TIME Veterans

Congressional Negotiators Strike VA Reform Deal

From right: Senator Bernie Sanders and Senator Richard Blumenthal during a news conference on Capitol Hill in Washington, D.C., on July 24, 2014.
From right: Senator Bernie Sanders and Senator Richard Blumenthal during a news conference on Capitol Hill in Washington, D.C., on July 24, 2014. AP

In three days, Sen. Bernie Sanders and Rep. Jeff Miller have turned around the state of negotiations and come up with a $17 billion solution

Updated at 3:55 p.m.

The two chief congressional negotiators to reform the scandal-plagued Veteran Affairs Department have struck a $17 billion deal to address long patient wait times and dishonest government employees who doctored records to make their hospitals appear more efficient.

The bill includes $10 billion to allow veteran patients to receive non-VA health care and another $5 billion to hire more doctors and health care practitioners. The cost of the bill is offset by $5 billion in cuts to the department elsewhere, said Vermont Independent Sen. Bernie Sanders Monday.

The bill is a compromise between two proposals created last week by Florida Republican Rep. Jeff Miller and Sanders, which they said would have cost $10 and $25 billion, respectively. Interim Veterans Affairs Secretary Sloan Gibson requested $17.6 billion two weeks ago to hire 1,500 doctors and build new clinics, among other things.

Sanders, the Senate Veterans’ Affairs Committee Chairman, said that the bill was “far from what I would have written if I had to do it alone” and that “God knows” there is more work to be done. But both he and Miller, the House Veterans’ Affairs Committee Chairman, said they support the bill and expect it to pass this week before members leave for a five-week recess.

The deal uses a variety of methods to speed up patient service. If the VA doesn’t grant an appointment to a patient within the current wait time goal of 14 days, or if a patient resides more than 40 miles from a VA facility, the veteran can use non-VA care, including from private health care providers that participate in Medicare, and Department of Defense health centers.

The bill would also allow the VA Secretary greater authority to fire employees, who would have three weeks without pay before an appeals board would be required to make its verdict. The new power will aid former Procter & Gamble CEO Robert McDonald, whose confirmation to the position is pending.

Miller and Sanders noted that the cost of the Senate and House bills that passed overwhelmingly in June made negotiations difficult. Each of those would have cost at least $35 billion, according to the Congressional Budget Office.

The Veteran Affairs Department has been rocked by reports of patients dying while on months-long waiting lists. Secretary Eric Shinseki resigned in May after an inspector-general report signaled a widespread practice of employees falsifying records to hide slow response times.

A deal had seemed unlikely Thursday, when Sanders said on the Senate floor that he wouldn’t be shoehorned to pass the Republican’s $10 billion proposal. “Any sixth-grader in a school of the United States understands, this is not negotiation,” he said. Miller then released a statement saying that it would be “impossible” to forge a bill if Senate Democrats refused to participate in conference meetings. With only a week left before the August recess, media outlets proclaimed that negotiations had “imploded,” “ground to a halt” and were “on the verge of collapse.”

But these squabbles may have actually pushed the negotiations further along, a congressional aide with inside knowledge told TIME. Asked Friday if the previous day’s press coverage was overblown, the aide said, “Maybe a little, but we all gave everyone plenty of fodder and it could be that some of the drama, intentionally or not, helps move things along.”

TIME Military

Quadruple Threat: Soldier, Sailor, Airman and Marine, All Rolled Into One

Branched out: From Marine, Soldier, Sailor to U.S. Air Force Airman
Now-Air Force Staff Sgt. Jesus Yanez has also served in the Army, Navy and Marines since 1993. Staff Sgt. Evelyn Chavez / Department of Defense

Staff sergeant has served in all four branches of the U.S. military

Despite the Pentagon’s nonstop jawboning about joint operations—where the military’s four sister services cooperate to prevail on the battlefield—those with time in uniform will tell you that each service is like a foreign land to the other three.

That makes Staff Sergeant Jesus Yanez, currently manning checkpoints at the biggest U.S. base in Afghanistan, a genuine world traveler.

Since 1993, he has served in the Army, Navy, Air Force and Marines.

