Battling bureaucracy to ensure long term care for veterans

I discovered this article surfing military.com the other day and found it emotionally riveting.  Many of us who served in the Armed Forces were fortunate enough not to have sustained life altering injuries of the magnitude described during a recent hearing on March 13th reflecting on the Care of Seriously Wounded After In-Patient Care conducted by the House Veterans' Affairs Oversight and Investigations Subcommittee.  The purpose of the hearing was to assess how the Department of Veterans Affairs cares for our nation's most seriously wounded veterans following inpatient treatment.

An opening statement by the Chairman, Representative Harry E. Mitchell, from Arizona set the tone for the hearing:

"We are here today to hear from veterans, their families, and the Department of Veterans Affairs about the long-term care of our most severely wounded Afghanistan and Iraq veterans.  We know that DoD and VA provide the excellent inpatient healthcare for these warriors.  But many of the most seriously injured require extensive outpatient care, some of them for life.  Their families need care and assistance as well.  Unfortunately, once these veterans leave the hospital, the care they receive does not seem to be on par with what they received directly following their injury.  I think we can do better."

He went on to say:

"...The Department of Defense and the VA are large organizations with an overwhelming bureaucracy.  Their care and services often overlap in messy and unpredictable ways.  At a time of enormous stress, this bureaucracy only hurts the injured warrior and his family... We are going to hear from people that have been dealing with the difficulties of the system for a long time.  On February 14, 2004 Army Sergeant Ted Wade lost his right arm and suffered severed traumatic brain injury, along with many other injuries, in an IED explosion in Iraq.  Sgt. Wade is here today with his wife, Sarah."

Next:

Marine Corporal Casey Owens of Houston, Texas lost both his legs when his unarmored Humveee struck a landmine in Iraq on September 20, 2004.  Corporal Owens and Mrs. Wade will tell us about the frustrations and difficulties they have faced, and we look forward to their testimony... We cannot repay that debt, but we can make sure that Corporal Owens and Sergeant Wade, their families, and everyone like them, get long-term care and services that are also world class."

The following testimony was given by Meredith Beck, National Policy Director, Wounded Warrior Project (WWP).
 
"During the recent conflicts in Iraq and Afghanistan, there have been approximately 30,000 soldiers, sailors, airmen, and Marines wounded in action.  Fortunately, due to advances in medical technology, the number of those killed in action is far lower.  However, in many cases, as the wounded have suffered devastating injuries and require long-term outpatient care and rehabilitation, WWP is pleased that the subcommittee has chosen to focus on this aspect."
 
WWP has identified the following areas of concern:

"Traumatic Brain Injury (TBI), those suffering from TBI require individualized, comprehensive care, and while the VA has made progress in this area, the agency is still in the process of establishing an extensive, consistent, long-term continuum of care available throughout the nation.  As such, and due to the need for ongoing therapy and rehabilitation, many seriously injured veterans and families have indicated that their number one request is increased access to options for care, including access to private facilities previously available to them while on active duty..."
 
Discrepancies in Benefits:  On a related topic, many veterans and families of the seriously injured have indicated confusion, frustration, and disappointment upon learning that they are not eligible for the same benefits and care as veterans as they were on active duty and vice versa..."
 
Respite Care:  For those who are seriously injured, one cannot discuss their care without discussing their caregiver.  While the VA currently offers some respite care, the available options are often not entirely appropriate given the average age and types of injuries of those serving in Iraq and Afghanistan.    For example, retired Army Sergeant Eric Edmundson suffered a severe brain injury in Iraq several years ago, but he is aware and responsive.  Eric’s family is unwilling to place him in a respite facility for fear that it could cause a regression in his rehabilitation and cause Eric distress... Eric’s family has used their personal funds to pay for an innovative type of individualized therapy that also provides a unique form of respite for the caregiver..."
 
"Caregiver Compensation:  Traumatic Brain Injury (TBI) has been widely identified as the "signature wound" of the Global War on Terror.  While many organizations appropriately focus on the needs of the affected servicemember, the Wounded Warrior Project (WWP) has also identified the family caregiver as an individual in need of assistance.  For example, in many circumstances, the spouse or parent is forced to leave his/her job to provide the necessary care for their loved one, leaving the entire family to suffer from an adverse economic situation.   In these cases, the VA relies on the family member to assist in the servicemember’s care, but has been denied financial compensation for such labor...In recognition of this reality, WWP developed and endorsed legislation introduced by Representatives Salazaar and Pascrell requiring the VA to train, certify, and make eligible for compensation the personal care attendants of severely injured TBI patients... WWP encourages the subcommittee to review the program and help to ensure its implementation."

"Oversight:  Finally, consistent with the recommendation of the Veterans Disability Benefits Commission and to ensure the best care and benefits for those who have sacrificed so much for our nation, it is imperative that a joint, permanent structure be in place to evaluate changes, monitor systems, and make further recommendations for process improvement.  This office must be structured to minimize bureaucracy and must have a clearly defined mission with the appropriate authority to make necessary changes or recommendations as warranted..."

