Army's Disability Benefit Review System Feels Strain
Report Also Finds Lack of Staff, Training at Medical 'Hold' Facilities for Veterans

By Ann Scott Tyson
Washington Post Staff Writer
Tuesday, March 13, 2007

The thousands of soldiers wounded in the wars in Iraq and Afghanistan have overwhelmed the Army's system for evaluating their eligibility for disability benefits, leading to a near-total failure to complete such reviews in a timely manner, the service's inspector general concluded in a report released yesterday.

The report also found that medical "hold" facilities lacked critical staff and formalized training for personnel caring for wounded soldiers, with more than half of unit commanders reporting "inadequate" staffing. It also cited inadequate and unreliable databases for tracking the wounded.

At some facilities, a lack of wheelchair access -- in violation of the Americans With Disabilities Act -- meant that wounded soldiers had difficulty reaching restrooms. One facility had ramps, but it also had a gravel parking lot and no sidewalks, "making it nearly impossible for soldiers in wheelchairs and difficult for soldiers using crutches and canes to access the building" without help, the report said.

More than 25,000 service members have been wounded in the two wars -- nearly half seriously enough that they cannot return to duty within 72 hours.

Delays in the Army's rating of disabilities have been a source of deep frustration for many, with wounded soldiers waiting to move on with their lives outside the military.

Problems with that rating system are pervasive, the report found, particularly in meeting time standards for processing cases.

More than 90 percent of the time, for example, the Army did not meet its 40-day time limit for completing physical evaluation boards, as the number of cases increased from 9,000 in 2001 to more than 15,000 in 2005, the report found. In 43 percent of cases, the Army did not meet its 30-day goal for processing medical evaluation boards.

The Army had 30 people assigned to manage all the physical evaluation boards, even though the organizations cited an "overwhelming need" for support staff, the report said. They did not receive funding to hire more people, however, and thus relied on "ad hoc manpower" agreements, including those with contractors.

Such issues "diminish the ability of the evaluation system to meet the needs of soldiers," the Army's inspector general, Lt. Gen. Stanley E. Green, stated in a memo on the report.

Army leaders "fully embraced" the report's recommendations and are acting upon them to improve soldier care, the service said in a separate statement.

The investigation, ordered last April by then-Army Secretary Francis Harvey and completed March 6, involved interviews with 650 soldiers, civilians and leaders at 32 Army posts in the United States and overseas.

Seventy percent of the medical hold unit leaders reported that they did not have adequate personnel assigned, affecting their ability to "provide soldiers the level of attention and support they required to complete their medical care," the report said. More than half said their staffing was "inadequate for them to execute their mission."

Especially worrisome, the medical hold commanders reported, was the lack of behavioral-health specialists who could help identify soldiers with depression, post-traumatic stress disorder or suicidal behavior.

The need for such specialists was underscored in a study published yesterday in the American Medical Association's Archives of Internal Medicine.

It said that 25 percent of Iraq and Afghanistan war veterans seen at Veterans Affairs health-care facilities were found to have mental health problems, and an additional 6 percent had "psychosocial or behavioral problems." It was one of the largest studies to date of veterans from the wars.

The youngest veterans, ages 18 to 24 -- who also make up a large proportion of the total -- were at the greatest risk for mental health problems and post-traumatic stress disorder, the study found.

As the Pentagon and Army review their systems for managing the wounded, the Department of Veterans Affairs is also stepping up scrutiny of its care.

The VA is ordering its 1,400 hospitals and clinics to conduct "a full and immediate review" on the quality of its facilities.

VA Secretary Jim Nicholson's March 7 memorandum, released yesterday by the agency, requests a full report by tomorrow.

"Negative responses are required," he wrote.

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