Who will pay for it is a question that frames one of the most significant barriers to care for service members and veterans. Americans consistently express their willingness to pay any price for the sacrifices of military veterans. But the wars in Iraq and Afghanistan, which have stretched the military’s resources for more than a decade, are now being conducted by a nation that has nearly tripled its national debt since 2001. Facts indicate a grim mismatch of needs and resources:

• In May 2012, the Associated Press reported that 45 percent of 1.6 million Iraq and Afghanistan veterans were seeking compensation for service-related injuries more than twice the rate of Gulf War I veterans.
• The VA treated 10,000 combat veterans for PTS in its hospitals every three months during 2011, pushing the number of PTS patients above 200,000.
• According to RAND’s “The Cost and Quality of VA Mental Health Services,” veterans with mental illness and substance abuse cost nearly three times as much to treat as the average veteran; while mental health  patients represented 15 percent of the patients using VA health care, they accounted for 33 percent of the costs.

Publicly, neither the Pentagon nor the VA rarely, if ever, claim they don’t have the resources to treat every service member or veteran. But the last year has revealed obvious signs of strain.

At Madigan Army Medical Center, located on Joint Base Lewis-McChord, Tacoma, Wash., a scandal began to unfold in September 2011, when an Army psychiatrist urged his colleagues to be “good stewards” of taxpayer dollars after pointing out that soldiers who retired with a diagnosis of PTS could eventually receive $1.5 million in government payments. An investigation revealed that Madigan psychiatrists subsequently reversed the PTSD diagnoses of more than 40 percent of those under consideration for medical retirement since 2007. The process of evaluating the reversals, and possibly reinstating the original diagnoses, was still ongoing in the fall of 2012.

Likewise, the VA’s claim that it performed full mental health evaluations for 95 percent of veterans in non-crisis situations within 14 days of their initial screening was debunked by its own inspector general, in an April 2012 report that detailed the widespread practice of date-fudging on the part of VA schedulers. The VA actually met this target in 49 percent of its cases; the rest waited an average of 49 days.

The armed forces and VA are rightly excoriated when they break faith with service members and veterans in such obvious ways. But they also suffer public scorn when they balk at providing services for which they have no discernible means of support. Despite positive initial results from both DoD and VA pilots involving service dogs for PTS patients, the VA announced in September 2012 that it would, because of a lack of long-term clinical research on mental health service dogs, be unable to provide a benefit to pay for them.

The VA says publicly that cost doesn’t factor into decisions about what it covers, but a quick number crunch is revealing: If a service dog costs between $15,000 to $50,000 to raise and train, the administration would need between $3 billion and $10 billion to provide a service dog to 200,000 Iraq and Afghanistan veterans with PTS. The VA’s entire health care budget for 2011 was about $52 billion.

Knowing the resources needed to tackle the mental health issues of this next generation of Iraq and Afghanistan veterans, another 1 million of whom will be returning to civilian life over the next five years, has experts such as Tanielian applauding government efforts – such as those championed by Obama in his Fort Bliss announcement – to leverage the capabilities of both the government and private sectors. “I think it’s a great idea to think beyond the federal services and come up with public/private partnerships to expand capacity and help deliver high-quality care,” said Tanielian.

 

Is Research the Key?

Retired Gen. Peter Chiarelli, the Army’s former vice chief of staff, has made it his mission to find effective treatments for PTS and TBI – and he’s convinced the government can’t do the job alone. In an interview with the website Politico posted on Sept. 20, 2012, he criticized the traditional method of diluting government research funds into small portions, in which “a little bit goes to everybody.”  His Seattle, Wash.-based nonprofit, One Mind for Research, has set a goal of $100 million in private-sector donations to study TBI – with the catch that all the donations have to be spent on one study.