Veterans for Common Sense

SWEETWATER, Tennessee — David Thomas has a left leg made of carbon fiber and steel, and the composed bearing of a man who has learned to wait.

The 42-year-old father of four waited six months for the Department of Veterans Affairs to declare him 70 percent disabled, based on the loss of his leg and damage to his vision during his service in Iraq as a sergeant with the National Guard’s 278th Regimental Combat Team. Now, 19 months after two anti-tank mines exploded beneath the humvee where he was manning the gunner’s turret, he still is waiting for the VA to make a disability judgment on his dozen other injuries.

“I don’t think they really expected all these injured people to come back (from Iraq),” Mr. Thomas said. “They’ve got paperwork for all these injured soldiers just stacked up.

The U.S. commander of the Veterans of Foreign Wars called the VA’s claims processing system “broken” in testimony in March before a joint hearing of the House and Senate Veterans Affairs Committees.

Gary Kurpius said the VA has an “unmanageable” backlog of claims. One in eight is decided wrongly every year, he said.

“It is unacceptable, because each delay and every wrong decision have real human costs,” he said. “No disabled veteran should have to wait for benefits many of them need to care for themselves and their families.”

Mr. Thomas’ wife, April, calls the claims process “ridiculous.” Her husband, who spent a year at Walter Reed Army Medical Center in Washington, D.C., now has to travel all over Tennessee — from Johnson City near the Virginia line to Murfreesboro outside Nashville — to have his injuries re-examined at VA medical facilities.

“They go through so much treatment and stuff at Walter Reed, and they have all his medical records — stacks of them — and then he comes back here and has to redo everything,” she said.

Mr. Thomas remembers how crowded the hallways were at Walter Reed, how hard it was to get simple things. The hospital didn’t provide him any clothes to wear during his first few months there — he finally got one shirt and one pair of pants from the Red Cross. The system is just overwhelmed, he said.

So he waits, his claim one of hundreds of thousands bottlenecked in the VA’s benefits system. Donald Samuels, a spokesman for the Tennessee Department of Veterans Affairs, calls the national backlog of VA benefits claims “tremendous,” estimating it at about 600,000.

“You’ve got vets out there that have to wait six, seven, eight, nine months to get a decision on their claim,” he said. “Chances are they’re going to lose their house and everything else while they wait for their claim to be decided.”

HIGH DEMAND

The number of claims handled by the Tennessee Department of Veterans Affairs has increased by about 60 percent each year for the last several years because of a combination of aging veterans from earlier wars and younger veterans coming home from Iraq and Afghanistan, Mr. Samuels said.

In fiscal 2006, the agency handled 84,000 claims. “This year it looks like it’s going to exceed that by quite a bit,” Mr. Samuels said.

There are about 540,000 veterans in Tennessee, he said.

In a study of the costs of caring for soldiers returning from war in Iraq and Afghanistan, Harvard University public policy professor Linda Bilmes reported the VA had a national backlog of 69,000 pending initial disability claims in 2000. As of January 2007 there were 400,000, she reported.

There is no time limit on when a veteran must make a claim for most disability benefits, and the VA still is handling hundreds of thousands of new claims from Vietnam veterans, according to her study.

“The current claims process is unable to handle even the current volume and completely inadequate to cope with the high demand of returning war veterans,” Ms. Bilmes wrote.

In testimony in March before the U.S. House Committee on Veterans Affairs, the VA’s deputy undersecretary for benefits pointed to a striking growth in demand for benefits.

“The number of veterans filing initial disability compensation claims and claims for increased benefits has increased every year since 2000,” Ronald Aument said.

Operations in Iraq and Afghanistan and increased outreach to veterans are major reasons for the growth in claims, he said. Also, disability claims have become considerably more complex, with the number of claims citing eight or more disabilities increasing from 21,814 in 2000 to 51,260 in 2006 — a 135 percent increase, he said.

“Under the very best of circumstances, it takes about four months to fully develop a claim,” he said.