His skills pay dividends when he’s spending his day off getting pizza or walking around with military colleagues at Bagram air base, just outside Kabul. After his buddies spy an American sailor wearing foreign-looking insignia they don’t understand, the questions begin:

“They ask me, `What rank is that?’ And I’ll say `He’s a petty officer,’ and they ask: `What’s a petty officer?’” referring to the Navy’s non-commissioned officers. “They’ll ask me, `Do you salute warrant officers?’”—those in the Army between enlisted and officers—“and I’m like, `Yes, Army warrant officers get a salute.’”

But military life’s not all about rank. “The food in the Air Force is much better than in the Army, Navy or Marine Corps,” says Yanez, who is in the middle of a five-month tour in Afghanistan with the Air Force—and enjoying every bite. Marine chow, not so much: “You could throw a biscuit into the wall and make a hole through it.” But the Marines, he concedes, score high elsewhere: “Their uniforms are probably the best in the military.”

Yet he says he has learned from each of the services. “In the military, you’re like a family,” Yanez says. “It doesn’t matter what branch you’re in, if something happens to you, everybody’s going to be there for you. And the military gave me an education—I have an associate’s, bachelor’s and a master’s.”

Yanez as a Marine 20 years ago. USMC

Yanez, 39, hails from El Paso, Texas. He served as an active-duty Marine from 1993-97. “They always say the Marine Corps’ boot camp is the hardest one to go through,” he remembers thinking. “In my mind, when I was in high school, I’d think if I could be a Marine, I could do anything.”

He left the corps and spent a couple of years in the civilian world. “After awhile, I missed the military, just in general,” Yanez recalls. The single father of two wanted to stay in El Paso. He was looking for a reserve slot, and checked out, but rejected, the El Paso Marine Reserve unit. “I didn’t want to do artillery,” he says of their specialty.

So he ended up in a nearby Navy Reserve unit. “The Navy Reserve had a master of arms program, which is almost like an MP [military police], and that when I enlisted,” he says. “I wanted to pursue a career in law enforcement.” But Yanez says he found the Navy too informal—“I wasn’t used to the first-name basis at the reserve unit”—especially following his Marine service.

He traded the Navy for the Army in late 2001. “After September 11, I just felt that I needed to go back and do my part for my country,” he says. But he spent time stateside after his new reserve unit already had deployed to Iraq, which Yanez found disappointing. “The opportunity for me to deploy with the Army wasn’t there,” he says. In his reserve service, Yanez generally has drilled one weekend a month, with a two-week block of training annually.

But while working as a civilian Army police officer at El Paso’s Fort Bliss, he heard from Air Force reservists there that they routinely deployed overseas. So in 2006, he joined the Air Force as a member of the Texas Air National Guard’s 204th Security Forces Squadron, and spent part of 2010 in Iraq.

“It sort of just happened, being in all four branches,” Yanez, with the 455th Expeditionary Base Defense Squadron at Bagram, recently told an Air Force public-affairs officer. “I didn’t even think about it until one of my friends mentioned it.” Pentagon officials said Thursday that Yanez’s quad-service heritage is “highly unusual,” but don’t have data detailing just how rare it is.

Yanez doesn’t boast of his unusual military background. “I don’t have any stickers on my vehicle—I don’t even have any tattoos,” he says. But something betrays his past, at least to keen observers. “People always ask me, even though I’m in an Air Force uniform, if I was a Marine,” he says. “Because I still have a high and tight flattop” haircut. “Saves me a lot of money.”

One more thing. Yanez doesn’t want those in the Coast Guard thinking he’s slighting them. Coasties always feel dissed when people talk about the nation’s four military services, because Coast Guard personnel insist they’re the fifth. The Coast Guard is part of the Department of Homeland Security, but can be commanded by the Department of Defense in times of war. “Maybe I’ll get a job with the Coast Guard,” he says, “when I retire.”

TIME animals

Ohio Man’s Therapy Ducks Fall Foul of Local Ordinances

Iraq war veteran Darin Welker holds one of his ducks at his home in West Lafayette, Ohio on July 10, 2014.
Iraq war veteran Darin Welker holds one of his ducks at his home in West Lafayette, Ohio on July 10, 2014. Trevor Jones—AP

Veteran Darin Welker says raising the birds helps him overcome PTSD from the Iraq War

Darin Welker loves his ducks. He feeds them, looks after them, and sometimes the Iraq War veteran from West Lafayette, Ohio just watches them interact. But Welker’s community doesn’t share the same affection for his feathered friends.