The following testimony was given by Corporal Casey Owens, (U.S. Marine Corps Combat Veteran):

I was seriously injured on September 20, 2004 while serving under 1st Battalion 7th Regiment.  I was assisting in a medivac (medical evacuation) to rescue Sgt. Foster Harrington when I ran over two anti-tank mines, which resulted in the loss of both legs.  Consequently, I also suffered two collapsed lungs, numerous shrapnel wounds, pulmonary embolism, broken clavicle and jaw, perforated eardrums, trauma to my head.  I was flown to Landstuhl, Germany from a field hospital in Iraq, and awoke from a coma three weeks later in Bethesda Maryland Naval Hospital.  After numerous surgeries to stabilize me, I was transferred to Walter Reed Army Medical Center and Brooke Medical Center for my recovery phase...

He was medically retired on February 26, 2006 and shortly thereafter needed his right myodesis repaired for a second time.  After enrolling in the VA system in June of 2006, he found that he needed his right myodesis repaired for yet a third time and was referred back to the DoD.  He asked for assistance from several non-profits called the Semper Fi Fund, Marine for Life, Wounded Warriors and other non-government personnel helped him.  Then he noted:

"What have the educated and highly paid personnel who have been appointed to correct the system been focusing their attention on?  While the system continues to be broken, where is all the government funding going that is supposed to be fixing the system and what are they doing with it ?"
 
Furthermore:

"When I enrolled in the VA, it took almost another year and a half to finalize those claims.   It is actions like this that make veterans avoid the VA.  My qualms is not that the VA does not have enough programs in place to benefit veterans or the adequacy of it, rather, it is the bureaucracy and red tape that are the problems.  While many problems have been addressed, it is time for SOLUTIONS."
 
Following his positive experience at Walter Reed, he suggests that:

"... the key staff meet weekly to discuss all aspects of patient care and keep an open line of communication between departments... The impression that (Owens) gets from the VA is that some within the organization think it is the duty of the veteran to endure and resolve these problems on their own.   Those, like me, who were paid as a Marine Corp Grunt to do their job to the best of their ability never questioned whether if we got injured my government would be there for me.  We all knew it would.  It is now time for those who are responsible for the VA to care for those who did their duty. "

The following testimony was given by Sarah Wade, on behalf of Sergeant Edward Wade (U.S. Army Combat Veteran)

"My husband joined the Army’s 82nd Airborne Division during the summer of 2000, and following the attacks of September 11, he was called on to serve first in Afghanistan and later Iraq.  On February 14, 2004, his humvee was hit by an Improvised Explosive Device on a mission in Mahmudiyah.  He sustained a very severe traumatic brain injury, or TBI, his right arm was completely severed above the elbow, suffered a fractured leg, broken right foot, shrapnel injuries, visual impairment, complications due to acute anemia, hyperglycemia, infections, and would later be diagnosed with Post Traumatic Stress Disorder.  He remained in a coma for over 2 ½ months, and withdrawal of life support was considered, but thankfully he pulled through."

She went on to say:
 
"His situation was an enormous challenge, as Walter Reed was only able to rehabilitate an amputee, not a TBI, the VA was able to nominally treat a TBI, but not an above elbow amputee, and neither were staffed to provide appropriate behavioral health care for a patient with a severe TBI...Ted has made a remarkable recovery by any standard, because we have strayed from standardized treatment, and developed a patient-centered path.  I had to educate myself about, and coordinate, additional outside care.  Often, access to the necessary services required intervention from the highest levels of government...I have been unable to return to regular work or school.  We have been blessed to have family, with the means to see us through these difficult times, and help with the expenses..."
After some more insightful testimony she concluded by saying:

"The challenges we have faced, are the same as countless other Veterans, many of whom have not had the resources Ted has had available to him, or an advocate capable of negotiating the system.  A Veteran I often think about, who had a young wife with a newborn baby, and nothing more than a high school education, should have received the same world-class care as my husband, but sadly will not.  Despite my best efforts to be a support to his spouse, who was overwhelmed by motherhood, while trying to negotiate a seemingly impossible system, she eventually left him, because it was more than she could handle.  A Veteran’s care should not depend on what family they were born into, who they married, or whether or not family obligations allow for their loved one to advocate for them, but sadly it does.  Though we will never be able to fully compensate seriously wounded Veterans for the sacrifice they have made on our behalf, we can certainly do a better job of managing their care, rehabilitating them to their fullest potential in a timely manner, and providing the necessary resources to maximize their quality of life..."

These soldiers and their families deserve our gratitude and respect for their sacrifices and injuries suffered on the battlefront against terrorism and in defense of freedom.  Their quality of life concerns affect us all and needs to be positively addressed.  Next time you see a soldier please be sure to thank him or her for their service!