Thousands of U.S. troops returning from Iraq and Afghanistan with physical injuries and mental health problems are encountering a benefits system that is already overburdened, and officials and veterans' groups are concerned that the challenge could grow as the nation remains at war.
The disability benefits and health care systems that provide services for about 5 million American veterans have been overloaded for decades and have a current backlog of more than 300,000 claims. And because they were mobilized to fight in Iraq and Afghanistan, nearly 150,000 National Guard and reservist veterans had become eligible for health care and benefits as of Aug. 1. That number is rising.
At the same time, President Bush's budget for 2005 calls for cutting the Department of Veterans Affairs staff that handles benefits claims, and some veterans report long waits for benefits and confusing claims decisions.
"I love the military; that was my life. But I don't believe they're taking care of me now," said Staff Sgt. Gene Westbrook, 35, of Lawton, Okla. Paralyzed in a mortar attack near Baghdad in April, he has received no disability benefits because his paperwork is missing. He is supporting his wife and three children on his regular military pay of $2,800 a month as he awaits a ruling on whether he will receive $6,500 a month from the VA for his disability.
Through the end of April, the most recent accounting the VA could provide, a total of 166,334 veterans of operations in Iraq and Afghanistan had separated from military service, and 26,633 -- 16 percent -- had filed benefits claims with the VA for service-connected disabilities. Less than two-thirds of those claims had been processed, leaving more than 9,750 recent veterans waiting.
Officials expect those numbers to increase as the fighting in Iraq and Afghanistan continues.
"I think we're doing okay now, but I am worried," VA Secretary Anthony J. Principi said in a recent interview. "It is something you have to be concerned about. We don't have a good handle on the extent to which the demand for care and benefits will be a year or five years from now."
Principi acknowledged that one of the most challenging elements of providing for recently returned veterans is the disconnect between the Defense Department and the VA. His department has been working to streamline the process, he said, placing VA staff members at 136 bases across the country and at military medical centers.
But people such as Westbrook still fall into a no-man's land.
Westbrook was deployed to Iraq in January as a drill sergeant, sent to train Iraqi army recruits. While on duty April 28 south of Sadr City in Baghdad, he was hit by a mortar shell, and the shrapnel severed his spine. He is now paralyzed from the chest down, has limited movement in his right arm, and battles constant infections. His wife takes care of him full time.
Though Westbrook praises the way the Army has treated him since his injury, including providing excellent medical care, he has struggled to make it on his regular pay since he returned July 14. "They're supposed to expedite the process, and they have not done that," he said, adding that officers in his Army unit have been trying in vain to help. Charities have been set up in his honor to help defray costs.
"It's very draining, because I don't know what to do, and my family is asking when we'll get the money," he said. "It's the hardest part about this whole thing."
What injured or ill veterans are finding when they return from overseas is a complex set of government processes for reviewing whether they will receive financial help. They have to navigate two of the largest U.S. government bureaucracies in the VA and the Pentagon, and multiple medical review boards assess the extent of their injuries.
Even with the current backlog and the prospect of staffing cuts, VA officials are trying to increase the department's visibility, reaching out to new veterans to make sure they are aware of the services they can receive and urging them to apply.
Principi said he recently sent letters to 178,000 veterans explaining the available benefits. He said the department is doing its best to keep wait times down by giving recent veterans higher priority, aiming for benefit claims that are filled within 100 days. Currently, the VA takes about 160 days per claim, and 60,000 to 70,000 new claims come in each month.
There is also a more concerted effort to identify veterans with post-traumatic stress disorder, a condition that experts estimate affects about 15 percent of veterans. Principi said he believes mental health concerns could become a dominant issue for the VA as insurgent warfare places new pressures on U.S. troops and as American society places more emphasis on mental health.
A Government Accountability Office report issued Sept. 20 concluded that the VA does not have enough information to determine whether it can handle a rush of PTSD cases.
"The system is already strained, and it's going to get strained even worse," said David Autry, a spokesman for Disabled American Veterans. "It's not a rosy picture at all, and they can't possibly hope to say they're going to provide timely benefits to the new folks if they can't provide timely care to the people already in the system."
For veterans, the VA's system for evaluating disability claims can be the most frustrating element of the process. Through the end of August, the agency had about 330,000 cases waiting to get a "rating," or a percentage figure approved by an evaluation board that decides how much a disabled veteran will receive monthly from the VA.
The ratings system uses a complex guide to calculate, for example, how disabling it is to lose a foot or to be blinded in one eye. Soldiers are rated from zero percent to 100 percent disabled, and compensation varies from nothing to thousands of dollars each month. Those rated 100 percent disabled are eligible to receive indefinite monthly payments aimed at allowing them to live without working.
Board decisions can take months as they weigh the severity of injuries and make sure they were suffered while the veteran was in the service. Appeals of such decisions can take years, and board decisions can be reevaluated.
"Sometimes it takes six months to a year to get your claim decided, sometimes longer," said Cathy Wiblemo, deputy director for health care at the American Legion. "We never think it's enough," Wiblemo said, referring to the disability payments. "It's hard to say that any amount of money can compensate for what these people have lost in defending our country."
Robert Acosta, 21, of Tustin, Calif., said he relies on his disability checks of $2,332 a month to survive, but the VA is now reevaluating his case. Acosta's right hand was blown off and his left leg was shattered when he was ambushed at the gate to Baghdad International Airport on July 13, 2003. The passenger in a Humvee, he grabbed a grenade that had been lobbed through the window, saving his driver.
Acosta said he cannot work because his prosthetic right hand has been giving him trouble, his left leg has not returned to normal and he suffers from nightmares. Initially, he was rated 70 percent disabled -- the medical board did not want to account for his leg injury, his PTSD claims and his hearing loss. After accepting those claims and rating him 100 percent disabled, the VA is questioning them again, asking Acosta to prove that some of his disabilities are service-related.
"They said there was no proof of it," Acosta said, referring to his PTSD claim. It took two months after he left the service for him to get his first disability payment, he said, and he spent his savings in the meantime. "I'm going to therapy every week. I'm working on it. I have bad dreams, I don't sleep at night and I get really jumpy. I don't know what they want me to do."
Rep. Lane Evans (Ill.), ranking Democrat on the House Committee on Veterans Affairs, said the VA is woefully underfunded and unprepared. The current budget for fiscal 2005, which is still pending in Congress even though the fiscal year ended on Thursday, calls for cutting more than 500 claims processors and does not meet the VA's basic funding requests.
"The VA is not ready for an influx of new veterans from the ongoing operations in Afghanistan and Iraq," Evans said.