Back Home, Disabled Vets Fight Injuries, Red Tape
Army And VA Can't Keep Up With Numbers Of Badly Wounded Soldiers And Their Families Awaiting Benefits
Esther Schrader, Times Staff Writer
August 08, 2004 "Los Angeles Times
MANASSAS PARK, Va. — The yellow ribbons are faded and fraying outside the neatly appointed house where Jay Briseno lies tethered to a respirator, his nearly motionless, 21-year-old body a shrunken shadow of the young man who last year went marching off to war.
Shot in the back of the neck in Baghdad on a sweltering afternoon in June 2003, Briseno was rushed with all the speed and efficiency the Army could muster to one hospital after another, brought back from multiple heart attacks and strokes.
But Briseno isn't a soldier anymore. He is a veteran, facing a lifetime of excruciating disability. The efficient war-fighting machine he was a part of has moved on. His care is left to his parents and sisters, who, bent over his bed day and night, are struggling to adjust.
For Briseno and his family — as for thousands of others wounded in the Iraq war — the transition from the life they knew as soldiers to a future as disabled veterans is filled with frustration and pain. The military is more efficient than ever in treating its wounded. But after the battle-scarred leave Army hospitals, they often find themselves on their own in an unfamiliar and difficult-to-navigate thicket of benefits and services.
Since the wars in Afghanistan and Iraq began, 6,239 troops had been wounded in action, according to a recent Pentagon count. Of those, 57% were so severely injured that they were unable to return to duty. Medically retired from active duty military service, they need immediate assistance from the Department of Veterans Affairs healthcare system.
The surge of newly disabled veterans represents a challenge of a magnitude unseen since Vietnam.
Aware of potential pitfalls, the Army and the VA have started programs to reach out to the most severely wounded soldiers. Among the steps being tried are putting social workers in hospitals where the severely wounded are being treated, adding benefits experts willing to meet bedside with soldiers and creating call centers that offer advice and help after the injured are sent home.
The pilot programs are small and nascent, and both the Army and the VA acknowledge they are not nearly enough.
Congress has yet to allocate funds for the programs, which are being covered out of general soldier and veterans healthcare budgets. But already, case workers say, they have helped some former soldiers get pay owed them and helped others get needed medical equipment and services.
In the case of Briseno, Army officials interceded with the VA to get him a specialized bed that his parents said made it far easier to care for him. The bed has a built-in scale so a nurse can weigh Briseno without moving him, and a platform that makes it easier to turn him the dozen times a day needed to avoid bedsores.
"From the beginning all we got from the VA was lip service," said Joe Briseno, who quit his job to care for his son at home full time. "They questioned every piece of equipment we asked for. They told us Jay should be in an institution. They told us to give up on him. We were desperate when these people from the Army called and said, 'Do you have what you need? Is there any way we can help?' "
Veterans Administration and Army officials say privacy laws prevent them from discussing Briseno's case. But they acknowledge that with soldiers as severely wounded as Briseno being evacuated from Iraq regularly, questions about the adequacy of the system to care for them over the long term are real.
"We found when we looked into this that there seems to be a gap in helping people transition into private life," said Brig. Gen. Michael C., who as director of the Army's Human Resources Policy Directorate is in charge of that service's new program.
"In previous wars the programs existed, but there was no one who was an advocate for the soldier, so the soldier basically navigated through the programs his or herself," Flowers said. "That's awfully tough when you are in the hospital and people say, 'Sign this. Sign that. Everything will be OK,' and then you get out and you're suddenly at the VA and people say, 'Where are your medical records? Where is this? Where is that?' And you don't know."
In looking to the government for their healthcare needs, new veterans follow a long line of their predecessors who, since the Civil War, have been assured that the country they fought for would make its best efforts to take care of them.
But there have always been difficulties in following through. And the VA is a difficult bureaucracy to navigate in even the best of circumstances, much less when dealing with devastating injuries.
For decades, the VA, with 7.5 million veterans enrolled, has struggled to keep up. At any one time, more than 3,000 vets are waiting for their first visit to the doctor. Those whose injuries from battle qualify them for disability compensation often wait six months to two years to receive it. The VA has taken steps to cut the wait for veterans of the Iraq and Afghanistan wars, said Terry Jemison, a VA spokesman. In recent months, it has begun to station benefits experts at the military bases of returning units. Newly discharged soldiers who have been helped by these experts have waited 54 days on average to get their first veteran disability compensation checks.
But with the VA's costs increasing by 10% to 15% a year, with aging facilities in need of modernization and with the newly disabled veterans draining resources, "the system is under a strain, a serious strain," said David Uchic, spokesman for Paralyzed Veterans of America, which was founded in 1946 to represent soldiers with spinal cord injury or disease.
"Having new patients coming into the system puts a strain on a system that is already under pressure," Uchic said. "It doesn't just end with them going to Walter Reed [Army Medical Center in Washington] and being treated. This is a lifelong situation for them for the next 60 to 80 years. So is the system going to be ready to serve them for all those years? That is the question."
