The Washington PostDemocracy Dies in Darkness

How Veterans Affairs denies care to many of the people it’s supposed to serve

These are people who put their bodies and minds in harm’s way for their country.

Veterans Affairs signage and logo. (iStock)

In April, John Rios stood in the Veterans Affairs hospital in Newington, Conn., seeking treatment. For more than 20 years, he had struggled with the effects of post-traumatic stress disorder. For the past eight of them, he had fought to have the Defense Department recognize his military service as honorable. Having finally prevailed, he went to VA seeking health care, his official paperwork in hand.

The hospital turned him away, refusing to recognize him as a veteran.

Rios had enlisted in the Navy in 1994, when he was 18 years old. He became a seaman on an aircraft carrier and deployed to support operations in Bosnia. But the weight of war took its toll on him. After witnessing injuries and death at sea, Rios developed symptoms of PTSD. When his ship returned to Virginia in 1997, the trauma of war manifested itself in misconduct. After a series of unauthorized absences by Rios, the Navy gave him an “other than honorable” (OTH) discharge six months shy of his end of active obligated service. Though he served in combat, his trauma-related breaches left him — in the eyes of VA — “not a veteran.”

Rios is one of more than 500,000 former service members who bear the OTH label. The military issues OTH discharges when troops engage in behavior that constitutes a “significant departure” from the conduct expected of service members, and it generally dispenses them without formal due process. This malfeasance can encompass major violations, such as theft or illegal drug use, as well as more minor infractions like arriving late for work, being out of uniform or being disrespectful to a superior officer. Administrative separations free the commanding officer of a struggling service member and can be imposed as a way of avoiding the burdens of the court-martial process.

But OTH separations carry great costs. These former service members are often excluded from VA health care, from VA housing if they are homeless, from VA benefits payments even if they’re disabled by their service and from the educational supports provided to other veterans. Veterans with the OTH label experience a higher risk of homelessness and are twice as likely to commit suicide. They also face the shaming effects of hearing from federal VA employees that they are “not a veteran.”

Five myths about VA health care

For many OTH veterans like Rios, traumatic episodes from their service led to early separation from the military. In 2017, the Government Accountability Office found that 62 percent of the 92,000 service members discharged for misconduct between 2011 and 2015 were diagnosed with PTSD, traumatic brain injury or other conditions that affect mental health and can manifest in ways that trigger disciplinary problems. Many of them remain without health care this Veterans Day.

The federal government excludes these veterans from health care under a complex and opaque system. The military characterizes most discharges occurring after a service member’s first six months of enlistment in five ways: honorable, general (under honorable conditions), other than honorable, bad conduct and dishonorable. Since Congress passed the G.I. Bill of Rights, the eligibility standard for most VA benefits and services includes a requirement that the former service member was “discharged or released under conditions other than dishonorable.”

This is where VA takes matters into its own hands. Instead of simply providing care to all veterans who pass statutory muster, VA creates its own set of regulations that further excludes former service members. It assumes that those who received honorable or general (under honorable conditions) discharges qualify as veterans and thus can receive services. For the rest, VA theoretically makes a case-by-case determination about whether a veteran is “honorable for VA purposes.” In practice, this often means that veterans with OTH or bad-conduct discharges are excluded from health care unless they can show that the criteria that would exclude them do not apply.

Congress has tried to address this problem by expanding coverage for some of these excluded veterans. The Honor Our Commitment Act of 2018 extended behavioral and mental health care to veterans who survived combat and military sexual trauma, even if they have an OTH discharge. But VA has not always followed the law. Although Congress directed the agency to notify newly eligible veterans within 180 days, it took about a year for VA to publicize the new benefits, and when it finally did, it did no more than mail letters (to people who are disproportionately homeless) and write a blog post, triggering a strong rebuke from members of Congress.

When it comes to helping our soldiers, talk is cheap

More troubling, VA staffers routinely misapply the law, misread military records and reject evidence that veterans qualify for treatment. Across the country, VA administrative staff members have failed to give veterans accurate information about their rights to mental health care, failed to properly recognize prior honorable terms of service when a veteran is ultimately discharged with an OTH and failed to serve veterans like Rios who have had their discharges upgraded. The result: VA staffers often tell survivors of combat or military sexual assault that they are “not veterans” and ineligible for mental health care, disability benefits and housing services.

The problem has grown in recent years. The wars in Iraq and Afghanistan have seen the highest rates of OTH discharges in history; currently, the rate of such discharges is four times what it was during World War II. These decades-long conflicts have left survivors with invisible wounds that require treatment, but too many of those who suffer under those burdens have been denied means to get help. While only 1.7 percent of veterans were excluded from VA health care in the World War II era, today 6.5 percent are denied care. They turned their mental and physical well-being over to their country, and the federal government turned its back on them.

For his part, Rios spent years fighting his PTSD on his own — struggling with depression, sporadic employment and bouts of homelessness. After finding mental health treatment, he obtained a legal aid attorney from the Connecticut Veterans Legal Center, where I am executive director, who helped make his case that he deserved to be upgraded to an honorable discharge. So, when VA turned him away, even after his discharge was upgraded, he had a lawyer to turn to for guidance. Many veterans don’t have those resources.

VA health care can save lives, but the systemic barriers erected by administrators are unconscionable. Rather than a cold shoulder and a shaming dismissal, veterans like Rios should be greeted with an open door. These are people who put their bodies and minds in harm’s way for their country. VA should recognize them for what they are: already honorable.

Twitter: @LBNewHaven

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