Where's the Support?
Funding for veteran services fails to satisfy demands
By Christie Chisholm
Lindol Hill has the kind of voice that brings to mind images of sweet and simple rural life. With a voice like that, one can only imagine that the self-proclaimed old farm boy must have lived a life full of hot summer days working soil. Yet, his voice has endured much more than the pastoral images that so eagerly serve our stereotypes. Indeed, its gentlemanly nuances and southern inflections have survived not only through the heat of summer days, but also through the heat of battle.
But Lindol Hill's voice, which accompanied him through 20 years of military service, does not speak of battle, or bravery, or what it means to serve one's country. Rather, it speaks of injustice. It speaks of what Lindol Hill considers to be "the most crucial element in what veterans are facing today," which is the underfunding of the Veterans Affairs Health Care System.
In recent weeks we've begun to hear about the plight of our returning soldiers from Iraq and Afghanistan, and the VA Health Care System that doesn't have the resources to treat all of those who need medical assistance to the best of its ability. We've heard about the ever-increasing estimates of Post Traumatic Stress Disorder and the VA's unpreparedness for the staggering figures of mental health disorders that are sweeping through their system. But what we haven't heard nearly as much about is the effect that the VA's underfunding has not only on returning veterans, but on veterans from past wars as well.
Locally, there seems to be some good news. In regards to PTSD, the Albuquerque VA Hospital is not having many problems compared to other states, says VA spokesman Joe Dean.
In fact, according to Mark Beasley, Legislative Chairman for the Disabled American Veterans (DAV) Department of New Mexico, Albuquerque's PTSD clinic was recently among the top seven in the nation in terms of quality, although he says that it is now beginning to experience budget cutbacks. Yet a sentiment that echoes throughout the New Mexico VA Health Care System, as well as throughout the veterans' services organizations that work around it, is that the larger issue is what is happening to all veterans across all health care programs as a result of a poor budget.
Not many local VA employees wanted to go on record talking about it, but everyone I interviewed consistently reported the same thing: The VA Hospital can't treat the veterans it already has, there isn't enough funding, and as a result, older veterans are being pushed aside. A National Guard Administrator who regularly visits the Albuquerque VA Hospital said that there is a tendency for veterans from past wars, such as World War II, Korea and Vietnam, to be offered less than the level of treatment they require. One veteran that she regularly visited last summer, for instance, became severely ill when he wasn't given a heart monitor that he needed the year before. When he asked his doctors and nurses why he hadn't received it, she said the man was told, "We didn't expect you to live that long."
The Bataan Death March veteran, who survived three-and-a-half years as a prisoner of war, didn't make much of a ruckus, primarily because the tumor in his lung kept him from speaking above a whisper. And because he has no family in Albuquerque, the National Guard source became his only ally, and the only person who would fight to get him better care. She did, however, add that most of the care at the VA Hospital is everything that it should be, and that there are many hardworking doctors and nurses on staff. The problem is that there aren't enough of them.
Most of the returning veterans from Iraq and Afghanistan, she said, are receiving great care, especially within the National Guard. She said that a variety of programs have been put in place to ensure that returning veterans are seen immediately, and that all veterans are seen by social workers upon their return to assess whether they have any signs of PTSD or other forms of trauma. In fact, returning vets have been given first priority at the VA, a practice that one VA source believes was put in place because returning vets get more media attention than older vets.
Nonetheless, the reality of the situation is that while younger, returning veterans are on the most part receiving good care, there simply isn't enough staff to provide timely, adequate care to older veterans as well. And, while most veterans report excellent care at the hospital when they receive it, they also say that receiving it can oftentimes be a lengthy and turbulent process, which includes prolonged waiting times.
For instance, getting a dental appointment at the VA requires a waiting time of anywhere from one and a half to three years, and it takes about six months to get an appointment for a checkup, in which another six month wait generally begins in order to see a specialist.
