This article originally appeared in the April 29, 2007 Asbury Park Press and on the Asbury Park Press web site.

Needs of new vets threaten to strain VA health system


Some analysts worry that the Veterans Health Administration will not keep up with the medical needs of the new generation of veterans coming home from Iraq and Afghanistan.

“There is definitely an issue of systemwide capacity. The VA has had to fight for resources in budgets before,” said P.J. Crowley, a senior fellow at the Center for American Progress, a think tank. “When you’re a bureaucracy that has been traditionally starved of adequate resources, you’re forced to ration care.

“It’s one thing if you’re a WWII veteran or a Vietnam veteran and you utilize the VA system, but you have some sort of means,” he added. “But these kids coming home, they’re 21 years old. They’ve lost limbs or they’ve lost cognitive function, and they may or may not be able to work. They will need intensive care, and they will need lengthy rehabilitation.”

A quick survey of recent VHA budget history spanning recent fiscal years paints the big picture. The statistics that follow are from a Congressional Budget Office report presented to the U.S. House of Representatives Military Construction Subcommittee in February:

This projection does not include the VA’s estimates for treating veterans injured during Operation Iraqi Freedom, which can range from $5 billion to $7 billion through 2016, depending on troop levels.

In the VA New Jersey Health Care System, some 1,900 veterans from the Iraq and Afghanistan campaigns have enrolled for care, but most have not sought treatment at the Lyons or East Orange campuses or the system’s outpatient clinics, according to VA New Jersey records. From October to December last year, 908 were seen in different parts of the system for different reasons.

The possibility of overwhelming the VA health care system may not be as dire as it sounds, according to U.S. Rep. Rodney Frelinghuysen, R-N.J. The Congressional Budget Office report, he said, also states that the predicted growth in appropriations for veterans’ health care is actually slower than actual growth in recent years.

Also, no one knows how many new veterans ultimately will enroll for VA health care. Veterans of the Iraq and Afghanistan campaigns are entitled to free medical care for any combat-related illness or injury for two years from their time of discharge. Some are slow to do it because they have so much to catch up with in civilian life.

There are some 750,000 war veterans in New Jersey, Frelinghuysen said.

“Yet through the doors of the East Orange and Lyons campuses go approximately 60,000,” he said. “So that’s a little under 10 percent of the veterans population using VA hospitals. Nationwide, about 7 percent of veterans use the VA medical system. In other words, 93 percent are using other private hospital facilities.”

Some veterans use the VA medical system for some of their needs and turn to Medicare or private insurers for other needs.

Additionally, some observers note the influx of new veterans will be offset by the deaths of older veterans. Media reports reveal World War II and Korean War veterans are dying of natural causes at the rate of some 600,000 a year.

Doing what is needed

If more money is needed to support veterans of Afghanistan and Iraq, Frelinghuysen said, more money will be appropriated. It may take taxes to raise the money, he said.

“Of course, some people think maybe the war is going to end tomorrow,” he added, “and then that money can be immediately transferred to these types of costs. I’m going to be quite blunt. We’re going to do whatever we need to do to look after our veterans. It’s a sacred debt we owe to those who volunteer.”

Meanwhile, the VA New Jersey Health Care System is making plans to accommodate veterans of current wars.

“We’re gearing up. We have the beds. We have the capacity,” said Kenneth Mizrach, director of the VA New Jersey Health Care System.

The buildings in use on the 300-acre Lyons campus are in excellent condition, he said. Some are extensively and artfully renovated, such as the Ambulatory Care Building with its copper-topped entrance rotunda. But a number remain unoccupied, sealed up and available.

VA New Jersey, however, is unable to quantify how many more patients it can accommodate.

Plans to establish a 10-bed unit for traumatic brain injury patients on the Lyons campus are in very early stages, according to VA spokeswoman Sandra Warren. If it materializes, it will be one of five such facilities in the country.

Services for post-traumatic stress disorder, known as PTSD, is another large need of new veterans. In the VA New Jersey Health Care System, the number of veterans seen for PTSD rose 67 percent from 2000 to 2006 — from 2,244 to 3,741, according to Warren. Of the 908 veterans of the Afghanistan and Iraq wars treated in the system last fall, 363 were seen for mental health treatment. A total of 173 were treated specifically for PTSD.

Prompt treatment

Warren said no new veteran waits more than two weeks to be seen for PTSD care. Those who require hospitalization or crisis intervention get it immediately.

The VA New Jersey system has 45 new open positions for mental health providers to cover a variety of needs systemwide, including military sexual trauma treatment, depression, substance abuse treatment and more.

Tapping into the broader civilian medical network may become necessary to meet the needs of returning veterans, according to Crowley, of the Center for American Progress, who added that such a measure could do more than treat patients. It can involve the whole country in dealing with the aftermath of the war, which is a good thing in Crowley’s view.

“We use the rhetoric of war as a society,” he said, “but the impact is only being felt by a relatively small, narrow sliver of the population — the military and their families.”