On Wednesday, the Associated Press reports, Welker will appear in a local municipal court facing a minor misdemeanor charge for raising 14 ducks in violation of local village rules. He could face a fine of up to $150.

Welker, an Iraq War veteran, says he’s been raising the ducks as a form of therapy for a back injury and post-traumatic stress disorder. Welker told the AP that although the Department of Veterans Affairs paid for his back surgery in 2012, they did not provide mental or physical therapy.

In March, he got the ducks to help fill that void, after hearing raising them could be therapeutic.

“Taking care of them is both mental and physical therapy,” Welker told the AP. “[Watching them] keeps you entertained for hours at a time.”

In West Lafayette, however, raising ducks or any farm animal violates a 2010 ban on housing “chickens, turkeys, ducks, live poultry or fowl of any kind, horses, ponies, cows, calves, goats, sheep, or live animals of any kind except dogs, cats, gerbils, hamsters, guinea pigs, birds or mice.”

But there is hope for Welker and his ducks. A local woman fought to keep the pot-bellied pig she and her daughter use for therapy in 2013. Mary Smith, the pig’s owner, told the Coshocton Tribune at the time that she would rather move than give up her pig. “He’s part of our family,” Smith said.

Smith obtained a letter from her doctor confirming her pig was for therapy. According to the AP, Welker has already gotten a letter from the mental health department of the U.S. Department of Veteran Affairs recommending he keep the ducks.

[AP]

TIME Veterans

Veteran Dies Waiting for Ambulance in VA Hospital

Veterans Health Care Cafeteria Death
The entrance to the Raymond G. Murphy VA Medical Center in Albuquerque, N.M., July, 3, 2014. Russell Contreras—AP

Just 500 yards from an emergency room

(ALBUQUERQUE, N.M.) — A veteran who collapsed in an Albuquerque Veterans Affairs hospital cafeteria — 500 yards from the emergency room — died after waiting 30 minutes for an ambulance, officials confirmed Thursday.

It took a half an hour for the ambulance to be dispatched and take the man from one building to the other, which is about a five-minute walk, officials at the hospital said.

Kirtland Air Force Medical Group personnel performed CPR until the ambulance arrived, VA spokeswoman Sonja Brown said.

Staff followed policy in calling 911 when the man collapsed on Monday, she said. “Our policy is under expedited review,” Brown said.

That policy is a local one, she said.

The man’s name hasn’t been released.

News of the man’s death spread Thursday at the Raymond G. Murphy VA Medical Center among veterans who were visiting for various medical reasons.

Lorenzo Calbert, 65, a U.S. Army veteran of the Vietnam War, said it was sad that a fellow veteran had to die so close to where he could have received help.

“There’s no reason for it,” he said. “They have so many workers. They could have put him on the gurney and run faster than that ambulance.”

Paul Bronston, a California emergency-room physician and chair of Ethics and Professional Policy Committee of the American College of Medical Quality, said it may sound ridiculous that staff had to call 911 but that practice is the standard at hospitals. Typically, an ambulance would arrive faster, and other factors can stall workers trying to rush patients to the emergency room on foot, he said.

“The question I would have (is) … was there an AED (automated external defibrillator) on site as required?” he said. Bronston said 90 percent of those who collapse are afflicted by heart problems and an AED could help them.

It was not known what caused the man to collapse or whether an AED was nearby.

The death comes as the Department of Veterans Affairs remains under scrutiny for widespread reports of long delays for treatment and medical appointments and of veterans dying while on waiting lists.

A review last week cited “significant and chronic system failures” in the nation’s health system for veterans. The review also portrayed the struggling agency as one battling a corrosive culture of distrust, lacking in resources and ill-prepared to deal with an influx of new and older veterans with a range of medical and mental health care needs.

The scathing report by Deputy White House chief of staff Rob Nabors said the Veterans Health Administration, the VA sub agency that provides health care to about 8.8 million veterans a year, has systematically ignored warnings about its deficiencies and must be fundamentally restructured.

