VETERANS’ HEALTH CARE: Masking true costs of war
November 12, 2007 – Five decades ago, Darrell Huff’s bestseller ‘How to Lie With Statistics’ showed how valid numbers can be manipulated to generate inaccurate or biased conclusions. In that vein, the wars in Iraq and Afghanistan have created opportunities for imaginative and experienced prevaricators at the Department of Defense (DOD) and Department of Veterans Affairs (VA) to manipulate numbers to mask the true costs of these wars. But even more important are the statistics not kept, or kept but not revealed.
Foremost are casualties, the most acute cause of public distress with our extended conflicts. The DOD publicly reports total “casualties” of approximately 30,000. Yet it provided figures exceeding 65,000 — more than twice as high — in responding to Freedom of Information Act (FOIA) requests. How does the same agency provide such wildly disparate numbers? It subtracts the injured and ill components for public consumption. Of course, bigger war numbers lead to some of the more gargantuan lies. President Bush’s top economic advisor, Lawrence Lindsey, was fired in late 2002 for having the temerity to suggest to the Wall Street Journal that the upper limit of the cost of the Iraq War might approach $100 to 200 billion. Yet the Congressional Budget Office calculates the cost to date as $415 billion, mounting to as high as $2.4 trillion.
Smaller but still significant are the numbers in the doctored VA budgets, which yielded deficits of almost $1.7 billion for fiscal years 2005 and 2006. As a government audit later found, the budgets assumed phantom cost savings and were based on pre-war data concerning the number of expected disabled veterans and the cost of caring for them.
More recently, press reports have focused on a rash of suicides by our troops on active duty. Yet the DOD and VA claim that they have no count on the number of suicides among veterans. This illustrates one of the most effective ways of controlling statistics — simply don’t keep track of those likely to be unfavorable or deny that you do so. Similarly, the VA has repeatedly assured the public that it is scrupulously providing for our wounded veterans. Yet the VA has not quantified the true incidence of post-traumatic stress disorder (PTSD) among veterans. Why keep track when the figure might bolster the conclusion that the VA health care system is inundated with veterans it lacks the capacity to serve? The VA’s responses to recent FOIA requests by Veterans for Common Sense show that only a third — 19,015 out of 53,275 — of Iraq and Afghanistan veterans seen by the VA for treatment or evaluation of PTSD receive at least some level of disability compensation by the VA.
The true health care numbers the VA is facing are staggering: The United States has deployed 1.7 million troops to Iraq and Afghanistan war zones, about 900,000 of whom remain in the military and are not yet eligible for VA benefits. Applying a conservative 20% PTSD rate, the VA can expect approximately 340,000 veteran patients with PTSD, and more than 600,000 mental health patients.
And despite the fact that most of our soldiers have yet to become veterans, the VA adjudication system is choking on an unprecedented number of claims. It now takes an average of eight to 10 years for a veteran to exhaust all appeals after a VA denial. The backlog at the VA regional offices, where claims are initially decided, has already risen from approximately 325,000 claims in 2002 to more than 600,000 in 2006, and is expected to swell to about 950,000 by 2008. More than 40,000 appeals to the Board of Veterans Appeals are pending, where it now takes an average of almost 1,000 days to decide an appeal. And the delays at the Court of Veterans Appeals are even more protracted: a record backlog of 6,000 appeals — and an average of more than 1,225 days to decide an appeal. These backlogs and delays will inevitably swell as more soldiers return from the wars.
Personality disorder discharges
And there are ominous signs that the DOD and VA have devised a plan to deal with the flood of returning veterans. Unfortunately, that plan is to find ways to deny health care and disability benefits to veterans with PTSD. Since 2001, the DOD has discharged more than 22,000 veterans exhibiting signs of PTSD based on pre-existing “personality disorders”; they include combat veterans, victims of sexual assault and soldiers with no history of mental disease. A “personality disorder” discharge makes it difficult for the veteran to obtain VA health care and benefits, and is listed on his or her DD-2214 form, which stigmatizes the veteran and makes it difficult to find employment.
It doesn’t require a statistician to conclude that we stand on a precipice. Will we continue to tolerate public servants who hide the ball and try to placate citizens with meaningless numbers, or will we insist that they sacrifice whatever is necessary to insure that the motto of the VA — “For him that hath borne the battle, and his widow and his orphan” — does not become just a hollow echo?
Gordon P. Erspamer, a litigation partner in Morrison & Foerster’s Walnut Creek, Calif., office, recently filed on a pro bono basis a class action in California, on behalf of veterans from the Iraq and Afghanistan actions now suffering from post-traumatic stress disorder. Paul Sullivan is a Gulf War veteran and executive director of Veterans for Common Sense, a lead-organization plaintiff in the case.