Veterans for Common Sense

BAGHDAD, April 24 — A suicide bomber rammed an explosives-rigged truck into a U.S. military outpost near Baqubah on Monday, killing nine soldiers and wounding 20 in one of the deadliest single ground attacks on U.S. forces since the start of the war in Iraq, military officials said early Tuesday.

Suicide attackers rarely penetrate defenses that surround American troops, but a 10-week-old U.S. counterinsurgency strategy has placed them in outposts and police stations that some soldiers say have made them more vulnerable.

The military said the attack occurred near the capital of Diyala province, about 35 miles northeast of Baghdad, where U.S. soldiers have been engaged in increasingly fierce fighting with Sunni insurgents. A 10th soldier was killed Monday in a roadside bombing in the Diyala town of Muqdadiyah, the military said.

The truck bombing caused the highest number of U.S. fatalities in a ground attack since Aug. 3, 2005, when 14 Marines were killed after their amphibious assault vehicle hit a roadside bomb in Haditha.

Another car bombing Monday at an Iraqi police checkpoint near Diyala’s provincial council headquarters in Baqubah killed seven Iraqi policemen and wounded 13, the military said. The council was about to begin a meeting to discuss its 2007 budget, the U.S. military said.

As fighters have fled an ongoing security crackdown in Baghdad, attacks have risen against American and Iraqi forces in Diyala, where the U.S. military is sending more than 2,000 additional troops to battle the insurgency. U.S. soldiers have recently moved into at least seven small outposts in and around Baqubah.

Monday’s deaths bring to at least 56 the number of U.S. soldiers killed in Diyala since November. The province has become the third-deadliest for Americans this year, following Baghdad and Anbar provinces. The attack also injured an Iraqi civilian, the U.S. military said.

Bombings in different parts of the country Monday killed at least another 44 people and wounded more than 100, police said. Twin car bombings killed at least 19 outside Ramadi, about 60 miles west of Baghdad, and a suicide bomber detonated explosives inside a restaurant near Baghdad’s fortified Green Zone, killing seven and injuring 14.

A U.S. military effort to curb violence by building walls around some Baghdad neighborhoods generated continued controversy Monday, as residents protested barriers now surrounding a Sunni enclave and Iraq’s government pledged to find alternatives to the strategy.

U.S. Ambassador Ryan C. Crocker, speaking at a Baghdad news conference, said the United States would “respect the wishes of the government” but stopped short of saying the walls would come down. The city’s top Iraqi military spokesman, meanwhile, insisted they would not.

“We will continue to construct the security barriers in the Adhamiyah neighborhood,” Brig. Gen. Qassim al-Moussawi said at a news conference, referring to the controversial new wall bordering a district of Baghdad that U.S. military officers say is a Sunni insurgent stronghold. “Setting up barriers is one thing, and building barriers is another. These are movable barriers that can be removed.”

The Adhamiyah wall is part of a U.S. military plan to cordon off at least 10 of the city’s most violent neighborhoods in an effort to limit the movement of militants. In some of the sealed-off areas, which U.S. military officers refer to as “gated communities,” Iraqi and American soldiers will issue badges to residents or use biometric devices to record their fingerprints and eye patterns, military officials said.

U.S. military officials say the walls are meant to protect, not divide, and were designed by both American and Iraqi commanders in the field.

Debate over walling off neighborhoods began last week, when the U.S. military issued a press release about the construction of a three-mile-long, 12-foot-high wall separating Adhamiyah from surrounding Shiite neighborhoods. The partition — dubbed “The Great Wall of Adhamiyah” by soldiers — was intended to curb sectarian violence in the area, the statement said.

The barrier quickly drew criticism from Adhamiyah residents, who said it would stoke sectarian tensions by separating them from Shiites and likened it to the barriers Israel has constructed around the Gaza Strip and the West Bank, which are much-maligned in the Arab world. Other critics joined the outcry, among them human rights activists and representatives of anti-American Shiite cleric Moqtada al-Sadr, one of whom told reporters in Najaf that the walls amounted to a “siege of the city.”

On Sunday, Iraqi Prime Minister Nouri al-Maliki told reporters in Cairo that he had ordered a halt to construction of the walls. Maliki was in Egypt for a meeting with Arab leaders. In an interview on the al-Arabiya television network Monday, government spokesman Ali al-Dabbagh appeared to back away from Maliki’s demand, saying only that the government was examining other measures for securing Adhamiyah. He declined to discuss possible alternatives, citing security concerns.

The walls have “political and psychological dimensions,” Dabbagh said, speaking to the network from Cairo. “It might solve a security crisis. But it has side effects just like medicine. Medicine has side effects that sometimes can be more harmful than the pain itself.”

In Adhamiyah, hundreds of residents protested, shouting and carrying banners that called the barricades a “big prison.”

“It is not a solution to turn the city into cantons,” one elderly man told television reporters.

