Saturday, November 17, 2012
WASHINGTON — Army Sgt. Jeremy Barnhart says anyone wanting to know what it's like to deal with the Department of Veterans Affairs can get a clue from the FedEx packages that land on the front porch of his San Antonio home.
They tell him when to show up for mental health assessments that help determine his benefits eligibility. If the time conflicts with his college classes, a VA benefit helping him prepare for a new career, he can't change the appointment directly by phone, he said. He can call only to say it doesn't work, and wait for another package giving him his new time.
Separately, he's been trying without success to see a VA neurologist for review of a brain injury incurred in a grenade attack in Iraq, he said. These efforts have been going on since he left the military in April 2011.
“How many circles do I have to run in to get the care that I need?” said Barnhart, 39, who served as a medic and is studying to become a physician's assistant. “It's a powerless feeling to be in a system like this.”
President Obama has pledged to serve veterans “as well as they've served us.” Yet to veterans like Barnhart, the VA's bureaucracy can bring more agony than reward. With as many as 1 million troops due to become veterans in the next five years, on top of the 22.3 million already in the system, the agency is staggering under backlogs in disability compensation claims, bottlenecks in mental health care and criticism over a general lack of accountability.
“The system is completely overwhelmed,” said Craig Bryan, a clinical psychologist and associate director of the National Center for Veterans Studies at the University of Utah. “We did not prepare the VA system for what many of us would argue is the natural consequence of combat and protracted warfare, and we're trying to play catch-up.”
VA statistics show an agency falling further behind even with increased and staff.
About 896,000 disability compensation and pension claims were pending as of the first week in November, almost double the cases on Oct. 31, 2009. Two-thirds have been in the system for more than 125 days, the agency's target processing time.
Less than half of veterans receive full mental health evaluations within two weeks of contacting the agency for care, according to an April review by the department's inspector general's office. For the remainder, it takes an average of about 50 days to get an exam.
Since the fiscal year beginning Oct. 1, 2010, the agency has rejected more than 50 percent of applicants seeking certification as veteran-owned small businesses. The program provides opportunities to veterans who want a piece of $530 billion in federal contract revenue. Some owners say they've fought the VA for months for eligibility, but were rejected for reasons that made little sense.
Josh Taylor, an agency spokesman, declined to arrange an interview with VA Secretary Eric Shinseki or Deputy Secretary Scott Gould, to comment on this story. He said he can't comment on individual cases without a privacy waiver.
By using technology and “a dedicated work force,” the VA “is boldly transforming itself in healthcare and benefits delivery, and in memorial affairs, to better serve all veterans,” Shinseki said in a statement released for Veterans Day.
Obama pledged to improve veterans' access to health care and jobs in a Veterans Day speech at Arlington National Cemetery in Virginia, saying he “won't let up” in addressing the backlog of veterans' disability claims.
The VA's budget has more than doubled to $125.3 billion in the past decade, while its full-time staff has risen 43 percent to 319,592 since 2002. Obama has requested about $140 billion for the agency in fiscal 2013, which would make the VA one of the few big winners in an austere budget environment.
The administration also put the VA off-limits to $1.2 trillion in automatic budget cuts, known as sequestration. The action is designed to protect veterans from a decade of reductions that will take effect early next year if Congress and the White House don't reach an alternate plan to reduce the nation's deficit.
“My administration has made it clear,” Obama said at a Veterans of Foreign Wars convention in Reno, Nev., last July. “Your veterans benefits are exempt from sequestration.”
U.S. lawmakers have warned the VA to ensure its funding increases were used to support veterans. They were outraged after learning the agency had spent $100 million on conferences last year, including two events in Orlando, Fla.
The costs for the conferences near Walt Disney World included about $50,000 for a 15-minute video spoofing the Oscar-winning movie “Patton.” Eleven employees accepted gifts such as Rockettes tickets, massages, helicopter rides and free meals from vendors while planning the conferences, according to an Oct. 1 inspector general's report.
