Veterans left in limbo by VA's bureaucracy
By Rick Rogers and Jeff McDonald
UNION-TRIBUNE STAFF WRITERS
March 9, 2007

Sgt. James Wright, who lost both of his hands to a roadside bomb in Iraq, was medically discharged from the military last May. But the former Camp Pendleton Marine is still waiting for his first Veterans Affairs disability payment.

And when a prosthetic part needs repair or replacement, Wright said, he avoids the bureaucracy of the VA medical center near his home in Houston. He instead mails it to the military hospital on the East Coast that first treated him.

"It's much more difficult to get things done once you're in the VA," Wright said. "If you're not being proactive and calling them every week, they just shove your paperwork to the side and forget about you."

Veterans Affairs case workers have done a poor job of explaining his potential benefits, he said. The agency has lost his documents, some of his phone calls haven't been returned, and there has been a big gap in overall communication.

Wright is among hundreds of thousands of recently discharged veterans nationwide who are still waiting after weeks, months or even years to receive disability benefits or medical treatment, according to veterans organizations, former VA employees and charity groups helping troops and their families.

Their limbo status has been the focus of congressional hearings this week. Days after launching investigations into substandard outpatient care at Walter Reed Army Medical Center in Washington, D.C., lawmakers are broadening their scope to include care for those served by the Department of Veterans Affairs.

"The VA is strained to the limits. . . . The frustration of fighting bureaucracy is almost more damaging than the original wound," said Rep. Bob Filner, D-San Diego, chairman of the House Committee on Veterans' Affairs, whose subcommittee held a hearing on the issue yesterday.

"We've had people die before their claims were adjudicated," he said, "or they don't have cash and they lose their home."

The VA system's 1,400 hospitals and clinics provide health care and rehabilitation to 5.8 million veterans after they are treated at military hospitals such as the San Diego Naval Medical Center in Balboa Park. It promises service members a seamless transition from their active-duty to veteran days.

But the VA network suffered from an array of problems even before the influx of veterans from the Iraq and Afghanistan wars further stretched its resources.

For starters, VA computers can't receive data from those of the Defense Department. Because most VA facilities can't transfer information electronically, their officials must go through the cumbersome process of faxing material back and forth. The General Accountability Office and former VA employees have cited numerous instances in which medical files and other documents were lost because of the antiquated recordkeeping system.

"I can't even begin to count the number of GAO reports over the years outlining these problems," said Rep. Steve Buyer, R-Ind., a member of the House Veterans Affairs subcommittee.

Michael Kussman, acting undersecretary for health at the VA, testified before the panel that his agency is trying to develop a new computer infrastructure as fast as it can.

He also acknowledged that VA leaders were caught off guard by the waves of new veterans seeking mental-health treatment.

Six out of seven VA medical facilities recently visited by the GAO expressed concerns about the growing demand for treatment of post-traumatic stress disorder. They estimated that delays could be as long as 90 days, even after certain VA facilities had contracted with civilian clinics to help handle their PTSD cases.

Studies done by the Pentagon and nonmilitary groups have shown that up to a third of service members returning from Iraq and Afghanistan have PTSD or other mental problems. The figure might grow because PTSD rates usually rise when troops serve multiple deployments, yet the current VA spending for mental-health care remains small compared with other portions of the agency's overall budget.

Despite facing months of criticism for their poor preparation, VA officials admitted this week that they are still reeling from a shortage of counselors and money to handle such cases. They said some of their remaining mental-health experts are suffering from burnout.

More broadly, the VA administration doesn't have enough people to handle a burgeoning load of increasingly complex cases across virtually all medical fields.

About 579,000 disability cases were filed nationwide in 2000. Last year, the figure was 806,000, said James P. Terry, VA undersecretary for benefits.

"It is expected that this high level of claims activity will continue over the next five years," Terry said Wednesday during a hearing of the Senate Committee on Veterans' Affairs.

Gary Rossio, director of the San Diego VA Healthcare System, said his doctors performed 700 to 800 "compensation pension" exams annually a few years ago. Today, the count is about 1,000.

The results of those tests are sent to the VA's regional office in Mission Valley, where reviewers decide whether a veteran can receive disability benefits and how much. It can take six months or more to get a decision.

"Years ago, a typical vet would claim three or four conditions," Rossio said. "Now they are claiming 10 or 12."

The backlog worsens when "there is a dispute about the level of disability. The appeal process is extremely lengthy," said Jeff Crider, a North County consultant for the national group American Veterans. "It is the delays in getting access to the full range of benefits that can land people homeless and on the streets. A lot of veterans simply give up."

Mason Fisher, a Camp Pendleton Marine honorably discharged in November 2005, hasn't gotten to that point.

But he has gone through two VA medical evaluations to determine the cause of his intermittent shoulder and knee pain. He recently received a letter from the agency informing him that he needs to schedule a new evaluation.

"I guess from there they'll figure something out," said Fisher, an Iraq war veteran from upstate New York who was awarded the Bronze Star for his courage in combat. "They didn't give me any timeline."

He said the VA initially told him that it didn't need copies of the medical reports he was given when he left Camp Pendleton. Then months later, a case worker wanted the documents to process Fisher's benefits claim.

To shorten the backlogs, VA officials have pledged to expand an outreach program to active-duty troops who will be discharged within six months so their cases can be started earlier.

Last month, they began giving priority service to all veterans of the Iraq and Afghanistan wars. VA leaders acknowledge that doing so will likely cause longer waits for vets from previous generations, but said they hope to minimize the problem by hiring more case workers.

The officials didn't specify how many additional employees are needed, but Filner said 2,000 more claims adjustors would help relieve the bottleneck. Military health experts have predicted that it will take years to hire and fully train that many individuals.

Until legislative, regulatory and administrative changes take place, a rising wave of newly minted veterans are turning to charity groups for financial, moral and job-networking assistance.

Their needs are especially great in San Diego County and other regions with a relatively high cost of living, said Meredith Leyva of Pensacola, Fla., founder of the national nonprofit organization Operation Homefront.

"Our case work is phenomenally higher for wounded folks and for our families dealing with someone who is injured and undergoing recovery," said Beth Steinke, a director for Operation Homefront who lives in Ramona. "And these are not problems that are here today and gone tomorrow. This will take years and years."

Last year, Operation Homefront helped about 140 families of wounded service members each month. Steinke said that figure is up five-fold for the first quarter of 2007.

"I think the numbers are being driven because we are more well-known and because there is a cumulative effect of four years of war," she said.