Dawood al-Azami, deputy director of the Adhamiyah local council, said 90 percent of respondents to a survey distributed in the neighborhood on Sunday were strongly opposed to the wall, the Associated Press reported.

U.S. military officials say many residents of the city’s newly walled-off neighborhoods are pleased with the barriers. Mohammad al-Kabi is one.

Kabi, a building contractor who lives about 500 yards from the Adhamiyah wall, said he saw 20 trailers rumble into the area Sunday night, carrying tall blast barriers to add to the partition. He said he welcomed their arrival.

Checkpoints and road closures already have severed his ties to friends and business partners on the other side of wall, he said. There used to be daily clashes on his street. Now, with the wall going up, he said he feels more protected.

“There are no other options,” said Kabi, a Shiite Muslim. “It has reduced the violence. The snipers are not shooting at us anymore.”

Correspondents Sudarsan Raghavan and Joshua Partlow in Baghdad, and staff writers Josh White and Thomas E. Ricks in Washington contributed to this report.

Beyond Walter Reed: the DOD’s Other Healthcare Scandal

The governmental and media response to the Walter Reed scandal scratches only the most visible layer of the larger crisis in the US military’s healthcare system. The fact remains that the majority of servicemembers — whose injuries in the course of duty do not necessitate being airlifted into Reed — face substantial barriers to receiving any kind of care at all.

As I reported in a series of articles on Raw Story this past October, servicemembers with mental disorders are treated particularly badly. As the violence in Iraq and Afghanistan intensifies and military recruiters continue falling short of their quotas, the problem grows. More troops are exposed to ever-worsening combat conditions for increasingly longer terms of duty. And when they return, these troops face systematic barriers to proper diagnosis and treatment, starting with a post-deployment process littered with disincentives to disclose any kind of problem whatsoever.

For example, these same troops that have served two and three times longer than they originally intended are warned, while they are at the post-deployment center awaiting their release, that anyone reporting any kind of potential physical or mental disorder will be held indefinitely “for a full evaluation” while their buddies go home to their friends and families. And it’s common knowledge that a mark like that on their military record could end all hopes of working for the police force, the fire department, or any other kind of security-related job.

Of the mere 5{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of troops still desperate enough to vault these hurdles and acknowledge potential symptoms of post-traumatic stress (PTSD), 78{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} are denied further mental health evaluation after being eyeballed by… just about anyone. As Paul Reickhoff, Executive Director of Iraq and Afghanistan Veterans of America (IAVA) and an Iraq veteran explained, “The form went to me and I passed it up to my commander. Essentially, you’re asking a group of people who have been in exactly the same situation, and who have no mental health training or background, to evaluate other people.”

A Veteran’s Administration report released this past August hints at the consequences of failing to diagnose and treat troops at the post-deployment stage: one-third of the nearly two million vets from the wars in Iraq and Afghanistan are seeking treatment from VA facilities. A full 35{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} received a diagnosis of a possible mental disorder. And they are waiting endlessly for treatment and compensation — in part because they didn’t report symptoms when they were supposed to, at the post-deployment center.

Of course, this isn’t the way it’s supposed to be. For years now the military has bristled at any suggestion that its healthcare system may be less than ideal. Even when it got busted by the General Accounting Office in 2003 for not enforcing a 1997 law that mandated pre-and post-deployment screenings for all servicemembers. Or last May, when another GAO report queried the military’s low rate of referrals: it also questioned DOD’s failure to require their providers to document why they had or had not granted servicemembers who showed potential symptoms of PTSD access to a professional mental health evaluation.

For all the committees and news accounts the Walter Reed scandal has spawned, there’s no sign so far of substantial infrastructural or ideological change at the DOD. It can wave the head of former Army Secretary Francis Harvey around on a pole all it likes. Ditto for Maj. Gen. George W. Weightman and Lt. Gen. Kevin Kiley, the two previous commanders at Walter Reed. What does it matter when there’s a limitless supply of scoundrels to run the show — the kind of guys we’ve come to expect from this administration. Middle managers who hold down costs and minimize damages.

Take Dr. Michael Kilpatrick, deputy director of Force Health Protection and Readiness at DOD. He won Keith Olberman’s “Worst Person in the World” award earlier this year for cooking the DOD’s books to lower the statistics on the number of injured American service personnel. (By limiting the number only to those war casualties who required air transport out, he dropped the total from 47,657 to 31,493.) He’s still there.

Or Michael J. Kussman, the acting undersecretary for health and the top doctor at the VA. He responded to last August’s VA report by insisting that the number of troops reporting symptoms of stress probably represented a “gross overestimation” of those actually suffering from mental health disorders. He’s still there, despite acknowledging in hearings that he’s known about the problems at Walter Reed since 2004.

