Mistreated Casualties

Veterans with psychological wounds are getting shabby treatment from the Department of Veterans Affairs.

JEANS CRUZ, a former Army scout who helped capture Saddam Hussein, lives in a bullet-riddled Bronx housing project, addled by nightmares about Iraq, voices in his head and the smell of dried blood in his nostrils. As Post reporters Dana Priest and Anne Hull recently described his situation, Mr. Cruz began cutting his arms and extinguishing cigarettes on his skin after returning home from Iraq. Mental health counselors characterized him as depressed and anxious, and, shortly after he reenlisted in the Army, he was discharged because of a "personality disorder." A Department of Veterans Affairs psychologist diagnosed post-traumatic stress disorder.

But when Mr. Cruz applied for disability benefits, Veterans Affairs refused, claiming, among other things, that he had not proved that he had seen combat in Iraq -- this despite his slew of combat awards and high-profile recognition. Now Mr. Cruz is barely supporting his family on a small income, and he is worried that he will lash out at those he loves.

There are far too many survivors who, like Jeans Cruz, have been mistreated upon their return. The intensity of the conflict in Iraq and Afghanistan can leave deep emotional scars. Many soldiers are returning home with mental wounds caused by traumatic head injuries or with post-traumatic stress disorder. The Department of Veterans Affairs must care for a large quotient of veterans with disabilities that were uncommon or little understood decades ago.

But the military medical establishment has not prepared itself to recognize, treat or compensate for these and even more traditional ailments. The bureaucratic morass into which Mr. Cruz fell is only part of the problem. According to the authors of a recent Institute of Medicine report, the department's method of adjudicating disability claims and even its terminology are outdated. The report blasted the schedule for rating disabilities, a set of criteria for assigning disability benefits: Veterans Affairs has no recent evidence that the scores veterans get adequately relate to the earnings veterans lose because of their disabilities, for example. Nor does the schedule reflect contemporary notions of disability.

The Institute of Medicine stresses, for example, that Veterans Affairs should consider more than just how much veterans lose in future earnings. The schedule should be retooled to "compensate for nonwork disability and loss of quality of life." And, the report argues, the department should hire additional staff members to regularly update the rating schedule according to current medical practices. Either proposal would help the next Jeans Cruz.

The first thing Veterans Affairs needs to do is simplify the adjudication process, with a particular emphasis on easing the burden on those with debilitating mental wounds. Next, the department should attempt to answer some essential questions. How can it better diagnose post-traumatic stress disorder? How can the agency measure "quality of life"? Do its guidelines account for disabilities that limit veterans' physical and social functioning outside of work? All of these, and the question of cost, should be promptly examined. Then Congress and the Bush administration must act to fund and implement the major changes the Department of Veterans Affairs needs.