Marc Landy, a political science professor at Boston College, said the Department of Veterans Affairs is a large bureaucracy with various local policies like the one under review in Albuquerque.

Although the agency needs to undergo reform, Landy said it’s unfair to attack the VA too harshly on the recent Albuquerque death because it appears to be so unusual.

“I think we have to be careful,” he said. “Let’s not beat up too much on the VA while they are already facing criticism.”

TIME publishing

Starbucks Chair Co-Writing Book on Military Vets

NEW YORK — Starbucks chairman Howard Schultz is collaborating on a book about veterans of the wars in Iraq and Afghanistan.

“For Love of Country: What Our Veterans Can Teach Us About Citizenship, Heroism, and Sacrifice” will be released by Alfred A. Knopf on Nov. 4. The book will be co-written by Washington Post correspondent and editor Rajiv Chandrasekaran.

“Given that less than 1 percent of our country has served in the military conflicts of the last decade, this is a time in America when it’s crucial to bridge the divide in our society between our civilian and military populations,” Schultz said in a statement issued Monday by the publisher.

The book will tell of deeds both on the battlefield and back home, whether an orthopedic surgeon who enlisted at age 60 and saved numerous lives or a military spouse helping wives of severely wounded soldiers.

Schultz has been a prominent advocate for veterans, saying that too little has been done for them once their service was completed. He has pledged to hire 10,000 veterans and military spouses, and earlier this year donated $30 million for research into post-traumatic stress syndrome and brain trauma.

According to Knopf, Schultz is giving all author proceeds to charity.

TIME Veterans

Obama to Tap Soap Salesman to Clean Up VA

Former Procter & Gamble boss is a West Point grad

+ READ ARTICLE

President Obama will announce he is replacing the retired Army general who was running the VA with a former Army captain—swapping four-star salutes for business smarts. The pick suggests just how tough the VA assignment is, and an acknowledges that the sprawling bureaucracy of 300,000 doesn’t always salute when it’s given orders.

Bob McDonald, a former chief executive of soap giant Procter & Gamble, is replacing Eric Shinseki, who stepped down May 30 after it became clear many officials at the Department of Veterans Affairs were hiding how long it took veterans to get their promised medical care.

Obama picked the right guy to clean an agency tarnished by accusations that its managers repeatedly gamed VA records—potentially leading to the deaths of some veterans—to help VA officials win annual cash bonuses. Early in his career at P&G, McDonald managed the company’s Tide detergent business, before heading to Canada and then Asia to run the company’s laundry and cleaning operations. The White House leaked news of McDonald’s nomination, expected Monday, and said his business skills and military background make him the right choice.

Paul Rieckhoff, chief of the Iraq and Afghanistan Veterans of America, suggested McDonald’s corporate background could be an asset. “His branding background may prove helpful,” he said. “There are few organizations in America with a worse reputation with its customers than the VA right now.”

A native of Gary, Ind., McDonald spent five years in the Army, primarily with the 82nd Airborne Division, after his graduation from the U.S. Military Academy at West Point in 1975. He joined P&G—and its lengthy roster of brands, which now includes Gillette, Crest and Febreze—in 1980. He ran the company for four years before retiring in 2013, after pressure from investors that he wasn’t cutting spending sufficiently.

Congressional reaction was muted. Senator Bernie Saunders, I-Vt., who chairs the veterans committee that will hold McDonald’s confirmation hearing, said simply that he looks forward to meeting McDonald “in order to ascertain his views” on the VA’s problems. His Republican House counterpart was even less welcoming. “The only way McDonald can set the department up for long term success is to take the opposite approach of some other VA senior leaders,” said Rep. Jeff Miller of Florida, chairman of the House Committee on Veterans Affairs. “That means focusing on solving problems instead of downplaying or hiding them, holding employees accountable for mismanagement and negligence that harms veterans, and understanding that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them.”

McDonald spoke about such fudging as P&G’s chief operating officer. “We don’t lie, cheat, or steal,” he said in remarks he would make to new P&G employees in 2008 and 2009, “and we don’t tolerate people who do.”