The VA is hiring to try to move claims more efficiently, he said, bringing in more than 580 employees during 2006 and adding 400 more by the end of June. However, it takes two to three years of training to get those workers “fully productive,” he said.

THE LINE OF DUTY

Mr. Thomas came home from Iraq on leave in July 2005 to move his wife and youngest children — Maci, 10, and Megan, 6 — into a three-bedroom house set on two grassy acres in rural Sweetwater.

Horses graze the land next door, a couple of cats hang around the back deck, the occasional pickup truck rattles up a gravel driveway to the neighbor’s house at the top of the hill.

“It’s quiet here,” Mr. Thomas said.

But it would be more than a year before he lived there himself. After his leave, he’d been back in Iraq 20 days when two anti-tank mines buried in a dusty road blew apart his humvee and left him with a left leg that ends 3 inches above the knee. Two of his comrades were killed that day — Aug. 22, 2005.

Sgt. Victor Lieurance was 34 and from Seymour, Tenn. Spc. Joseph Hunt was 27 and from Sweetwater.

Mr. Thomas joined the National Guard in February 2003 knowing he would be sent to Iraq. On May 14, 2004, he deployed with the 3,700 members of the 278th for six months of training in Mississippi and California followed by a year of service in Iraq.

“That’s what I jumped in it for,” he said. “You’d see all these guys getting wounded and getting killed, and you just feel worthless.”

He’d been in the Army from 1987 to 1990, so he already knew something about military service. And he’s not sorry he went to Iraq. He loves his country; he did what he thought was right. He would do it again, he said.

The month before he was injured, he had signed up for six more years in the Guard.

“I didn’t see this coming,” he said quietly, resting his right ankle just above his mechanical left knee. “But I can’t complain. My two friends — they’re gone. I lost two good buddies, and they were good boys.”

His friend Joey Hunt had re-enlisted that month, too.

“He believed the same way I did,” Mr. Thomas said. “We believed in what we were doing.”

THE HOME FRONT

April Thomas, 35, was at work when she got the call from her husband’s commanding officer. She walked away from her construction job that day and would not see another paycheck for 17 months.

She lived for several months at Walter Reed, then spent several more months taking care of her family and helping her husband travel back and forth for visits home. While she lived at Walter Reed, the Army paid her $48 a day for meals and other expenses.

“I just went back to work in January,” she said. She drives an hour to Oak Ridge, Tenn., every day to work construction.

During his year at Walter Reed, Mr. Thomas waited six months for the Department of Veterans Affairs to make a determination on his disability claim. The grisly arithmetic of war assigns 60 percent disability for amputation above the knee. The VA gave Mr. Thomas another 30 percent disability because of the his loss of vision from the blast.

But his total disability came back at 70 percent, not the 90 percent he expected.

“Don’t ask me how they do their math,” he said.

He earned about $4,000 a month while he was in Iraq. The 70 percent disability ruling meant an income of about $1,600 a month. Eager to get home to Tennessee and his family, he took it.

“I just wanted to go to my house and live a normal life,” he said.

A lump-sum insurance settlement because of the loss of her husband’s limb carried the family for a while, along with his disability payments, Mrs. Thomas said. But she had to get back to work.

“I made 50 (percent) or 60 percent of our income,” she said. “You lose that much and the bills are based on that, there’s no way you can make it. We wouldn’t have been able to make the house payment.”

Her husband, who spent nine years making truck parts at a factory in Sweetwater, has not been able to find a job. He ferries his daughters to and from school. He catches up on TV shows he missed while he was deployed.

A friend is trying to help him get a job working dispatch for an area law enforcement agency. Mr. Thomas said he hopes the job comes through, though “I’d rather be patrolling.”

If he were declared 100 percent disabled, Mr. Thomas would get about $2,400 a month. He called the VA a couple of weeks ago to check on the status of his disability claim.

It will be 60 to 90 more days before he hears anything, they told him.

So David Thomas waits.

WASHINGTON, March 29 — Lapses in using a digital medical record system for tracking wounded soldiers have led to medical mistakes and delays in care, and have kept thousands of injured troops from getting benefits, according to former defense and military medical officials.