At least we’re finally rid of William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs who will be replaced in what the White House is spinning as a “previously scheduled departure from his job.” He’s the guy who swore, in testimony before the Senate Armed Services Committee last month, that ” Walter Reed’s problems did not result from lack of financing.” (In 2003 he testified that all deploying and redeploying troops were receiving individual health assessments.)

Yes, the Walter Reed scandal is long overdue. But it’s vital that government officials and media alike recognize that more of the administration’s hacks still need to go, and that for many troops the issue is access to any kind of care at all.

Nancy Goldstein lives and writes in New York City.

ST. LOUIS — Patricia Fry, whose son is a Marine infantryman, was explaining the fine art of creating a scrapbook to Rita Swift, whose son is a Marine helicopter pilot.

“I think the blue looks great because it brings out the blue in the flag,” Fry told Swift as she arranged a picture of her son, Maj. Mike Swift, on a page in her book.

The scrapbooks have a dual purpose: They keep parents busy during the anxious days of their son’s or daughter’s deployment to Iraq or Afghanistan. And, should the worst happen, the scrapbooks will be a memorial to a lost loved one.

“I’m looking for ways to stay busy, to make it easier,” said Swift, of Palos Heights, Ill. Her son has deployed to Iraq and Afghanistan and may return to Iraq once his tour as a test pilot is complete.

The scrapbook session was part of the second annual national convention of Marine Parents.com, a nonprofit, nonpolitical support group for parents of Marines, particularly those with a son or daughter in Iraq or Afghanistan.

For three days of seminars, which ended Sunday, several hundred parents gathered here to learn coping skills for themselves and strategies for helping their sons and daughters once they return home.

Parents learned about military benefits, psychological counseling for returning veterans, volunteer groups that send packages to deployed troops, the Purple Heart Society for service members who have been wounded, and more.

From across the country, the parents came looking for kinship. The military has programs to provide emotional support for the spouses and children of deployed troops, but parents are largely left on their own.

Most do not live near military bases. Their neighbors, even those who try to be sympathetic, do not really understand their strain and the fear. Or if they do, they can quickly tire of being supportive.

“My Marine son went three times to Iraq and my Army National Guard son went once,” said Jeannine Hubbell of Lathrop, Mo. “I’m looking for a connection to people who understand, who can relate.”

Like Hubbell, Kay Hale of Richardson, Texas, has a son in the 3rd Battalion, 7th Regiment based in Twentynine Palms, one of the Marine Corps’ most deployed battalions. “We’re 3/7 moms,” Hale said. “It’s not like Vietnam: We have a limited supply of bodies, and they’re using the same ones over and over again.”

Retired Navy Cmdr. Michael Colson, a chaplain who is now a counselor with the Seattle Vet Center, advised parents to give their returning sons and daughters a certain latitude because their language and behavior will have changed.

“Don’t ask them about their dreams,” Colson said. “Dreams in a combat environment are vivid and intense, and they don’t make any sense.”

Still, parents should be on the lookout for signs of reckless or dangerous behavior, he said, or signs of depression, which is common among combat veterans.

In a session devoted to the parents of Marines killed or wounded in combat, Cyd Deathe of Tampa, Fla., talked of her son, Lance Cpl. Adam Sardinas, who lost four buddies in a roadside bombing in Ramadi and later was injured himself.

“He doesn’t want to live without them,” said Deathe, tears filling her eyes. “He’s going through horrible survivor guilt and PTSD [post-traumatic stress disorder]. I’m supposed to be able to take care of him because I’m his mom.”

Deathe was embraced by Georgette Frank of Elk Grove Village, Ill., whose son Phil was killed near Fallouja, and by Rich and Christine Dybevik of Coos Bay, Ore., whose son Gary Van Leuven was killed in Husaybah.

Frank led a prayer. Christine Dybevik talked of the helplessness felt by many mothers. “You hear your son is injured and the mom instinct kicks in: I’ve got to fix it,” she said. “But in these cases, you can’t fix it.”

MarineParents.com was started in 2003 by Tracy Della Vecchia of Columbia, Mo. What began as a diversion has become a full-time undertaking, with three staff members and dozens of volunteers. The website gets millions of hits a week.

“It just got huge,” said Della Vecchia. Her son, Cpl. Derrick Jensen, has made three tours to Iraq and just received a letter indicating that, as a reservist, he could make a fourth.

The group began as MarineMoms.us but switched names nine months later to encourage participation by dads. Still, mothers far outnumbered fathers at the convention.

Jackie Parker of Kingston, Mo., said she has endured four deployments to Iraq: one by her son in the Army, two by her son in the Marines, and one by a daughter-in-law in the Army.

“If it wasn’t for Marine Parents.com, I wouldn’t have made it through,” she said.

The website offers news, links to other support groups and projects, message boards, and chat rooms, many tailored to specific battalions.

Many of the mothers had been communicating on the chat rooms for months and felt like old friends even before they arrived here. “We have an online community but we’ve never really met before,” said Joni Dafflitto of St. Louis.