At Walter Reed, most often the first stop in the United States for soldiers in need of extensive medical treatment, VA social workers have been meeting with injured soldiers and their families about healthcare benefits since last summer.
"This is really a new idea. Before, we would wait for new veterans to knock on our door. Now we are going out to find them," said Xiomara Telfer, one of the social workers who is spending time with patients at Walter Reed.
But the VA program is still small — a handful of social workers at Walter Reed and a few Army medical centers. Telfer and others say that, judging by their experiences, problems with delayed paychecks, confusion about benefits and entitlements are rife.
"There are holes we are trying to plug," said Dr. Michael J. Kussman, acting deputy under secretary for health for the veterans health administration of the VA. "The flow of information from the Department of Defense to the VA is something that both agencies are working hard on improving. We're trying to raise the bar."
The VA has not allocated any money for the effort; the social workers it has assigned were already on staff. The Army's program — called the Disabled Soldier Support System — is run by fewer than 10 people on a budget of $1 million this fiscal year.
It was born when Gen. George W. Casey Jr., then the Army's vice chief of staff, visited recovering soldiers at Walter Reed and was struck by their anxiety and confusion about what lay ahead. Since it was started last fall, the program's small staff has been able to reach out to nearly 200 severely wounded soldiers.
Crammed into a crowded office suite in Rosslyn, Va., staff members spend much of their time struggling to locate wounded soldiers who have been discharged.
The Army doesn't keep track of their addresses, and the Veterans Administration doesn't keep track of their disability status in a way that would help pinpoint those most in need. To fill in the gaps, employees have gotten creative — combing through newspaper articles and databases to locate the most seriously wounded former soldiers and get them help.
Working under banners that say "Army Families Are Special," and "We Love Our Troops," two women, both wives of soldiers, take 60 calls a day from wounded soldiers seeking help. One spent four months unraveling a problem that had prevented a soldier who lost a limb in the war from getting paid for six months.
Another got a former soldier who lost both legs and his sight into Braille classes. The young man had been sitting at home since getting out of the hospital, depressed and confused. Now he is working with the VA to build a home that meets his physical needs.
"We really pushed ourselves into this guy's life. We knew he needed help," said Col. Jacqueline E. Cumbo, director of the program. "We'll continue to follow this service member until he says, 'I no longer need your services.' This is not a one-time shot."
Flowers said he was proud of the program's initial successes but acknowledged it was only a beginning. "It is not enough," he said. "This just has to grow."
Kristopher Atherton, 24, lost his left arm on July 26, 2003, when an improvised explosive device hit the Humvee he was driving near Abu Ghraib. With the remains of his arm dangling, he clenched a rag in his mouth to blunt the pain and drove another 20 minutes to get himself and his passengers to a hospital.
"I had a lot of things going for me," Atherton, now living in Orting, Wash., said of that day. "About a month before I got injured my daughter was born. I had not seen her yet. I was thinking about coming home alive at least and making sure everybody else comes home. I had a newborn daughter I hadn't seen. I didn't know about the other guys. Maybe they had someone they hadn't seen."
Atherton spent five months at Walter Reed getting what he said was excellent care, even though the amputee ward was severely understaffed at the time. He said it was not until he got out of the hospital and left the Army that his troubles began.
For almost two months, he wasn't paid at all. He arrived at Ft. Riley, Kan., where his family was waiting, and was told he had to be out of his free, on-post housing in 60 days.
"There were times like that [when] I didn't know who to talk to, but Hank helped me out when he came into the picture," said Atherton, referring to Hank Minitrez, one of the civilians working to help the newly Army disabled veterans.
Within a month, the new Army support program found Atherton and his wife a townhouse in Orting and got his pay reinstated.
They also helped him get a specially outfitted car through a VA program he hadn't been aware of. The VA paid $11,000 of the total cost of his 1999 Jeep Cherokee.
A local American Legion post gave him $1,000.
He and his wife are still struggling. Changing diapers is nearly impossible one-handed, he says, and Atherton winces when he visits friends who are able to toss his daughter, squealing with delight, up in the air.
But Atherton said the help from the Army and from social workers with the VA had made a difference. Starting in September, the VA will be putting him through school — first at a community college and then at St. Martin's College — to study civil engineering.
The future is far more limited for Jay Briseno.
In his parents' home, he lies in his bed, a stuffed animal from his childhood tucked into his motionless arms.
A photo of him in uniform rests on the mantle nearby. Although conscious, he is unable to move and his ability to communicate is severely impaired.
His teenage sisters have dropped many of their after-school activities to help out. The deacon of their church comes by three times a week.
His mom and dad don't stay in their bedroom anymore — they sleep on a futon next to their son's bed to care for him through the night.
They have to: The money they get from the VA is only enough to pay for 19 hours a day of nursing care and he needs help all 24.