The United States Department of Veteran’s Affairs (VA) was created in 1930 to ensure the welfare of war veterans by providing coordination and cooperation at the Governmental level with programs such as disability compensation, education, home loans, life insurance, finding a job, medical benefits, pension as also benefits for a decent burial. The aim of the department was to ensure that all veterans and their families would be looked after by the state for the supreme sacrifices that they had made in the line of duty to the nation.
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The department’s mission statement borrowed from Abraham Lincoln’s second inaugural address “for he who has borne the battle, and for his widow and his orphan” (Scurfield 88) encapsulates the recognition a state gives and owes to its men in arms. However, there is a mismatch (real or perceived) between the lofty ideals and the actual performance of the VA, a charge which is the main focus of this essay.
To examine the performance of the VA since its inception it is necessary to first examine its structure and administration. The VA is a government run health-care system that has a budget of $ 87.6 Billion and employs about 280, 000 people in scores of VA facilities spread over US territories. The department is headed by a Secretary and is usually a retired service officer chosen by the President. The Department has three main branches; Veterans Health Administration, Veterans Benefits Administration and National Cemetery Administration. Since the entire concept looks at ‘invalidation to grave’ time span, the department has to prioritize its activities to maintain its costs within the allotted annual budget.
Prioritization is carried out by classifying the veterans into eight groups and several additional groups based on a complex matrix of factors such as service related disabilities, the individual’s income and assets. The classification of a disability is carried out by a VA rating board by the numerous VA regional offices. Those who are rated with 50% or more disability get a comprehensive medical care free of cost; others with lesser disabilities have to make pre-determined contributions to receive the medication and care at subsidized rates.
In recent times, veterans have expressed growing dissatisfaction with the performance of the VA department’s ability to look after their genuine needs. One of the main reasons has been that the number of casualties have increased dramatically since the US ‘War on Terror’ unfolded in 2001 and shows no signs of being closed down. The number of veterans with 50% or more disabilities is steadily increasing as militants and terrorists in the two main war fronts; Iraq and Afghanistan use Improvised Explosive Devices (IEDs) and suicide bombers to deadly effects.
Most of these weapons cause US armed personnel to lose limbs or other grievous injuries that qualify for 50% or more disability and this fact is straining the limited VA budget. The sheer number of veterans claiming disability has resulted in a back log which some estimate to be about 340, 000 personnel. In 2006, 7.5 million veterans were listed on the rolls of the VA department (Lee¶ 2). In the US, out of 24.4 million veterans, 16.9 million are not enrolled in the VA health care system (Lee ¶4).
The tragic part of this waiting period is that those personnel who are no longer considered to be on active duty have no medical care cover provided for active duty personnel and till such time they get their VA disability benefits, the veterans have to look after themselves. Such a time lag is ruinous for the veterans, because they then suffer not only physically and mentally but also financially.
The Veteran’s Affairs Department’s own investigation reveals that “a study of group of 52 patients that received VA treatment had gaps in follow-up care and family counseling 16 months after the injury” (Veterans Today ¶3). The Government Accountability Office had found that it takes an average of six months for veterans to get their disability payments (Allen ¶2). One of the main reasons for the delay has been the inadequate numbers of professionals that are employed by the VA department to carry out diagnostics. Post Traumatic Stress Disorder (PTSD) is very hard to diagnose and inadequate health professionals add to the problem.
As far back as 2001, the US Government’s General Accountability Office had noted that “there is a potential shortage of skilled nurses” (GAO 2001 7).It is a fact that some 38 percent of veterans have been identified with some mental health condition (Stiglitz and Bimes 82) and the lack of adequate staff extends the time which veterans suffering PTSD have to wait. Similar is the case with brain injuries. The actual extent of brain injuries again requires specialists, the numbers of which are limited by the budget limitations of the VA department.
The other major weaknesses in the VA department’s structure has been the weakness of its quality and reliability of its workload and cost data. Without reliable data the VA department remains handicapped in its ability to carry out comprehensive long range forecasting. Of the approximately 4,700 buildings and 18,000 acres of land holdings, many regional offices amongst the 57 regional offices are still using legacy IT systems. Some still rely on fax machines and paper records. Since a comprehensive computerized data base of all the veterans is not available at the VA headquarters, identity processing takes a long time which then impinges on the overall planning parameters and leads to further delay.
Delays in getting help from the VA department drastically affects the psychological stability of an already vulnerable veteran who then may soon end up as an alcoholic, taking drugs or resort to violent anti-social behavior.