Fry’s scrapbook classes were filled with discussion of how to use different kinds of tape and stickers and how to do captions and where to buy the best supplies. But there was a serious undercurrent.

“It’s therapy,” said Fry, of Menomonee Falls, Wis. Her son, Lance Cpl. Erich Fry, will soon return to Iraq.

“Doing a scrapbook,” she said, “is like you’re with your kid, with your Marine.”

The Department of Veterans Affairs on Monday will allow every clinician at all its hospitals and clinics to access in real-time electronic health records of wounded soldiers evacuated from Afghanistan and Iraq through a VA version of the Department of Defense’s Joint Patient Tracking Application, Government Executive reports.

The Web-based Veterans Tracking Application, or VTA, will provide VA physicians with access to all DOD medical records they need on a patient, beginning with the data entry from a combat medic into a handheld computer on the battlefield, Army Lt. Col. Mike Fravell, who helped develop the Joint Patient Tracking Application, said.

The Pentagon in January blocked VA physicians’ access to the Joint Patient Tracking Application while an information-sharing agreement was negotiated between the two departments. Sens. Daniel Akaka (D-Hawaii) and Larry Craig (R-Idaho) discovered the restrictions and wrote to DOD in February 2006, calling for restored access to the system for VA.

VTA also will be used to coordinate the care of soldiers transferred from military treatment centers such as Walter Reed Army Medical Center, to a VA hospital for care, Dr. Edward Huycke, chief DOD coordination officer at VA, said.

The application will aid the coordination of benefits for veterans being discharged and help soldiers transition from active duty to veteran status, Daniel Cooper, VA’s undersecretary of benefits, said. Cooper recently told the Senate Veterans Affairs Committee that the Veterans Benefits Administration already has begun using VTA to identify service members who have filed claims.

The Veterans Health Administration also intends to quickly integrate VTA, which initially will be a separate applications window into the Computerized Patient Record System component of VA’s Veterans Health Information Systems and Technology Architecture EHR system, Huycke said.

Fravell said the development and deployment of VTA is inexpensive, but he would not provide details. ASM Research and Computer Sciences are providing contractor support for VTA, Fravell said (Brewin, Government Executive, 4/20).

Nurse Diane Birmingham offered her resignation to the Cheyenne Veterans Affairs Medical Center last Monday with great relief. She was tired and demoralized and no longer able to fight for the patients.

Birmingham is the second medical practitioner in two years to resign from Cheyenne. Both she and Dr. Cephus Allin lodged grievances with the VA about scheduling practices and resource problems that they say impacted their ability to care for patients at the Fort Collins clinic. Both say they were then transferred to Cheyenne and harassed out of their jobs for speaking up.

“There’s a point at which you just cannot go against your own sense of what is right,” Birmingham said of her resignation. “I love the patients. I still do miss them. Some of these guys were like old friends.”

The Veterans Administration hospitals have received high marks in recent years for installing new bar-code technology to ensure patients receive the correct medication, and implementing electronic prescription orders and electronic medical records. The Cheyenne center’s patient satisfaction data ranks 87.7 out of 100, above the 78.1 rating of national VA hospitals.

Yet, Birmingham and Allin say that VA policies and data collection are catered toward creating a positive face for the organization, instead of improving care for the country’s most revered patients.

Few resources, many patients

Birmingham came to the clinic six years ago with a master’s degree in public health. She enjoyed the fast-paced workload, her coworkers and her patients, but it wasn’t long before she had questions about the resources and policies at the clinic.

Birmingham said the small Fort Collins building lacks the infrastructure to serve the large number of patients with complex problems who come there. Fort Collins staffs 1.5 doctors, a nurse practitioner, a registered nurse, a licensed practical nurse and a phlebotemist with a rotating set of specialists using only four exam rooms and one patient room. In fiscal year 2006, 2,776 patients came through the doors.

Birmingham also noted that the average veteran comes to the clinic with far more problems than a regular doctor’s office would see. “We have the oldest and we have the sickest (patients),” she said.

Due to the space constraints, nurses were routinely forced to assess patients in the hallway, performing blood pressure checks and asking routine questions when no rooms were available, Birmingham said. Although this was a violation of the Health Insurance Portability and Accountability Act, the nurses were also under pressure not to reschedule appointments and to see as many patients as possible.

The Fort Collins clinic is under the auspice of the Cheyenne Veterans Affairs Medical Center. Spokesman Andrew Ruben said that the center does the best it can with the resources available and is constantly assessing whether outpatient clinics need more space or staff. Ruben recognized that the clinics are busy, but said a committee is due to make recommendations about needs by October.

“The clinics are pretty much approaching their full capacity. That’s why we’ve got that committee in place now to make sure we are aware of the workload data,” Ruben said.

Dan Frantz, clinical specialist in psychiatric nursing in Greeley, lauds the care veterans receive at his clinic, but said of course he’d like more resources. “More days than not, every room is double booked,” he said. “Expanding this clinic would make a difference in terms of waits.”