McDonald has his work cut out for him, as detailed in a report by White House deputy chief of staff Rob Nabors, who Obama dispatched to the VA’s Veterans Health Administration to determine how bad things are. “The VHA leadership team is not prepared to deliver effective day-to-day management or crisis management,” Nabors report, released Friday, concluded. “Instead, VHA is marked by an inherent lack of responsiveness and a belief many issues raised by the public, the VA Leadership, or oversight entities are exaggerated, unimportant, or `will pass.'”

McDonald will be the first VA chief of the last four who didn’t retire from the service after an Army career. The prior four VA secretaries—since it became a Cabinet-level agency in 1989—served, like McDonald, in uniform early in their careers. He qualified for many badges during his five years in uniform: Airborne, Ranger, Jungle, Arctic and Desert Warfare, Jumpmaster, Expert Infantry, and Senior Parachutist.

He brought that same approach to P&G. When he took control of the Tide account in 1984, “Tide only came in one form, which was powder Tide regular scent,” he told a Yale audience last year. “Today…you can get liquid Tide, you can get Tide with bleach, and you can get Tide with Febreze. We just launched a Tide for fitness clothes.”

Knowing consumers—and what they want—is key, he explained: “You’re going to create better loyalty, more indispensability, and as a result of that you will have a higher market share.”

He’s going to need all the business savvy he can muster, assuming Senate approval, in his new job. When McDonald left P&G, it had annual sales of about $84 billion, half of the VA’s annual budget. The Congressional Budget Office estimated earlier this month that the reforms the Senate wants to make in providing veterans with better access to health care could double the VA’s annual $44 billion health-care budget.

TIME Veterans

2 Veterans Affairs Officials Resign in Scandal’s Wake

Following Eric Shinseki's resignation

The Department of Veterans Affairs said Wednesday that two senior officials are stepping down next week as the agency looks to rebound from a scandal over concealing long wait times for veterans to get care.

The VA said the resignation of Will A. Gunn, the current General Counsel, and the replacement of Dr. Robert Jesse, the acting Under Secretary for Health, are “aimed at accelerating Veterans’ access to quality health care and rebuilding the trust of America’s Veterans.”

Jesse served as principal deputy under secretary for health beginning in 2010. In May, he assumed the new position amid reports veterans weren’t receiving adequate care. On July 2, Dr. Carolyn Clancy, who has been at the VA since 2013, will replace him.

“Dr. Carolyn Clancy is a leader and a real innovator when it comes to Veterans’ health care quality and safety,” Acting VA Secretary Sloan Gibson in a statement. “As we conduct our search for an Under Secretary for Health, there’s no one better to take on the issues we face. Dr. Clancy will be charged with the Department’s top priority – getting Veterans off of wait lists and in to see their doctors.”

Gunn’s resignation goes into effect July 3 when he will be replaced by the current principal deputy general counsel Tammy Kennedy. Gibson also announced that Dr. Jonathan Perlin, who served as the undersecretary for health under President George W. Bush, would be returning as a senior advisor to the Acting Secretary.

“We’re pleased to welcome this exceptional leader back to VA,” Gibson added. “I look forward to the contributions of Dr. Perlin who is recognized for his national healthcare leadership roles, as part of the VA team as we continue our work towards accelerating access to care and rebuilding trust with Veterans.”

Secretary of Veterans Affairs Eric Shinseki under fire in May.

“The only way today’s VA personnel actions can be viewed as positive developments is if the department fills the vacancies with leaders who put veterans first—not the VA bureaucracy—focus on solving problems instead of downplaying or hiding them, and understand that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them,” Florida Republican Rep. Jeff Miller, who chairs the House Committee on Veterans Affairs, said in a statement.

TIME

On Iraq, Leaders Should Listen to Ghosts of Dead Soldiers

The leaders who will decide how American will handle instability in Iraq would do well to look around their own haunted city

Iraq is not my war. But I spent 14 months in Afghanistan, and am one of the only combat veterans known by my circle of DC friends. I receive many questions of what I think about ISIS steamrolling their way towards Baghdad.

The next time one of them raises the prospect of America involving itself in a third conflict in Iraq, I’m going to tell them about Dan Whitten.