Lou Helwig, director of field services and benefits for veterans with the Department of Veterans Services, says that two years ago there were 4,000 backlogged hearing exams at the VA, and that currently there are 2,100 backlogged dental appointments—a fact that he says the VA is proud of, since that number is lower from what is was several years ago. He says programs such as these are suffering because the VA "can't pay ophthalmologists as much as they make at Wal-Mart."
Because waiting times are so severe, many patients opt out of waiting lists by going straight to the hospital's emergency room, where they know they won't be refused treatment. However, because so many of them are using this tactic, it just adds to the already overburdened ER system. And, as Helwig says, because the local VA hospital now has twice as many patients and half as many staff as they did in 1995, there isn't much hope of it clearing up.
Another problem that the VA is facing regards disability claims. A report filed by Rep. Tom Udall's office in October 2004 stated that there are currently over 300,000 veterans waiting for disability assessments nationwide to determine if they qualify for benefits, 26,000 of which are veterans from Iraq and Afghanistan. It also showed that in New Mexico, there are 3,000 disabled veterans waiting on resolutions to their claims, and that the average veteran in the state will wait five months before seeing any aid—an amount that, for some, could delay funds upwards of $13,400.
Lindol Hill, a cancer survivor who worked around the VA Health Care system since 1963, and most recently served as a National Field Director for the Paralyzed Veterans of America (PVA), has seen the system go through many changes. But the one thing that hasn't changed, he says, is an insufficient budget, which he attributes as the primary cause for the VA's shortcomings.
According to spokesmen from the Department of Veterans Services, DAV and PVA, the reason that the VA is always underfunded is because it doesn't have a mandatory budget. It is the second-largest federal agency in the country, falling only behind the Department of Defense, yet it is the only federally-funded agency without mandatory funding, which essentially means that the federal government isn't required to give the VA a set budget every year, or to ensure a certain percentage of increase. And, to Lindol Hill, this means that veterans are getting shafted.
Currently, a number of national veterans' services organizations are lobbying Congress to instate mandatory funding—but most organizations aren't hopeful that it will ever be passed. Figures from the Disabled American Veterans provide a very real example of why mandatory funding is, in the eyes of many, a necessary change. They show that nationally, there was a 134 percent increase in patients at the VA over the last seven years, from 2.9 million in 1996 to 6.8 million in 2003. One of the reasons that the surge of patients spiked so high is because in 1996 the Veterans' Health Care Eligibility Reform Act was passed, which expanded eligibility for VA services.
When the bill passed, veterans flooded the VA, and the 2003 invasion of Iraq only exacerbated an already struggling system. Many veterans who avoided the VA when their service ended, acutely aware of its limitations after the Vietnam War, were now coming to the VA for the first time. Post-traumatic stress that had been buried deep within the psyche of soldiers was now resurfacing after they were faced with images of war through the media. Old wounds were rehashed.
Scott Hilliard, a disabled veteran who served in Somalia in 1993 in the battle that would spawn the movie Black Hawk Down, is a prime example of the kind of veteran who is now going to the VA for the first time. Hilliard, who considers himself lucky that his only war injury is PTSD, originally shunned the VA when he was discharged from his service. He says that back then, there was no program in the military to check for PTSD among returning veterans, and that he received no training to prepare him for the disorder before he was sent out. In fact, several years passed after his return before he even learned about PTSD.
When Hilliard recognized that he had PTSD symptoms, he went to the VA for treatment, as many veterans from past wars are now doing. A great majority of veterans with mental disorders are only now going to the VA because, like Hilliard, they weren't even previously aware that they had a condition, or that it had a name. When awareness of PTSD increased, and the war in Iraq flared up symptoms that had lingered below the surface for years, veterans shuffled into the system. But now, Hilliard says, because there are so many veterans wanting treatment, the waiting lists at the VA are daunting, because the budget increases are never enough to handle the influx of patients.
In fact, over that seven year span, when the number of patients increased by 134 percent, there was only a 44 percent increase in VA funding, from $16.6 billion in 1996 to $23.9 billion in 2003. DAV figures also show that in order to maintain already existing services, the VA needs to receive a 14 percent increase in funding annually, a number that they are certainly not receiving. And when the VA is forced to work around a budget shortfall, cutting staff and programs, it means that they aren't able to buy new, state-of-the-art equipment that other hospitals can afford.