“There has been very little if any oversight on what is being bought, who it's being bought by and who is signing the checks,” Rep. Jeff Miller, R-Fla., who chairs the House Committee on Veterans Affairs, said. “This goes way past VA conferences.”
Dawn Halfaker, an Army captain who lost an arm in 2004 during an attack in Iraq, said the VA has a “culture problem,” with some employees too distant from veterans' struggles and too dependent on paperwork and processes.
Halfaker, 33, recalled meeting with a clinician at a VA medical center in Washington as part of the process to determine the compensation she would receive for her disabilities. He read from a sheet that noted she had suffered burns, lung damage, broken ribs and other injuries.
She reminded him she was also missing her right arm.
“He said, ‘Well, I don't have that down here,’” said Halfaker, who owns an Arlington, Va.-based consulting business. “I'm very clearly an amputee, but it has become such a bureaucratic system that this individual didn't really have the wherewithal to realize what was going on in front of him.
“Then he contested whether I'd ever been in combat because I was a woman,” said Halfaker, president of the board of directors for the Wounded Warrior Project, a Jacksonville, Fla.-based nonprofit.
The VA is improving, said Mark Ballesteros, another department spokesman.
“In 2009, President Obama charged Secretary Shinseki to transform VA into a high-performing 21st century organization,” Ballesteros said in an e-mail. “Both the president and Congress have afforded VA the resources to make that transformation a reality. We have made significant progress since 2009, but we know more remains to be done.”
During Obama's tenure, the agency has increased the number of disabled veterans receiving compensation and life insurance coverage, and the number of education beneficiaries, he said. In 2011, the number of homeless veterans dropped 12 percent to 67,495 from 76,329 a year earlier, as the result of a VA campaign to end veteran homelessness by 2015, according to data from Ballesteros.
Some veterans, advocacy groups and state officials say they are so frustrated with the system they have acted on their own. Most of their efforts have targeted the daunting number of disability case filings, which jumped 48 percent to 1.3 million in 2011 from 2008.
The backlog in Texas alone has more than doubled since 2010, with more than 107,000 pending claims in July and about 28,000 appeals, according to Lt. Gov. David Dewhurst's, R, office.
Texas Gov. Rick Perry, R, Dewhurst and Joe Straus, speaker of the Texas House of Representatives, approved $1.5 million in state funding to activate a “strike force” of workers that would help the VA process outstanding claims.
“It is unconscionable that the federal government penalizes states with backlogs for welfare but makes someone who has volunteered to serve our country in uniform wait well over 125 days — and often more than a year — for benefits they have earned,” Dewhurst said in a statement.
John Armstrong, 50, is a Marine sergeant from Waco who served in the Gulf War and left the military in July 1991. He's been waiting three years for the VA to process claims related to post-traumatic stress disorder, depression, numbness and white spots covering his legs that doctors have said may be Gulf War syndrome, he said.
“I understand now what my uncle, who served in Vietnam, talked about,” Armstrong said. “The system appears like it's designed against you.”
The surge in claims is partially due to the VA's decision to recognize additional Vietnam veterans' claims tied to Agent Orange, a chemical defoliant used by the United States.
So many disability claims are stacking up that their weight threatened to compromise the “structural integrity” of some VA buildings, according to reports from the department's inspector general.
At an agency office in Winston-Salem, N.C., about 37,000 claims folders were stacked “two feet high and two rows deep” on top of filing cabinets, according to an August review. They were also piled in boxes on the floor.
“We noticed floors bowing under the excess weight,” the inspector general said.
The staff who conducted the review didn't look into the folders, so they aren't sure whether the files were processed or pending claims, said Cathy Gromek, a spokeswoman for the inspector general's office.
Concern is growing about veterans taking their own lives. Each year, 1,600 to 1,800 veterans receiving VA care commit suicide, according to a March 2011 report by the inspector general.
Tara Dixon, a surgeon who served in Iraq as an Army reservist, told military families in a packed Washington conference room in September that she tried to kill herself by overdosing on aspirin and Tylenol last year.