Appointments not by the books

Allin worked at the veterans administration for three years. As a doctor in Fort Collins, he consistently served a higher number of patients than many other doctors in the Cheyenne network. He also helped implement the emergency medical record system there.

As a self-professed computer geek and passionate doctor, Allin said he noticed that the VA’s patient appointment policy was causing the sickest patients to fall through the cracks.

The administration created its scheduling policy to free up the doctors and get patients in the door as quickly as possible. To do that, the computer only allows schedulers to make appointments for the next 30 days. Patients who come out of the doctor’s office with instructions to return in five weeks are put into a reminder system, which sends them a letter telling them to call and make an appointment.

Birmingham said the aging, ill patients who come to the VA aren’t good at rescheduling. “That population doesn’t do a lot to follow up on anything” that isn’t done the time they leave, she said.

Allin found the data to back up his claims. Using the VA system when he worked there in 2005, he determined that 24.7 percent of the people receiving letters didn’t actually schedule appointments. “People who are going to have the greatest problems getting around to making appointments are probably the most vulnerable patients,” Allin said.

Nurse Mary Walton of the Greeley clinic, who speaks highly of the veterans administration as an employer, agreed that patients can fall through the cracks in the system.

Birmingham said that the system makes the VA look like there is a smaller waiting list to get into the clinic, instead of showing concern for patients. “We’ve got to look good, whether it’s real or not. And isn’t that what politics is all about?” she said of the VA policy.

Allin: Managers lie to improve statistics

Allin also noticed in his clinic that schedulers weren’t following the correct appointment procedures. His suspicion was that the divergent scheduling was a strategy to make the patient wait times look better. Only six months before he left the clinic, an audit verified his complaints.

A report by the Department of Veterans Affairs Office of the Inspector General on outpatient scheduling found that 41 percent of the schedulers in the eight facilities scrutinized were directed by supervisors to enter information incorrectly. Because of this, the VA numbers looked far better than reality when the statistical sample was applied nationally. While only 65 percent of patients were truly seen in 30 days, the VA reported 81 percent. Further, the average waiting time was actually 44 percent higher than reported by the VA when errors were corrected, according to the audit.

Using the model from the sample, the office determined that the error rate applied to as many as 24,463, veterans nationwide.

Both Allin and Birmingham said that doctors and nurses were constantly under pressure to keep waits down and serve an increasing number of patients. This, Allin said, resulted in a culture where managers would lie to make their facilities look better.

The Veterans Health Administration uses scheduling data to measure performance and plan budgets. The report concluded that the inaccurate data compromised the VA’s ability to assess and manage demand for medical care.

Laurie Tranter, a spokeswoman for the Department of Veterans Affairs, said the administration is currently rolling out new policies and training in response to the audit. She said the VA did a thorough review of the situation and issued two directives to rectify the scheduling problems.

Allin worked for the VA for six months after the report was released and saw no changes in policy at the clinic. During that time he testified before a U.S. Senate committee hearing on rural veterans and discussed the scheduling errors. Despite the new policies being rolled out, Allin said that until the VA fires the 41 percent of managers instructing their employees to fraud the system, the problem would likely continue.

A gold standard

While Allin and Birmingham had bad experiences as VA employees, Frantz and Walton tell a different story about the organization.

Frantz has worked at the VA for 20 years and lauds the organization’s integrity. Walton also loves her job and praises the incredible patients, who she says share their lives with her. She has a room full of fishing antiques given to her by veterans.

Both Frantz and Walton see room for improvement at the clinic, which is also run by the Cheyenne Medical Center, but believe the clinic is the “gold standard for medical care.”

Ruben would not offer specific employee satisfaction data for the Cheyenne Medical Center, except to comment that the data tracks along the same profiles that are generated nationally. “The raw data is intended for internal analysis, program development and employee recruitment and retention and I am happy to have summarized it for you,” he said.

Allin is now a private consultant helping medical facilities implement electronic medical record systems, which he also did at the Veterans Administration. The day after Birmingham filed her resignation, she received a job offer in public health.

VA whistleblowers nationwide unite

Dr. Jeffrey Fudin formed the VA Whistleblowers Coalition in 2005 to lobby Congress to prevent retaliation against those who report abuses in the U.S. Department of Veterans Affairs. Fudin underwent a long and much-publicized battle for his job as a pharmacist at the Stratton VA Hospital in Albany, N.Y., after he disclosed cancer research violations and patient abuse. The whistleblowers group has 20 signing members in 13 states and about 40 anonymous members who fear for their jobs and pensions.

Salazar announces rural clinic for Craig, introduces bill for rural vets

U.S. Sen. Ken Salazar announced last Wednesday that the U.S. Department of Veterans Affairs is planning to open a community based outpatient clinic in Craig. An organized group of veterans in Craig have fought for the clinic for decades, Salazar said. Approximately 4,200 veterans, who currently must drive to either Grand Junction or Denver for service, could use the clinic. The VA plans to open the clinic this fall.