Last week, I was headed to my air-conditioned office building in downtown Washington in the already scalding 9am heat. The humidity was so thick I practically waded through it.

Just before my sweat forced me into a foul mood, I spotted him in the crosswalk. I hadn’t seen Captain Daniel Whitten since we were in Afghanistan in 2008. He had been an officer in my company, but got called up to be an aide to one of the 82nd Airborne Division’s Generals. We weren’t close, but we were friendly. We shared a cigar together at Musa Qala. Just before the deployment, we ran into each other at a Fayetteville CarMax, each there with our wife, trying to sell the vehicles we wouldn’t need for the next fifteen months. We spent a couple hours talking baseball, and discussing a mutual friend from West Point who had washed out and now worked as an enlisted man in the same office I did.

The corners of my mouth lifted as I prepared to ask Cpt. Whitten—whom I could now just call “Dan”—what he was doing in a suit in DC, still wearing a pair of sporty Oakleys like he had back then.

Then I remembered it couldn’t be Dan Whitten. Because Dan Whitten is dead. He was killed by an IED when he came back to our battalion to take a company command for the next deployment. I passed shoulders with this man who looked like Dan and went on my way.

I’ve had a handful of these moments since 2008. I’ve seen Drak and Frazier and Cleaver at various times in different parts of the country. No matter the distance between me and my time in Afghanistan, their ghosts drag me back.

Washington, D.C., is more haunted than most places. When I first moved inside the Beltway to a one-bedroom apartment in Arlington that I shared with my daughter, my bus took me by Arlington National Cemetery every morning. If I strained, I could see section 60, where Charlie and Slip and Frazier rest.

And there are the monuments to Korea, Vietnam, and World War II. From in front of the Capitol building that was burnt by British troops in 1812, General Grant gazes at General Washington, and beyond him the Commander-in-Chief of the War of the Rebellion. Admiral Farragut looks over the square where my bus arrives each morning. The African-American Civil War veterans keep watch on the street where I drink. More heroes and remembrances and former installations dot the District than I know.

For all those ghosts that haunt This Town, the city that sends American men and women into harm’s way never seems to heed—forget remember—their warnings. We cast the specters in bronze and put their spirits on our lapels and car bumpers. We neglect to consider why they haunt us in the first place. These walls and figures and marble temples are placed for the deliberate purpose of remembering the awful brutality of war. How many tourists or even residents can point to Peace Circle on a map? Or can tell you what FDR says about war in his monument (he hates it)? Or know that the MLK, Jr., monument engraves opposition to war in stone?

Every day, those of us who live and work here walk by these ghosts without a second thought. We come home and turn on our televisions and watch other (usually) men who work in This Town argue over whether we’re leaving a war too fast, or if the third time would be a charm for Iraq. If we paused for a moment and listened to our ghosts, even those of the just wars, they would tell us that war is horrible, and that no matter how righteous the justification many will die needlessly. And yet, men and women who now wear the same uniform I did and took the same oath have pledged to go anywhere in the world in the name of their county, and are willing to die for it. They pledged, as Dan and Charlie and Drak and Slip and Frazier did, to do this without asking whether such a sacrifice would be worth it.

The least we can do, as a nation, is ask that question for them.

 

Richard Allen Smith is a former Army sergeant. He served five years on active duty, including a deployment to Afghanistan with the 82nd Airborne Division from February of 2007 to April of 2008. Smith is currently a graduate student in writing at Johns Hopkins University.

TIME Military

The PTSD Epidemic: Many Suffering, Few Solutions

Soldiers with the U.S. Army's  Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afgan National Police compound before going on patrol near Command Outpost AJK (short for Azim-Jan-Kariz - a near-by village) in Maiwand District
Soldiers with the U.S. Army's Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afghan National Police compound before going on patrol near Command Outpost AJK in Maiwand District, Kandahar Province, Afghanistan on Jan. 24, 2013. Andrew Burton—Reuters

The scourge of wars in Afghanistan and Iraq is worse than we thought

Now that Iraq is falling apart, it seems only fitting that the U.S. government issues a fresh accounting revealing that neither the Pentagon nor the Department of Veterans Affairs has any idea if the billions they’re spending on PTSD treatments are doing any good.