The Defense Department’s inability to get all hospitals to use the system has routinely forced thousands of wounded soldiers to endure long waits for treatment, the officials said, and exposed others to needless testing.

Several department officials said the problem may have played a role in the suicide of a soldier last year after he was taken to Fort Lewis in Washington State from Iraq. His intentions to kill himself were clearly documented in his digital medical record from overseas, but doctors at Fort Lewis did not consult the file and released him, according to department records and defense officials.

“The D.O.D.’s failure to share data and track patient records is truly a matter of life and death,” Senator Patty Murray, Democrat of Washington, said in a statement. “This isn’t an isolated case, but a system-wide failure.”

The system was designed to make seamless the transition of soldiers who were wounded in Iraq and Afghanistan as they moved to hospitals stateside. But only 13 of 70 military treatment centers in the United States use it even though it was mandated by the Pentagon more than two years ago, according to agency documents.

As a result, military doctors say they are less able to learn from mistakes since they cannot track the progress of wounded soldiers from one location to another. Others complain of costly and redundant testing.

“Patients are being unnecessarily exposed to radiation,” said Lt. Col. Gina Dorlac, medical director of the intensive care unit at a hospital in Landstuhl, Germany, where most severely wounded soldiers are taken from Iraq.

She said doctors from Walter Reed Army Medical Center and elsewhere regularly ordered CAT scans and M.R.I.’s even though the same tests had already been performed and the results were in the tracking system. “It’s a waste of time and money,” Colonel Dorlac said.

X-rays and CAT scans are generally considered safe, but doctors are wary of unnecessary tests because radiation can be harmful if it accumulates in a patient over time.

M.R.I.’s do not produce radiation.

Colonel Dorlac said that most doctors who used the system agreed that it worked well. But she said many doctors at United States military hospitals seemed reluctant to use it because doctors did not know they had access or were unwilling to learn how to use it.

Until he left the Defense Department in August, Tony DeNicola was responsible for ensuring that the digital system, known as the Joint Patient Tracking Application, was used throughout the military. In an interview, Mr. DeNicola said he ran into resistance: “We couldn’t get the services to use the system because they wanted to use their own. We also never got enough cooperation from the office in charge of electronic patient records.”

The application was developed in 2004 to allow doctors and military officials to track the medical care given to troops from the moment they arrive at field hospitals in Iraq or Afghanistan through their stay in military hospitals stateside.

The Internet-based system allows doctors or other personnel to enter or view clinical data and upload images from certain types of tests. Defense Department officials said the system was just one of several sources of information used in providing care for soldiers.

Tommy J. Morris, director of deployment health technologies and support programs, also said that the record system was being integrated into a larger defense system, which would particularly help in tracking patients moving into the Department of Veterans Affairs system.

Frustrations with the Pentagon’s tracking of medical data come at a time of growing concern on Capitol Hill about medical treatment and benefits for soldiers coming home wounded from Iraq and Afghanistan.

On Tuesday, defense officials testified before Congress that their department was improving data tracking and increasingly sharing medical information with Veterans Affairs. But Senator Murray raised concerns that the Joint Patient Tracking Application was not being used.

The Defense Department blocked Veterans Affairs access to the system entirely in January and as of this week only 12 of the 40 authorized V.A. officials and doctors had had their access restored, according to Defense Department records.

Representative Steve Buyer, Republican of Indiana, said he sought a meeting with Defense Department officials after visiting a V.A. hospital in Minneapolis where doctors lacked direct access to the patient tracking system and were still receiving faxed medical records from military hospitals.

He said he left that closed-door session on Wednesday after an hour and a half of discussion “not knowing the answer” to when the problems with data tracking would be resolved.

For wounded troops, the difficulties have complicated an already frustrating experience, according to veterans advocates and defense officials. At military hospitals that still depend on paper records, wounded soldiers endure long waits for appointments because their records cannot be found or were never transferred, advocates say. Soldiers also face delays in getting rehabilitation because defense officials do not use the system to assign specialists to centers with the biggest backlogs.

