Nicholson, 67, leads the government's second-largest department, overseeing 235,000 employees and a $72 billion budget. The department administers benefits for the nation's 25 million veterans, provides care for the 7.5 million veterans enrolled in its health system and manages 121 national cemeteries.
Nicholson met with reporters and editors of The Washington Post last week. Among the subjects he discussed was the medical care that the Department of Veterans Affairs has provided to 103,000 military members who have returned from the wars in Iraq and Afghanistan. Following are excerpts of the conversation:
Q How do the health care issues of today's veterans compare with those from prior conflicts?
A Post-traumatic stress disorder is the current mental condition that is getting a lot of attention. We are seeing people that are experiencing what the psycho-therapeutic world tells us are common reactions to uncommon experiences, and combat is an uncommon experience for human beings. There are different ways it is manifested: sleeplessness, irritability, some have incontinence, some claim impotency. Those are common. And what we're trying to do is make people aware that they're not losing their mind, and that there's no stigma. This can be treated. We have wonderful PTSD treatment centers.
These PTSD cases that you are seeing from the war in Iraq, are they similar or different in any way from those with PTSD in past conflicts?
They are really quite similar.. . . The VA didn't see very many from World War II or from Korea. Many people had those same reactions, but there wasn't the outreach and the treatment, and they just sort of worked their way through it. A few didn't. We all know about that. . . . Vietnam has been the thing that has spurred the volume of this -- delayed Vietnam, people who started coming in in the '90s. We take this very seriously at the VA. Our goal is to try to make people well. If they are not or cannot be made well, they do then get compensated through our benefits program. Quite a high number of cases of the "100 percent disabled" [a VA rating of disability] are as a result of post-traumatic stress disorder.
Are you experiencing any surges in any unforeseen illnesses as a result of the conflicts in Iraq and Afghanistan?
We are not, not yet.
Have you seen the symptoms of Gulf War Syndrome affecting veterans of the current war?
No, we haven't.
Of the 103,000 returnees from Iraq and Afghanistan who have been treated at VA facilities, how many had suffered psychological trauma?
Twelve percent of the people that we've seen are with PTSD. There now have been over 400,000 people that have come back from service over there. We've seen 103,000 of them.
Earlier this year, Congress approved a $1.5 billion emergency increase for veterans' health care programs after the VA miscalculated its budget needs. With more veterans returning from overseas conflicts, is the VA prepared to handle the load?
Yes. . . . [In the spring] we saw this surge in demand from people coming back from the theater, plus a real increase in demand from veterans of other eras. That was not anticipated. . . . We sat down and we said, 'We definitely need more money.' The '06 budget will have been plussed up for the anticipation of that in '06. And, of course, we're working on it [the budget] for '07 now.