A congressionally mandated Institute of Medicine panel reported Friday that neither agency assesses the success of their PTSD care. “Without tracking outcomes, neither DOD nor VA knows whether it is providing effective or adequate PTSD care, for which they spent $294 million and more than $3 billion, respectively, in 2012,” the 300-page study concludes.

Roughly 5% of all troops have been diagnosed with PTSD, the report says, but it’s nearly double—8%—for the 2.5 million who served in Afghanistan and Iraq. Post traumatic stress disorder is also increasing among older veterans. In 2013, the VA diagnosed 62,536 new cases in veterans who did not serve in the Iraq and Afghanistan wars. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran. All told, the number of veterans seeking PTSD care jumped from 190,000 in 2003 to more than 500,000 in 2012.

“Although these numbers are likely to underestimate the incidence and prevalence of PTSD, they demonstrate that action is needed to respond to this growing problem,” the study says. “Demands for post traumatic stress disorder services among service members and veterans are at unprecedented levels and are climbing.”

The IOM report is crammed with data about the extent of the problem, and figures to back them up (you can see more of them here):

  • Total Pentagon spending on PTSD treatment jumped from $29.6 million in 2004 to $294.1 million in 2012.
  • Outside PTSD care funded under the Pentagon’s TRICARE program climbed from $22.4 million in 2007 to $131 million in 2012.
  • Between 2006 and 2012, the number of hospitalizations of service members for PTSD increased by 192%.
  • The total annual cost for health care for a veteran who had PTSD was estimated to be $11,342, which was more than double the annual VA health care cost of a veteran without PTSD.

Even those who have dealt with the issue for years are surprised. “The acceleration of PTSD among service members and veterans is staggering,” says Elspeth Ritchie, a retired Army colonel and the service’s one-time top psychiatrist.

The Pentagon’s PTSD treatments “appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes,” the IOM report says. While the VA’s programs are “more unified,” they both lack records of what treatments work, meaning they “have no way of knowing whether the care they are providing is effective.”

The Pentagon PTSD bill grew 10-fold between 2004 and 2012. IOM

“Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” says committee chair Sandro Galea of Columbia University’s Mailman School of Public Health. The report is a follow-up to an initial IOM assessment of PTSD treatment released in 2012 that only surveyed what was available; Friday’s study was to find out if they work.

The number of veterans of all eras who sought care for PTSD from the VA more than doubled from 2003 to 2012—from approximately 190,000 veterans (4.3% of all VA users) in 2003 to more than a half million veterans (9.2% of all VA users) in 2012. For those treated for PTSD in the VA system in 2012, 23.6 percent (119,500) were veterans of the Iraq and Afghanistan wars.

PTSD can happen when someone experiences a traumatic event, on the battlefield or elsewhere. It can lead to anxiety, depression, sleeplessness and other symptoms that can interfere with life, sometimes contributing to domestic violence, divorce and suicide. The multiple deployments required by a force too small to support the wars fought has played a major role in the PTSD increase among recent vets.

Unfortunately, even if the government begins tracking outcomes, the results may be what the IOM calls “modest,” at best. The only program that routinely conducts such assessments is the VA’s small specialized intensive PTSD program (SIPP). “In 2012, the 39 SIPPs had 3,792 entrants for a total cost of $88,572,953, or $23,578 per patient,” the study found. “The average PTSD Checklist (PCL) scores for veterans at admission to the programs and 4 months after discharge were 65.9 and 60.2, respectively. That indicates that most program graduates met the criteria for clinically significant PTSD after discharge on the basis of a PCL cutoff score of 50.”

TIME Veterans

Veterans Offer Each Other Help as Iraq Falls Apart

A US marine from the 3/5 Lima company po
A U.S. Marine in Fallujah in November 2004. PATRICK BAZ / AFP / Getty Images

One group warns of “frustration” that could lead to suicide

More than 1.5 million Americans served in Iraq between 2003 and 2011. More than a few of them are upset with what’s happened to that country, where they fought and their friends died, over the past week.

That’s why the Wounded Warrior Project sent an email Tuesday to its 50,000 members acknowledging their sacrifices and offering mental-health services if they find the latest happenings from Iraq depressing.

