Returning troops face a battle for medical care
ROUGH ROAD TO RECOVERY: Service members wounded in Iraq say they must defeat layers of bureaucracy to get treatment they need
Erin Allday, Chronicle Staff Writer
Saturday, March 17, 2007
Sgt. Joe Baumann's physical injuries -- from a sniper shot to the gut in Iraq in 2005 -- are clear. He walks with a cane. He suffers chronic abdominal and back pain. He can't sit or stand for more than 30 minutes at a time.
But his flashbacks, his troubles with concentration and memory retention, his anger-management problems -- all symptoms of disabling post-traumatic stress disorder, Baumann says -- aren't nearly as obvious. Proving them to the U.S. Army has been an exercise in near-constant frustration.
Baumann, 22, a Rohnert Park man who serves with the California National Guard, has endured multiple rounds of physical exams and appointments with doctors who he says were rude and demeaning. He sought the aid of a lawyer to help him untangle the knot of Army health care bureaucracy.
He said he has few complaints about the quality of care he's received for his injuries, the kind of complaints that have surfaced at Walter Reed Army Medical Center in Washington in recent weeks. But like many soldiers who fought in Iraq and Afghanistan, Baumann returned to the United States to face a daunting and unexpected battle on the home front: a health care system that is such a maze of bureaucracy that it baffles experienced lawyers and veterans advocates, never mind infantrymen in their 20s with disabling physical and psychological injuries.
"The system is not set up to be soldier-friendly at all," said Baumann. "It's designed to scare and belittle soldiers. It's designed to be a fast and efficient process and get people out of the way."
If the Army gives him the diagnosis he's hoping for, Baumann will retire from the military to a lifetime of free health care for his family, and financial support. If he doesn't, he will be discharged and get a check for $8,000 -- and he'll start over with a brand-new bureaucracy, the Veterans Affairs Department, and a brand-new set of frustrations.
"It's an unwieldy process, and the people who most need the help are least likely to get it," said Amy Fairweather, Iraq coordinator for the San Francisco-based Swords to Plowshares, a nonprofit veterans support group. "The backlog is as big as it's ever been. We have people who are waiting for disability benefits, unable to work, and these aren't people who have money in the bank to tide them over. It's a real problem."
The Department of Defense handles medical care for soldiers on active duty in the military; Veterans Affairs provides their care after they are discharged or retire. Both have been swamped with cases from injured and ill soldiers returning from Iraq and Afghanistan.
The medical review process of the Department of Defense usually takes about three months. Injuries are assessed and decisions are made about whether the soldier is fit for duty or needs to be discharged or retired. Soldiers face separate review boards and multiple physical exams before their fate with the military is decided. They have to write a lengthy report detailing their medical history. If they're claiming post-traumatic stress disorder, soldiers have to provide proof that they witnessed a traumatic event, usually with a letter from their commanding officer.
About two-thirds of soldiers who go through the process are discharged, and they then move into an equally complex process with the VA that can take six months or longer to determine how much care and financial support they will receive.
At the VA, soldiers must go through another round of physical exams. If their military records are unavailable -- a common problem, since the Department of Defense and VA can't easily share computerized records -- an account of their injuries must be created from scratch.
Soldiers are offered advice at every step of the way, but it is a complicated process, said Col. George Giacoppe, deputy commander for clinical services at Madigan Army Medical Center in Washington state, where Baumann is undergoing the medical-review process.
"We really do try to help these soldiers -- we're not trying to discourage them," he said. If any soldiers felt they were treated poorly, he added, "then we're doing something wrong."
Although it might not seem that way to them, the health care system for active soldiers is designed to be fast and efficient. Soldiers returning from combat are eager to get through the medical-review process and return to their friends and families, or return to active duty.
But until they are deemed fit for duty or released from service, often they are stuck in a "military hold" -- living in barracks on a military base with access to health facilities. Hospitalized soldiers can be stuck for much longer than the typical three months, waiting until their conditions stabilize before the military decides their fates.
When the medical-review process is speedy, it is sometimes to the detriment of the soldiers.
Warren Hardy is challenging his medical discharge after he says he was rushed through his medical review and the Army failed to diagnose his traumatic brain injury. He believes he should be eligible for a military retirement with full lifetime benefits for his family.
Hardy, a sergeant in the Army, was wounded by an anti-tank mine in May 2004 but returned to active duty a few days later. He finished his tour and returned to Germany, where his unit was based. Hardy said he felt "off," and doctors ended up diagnosing him with a spinal cord injury related to the explosion. But he said they ignored his other complaints.
"When I told them I was having trouble remembering stuff and my hearing would disappear, they just told me it was my age. I was 32 at the time," Hardy said. "When you go for the medical, they want you back to work or gone. I had a lot of pressure to get my case resolved. That meant I had to sign whatever they put in front of me."
Baumann said he knows of many soldiers who rushed through the medical-evaluation process because they were either in a hurry to go home or confused by the process and didn't know how to fight it.
He said he understands their confusion, because he felt the same when he realized the Army was going to reject his claim of PTSD, and he didn't know what, if anything, he could do about it. That was when he turned for help, from a lawyer and fellow guardsman.
"When I looked at the regulations, it became clear to me that it was very complicated, even for an experienced lawyer, much less an enlisted soldier," said Maj. Jesse Miller, Baumann's former commander in the California National Guard. "That's not how it should work. It shouldn't feel like a legal battle just to adjudicate somebody's disability rating."
Baumann's Army medical review labeled his mental health symptoms as an anxiety disorder or depression, not the PTSD Baumann says he suffers from. He is challenging that review with pro bono help from Miller, who is an attorney with Reed Smith in San Francisco.
