speed up the process for the most severely wounded. The Obama administration has promised technological progress on medical-records sharing between DoD and VA. The crux of the problem usually comes back to the VA disability claims backlog, a frustration veterans and VA alike have faced for generations. A staggering number of men and women wait months, or even years, to get fair and timely disability ratings, appropriate compensation, medical treatment, vocational retraining and an efficient means of appealing denied claims. Priest and Hull found nearly 700 soldiers and Marines stranded in the system at Walter Reed, caught in a backlog of their own, between active duty and medical discharge. They later identified another 4,000 with similar issues, scattered at military medical centers across the country. Meanwhile, some 770,000 veterans were slogging through the VA benefits system, in some cases fighting for decades just to get a post-traumatic stress disorder case resolved. Sen. Dole, who was wounded in combat during World War II, describes the long-lived problem of VA benefits bureaucracy in four words: “It’s a national embarrassment.” “People don’t really care if it’s VA or Department of Defense,” says Michael Walcoff, VA deputy undersecretary for benefits. “It’s their government that’s supposed to take care of veterans, and they are right: we are both responsible. The fact is, we owe it to the American people, we owe it to the veteran, to provide the services the veteran earned.” While some headway has been made since the Dole-Shalala Commission issued its recommendations, the basic problems persist. Baffling regulations stymie well-intentioned caseworkers and discourage veterans from pursuing benefits due to them under the law. Obtaining accurate military documentation, particularly medical treatment records, can take the rest of a veteran’s life; sometimes, they are simply lost. VA claim centers are notorious for warehousing stacks of folders and files, all of which need individual attention from caseworkers. Although VA staunchly denies it, critics have long grumbled that the government quietly abides this dysfunctional system to control costs. Aging veterans, changing laws, and a surge in PTSD and traumatic brain injury cases are adding pressure to the system, which former VA Secretary James B. Peake described as decades out of date. VA has responded to the need for faster claims resolution by rewarding workers for the number of cases they churn through, opening the door for rubber-stamp denials. Last November, VA’s inspector general revealed that about 500 claims records had been wrongly routed to shredders. Meanwhile, as many as 70 percent of the cases that reach the Board of Veterans Appeals and the courts are sent back to VA for more work, or to be redone. The ultimate insult, according to many veterans filing for benefits, comes when they are treated as if they are trying to scam the system. It’s as if “their job is to call you a liar when you submit a claim,” says U.S. Rep. Bob Filner, D?Calif., chairman of the House Veterans Affairs Committee. A Soldier’s Story. By the time the Washington Post series was published, Vietnam War veteran Leroy Comer had been fighting the disability claims system for 19 years, generally going it alone. Nearly incapacitated by PTSD, Comer had filed handwritten appeals and stubbornly refused to give up, even though he lived on the streets, was in and out of prison, or under psychiatric care much of that time. VA “seemed bent on finding reasons to deny my claim rather than helping me,” says Comer, now 58 and living in a small town in eastern Texas. “A lot of times, I thought about giving up on it. I just decided I wasn’t going to let them push me aside like that ... like you were nobody.” Comer joined the Army right after high school, trained as a supply clerk and was reassigned to the infantry after deploying to Vietnam. He was sent to guard an ammunition dump on the outskirts of Saigon that was being attacked with mortar fire about four nights a week. Some nights, he patrolled the perimeter. Other nights, he was posted at a guard tower or near the dump. He remembers running for cover with mortars exploding all around him and seeing fellow soldiers killed – memories he would like to erase. Nightmares flooded his sleep after he returned to Fort Riley, Kan., in 1970. He left the Army a few months later and went home to his fiancée in Fort Worth, Texas. “She quit me,” Comer says in a gentle drawl. “She was scared of me. She said I changed.” Comer was scared too. A few months later, his mother woke to find her son trying to get up on the living-room coffee table. “I thought the Viet Cong was firing on me through the windows,” Comer says. “My mom looked scared and asked me what was wrong with me. I didn’t know myself. I had a bad dream. I thought it would go away.” The bad dreams and flashbacks persisted. “In my nightmares, I could see the Viet Cong moving around, and I couldn’t do anything,” Comer says. “Once I would wake up, and I could move and function, I was afraid to go back to sleep. I’d turn on all the lights, turn all of the noise-makers off and sit up for two or three nights in a row.” Comer first tried working as a general laborer, then assembled CB radios and electronic components. He began abusing alcohol and drugs. Strung out and sleep-deprived, he was unable to hold down a job. He last worked full time in 1975. Divorces and incarcerations punctuated his life story for years to come. “It was a trying time, with something I didn’t understand,” he says. “You wonder why you can’t have a normal life.” Comer turned to the Dallas VA for help in the late 1970s. He spent 18 days in drug treatment. His psychological problems, however, seemed more of a curiosity or research project at the time for VA. Every morning for a month, he remembers, a doctor asked him questions about his nightmares, took notes and tape-recorded the answers, and that was it. “It’s like they were gathering information for their own records, not like they were going to get help for (my PTSD),” he says. Comer was homeless for most of the 1980s. An outreach group found him on the streets of San Antonio in 1988, helped get him lodging at a halfway house and took him to the Audie L. Murphy VA Hospital for treatment. There, after his first session, he was advised to file a claim. It was denied. According to Comer’s medical records, the examining psychiatrist dismissively noted, “The veteran apparently served in Vietnam for approximately one year.” PTSD was acknowledged, but VA ruled that his mental illness was not connected to military service. “They said there was no PTSD in my (Army) record,” Comer says. “None of us had anything in the record that said we had post-traumatic stress disorder. “They said I was never in combat, even though it was right there in my (military) file.” Burden of Proof. Two decades after Comer began his marathon pursuit of VA benefits, the 2007 Washington Post series found that wounded warriors from Iraq and Afghanistan were running into similar skepticism over their mental-health claims. In one case, an Army doctor decided a soldier had been slow as a child; therefore, the head wound that prompted his evacuation from Iraq couldn’t be blamed for any future mental impairment. Military physicians also probed middle-aged National Guardsmen and reservists for pre?existing conditions, like signs of personality disorders that could become the basis for denying disability benefits. “They were getting nothing for traumatic brain injury and PTSD,” Hull says. “That was the single most frustrating, anxious thing for these guys: ‘Am I going to get anything? Are they just going to kick me out with nothing?’” The military had a mind set of, “Push it all off on VA,” Hull says. “Let VA handle it.” VA, meanwhile, struggles to resolve the disability claims backlog and overwhelming demand for patient care. VA was forced to suspend new enrollment of Priority Group 8 veterans, as the backlog of patients waiting 30 days or more for appointments eclipsed 300,000 nationwide in 2003. The American Legion criticized the suspension as a way to ration care and control costs by limiting access. Access to care also can be controlled by denying service connection whenever there’s a gray area in an individual case, even though the law requires VA to give veterans the benefit of the doubt. “We’re seeing people coming out of combat who have been awarded Purple Hearts or were combat medics,” says Rich Cohen, director of the National Organization of Veterans Advocates, Inc. “They have PTSD, and the VA doctors conclude, remarkably, these people do not have PTSD but they have non?service connected anxiety or depression related to a bad marriage or bad credit. How could somebody deny a combat medic a rating for PTSD?” Veterans who fought in Afghanistan or Iraq are more likely to have their service records than veterans of previous wars, who express tremendous frustration about the difficulty of retrieving documents they need to prove an injury occurred, or was exacerbated, while they were in the service. But even proper documentation is no guarantee. “If the Department of Defense has a record of injury and doesn’t communicate it to VA, there’s no evidence, and a claim is denied,” says Gregory Demarais, an American Legion veterans service officer in Portland, Ore. “I have claims under way for veterans coming home right now, where VA has requested their service-treatment records up to seven times and received nothing.” That problem usually starts long before the injured arrive at VA. For example, the Army had no records for some soldiers who served in Iraq, even those with Purple Hearts, according to the Post. Patient paperwork was so frequently lost or difficult to obtain that soldiers’ wives “all went out to Office Depot and bought copiers to keep in their rooms at Walter Reed,” Hull says. Field hospitals don’t always document injuries. Soldiers may not go through the trouble to report being stunned by IED blasts that may have caused their traumatic brain injuries. Medical records tied to classified missions – common for Afghanistan operations – either don’t exist or are impossible to obtain, Demarais says. The problem is even greater for veterans from World War II, Korea, Vietnam and the Gulf War who don’t start the claims process until long after discharge. “I have a Coast Guard veteran whose records are lost because of the closure of a medical facility,” Demarais says. “It’s next to impossible to substantiate his case. And it happens frequently.”