“Your feelings are justified,” Ryan Kules, 
the project’s national alumni director and a double amputee, said. “If you feel frustration watching the news, remember that we did our duty and served admirably, coming home with the visible and invisible scars of that service.”

The reaction of those who fought, and whose friends died, in Iraq has been somber. There wasn’t so much bitter anger as a palpable sadness. Those who thought the invasion was a mistake consoled themselves by blaming President George W. Bush; others blamed President Obama for not fighting harder to keep some U.S. forces in the country after 2011 to try to ensure the lives of the 4,486 Americans who died there didn’t end in vain.

“So many of my friends died in a war that didn’t need to be fought, but that did ultimately provide a reasonable chance for a democratic Iraq in the center of the Middle East,” retired Army officer John Nagl says. “It now appears that all those lives have been squandered because of an unwillingness to pay an insurance premium of a few thousand advisers and some airpower.”

Such grim tidings can lead to despair, which is why Kules of the Wounded Warrior Project reached out. He urged troubled vets to seek help “if you are dealing with PTSD triggers because of current media coverage,” and gave a phone number—1-800-273-8255—for any veterans “struggling with thoughts of suicide.”

Michelle Roberts, the communications chief at the project, says the group reaches out when an event—like last year’s Boston Marathon bombing—might trigger adverse reactions among those who served. “We’re very aware of the conversations our alumni are having with each other, and our staff, about the recent developments and how they affect them,” she says. “We just felt it was a really appropriate time to communicate with them.”

Interviews with veterans echo that view. “I’m just heartbroken, tired and nearing mute,” says Alex Lemons, an Iraq vet and former Marine sergeant. “I never saw a concrete objective and, in consequence, a willingness to win on our part.”

Lemons pulled three tours in Iraq, and says the goal shifted with each:

I was told this at the beginning: `And our mission is to clear, to disarm Iraq of weapons of mass destruction, to end Saddam Hussein’s support for terrorism, and to free the Iraqi people.’ WMD? Nothing. Fiction. Al Qaeda and indigenous terrorism? Terrorists entered the country after we invaded and then recruited heavily amongst those Iraqis we alienated with de-Baathification and firings throughout the army. Even during the surge, we could not crush every insurgent group. Regime change? We mishandled the trial and subsequent execution of President Hussein. In some ways, the Maliki government is another Baath party in Shiite garb.

“All Americans who fought there want Iraq to succeed so that we can have personal closure and know our sacrifices were worth it even as the rest of America, like the Vietnam experience, wants to forget,” Lemons says. “But Iraq will never give us that.”

Even Army Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, feels the sting. “Many of you have served in Iraq or know friends and family who made great sacrifices there,” he said in a message sent to troops Thursday. “Like many of you, I was disappointed at how quickly the situation in Iraq deteriorated as well as the rapid collapse of many Iraqi units.”

“It was somewhat expected, yet still disappointing, says Rob Kumpf, who served in Iraq as an Army non-commissioned officer. “Fighting an asymmetric war with one hand tied behind your back, with poor planning and unengaged leadership, led to the current situation Iraq’s security forces face. We screwed up the end game when we withdrew, and will soon do the same in Afghanistan.”

But other veterans have shrugged off what is happening. “Iraq’s political situation is not the concern of individual veterans of the war,” says William Treseder, who deployed to Iraq and Afghanistan as a Marine sergeant. “Combat veterans should value their service based on what they did, not on what happened after the fact or in some larger international context.”

Those who haven’t fought don’t know how combat can change one’s perspective. “Love, loyalty, sweat, and blood are the currency of service—its beating heart. Politics is a dry husk that tries to cover and limit that vitality,” Treseder says. “I wish Iraq and Afghanistan the best as countries, but I do not give them the power to determine how I feel about my service to the United States of America. Nor do I think it’s wise for any other combat veteran to do so.”

But some plainly do. “Your examples of valor and strength educate and inspire those around us,” Kules of the Wounded Warrior Project told them in his email. “Remember, you are not alone. Many of your fellow warriors make themselves available to help others…and WWP remains by your side to provide whatever support and assistance you need.
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