Soldiers trapped in limbo
ON THE fourth anniversary of the invasion of Iraq, one of the lasting images for Americans remains the squalid conditions at Walter Reed Army Medical Center. Who can forget the pictures of soldiers recently returned from the battle, trying to recover from horrific wounds while forced to keep fighting against dirt, mold, and bureaucracy?
The seeds of the Walter Reed scandal were sown in weak leadership, heavy reliance on outside contractors, and a failure to foresee the sheer number and severity of casualties. But the real culprit lies in a lack of trust between the Pentagon and the Department of Veterans Affairs. When a soldier is injured, the military decides whether he or she is fit to return to duty. If not, a second level of evaluation determines just how unfit he is. Soldiers awaiting this second level evaluation -- including those at the Walter Reed outpatient clinic and scores of other military bases -- are often trapped in limbo between military and veteran status.
Of the 1.4 million of service members deployed to the Iraq and Afghanistan wars, about 53,000 were officially listed as wounded or injured. Tens of thousands of others suffer from less visible wounds, such as traumatic brain injury, post-traumatic stress disorder and debilitating chronic pain.
The military does not have enough healthcare practitioners to evaluate all soldiers before discharge. Some simply stay in the military, knowing that if they leave, they lose valuable housing and healthcare benefits, especially for their families. Others go to a VA hospital for an evaluation, either because they gave up waiting or they aren't satisfied with the military evaluation and hope the VA will do better. As a consequence, the transition from active duty to veteran status becomes a quagmire instead of the seamless process desired by both departments.
This bureaucratic turf war extends beyond the wounded. More than 200,000 war veterans have already been treated at VA hospitals and clinics. But a penchant for privacy and outdated information technology means the Defense Department is unwilling and in some cases unable to provide medical records to the VA and thus to provide a continuity of care. Even when the VA gets the records, it often insists on repeating all the medical procedures and diagnostic tests before disability status can be granted. Many veterans travel 90 miles or more to reach the nearest VA medical facility. Even veterans already in a wheelchair must endure this prolonged, costly, and redundant process.
Soldiers injured in theatre are supposedly able to apply for disability benefits before they are discharged. But to take advantage of the program a soldier must know when he is going to be discharged. Unfortunately, much of the force doesn't know when it will be discharged because of repeated deployments and "stop-loss" orders. Furthermore, National Guard and Reserve soldiers are excluded from the pre-discharge program.
The bureaucratic fumbling between the Department of Defense and the Department of Veterans Affairs also diverts the VA's stretched medical resources into claims processing and away from providing prompt, needed treatment.
Here are some simple lessons from the Walter Reed scandal that will improve the lot of the 900,000 servicemen who are still deployed into the Iraq and Afghanistan wars:
First, the military should be required to give everyone a medical exam before discharge, and the Department of Defense should promptly transfer all records to the VA to expedite delivery of medical care and disability benefits.
Second, Veterans Affairs must hire thousands of additional mental health professionals and triage nurses, and double the number of local "veterans centers," which offer readjustment counseling in convenient neighborhood locations.
Third, the departments must work together to make the successful "Disability Benefits at Discharge" program into a workable option for all war veterans. This means sending more benefits experts to military bases, and expanding the program to include Reservists and National Guards.
Finally, the lack of planning that has characterized the war has led to overcrowded veteran facilities, waiting lists, and a backlog of pending disability claims. Needs of returning troops must be immediately analyzed and plans made for their return.
It may be too late to secure the peace and democracy in Iraq this war was supposed to achieve. But it is not too late to make sure the government provides decent welfare to the troops who have borne the burden of combat.
Linda Bilmes, an assistant secretary of Commerce in the Clinton administration, teaches public finance at the Kennedy School of Government at Harvard University. Her recent paper, "Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits," is available at ksgnotes1.harvard.edu/Research/wpaper.nsf/RWP/RWP07-001. 