It also means that they can't pay doctors and nurses competitive wages, which contributes to their loss of staff, and therefore their extended waiting times and decreased quality of service. Many private practices and hospitals offer doctors and nurses signing and retainer bonuses; but the VA can't offer those, and so health care workers go elsewhere.
In Albuquerque, the VA Hospital has seen the consequences of underfunding. According to VA Public Affairs Officer Joe Dean, in 2002, the hospital's budget had a projected shortfall of $22 million. After employing cost-saving measures, the next year the shortfall was reduced to $12 million, and in 2004 it was down to $5 million—a trend that would seem to indicate services are improving. Yet, John Garcia, cabinet secretary for the New Mexico Department of Veterans Services, says that currently the VA Hospital is $27 million short of what it needs; and Helwig says that the last three years at the VA represent the most severe shortfalls in their budget that they've ever seen.
The situation is not an optimistic one. The VA has already been forced to engage in hiring lags, wherein departments must wait an established amount of time before they're allowed to replace former staff, and it has also started to cut back programs.
Beasley recalls one such program that, two years ago, began to suffer the consequences of underfunding. The cutting of a swim therapy program, he says, began when the man who washed the towels retired and was never replaced. But that was just the first ominous sign for the program; eventually, the whole thing was cut.
Possibly one of the more disheartening results of the VA's situation is that nonservice connected disabled veterans are no longer able to receive treatment at the hospital. Being service connected means that a veteran was injured while on active duty. A veteran who is injured once they've left active duty, however, is considered nonservice connected, and no longer has any priority in the system, despite the fact that they still served for their country.
Lindol Hill describes the situation that many nonservice connected veterans now go through. "Many of them went to war, and they served two or three years overseas during winters, and served in mudholes and snow," he says, "and, thank goodness, they weren't wounded, and they came back and they immediately tried to find a job and take care of their families. Then later on they come down with some problems, but since they're nonservice connected, they can't be treated."
The fact that these veterans can't be treated can potentially have a dramatic effect on their health and finances, especially in New Mexico where there is such a high number of uninsured and underinsured patients among the general public.
But Hill says that it is important to remember that it is not the staff at the VA Hospital that are the problem, but rather, it's the fault of "our senators and congressman and our president for not making sure that there's sufficient funds in the VA budget to take care of those who have made it possible for this to remain a free nation, and who have made it possible for those people to run for office."
There is a great amount of pressure on the current administration to institute mandatory funding at the VA, even though there's a slim chance of it actually happening.
John Garcia says the least that the Bush administration could do is consider the VA as a cost of war, instead of as a social entitlement program, and raise their budget accordingly. As it stands today, the cost of war in Iraq is $4.5 billion a month, Garcia says, but that accounting doesn't include VA services.
"This is not just another social entitlement program," adds Lou Helwig. "This entitlement program has been paid for in blood."
Yet it doesn't seem like the Bush administration has the same philosophy. In fact, shortly after President Bush was elected to a second term, he mentioned further VA program cutbacks, proposing to take away health care supplements such as CHAMPVA, which shares the cost of health care services with spouses or widows of veterans who were totally disabled and service-connected. It is yet to be seen whether such a proposal will pass.
But Lindol Hill—and many others who have worked with the VA system for years and become well acquainted with the disconnect between support our troops sloganeering and the bureaucracy that manages funding—doesn't seem hopeful that the system will be adequately funded anytime soon.
"We're so quick to say ’hey, put on the uniform,'" says Hill, "but then, all of a sudden, it seems like once they're removed from the uniform we're not as quick to say ’Gee, we're adding all these new veterans, we need to add more money to the VA system budget.'"
Hill has a distinctive voice. And his voice, along with the voices of many others, is asking for the government to take care of its veterans—all of them. But is anyone in Washington listening?
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