According to a congressional aide who attended the meeting on Wednesday, Defense Department officials said they were not familiar with the details of the Fort Lewis suicide.

According to other defense officials and department records, that soldier was evacuated from his unit in Mosul, Iraq, on Aug. 18, 2006, after telling doctors he had thoughts of suicide. After being evacuated to a military hospital in Germany, the soldier received psychological treatment and his condition was noted in the digital records system. On Aug. 24, he was sent to Madigan Hospital at Fort Lewis but was not admitted.

On Sept. 7, he killed himself. Defense records indicated that doctors at Fort Lewis did not check the soldier’s file in the digital system, where his suicidal tendencies were described, until a day after his death.

Sharon Ayala, spokeswoman for Madigan Hospital, said the hospital would not comment on the case because of privacy issues.

“Please be assured that the Army takes suicide and the risk of suicide very seriously,” Ms. Ayala said, adding that all troops returning from Iraq and requiring mental health evaluations are seen and evaluated by mental-health providers the day they arrive.

Soldiers may also not be receiving certain benefits, such as $430 a month for combat-related injury rehabilitation pay, because the office that provides those checks depends on data from the digital system to determine which soldiers qualify, according to Mr. DeNicola, the official who used to oversee the system.

Lt. Col. Mike Place, a physician at Blanchfield Army Community Hospital at Fort Campbell, Ky., said it was important for stateside doctors to use and update the digital records because doctors in Iraq and Afghanistan often access the files to check up on soldiers they cared for and to learn from the results.

Colonel Place said, for example, that many soldiers with blast wounds in Iraq experienced certain complications after returning to the United States, like muscle swelling that causes severe nerve damage. If battlefield doctors knew that, they could change how they treat soldiers immediately after they are wounded.

With the Joint Patient Tracking Application, Colonel Place said: “We don’t have to wait until the surgeon comes home to tell them. They can see the trend right away and start making changes.”

Steve Robinson, a veterans’ advocate, said virtually all military doctors agreed that the digital system was effective in tracking patients. But he added that he had participated in seven Congressional hearings, most recently last week, that focused on problems with how the defense and veterans departments track medical information.

“We don’t really have time to wait for another system to come online when we have one ready now that the D.O.D. approved,” Mr. Robinson said. “The tools are there, but we just keep having meetings about whether to use them.”

Defense Department officials say they need more time — and an additional $30 million in the next fiscal year — to integrate the joint patient tracking system with the department’s larger system, an effort that has already cost more than $200 million. The Joint Patient Tracking Application cost an estimated $320,000 to develop and about $2 million a year to operate, according to Defense Department documents.

But last September the department certified that the tracking application had adequate security and privacy protections, according to documents from the office of the deputy assistant secretary of defense for force health protection and readiness.

WASHINGTON — Veterans Affairs officials wasted millions on a $100 million computer security contract that became a virtual “open checkbook” because of poor oversight and sloppy management, an internal review says.

The audit by the VA inspector general brings renewed attention to problems of data security and contract management after the department sustained blistering criticism for its loss of nearly 26.5 million veterans’ sensitive personal information last May.

It found that the VA put out multiple and inconsistent changes to the contract awarded in 2002 to VAST, a small business joint venture based in Texas, for computer service work aimed at fending off computer hackers.

In the report, the VA generally agreed with the findings. It said it has created contract review boards to help improve oversight and will seek to recoup lost or unaccounted for payments.

“VA is committed to being a good fiscal steward of taxpayer dollars in carrying out our important mission of serving veterans,” spokesman Matt Burns said Wednesday.

According to the findings, the VA:

—Spent more than $35 million for equipment and supplies under the contract that it cannot account for.

—Hastily increased the scope of the contract several times, bringing the total value of the contract from $102.8 million to $250 million with little thought or oversight. “This made the contract an open checkbook … with little assurance of price reasonableness and no planned funding.”

—Did not ensure that the joint venture, VAST, met requirements to qualify as a small business.