Salazar also announced that he introduced the Rural Veterans Healthcare Improvement Act last week. The measure aims to address the disparity in treatment between rural and urban veterans, expand options by partnering with local clinics and provide additional transportation options.

Today’s congressional hearing on patient care problems at the Salisbury VA hospital could be the first of many sessions intended to bring tougher oversight to the nation’s largest healthcare system.

The hearings follow Observer stories about accounts of poor treatment at the main veterans hospital for the Charlotte area.

U.S. Rep. Bob Filner, the California Democrat who heads the House Veterans’ Affairs Committee, says problems make the Salisbury VA hospital a “case study” for nationwide reforms.

“We need a more aggressive investigative process,” Filner told the Observer on Wednesday.

“What exists is just broken.”

He said workers he’s talked with at other VA hospitals fear losing their jobs if they discuss worries about patient care.

“When there is that kind of fear, there are enormous systemic problems,” he said.

Matt Burns, VA press secretary in Washington, said he disagrees with that characterization. “The department has numerous mechanisms in place and an environment which encourages employees to notify superiors when issues arise.”

The Observer has reported that two top former employees say they were forced out of their jobs after warning of patient care problems at the Salisbury VA hospital. One was a radiologist, Dr. Paul Karmin, and the other a chief nurse, Donald Doering.

Results of two VA inspections in the last month also are expected at the hearing. Filner said there will be “lots of” hearings to determine more effective monitoring of VA health care.

Salisbury hospital officials have said they made fixes when problems were identified. Documents obtained by the Observer indicate some problems persisted. Karmin and Doering said hospital management did not act on their concerns.

A key issue at the hearings will be whether there was adequate follow-up after VA investigators found in 2005 that the hospital provided bad care in cases reviewed, including two deaths. The VA closed the investigation last year, without a second visit, after the hospital said it made recommended changes.

The report of the 2005 VA investigation was not made public until the Observer obtained it last month. Last year, the VA didn’t tell its investigators conducting a routine inspection about the problems identified in 2005 by another branch of the agency. The 2006 inspection report revealed other problems.

Three N.C. members of Congress requested Filner hold hearings: Republicans Howard Coble of Greensboro and Robin Hayes of Concord, and Charlotte Democrat Mel Watt.

They urged the same intensity of scrutiny being given to Walter Reed Army Medical Center following reports this year of deplorable conditions for wounded soldiers. Army hospitals are not part of the VA system.

Since learning of the 2005 VA report, family members of one patient whose death was investigated have been questioning what more they could have done.

Carrol Edward Minish, 68, of Conover, died in 2004 after surgery to remove a gangrenous toe. VA investigators said the surgeon’s grasp of critical information was “rudimentary at best.”

Minish’s daughter, Carolyn Winters, said she wishes she had spoken up at the time about frustrations she had with her father’s care. She hopes the hearings will prompt the agency to improve.

“They risked their lives for us,” she said of veterans. “You go to a hospital to get better, not to come out in a body bag.”

All Things Considered, April 20, 2007 · When service members are forced to leave the military by war injuries or illness, they face a complex system for getting health and disability benefits. Sometimes, health care gets cut off when new veterans find they need it most. Some retired soldiers and their families say they are worried that the Pentagon won’t spend enough money to give the injured the care they deserve.

Click here to listen to the NPR broadcast:  http://www.npr.org/templates/story/story.php?storyId=9710383

’10 Percent Disabled’

Tim Ngo almost died in a grenade attack in Iraq. He sustained a serious head injury; surgeons had to cut out part of his skull. At Walter Reed Army Medical Center in Washington, D.C., he learned to walk and talk again.

When he got back home to Minnesota, he wore a white plastic helmet to protect the thinned-out patches of his skull. People on the street snickered, so Ngo’s mother took a black marker and wrote on the helmet: U.S. ARMY, BACK FROM IRAQ. On this much, everyone agrees.

But here is the part that is in dispute: The Army says Tim Ngo is only 10 percent disabled.

“I was hoping I would get at least 50 or 60 or 70 percent,” Ngo says. “But they said, ‘Yeah, you’re only going to get 10 percent’… And I was pretty outraged.”

When a service member is retired for medical reasons, the military’s disability rating makes a difference. If Ngo had been rated 30 percent disabled or higher, he would have gotten a monthly disability check instead of a small severance check. He also would have stayed in the military’s health-care system.

Instead, Ngo enrolled with the Department of Veterans Affairs. Typically, there’s a waiting period for the VA.

In October, while he was uninsured, Ngo had a seizure, caused by his war injury. He remembers being outside and blacking out; he fell to the ground on the driveway.

“My girlfriend was freaking out because she didn’t know what to do,” Ngo says. “She didn’t know if I was going to die because I had hit the wrong side of my head.”