The PTSD ruling would allow Baumann to get a disability retirement, which would include lifetime health insurance for him, his wife and any children they might have, as well as a monthly retirement check from the Army.
Without the PTSD diagnosis, Baumann's injuries fall just short of meeting the standards for disability retirement, and he would be simply discharged instead, offered a one-time severance check and shunted to the VA health care system, which would pay for treatment of his combat injuries.
"The PTSD is something that affects me just as much as my physical injuries. It's hard to focus on anything, I can't concentrate, I forget what I'm doing," Baumann said. "The system doesn't take into account whether a soldier can work or not. They don't look at how your wounds affect the rest of your life."
Once soldiers make it through the military medical-review process and are discharged, they are handed over to the VA.
There it can take months to determine what injuries veterans suffered, what level of medical care they need, and how much money they will receive in monthly disability payments for the rest of their lives. For many veterans, that means living off whatever severance money they got from the military until the VA comes through.
In Hardy's case, the severance wasn't enough. While he waited for the VA to address his case and determine whether he'd suffered a brain injury, Hardy struggled to support his family. He was too injured to work, and he and his wife, living in Campbell with a toddler at the time, were expecting triplets.
"I was getting to the point where home life wasn't good," Hardy said. "I really wanted to give up and become a bum on the street. The system is sometimes so hard to deal with that it's just easier to give up."
Hardy now supports his family on $3,300 a month from the VA, which he hopes to augment with $2,500 more from the Social Security Administration once he gets through that paperwork. The VA pays for part of his family's health expenses. The family moved to Vancouver, Wash., earlier this year so they could afford a house.
The health care bureaucracy has long been a source of complaint for soldiers and veterans.
As awful as the news out of Walter Reed and the treatment of Iraq veterans has been in recent weeks, soldiers and advocates alike say they hope the investigations that follow will improve the health care system as a whole.
"If anything positive comes out of this, I'm hoping they find a way to help these men and women to more easily maneuver through the two systems," said Kerri Childress, spokeswoman for the VA Palo Alto Health Care System, which includes three inpatient facilities in the Bay Area and half a dozen outpatient clinics. "I think they're absolutely going to be looking at that, because it's incredibly frustrating."
http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/03/17/MNGGEON77P1.DTL&type=printableVA's thorough care a shock to soldier
After a year in Army's care, wounded vet finally gets aid
Erin Allday, Chronicle Staff Writer
Saturday, March 17, 2007
When Sgt. Brett Miller arrived at the Veterans Affairs hospital in Palo Alto, the staff checking him in for an extended inpatient stay asked who had dropped him off.
Miller told them he'd driven himself.
"They said, 'Whoa, you what?' " Miller, 31, recalled.
He was a patient with traumatic brain injury, recently arrived from an Army hospital in Washington state, where he'd been living in the barracks on and off for close to a year -- driving himself around the base despite the fact that he could barely walk or talk, he was blind in one eye, and his balance was so bad he couldn't ride a bike.
The difference between the Army's and the VA's hospitals was shocking, Miller said.
"Here, you're inpatient, and they monitor you 24 hours a day to look for the telltale signs that are going to be complications down the road," said Miller, who has been at the Palo Alto hospital since October. "With the military, it's like, if you're not literally in a bed hooked up to something, you're an outpatient. There's no supervision.
"You have people with head injuries who are prone to strokes and seizures, and there's alcohol consumption. People go to the bars at night, and they're driving when they haven't even been cleared or screened."
Miller, who serves with the Oregon National Guard, was injured by a roadside bomb in Iraq in August 2005. After four months of treatment in Iraq and Germany -- and several weeks at the scandal-plagued Walter Reed Army Medical Center -- he was transferred to Madigan Army Medical Center in Fort Lewis, Wash., for an extended outpatient stay.
All told, he spent 14 months in and out of military hospitals before he landed at the VA Palo Alto Health Care System, a nearly 70-year-old facility with ties to Stanford University Medical Center that is considered one of the best veterans' hospitals in the country.
Like other soldiers and veterans in the Bay Area, Miller said he has been impressed with his care at the Palo Alto VA, which is one of four designated polytrauma rehabilitation centers -- designed to treat men and women with multiple disabling injuries -- in the Veterans Affairs system. The hospital has a special ward for men and women who have suffered traumatic brain injuries and is attached to a center in Menlo Park for inpatient treatment for post-traumatic stress disorder.
"These men and women are coming to us oftentimes having miraculously survived their injuries," said Kerri Childress, a spokeswoman for the VA hospital. "They get through acute care, and then they come out to Palo Alto, and they come for the long term, the arduous work to regain the kind of life they had before. We're talking not just months, but years."
Military hospitals are not designed as a source of long-term care for brain injury patients, so it's no surprise that the level of care Miller receives from the Palo Alto VA is more advanced than what he experienced at the Army hospitals.
His medical and physical therapy appointments keep Miller as busy as a full-time job, and in another couple of months, he will be transferred to the PTSD center for treatment there. Miller, a former firefighter who taught wildland fire science and meteorology at the college level before he was sent to Iraq, doesn't expect to get all of his former life back. But his condition has improved dramatically at the Palo Alto VA, he said.
His speech, while slow and focused, sounds normal to someone who doesn't know him. He walks with few problems and has learned to work around hearing and vision losses. He has regained enough of his balance that he's able not only to ride a bike but to compete in mountain-bike races -- a sport that his medical staff has supported both as physical therapy and a way to help him overcome multitasking and concentration problems.
"Racing has been a part of my recovery because I have to manage my sponsors and I have to mange my race dates, so they use that as executive skills and occupational therapy," said Miller.
But he's taking driving lessons before they will let him behind the wheel of a car again.
http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/03/17/MNGGEON7711.DTL&type=printable