—Made overpayments on the contract as high as $8.5 million.

—Did not conduct required background investigations on the contract employees.

In addition, because the department spent money on the contract so quickly, it was left temporarily without a defense against hackers after the 10 year contract was allowed to expire prematurely in 2005.

In recent weeks, VA officials have faced a fresh round of bipartisan criticism over data security, with auditors telling Congress that gaping holes persist and that most VA data remains unencrypted.

At a hearing last month, Maureen Regan, counselor to the VA inspector general, said the department still hasn’t fully implemented any of its recommendations from reports dating back to 2001.

The department also hasn’t adopted five key recommendations issued shortly after the massive data breach last May involving veterans. That data was later recovered.

The IG report was publicly released Feb. 26 and first noted Tuesday by McClatchy newspapers.

Letter to the Editor, 

Thank you for a fantastic article about the problems veterans face obtaining disability compensation payments for their military-related medical problems from the Department of Veterans Affairs (“Insult to Injury,” by Lisa Sorg, March 14, 2007). Link: http://www.indyweek.com/gyrobase/Content?oid=oid{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}3A46354

Here’s more bad news. The problem is very serious for older veterans, and it is getting even worse for new veterans. More than 180,000 Iraq and Afghanistan war veterans already filed disability claims against the VA, further increasing the backlog of delays and bureaucratic red tape. As the wars continue to escalate, based on current trends, new war veterans will file hundreds of thousands of more claims against the VA.

There are three solutions to the VA’s claims crisis. First, veterans should be able to hire attorneys, and Congress moved in that direction last year, as you reported. Today, when a veteran gets a reject letter from the VA, the veteran should send in a “notice of disagreement” right away and hire a lawyer to avoid the two years it takes for VA to process appeals. Veterans should be able to hire an attorney for their initial claim so they are on equal footing with the hundreds of lawyers working for the VA.

Second, the VA should immediately hire and train more claims processors so veterans and their families can put food on the table. Veterans shouldn’t be forced to suffer from bad credit, evictions, foreclosures and worse because the VA didn’t hire more staff to deal with the surge in new claims from the Iraq and Afghanistan wars.

And, third, the VA needs a massive overhaul. To do that, the agency needs to think outside the box. Harvard Professor Linda Bilmes testified before Congress last week that the VA should grant all new claims because it approves nearly 90 percent anyway. Then the VA can audit the completed claims for fraud and problems. There are two bills, S117 and S713, that provide practical solutions now. Call Congress and demand these bills be debated and enacted.

If the VA doesn’t act now, not only will the crisis worsen, our war veterans will needlessly suffer, and that’s not right. When our veterans need medical care and benefits, they should get them right away.

Paul Sullivan
Executive Director, Veterans for Common Sense
Washington, D.C.

Experts: Many Civilians Scared To Ask For Help

WASHINGTON — A rising number of American troops are being treated for post-traumatic stress disorder, but another segment of the population is also dealing with the disorder.

They are civilians who choose to work in war zones.

Video: Watch The Report

America’s current conflicts have placed civilians including federal workers, journalists, relief agency employees and government contractors in harm’s way.

“All the people who are in that war zone for a prolonged period of time absolutely are at risk,” said Dr. Barbara Romberg, a clinical psychologist.

Romberg has created a network of more than 200 mental health experts to help returning veterans receive counselling for PTSD.

She is also hoping to expand the services to civilians.

Experts said that civilians who return from war zones shouldn’t be afraid to ask for help if something doesn’t feel right.

“People who have seen the worst don’t like to complain,” said Dr. Jeffrey Jay, a clinical psychologist. “So they tend not to seek help for themselves.”

Jay has studied and treated PTSD for the past four decades.

He said civilians often say fear is a reason they don’t seek help.

“They sort of, like, quietly come here because they don’t want to let their organization know that anything is going on because they’ll lose their position, they’ll lose their pay,” said Jay.

Experts said most people working in Iraq are mainly afraid of suffering physical wounds but that too often, the mental wounds are the hardest to recover from.

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