A sizeable group of World War II and Korean War veterans’ records were lost in a fire at the National Personnel Records Center in St. Louis in 1973. That makes it extraordinarily difficult for some veterans to verify their claims. Many also call the St. Louis fire an easy out for VA. “VA has a standard template letter: ‘We were informed by the National Personnel Records Center your records were lost or destroyed,” says Steve Smithson, deputy director of The American Legion’s Veterans Affairs & Rehabilitation Division in Washington. “I know veterans who got out of service in the ’80s or ’90s who get the ‘your-records-were-lost-in-the-1973-fire’ letter. Some of these guys weren’t even born in 1973 or were in grade school.” Who’s to Blame? Few issues in government bureaucracy are more daunting than VA claims administration. The disability claims backlog alone persistently numbers in the hundreds of thousands – usually somewhere between 400,000 and 800,000. VA argues it shouldn’t be penalized for the nearly 200,000 claims that are somewhere in the appeals process. The problem has been a priority for at least the past three presidential administrations. The bottom line, however, is that  the bureaucratic logjam veterans often face in their transition out of DoD was partly to blame for the Walter Reed scandal; the Dole-Shalala Commission saw it that way. While billions have been poured into various programs to help wounded warriors restart their lives, the never-ending battle to achieve a better system drags on. In cases like that of veteran Leroy Comer, the result is a large part of a life spent homeless and in despair, fighting for a few hundred dollars a month. “People say, ‘How did this happen? Who’s to blame?’” says Priest, who, along with Hull and photographer Michel du Cille won the Pulitzer Prize for Public Service for the Walter Reed series. “You know, everybody’s to blame. Congress has the oversight of this. Some of the problems came out in those committee hearings. Did they not want to hear the problems?” The best solution, the Legion’s Smithson says, “is to fix the entire VA claims adjudication system. Piecemeal solutions do not work.”

View Part I as it appeared in The American Legion Magazine.

View Part II as it appeared in The American Legion Magazine.

View Part III as it appeared in The American Legion Magazine.