Crowell reports that one such veteran on not getting a prosthetic leg for months, got drunk and drove his vehicle into a building (Crowell 5). Veterans reveal stories that in an effort to keep the expenses down, the VA regional offices often try and discourage veterans from opting for college education as that would be too expensive for the VA to afford. This sort of negative counseling only increases the frustrations of the veterans who then feel ‘cheated’ and ‘used’ by a country which does not care. Whether such stories are true or figment of imagination of disturbed minds is a contentious issue. The very fact that they surface in the media, points to the fact that all is not well at the VA department.
To cut costs, the VA department has teamed up with the Department of Defense to pool resources. Local VA medical centers and military medical centers have entered into agreement to exchange inpatients, outpatients, and specialty and support services. However, such sharing has been patchy and that overall, 75% of direct medical care episodes provided under the sharing program occurred under just 12 agreements for inpatient care and 19 agreements for outpatients care, which by any standards is just a drop in the ocean.
Another major problem has been the spatial distribution of VA health care facilities. The 2003 GAO report observes that of more than 25 % of the veterans enrolled, about 1.7 million stay more than 60 minutes driving distance from the nearest health care facility (GAO 2003 6).
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This means that veterans who require critical health care at critical times may find it difficult to reach the facility in time. The standard is only for those staying in urban areas. For those staying in rural areas, the time lapse is in excess of 90 minutes and those veterans staying in remote parts of America, in excess of 120 minutes. These time delays in reaching critical health care facilities and the uneven spatial distribution of healthcare infrastructure is yet another failing of the VA department which is yet to be rectified.
Not only are the facilities unevenly distributed, they are being kept alive on shoe string budgets as the disgrace of Walter Reed Hospital shows. The Washington Post story vividly describes the state of the hospital rooms with torn walls and black mold, mouse droppings, dead cockroaches, holes and smell of grease (Priest and Hull ¶1) signifying a larger decay of the system – of accountability at the highest levels.
Yet another problem is the demographic profile of the veterans. More and more veterans are living to a ripe old age. This puts a strain on the health care system for the aged especially when the budget limits the options. The requirement of nursing home facilities is sure to increase as the GAO report states that veterans 85 years or older will increase to one million by 2012 (GAO 2003 11). Thus a long term strategy and requisition for matching budget is required from the VA department leadership.
These problems are only going to be exacerbated. The ongoing ‘War on Terror’ shows no signs of abatement. By reducing force levels in Iraq and increasing those in Afghanistan will not stop the flow of casualties that happen on account of militant attacks. Realizing the gravity of the situation and estimation of possible increase of war veterans, the “Department’s resource request for 2010 is nearly $113 billion–up $15.1 billion, or 15 percent, from the 2009 enacted budget” (VA ¶1).
This estimation is however; far lower than what some scholars and experts have appreciated could be the likely cost to America. Joseph Stiglitz has calculated that the two wars will cost the United States more than Three Trillion dollars in which $717 Billion will be the total long term cost to the US government to provide $285 billion medical costs, $388 billion in disability benefits and $44 billion in social security compensation (Stiglitz and Bimes 87). This humungous medical bill seems too pessimistic for the authorities to even contemplate. However, a study cannot be wished away without basing it on hard facts, which as of now is not forthcoming from Washington.
In conclusion, it can be reiterated that though the Department of Veteran Affairs was set up with all the good intentions, the infrastructure and long term planning has not kept pace with the sheer numbers of veterans entering the system. The fact that the number of facilities are scarce and the policies implemented faulty, only serves to increase the frustrations of the proud men who fought for their country but were let down by a system unable or incapable of looking after them. The problems of the veterans point not just to the VA department but to the problems of the overall direction of American foreign policy and whether America requires sending it’s finest the harms way and at what cost and for what just causes.
Allen, Mike. “Veterans still getting a Shoddy Treatment.” 2007. Web.
Crowell, Alan. “Demons and Difficulties:Detroit Veteran Not Getting Promised Post-War Assistance.” 2007. Kennebec Journal. Web.
GAO 2001. Major Management Challenges and Program Risks: Department of Veterans Affairs. Washington D.C.: GAO press, 2001.
GAO 2003. Department of Veterans Affairs Key Management Challenges in Health and Disability Programs. Washington D.C: Diane Publishing.
Lee, Christopher. “Many Vets Not Getting Benefits.” 2006. BNET. Web.
Priest, Dana and Anne Hull. “Soldiers Face Neglect, Frustration At Army’s Top Medical Facility.” 2007. Washignton Post website. Web.
Scurfield, Raymond M. A Vietnam Trilogy: Veterans and Post Traumatic Stress, 1968, 1989, 2000. NY: Algora Publishing, 2004.
Stiglitz, Joseph E and Linda Bimes. The Three Trillion Dollar War. NY: Boydell & Brewer, 2008.
VA. “FY 2010 Budget Submission.” 2009. VA website. Web.
Veterans Today. “VA:Brain-injured War Veteran Not Getting Proper Care.” 2008. Veterans Today website. Web.