She said she suffered from post-traumatic stress disorder after leaving the military. It was “cumulative,” she said.
Dixon was haunted by images of injured Iraqi children seeking medical attention, memories of treating other female soldiers who were victims of sexual trauma and of performing surgery on a soldier “to repair a hole in his heart or liver” a few hours after having breakfast with him.
“I felt lost,” Dixon said at the conference. “I felt hopeless.”
Nurses couldn't find a VA mental-health facility with less than a two-year waiting list for a female veteran with PTSD, she said. Her family arranged for private care at an Ocklawaha, Fla., facility.
“I cashed in all my savings and came here,” Dixon said.
She hasn't asked the VA to cover her treatment costs, saying she's still working to get medically discharged from the military. It took three months to be seen by an agency psychiatrist even though a general practitioner for the VA flagged her case as urgent, she said. Since then, she's been happy with her treatment, she said.
“Is the system perfect? No,” she said. “I do feel like they're trying. The people I've spoken to have been very kind, but there have been a lot of times where they say we just don't have anything yet.”
The inspector general has challenged the VA's claim that 95 percent of first-time patients last year got a full mental-health evaluation within two weeks, as required by the agency's policy.
That data is “not accurate or reliable,” because the VA considered the next available appointment slot as the new patient's desired appointment date, according to the watchdog's April report.
“VA is failing to meet its own mandates for timeliness and instead is finding ways to make the data look like they are complying,” Sen. Patty Murray, D-Wash., who chairs the veterans committee, said during an April hearing. “The hard work remains in front of us at the time when veterans are dying by suicide at an alarming rate.”
Benjamin Krause, 36, a law school student and Air Force veteran, says stories of delayed or nonexistent mental health care led a coalition of veterans from two nonprofit groups, Veterans for Common Sense and Veterans United for Truth, to sue for a forced overhaul of the VA's operations.
A panel of U.S. Court of Appeals judges in San Francisco last year accused the VA of “unchecked incompetence” and ordered the agency to change how it operates. The Obama administration fought the decision, which was later reversed by a larger group of judges from the same appellate court.
The veterans groups have asked the Supreme Court to take the case, Krause said.
“Going into the system, you assume the VA is looking out for you,” said Krause, who lives in Minneapolis and serves as Veterans for Common Sense's assistant director for policy advocacy. “Then you realize the VA itself is functioning as an insurance company and trying to make sure the cost of war is as cheap as possible.”
Barnhart, the veteran trying to schedule his exams via mailed packages, says there is “so much wasted time and money” in the VA's operations.
The Purple Heart recipient, who said he has PTSD, is frustrated he can't get an appointment with a VA neurologist. Meanwhile, his disability payments may be jeopardized if he can't make the mental health exams at the time selected by the VA's vendor, he said. Those payments and Social Security disability funds are the only source of income for Barnhart, his wife and four children, who were selected as the “Volunteer Family of the Year” in 2011 by the Association of the U.S. Army. The nonprofit advocacy group, based in Arlington, Va., honored the family for its commitment to charity work.
VA contractor Lockheed Martin, the world's largest defense company, is one of five vendors that assist the VA with disability exams, including mental health reviews, according to the department.
Lockheed's policy is to “make multiple attempts to reach veterans by phone to schedule examination appointments,” said Jack Robling, a spokesman for the Bethesda, Md.-based company. It mails appointment details to veterans after speaking with them on the phone and veterans can reschedule if the timing doesn't work, he said.
“We recognize that this important information needs to reach veterans,” Robling said in an e-mail. “For that reason and per contractual agreement, if we are unable to reach a veteran by phone, we will schedule an appointment and mail a notice regarding the examination to the veteran.”
Barnhart said the VA should make the transition to the private sector as easy as possible for wounded warriors.
“The VA's focus is supposed to be on helping veterans, people who've been wounded serving our country, and they're sending us to a contractor,” he said.