An ambulance took Ngo to the nearest emergency room for treatment. It cost him $10,000. Ngo says that today, the bills for the incident are still unresolved.

Shrinking Numbers

Since that day, Ngo has gotten health coverage through the VA. Earlier this month, the VA said it would pick up his leftover bills from the emergency room.

The VA has been more generous than the Army all around. It rated Ngo as 100 percent disabled compared with the Army’s 10 percent rating.

The VA gives him a monthly disability check, which helps with his finances; his head injury and post-traumatic stress disorder have prevented Ngo from holding on to even a simple job since he returned home.

Ngo’s mother, Hong Wyberg, says the Army gives soldiers such as her son low disability ratings to save money.

“I don’t fully think they were prepared for the length of time this war is going to last,” Wyberg says. “They had no idea of how many injuries or the type of injuries that were going to come out of this.”

Michael Parker retired from the Army in October, and he thinks Wyberg’s suspicion is correct.

“The more I looked into it, I realized that this system does not have the soldier’s back at all,” says Parker.

Parker was a lieutenant colonel when he retired last year. Today, he has a disabling condition similar to rheumatoid arthritis. Parker was able to get the Pentagon’s lifelong health coverage for himself and his family; he had been in the military long enough — for at least 20 years.

But Parker saw that a lot of other soldiers weren’t as lucky, and it inspired him to become an advocate.

“I started posting questions and concerns and opinions on various blogs,” he says, “and it just kind of mushroomed from there.”

Parker started digging through Pentagon data, and the numbers he found shocked him. He learned that the Pentagon is giving fewer veterans disability benefits today than it was before the Iraq war — despite the fact that thousands of soldiers are leaving the military with serious injuries.

“It went from 102,000 and change in 2001… and now it’s down to 89,500,” says Parker. “It’s counterintuitive. Why are the number of disability retirees shrinking during wartime?”

A ‘Cost-Saving Device’?

Retired Army Lt. Gen. James Terry Scott heads a commission, set up by Congress, to study veterans’ disability benefits. At a Senate hearing last week, Scott said that his commission had compared the way the Pentagon and the VA rated the same soldiers.

“The Department of Defense records were matched with VA records on 2.6 million veterans receiving disability compensation,” Scott said. “Those rated zero, 10 or 20 percent [disabled] by the Department of Defense were rated in the 30 to 100 percent range by VA more than half the time.”

In other words, troops often get small disability checks and no military health care when rated by the Pentagon’s disability boards. But when they go to a VA board — with the same injuries — they get much more.

Scott said one reason is that the military’s ratings determine whether a person is fit for duty, whereas the VA looks at all conditions that create health problems for a veteran. So the VA ends up rating more disabilities per retired service member.

But Scott said another reason may be that the Pentagon wants to keep down its costs.

“It is also apparent that the Department of Defense has a strong incentive to rate less than 30 percent, so that only severance pay is awarded,” Scott said.

These numbers yielded some tough questions for Pentagon officials at the Senate hearing, such as Deputy Defense Secretary Gordon England.

“How do you respond to [the] assertion [that] the Department of Defense reduces disability ratings as a cost-savings device?” asked Sen. James Inhofe (R-OK).

“I can tell you… there’s no incentive to do that, senator,” England replied. “I mean, maybe that’s read into that. But I can tell you, we try to treat people fairly and accurately. And so there’s certainly no incentive.”

Pentagon officials conceded that the disability system doesn’t work as well as it should. They admitted it is too bureaucratic and too often adversarial. They said they would listen to suggestions for change.

Navigating the System

But change in the future will come too late for many soldiers.

April Croft was serving in Afghanistan when she was diagnosed with leukemia. She was treated for a year at Walter Reed. The cancer seemed to go into remission and she was sent home.

“They told her that she was only eligible for a 10 percent rating with the illness of leukemia,” says her husband, Mark Croft. “She was livid. She’s actually contested that situation about three times already.”

The Army never increased its 10 percent rating, but the VA rated her 100 percent disabled.

Croft spoke from his wife’s room in a VA hospital in Seattle, where she recently underwent a bone-marrow transplant.

“The VA originally gave her 50 percent and upped it to 100 percent once… she got sicker,” Mark Croft explains.

The VA provided the life-saving operation April Croft needed, but the low rating from the Army still mattered: The VA only covers veterans, not their families. It is the military health-care system that will insure an entire family — but only if the vet has a disability rating of 30 percent or more. April Croft has two young children, who are living with their grandparents in California.

Her kids eventually did get military health care — but only recently, after their mother married Mark, who is still in the Army. Mark and April wed in Reno in March. Afterward, he was given leave from the Army. Instead of taking off for a honeymoon, the newlywed couple drove to Seattle and checked into the hospital.

It’s the kind of complicated arrangement that many veterans must make to navigate the military’s complicated disability system.

