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Shellshocked: Veterans Health Care

According to polling in the past few months, the biggest issues troubling Americans are health care and the war in Iraq. What gets talked about less often is the point where these two issues intersect:

Health care for our soldiers, and who is going to pay for it.

As of April 2008, 1.6 million U.S. troops have deployed in support of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom.

One would assume that these soldiers and their dependents could expect to have their health care needs fully met. It’s the least this nation can do to thank them for their service and sacrifice.

But anyone who has encountered a homeless veteran on the street, followed the Walter Reed scandal, or seen how those with Post-Traumatic Stress Disorder are being denied mental health treatment – under the assertion their Post Traumatic Stress Disorder (PTSD) doesn’t exist or reflects a pre-existing condition – knows this isn’t the case.

Around 12% of the 47 million uninsured people in the United States are veterans and their families: this adds up to 1.8 million uninsured veterans. These 1 in 8 veterans are typically 45-year-old men who worked in the past year and are earning from $30,000 to $40,000. Almost two-thirds of uninsured veterans were employed, and nearly 9 out of 10 had worked within the past year.

Why are they uninsured?

Defense Department data released in late 2007 show that thousands of National Guard and Reserve members who had to give up civilian jobs when they were deployed overseas have now permanently lost these jobs and with them their health insurance, pensions, and other benefits. (Federal laws are supposed to protect them from being penalized for leaving civilian employment for wartime service.)

For others it’s a Catch-22: many veterans make too much to qualify for federal benefits and too little to afford it themselves under current regulations. A 1996 law opened VA care to all veterans, but in 2002, limited resources forced regional directors to limit new veteran enrollment. A year later, enrollment was further denied to veterans without qualifying medical conditions or incomes. The question is – What does qualifying mean?

The numbers of uninsured veterans are rising and are predicted to climb further as demands for care and the costs of care outpace the Veterans Health Administration’s budget.

Why are veterans health care costs rising?

A veteran who becomes disabled during military service receives from the government anywhere from $115 a month for a 10% disability to about $2,400 a month for total disability – at least $1.4 million in their lifetime.

A November 2007 report from the Nobel Peace Prize winning Physicians for Social Responsibility predicted that providing medical care and benefits to Iraq veterans could top $660 billion: this is greater than the current operational costs of the war ($500 billion).


Advances in military technology and battlefield medicine are leading to a high survivor rate for U.S. soldiers, but more than 60,000 have been physically injured, or are medically ill.

SIDEBAR: U.S. Wounded and Killed in Iraq and Afghanistan

As of October 29, 2007

# of U.S. service members who died in Afghanistan 453
# of U.S. service members who died in Iraq 3,839
# of U.S. service members physically wounded tens of thousands
# of U.S. service members with mental injuries and/or mild traumatic brain injuries hundreds of thousands
# of Operation Iraqi Freedom or Operation Enduring Freedom veterans who sought treatment from the

Department of Veterans Affairs between 2002 and December 2006

% of Soldiers and Marines in Iraq who will be in a situation where they could be seriously injured or killed 75%
% of U.S. service members wounded in action in Iraq who are injured in an explosion 65%
% of U.S. service members who died in Operation Iraqi Freedom or Operation Enduring Freedom who left behind spouses and/or children 47%
  • Iraq: The ratio of wounded to killed in combat is 8:1, compared with 3:1 for the Vietnam War, and 2:1 for World War II.
    • The percentage of injured requiring amputations is the highest seen since the U.S. Civil War.
    • The type of warfare soldiers are engaging in often results in Traumatic Brain Injuries (TBI), which can have symptoms ranging from headache to severe mental and physical impairment, and is difficult and expensive to diagnose and treat.
    • Veterans for America cited US Army data in a recent report that found hundreds of thousands of soldiers returning from Iraq are psychiatric casualties or have Traumatic Brain Injuries (TBI). (New medical studies show that many cases of PTSDs are actually TBIs, typically caused by being near explosions.)
    • Up to 30% are predicted to meet criteria for serious mental health disorders (49% for the National Guard), with a significant fraction of these being lifelong, chronic afflictions.
    • As our strategic need for troops increases, soldiers are returning to the field more often, for longer, and with less rest in between. Soldiers on their second tour in Iraq are 50 percent more likely to develop a mental health problem than those on their first tour because they do not have time to “reset” between deployments given the current ratio of 15 months deployed to 12 months at home.
    • Post-Traumatic Stress Disorder has been recently found to have a genetic link, which explains why some recover more rapidly from it than others.
    • Improved understanding and treatments for PTSD have led to a 50% increase since 2000 in the number of World War II veterans seeking belated recognition of and compensation for related disabilities.
  • Iraq and Afghanistan combined:
    • About 30% of all deployed servicemembers have experienced at least one of 3 problems:
      • 18.5% meet criteria for PTSD, depression, or both
      • about 19% reported experiencing probable TBI during deployment
      • about 7% meet criteria for a mental health problem and also report possible TBI.
    • Analysts estimate that about 300,000 returning service members currently have PTSD, depression, or both and that about 320,000 may have experienced TBI.

The other issue is that these kinds of psychiatric or neurological injuries can become long-term problems. Researchers studying the effects of the Vietnam War found that in 1998 – almost 3 decades after the Vietnam War – approximately 10.5% of the surveyed veterans were continuing to experience problems with severe PTSD, down only slightly from approximately 11.8% in 1984 when they were first interviewed. (About 1 in 2 soldiers surveyed met some PTSD criteria both times.) Furthermore, the severity of their PTSD had increased in terms of its negative effects on their life.

The researchers have determined that PTSD is most strongly linked to high combat exposure i.e. being ambushed, shot at, or seeing comrades wounded or killed. Of course the more often we send the same troops into battle in Iraq – a new kind of battlefield that has been described as highly chaotic and violent – and the longer they’re deployed the more likely they are to experience these things.

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