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Thursday, Feb. 24, 2005 01:06 pm

VA under fire

More than any other war in U.S. history, the conflict in Iraq has provoked a surge of concern for soldiers returning home bearing the psychological burdens of battle.

From the war’s first days, veterans’ groups, mental-health organizations, and some members of Congress have claimed that the Department of Veterans Affairs (VA) is unprepared to treat the tens of thousands of U.S. soldiers likely to come back with posttraumatic-stress disorder, a debilitating psychological condition.

A new federal report indicates that those fears are not unfounded. On Feb. 16, the Government Accountability Office, the investigative arm of Congress, released a report criticizing the VA for failing to improve its PTSD services, even when confronted with numerous reforms suggested by its own Special Committee on PTSD. The report follows a five-month investigation by the GAO that sought to determine whether the VA had implemented 24 of the 37 recommendations made last year by the Special Committee on PTSD, a group of VA doctors who report annually to the VA.

The GAO concluded that the VA had not fully addressed any of the 24 recommendations, which run the gamut from hiring regional PTSD coordinators to developing credentialing standards for PTSD clinicians to establishing PTSD screening and referral systems. Specifically, the GAO report found that the VA had met 14 recommendations only partially and left 10 completely unmet; nearly half of those had been asked for since 1985. The GAO also determined that the VA had no plans to address most of the recommendations until at least 2007.

“This report confirms my concerns about the VA’s capacity and ability to meet the rising demand of veterans seeking mental-health services,” said Rep. Lane Evans, D-Ill., ranking Democrat on the House Veterans’ Affairs Committee, in a Feb. 16 statement. “It is inconceivable that the VA has yet to even name a PTSD coordinator in each of its health networks as recommended by the Special Committee.”

Evans, a Vietnam-era veteran, asked the GAO to investigate last May after growing frustrated with what he saw as the VA’s dawdling at improving its PTSD services.

National mental-health organizations and veterans’ groups have long warned that such services were being overwhelmed by an emerging population of psychologically troubled veterans and an ever-tightening budget. In 2004, at the behest of former Secretary of Veterans Affairs Anthony Principi, the VA began drafting a mental-health strategic plan that involved reinforcing PTSD programs by 2007, but at an estimated cost of $1.65 billion not yet in the agency’s budget. Publicly, the VA worried about the potential strain on services but has insisted that it’s ready for the estimated 16 to 30 percent of soldiers who will likely return from Iraq and Afghanistan with some psychological trauma.

Not surprisingly, the VA adamantly refutes the GAO’s findings. “They’ve taken a negative stand on what this agency does, and the report discounts all the wonderful accomplishments we’ve made with regard to PTSD,” says Dr. Mark Shelhorse, the VA’s acting deputy consultant for patient-care services for mental health. According to Shelhorse, seven of the recommendations the GAO categorized as partially met have been fully satisfied, including providing PTSD screenings for new veterans. He also says that the VA allocated $15 million of its 2006 $28 billion budget for additional PTSD and substance-abuse programs and that the agency was placing teams of PTSD experts in locations with high concentrations of veterans.

For Congressman Evans, however, the VA’s response is part of the problem. “What troubles me most about this latest GAO report is the VA’s hypersensitive posture,” Evans said in an e-mail last week. “VA leadership seems unwilling to accept that GAO has found areas where improvements are necessary.”

Cynthia Bascetta, director of veterans’ health-care issues for the GAO, says that she, too, was surprised at the VA’s reaction and that the agency needs to do a better job of prioritizing, given that wars in Iraq and Afghanistan have made the task of addressing mental-health gaps more pressing. Although estimates have varied, the VA now says that 6,400 veterans from Iraq and Afghanistan have sought help for PTSD since those wars began, but the GAO questioned whether that number is even accurate. Regardless, the incidence of PTSD is expected to increase substantially as more soldiers return home, and the GAO has urged VA brass to speed all of the recommended improvements cited in its report. The agency plans a follow-up investigation later this year.

Because the VA disagrees, it has 60 days to draft a response to the Senate Committee on Homeland Security and Governmental Affairs. The GAO issued an earlier report in September proposing that the VA update its data-keeping methods for PTSD veterans; the VA concurred. Says Bascetta, “The VA’s mental-health plan, which is still only in draft form, is set for 2007 or later. But this looks to be a serious problem right now.”

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