Newsweek Cover: Failing Our Wounded

Recent revelations about the decay and mismanagement at Walter Reed Army Medical Center in Washington, D.C., were especially shocking because it is one of the most prestigious U.S. military hospitals. But a Newsweek investigation--which focused not on one facility but on the services of the Department of Veterans Affairs, a sprawling 235,000-person bureaucracy--found that the VA system is unprepared for the scope of the task at hand and ahead.

Around 50,000 service members so far have been banged up or burned, lost limbs or sacrificed something less tangible inside them in the wars in Iraq and Afghanistan. And a new study projects that at least 700,000 moreveterans from the global war on terror will flood the system in the coming years. In the March 5 cover story, "Failing Our Wounded" (on newsstands Monday, February 26), national security correspondent Dan Ephron and Assistant Editor Sarah Childress paint a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA's arcane system of rights and benefits.

Tonia Sargent, whose husband, Kenneth--a Marine master sergeant who had been in the corps for nearly 18 years--nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don'task, don't tell system," she says. The Sargent's story, and the stories of many other veterans, is raising concerns that the United States is failing to meet its most basic obligations to those who fight its wars, Newsweek says.

"In no way do I diminish the fact that there are veterans out there who are coming in who require treatment and maybe are not getting the treatment they need," White House Deputy Press Secretary Tony Fratto tells Newsweek. "It's real and it exists."

Dr. Michael Kussman, the VA's acting under secretary for health tells Newsweek that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely.

"The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it."

But the number of veterans has to grow and critics worry the VA is in a state of denial. In a broad sense, Newsweek reports, the situation at the VA seems to mirror the overall lack of planning for the war. "We know the VA doesn't have the capacity to process a large number of disability claims at the same time," says Linda Bilmes, a Harvard public-finance professor who last month released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan.

Veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war, Newsweek says.

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U.S. Troops, Vets Not Getting Care They Need, Playboy Says

American troops fighting in Iraq and Iraq war veterans are not receiving the mental health care they deserve, specifically when it comes to the diagnosis and treatment of post traumatic stress disorder (PTSD), according to an investigative report for Playboy magazine.

Journalist Mark Boal spoke with numerous mental health experts, government sources and former military personnel who paint adisturbing picture about the government's handling of PTSD, according to Playboy.

Boal found that the Department of Defense (DOD) diagnoses about 2,000 cases of PTSD a year. Yet according to a landmark study conducted by Army researchers and published in The New England Journal of Medicine, PTSD rates for soldiers in Iraq and Afghanistan are running between 10 and 15 percent. That means one would expect to see the military diagnosing 13,000 to 20,000 cases of PTSD, Playboy says.

Former government officials agree there is a problem, according to Playboy.

"PTSD is being underdiagnosed on a fairly wholesale level," Playboy quotes Dr. Robert Roswell, a former undersecretary at the U.S. Department of Veterans Affairs, as saying.

Sources in the Pentagon and former officials of the VA, doctors working for the VA and DOD are being pressured to limit diagnoses of PTSD in order to save the military money and manpower, reports Boal.

Budget pressures may be the motivation to discourage diagnoses of PTSD, according to the Playboy article, which reports that when the DOD submitted a war budget to Congress, the line item for mental health casualties was simply left blank.

"DOD never prepared for a long war; it never prepared for anoccupation," says one senior congressional staffer, according to Playboy. "Now we're seeing the third thing it didn't anticipate: what to do with the soldiers when they come home. Now they really don't have the money."

Boal discovered politics may also be a factor, Playboy says.

"The soldier has tremendous symbolic power in American politics. Healthy, happy soldiers bespeak a just war. Like the amputees and flag-draped coffins the administration hides from public view, such soldiers are antithetical to the hawkish goal of mitigating the costs of the conflict," writes Boal."The critical difference is that mental illness isn't always obvious and is therefore easier to sweep under the rug."

As one congressional staffer puts in the Playboy story, "It's much easier to deny the reality of mental illness than it is to deny the spinal cord injury of some guy sitting in a wheelchair."

When questioned for the piece, Pentagon and VA officials vigorously denied there is a policy to underdiagnose PTSD, Playboy says.

"That would be immoral and unethical," Playboy quotes Dr. Michael Kilpatrick, the assistant secretary of defense for troop readiness as saying.

Officials attribute the low rates of diagnosis to a reluctance on the part of military doctors to "stigmatize the person or bring harm to their careers" by labeling them with PTSD according to Lieutenant Colonel Dr. Charles Engel, the director of the deployment health clinic center at Walter Reed Medical Center. "It's out of respect for the patient that they don't make the diagnosis."

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Nearly 200,000 Veterans May Be Homeless Tonight

Americans say they want to "support the troops." But what about the veterans?

Nearly 200,000 veterans may be homeless on any given night and twice that many veterans experience homelessness during the year, according to a report released by a coalition of advocates for homeless persons.

The report released finds that affordable, permanent housing coupled with supportive services provides a powerful tool for preventing and ending homelessness among veterans, particularly thosewho confront chronic disabling health problems such as mental illness, substance addiction and HIV/AIDS.

Homeless male veterans are more likely to be homeless for an extended period of time than homeless male non-veterans, the report, titled "Ending Homelessness Among Veterans Through Permanent Supportive Housing," says.

The report notes that 32 percent of homeless male veterans reported that their last homeless episode lasted 13 or more months compared to 17 percent of male homeless non-veterans.

Homeless housing and service providers reported that they are already serving returning Iraq and Afghanistan war veterans at local emergency shelters, U.S. Department of Veterans Affairs-financed transitional housing programs and local permanent supportive housingprojects. Participants noted that while it is too soon to have a complete picture, evidence suggests that unique risk factors for homelessness and mental illness will confront veterans of Iraq and Afghanistan.

These factors include a housing market that is far tighter and morecostly than it was in the Vietnam era. Expert observers also contend thatthe nature of the current conflicts, including the near-complete blurring of combat versus non-combat zones, will generate higher rates of Post Traumatic Stress Disorder (PTSD) and other mental health traumas. A recent study in the Journal of the American Medical Association documented that 19 percent of soldiers who served in Iraq screened positive for the signs and symptoms of a mental health disorder.

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