Today’s Disability Retirement Squeeze Began Years Ago       

Wary of rising disability retirement costs, the Department of Defense under then-secretary Caspar Weinberger quietly sought and received an internal legal opinion that, to this day, tamps down the number of wounded or ill service members awarded military disability retirement.

The March 25, 1985, memo from the DoD office of general counsel, which only recently came to light, gave Defense health officials a green light to restrain military disability ratings without a change in law.

They did so by directing the services to stop setting disability awards based on all service-connected ailments found during medical evaluations, and start basing them only on conditions that leave members unfit for duty.

The policy change took effect in February 1986 with a revised DoD instruction to services. Its impact can be profound on individuals, particularly in wartime. The Veterans’ Disability Benefits Commission is studying the effects and its chairman this month sounded an alarm.

The advantages of receiving disability retirement, which requires a 30-percent or higher disability rating, are great for members with less than 20 years in service. Beside an immediate annuity, disabled retirees and their families gain lifetime access to TRICARE, to base shopping privileges and to a host of other perks tied to “retiree” status.

Veterans with disability ratings of 0 to 20 percent receive only a lump-sum severance payment upon discharge. They can apply to the Department of Veterans Affairs for a higher rating and will often get one, which can mean monthly VA compensation and improved access to medical care. But VA care isn’t available to families and VA doesn’t offer base-like support services.

The experience of Army National Guard Spc. Kenneth Parham, 47, shows the impact of the 1986 policy shift on disability awards today. In April 2005, Parham was in the gun turret of a Humvee when it drove over a bomb buried beneath a road outside Kirkuk, Iraq. The explosion tossed his Humvee high into the air. It was Parham’s third contact with an improvised explosive device in five months. This one collapsed a lung, fractured ribs and damaged discs in his neck and back.

Today, the once vigorous Parham, who as a civilian drove a moving van and lifted up to 5000 pounds of household goods a day, needs a motorized cart to shop in stores. He has chronic neck and back pain. He must walk slowly, sit frequently and can’t lift more than 20 pounds. Because he can’t wear a helmet or his carry a rucksack, the Army has found the former Marine unfit for duty. It plans to discharge Parham with a 20-percent rating and about $40,000 in severance. Next week, he will travel from his home in Lewiston, Idaho, to Fort Lewis, Wash., to appeal that rating decision before a physical evaluation board.

His wife, Cheryl, said a 20-percent rating is so unjust, given how her husband’s quality of life and job prospects have plummeted.

“How’s he going to support himself the rest of his life,” she asked. Service-connected ailments that the Army ignored in setting the 20-percent figure, she said, include post-traumatic stress disorder with nightmares, a weakened leg, the sleep apnea, high-blood pressure and arthritis.

Injured war veterans of Iraq and Afghanistan are becoming more aware of the critical 30-percent threshold. Some credit for that goes to retired Army Lt. Gen. James Terry Scott, chairman of the Veterans’ Disability Benefits Commission. Scott spotlighted the value of 30 percent ratings, and ruffled feathers of DoD officials, before a Senate hearing last week when he said the higher cost of disability retirement, versus severance pay, gives DoD “a strong incentive” to award 20 percent or less.

No service does it more often than the Army, according to fresh service data released by Scott. From 2000 through 2006, the Army gave ratings of 30 percent or higher to only 13 percent of soldiers deemed disabled. By comparison, the Navy awarded disability retirement to 36 percent of its disabled members. The Air Force number was 27 and the Marines Corps 18 percent. 

More troubling, Scott suggested, was data showing Army awarded a 0 percent rating to 13,646 soldiers that it found unfit for duty. The Navy, Marine Corps and Air Force had assigned 0 ratings only to 400 apiece.

Scott said he wasn’t speaking for the commission which won’t finish its report until fall. But he urged Defense officials to allow the services to begin setting disability awards based on all service-connected disabilities found.

To ease rating disparities across the services, and between DoD and VA, he recommended that the VA alone conduct all medical evaluations and set all disability ratings before members leave service.

Col. Andy Buchanan, deputy commander of the Army’s Physical Disability Agency (PDA), said he would quibble with some of the commission’s data but clearly there are troubling disparities in ratings between services that can’t be explained by “mission differences” alone.

“I know where we’re different right now, but I have to find out why,” said Buchanan. He has recommended an independent audit of service disability awards to identify the factors creating the service disparities. But Buchanan, in our phone interview, denied that the PDA or individual evaluation boards operate with any concern for how rating decisions  impact Army budgets.

The Army does not follow VA criteria to rate every condition. For example, the VA rates some sleep apnea as 50 disabling, higher than the loss of a limb, Buchanan said. Also, unlike the VA, the Army does not presume that every medical condition that surfaces while in service is “service-connected.”

“We’re pretty rigid – and that may be why we’re perceived as stingy — about following the rules, looking for evidence,” Buchanan said.