Willing to Serve, Unable to Wait

by Colton Silvia

In the United States, less than 1% of the population will serve in some branch of the military and every year 10% of these select few will become veterans.[1] These men and women who voluntarily join the military, whether it be through officer enrollment or enlistment, are told they will receive several benefits for their service. Joining the military service provides these individuals with a steady form of employment and fair paygrade for the amount of training required. The job comes with the perk of health care and assumption that the US Department of Veteran’s Affairs (VA) will work with them and provide reliable and timely services once they have retired. The VA does not always provide medical care in a timely manner, unfortunately. This major issue is currently being addressed by state governments, but minimal success has come from recent efforts.

Early Days of the VA
The VA first became a federal administration in the 1930s when president Hoover signed executive order 5398.[2] Versions of the VA had existed before that point in time, but that was when large sums of money started getting set aside for military veterans. Following World War II, the VA received a significant boost in funding and started to provide many new services to its members. Overall, veterans were receiving fair benefits and good care. This good, but not great, care continued up through the Vietnam War. Prior to the Vietnam War, individuals could willingly join the military but many were drafted. After the Vietnam War, service in the United States Military became entirely volunteer based. The men and women who would be joining from that point on would all be doing so of their own will. This is a key factor because it means that individuals who volunteer know of the potential dangers: physical wounds, mental trauma, and even death, but they still sign up. With the Vietnam War not being popular in public opinion, the VA faced some serious challenges in maintaining their budget. Regardless of the popularity or the results of the war, soldiers had to return home and when they did they came home with both mental and physical wounds. Unlike past wars, however, they did not have a warm welcome awaiting them. Protests and some violent behavior welcomed the service members home. The manner in which veterans were being treated caused a great deal of reform within the military because new strategies and perks would be necessary in order to keep people interested in joining. Perhaps one of the most important perks, along with education, is the health care service members are offered.

Care after Service
Before discussing the issues with the VA, it is pertinent to first discover what military health care is like for veterans as well as their families and the treatment methods used. Veterans are covered by “direct care system, military treatment facilities, and the purchased system TRICARE.”[3] There is a hierarchy to who is receiving care, however, and veterans are prioritized after active members. That’s not to say that veterans should be prioritized over active members, but medical problems of high need should be addressed immediately, rather than simply following a hierarchical structure. Veterans also have the option to purchase other forms of care if they aren’t able to utilize VA services. A large percentage of veterans qualify for health care and don’t use it, some qualify but aren’t close enough to a center to actually take advantage of it, and some veterans for some reason or other don’t qualify for care.

In treating veterans it is important for physicians to be wary of both physical and mental ailments. The main issue facing the treatment of physical problems is the long waiting lists for not only treatments but appointments, and this issue will be discussed shortly. Regrettably, there is a stigma pertaining to mental health in the active service member and veteran communities. This stigma causes several veterans and active members to not seek mental health care when it may be beneficial. Active members fear no longer being deemed qualified to do their jobs while veterans took part in a culture that labeled mental problems as a sign of weakness. Thus physicians who work in VA and civilian clinics should also be conducting brief mental assessments during their appointments because many problems need to be discovered by the physician as they won’t be admitted by the individual. Around 14% of veterans will experience PTSD as a direct result of their time spent serving.[4] This statistic is important because it emphasizes the care which physicians should be using when they are examining and treating veterans. As PTSD has been linked to several physiological problems it can be useful to first evaluate and determine which veterans have PTSD. Also worth noting is that 14% is the percentage of veterans that are being diagnosed. Considering the stigma related to mental health, it wouldn’t be surprising if that number was actually higher. TBI is also a large problem facing many veterans. With PTSD and TBI in mind, it is important for veterans to be able to make simple check-up appointments. These appointments are becoming more and more challenging to make however as wait lists are posing a ridiculous challenge for veterans.

Specific Communities
Before they can even get in the line for an appointment, veterans have several other standards that must be met. Minority communities as well as homeless veterans struggle to receive health care. These veterans were more likely than their counterparts to receive all of their healthcare from the VA.[5] This essentially means that the only form of health care they can afford is through the VA. Which for them would mean joining the unnecessarily long waiting lists. Veterans already have a low priority and from there it appears that minorities are ending up at the bottom of the priority hierarchy. Many issues face these veterans such as language barriers or lack of medical centers where they live. The homeless veterans have a hard time because they do not have telephone numbers to be reached at or addresses to list when trying to schedule an appointment. This makes it challenging for record keeping as well as sending out information to the veterans. There is also the issue of mental health pertaining to female veterans. Approximately the same percentage of women use mental health care from the VA as male veterans but a significantly larger percentage of females seek mental health care outside of the VA.[6] This unsettling statistic prompts the questions why are so many female veterans seeking mental health services outside of the VA and how can the system be changed to better serve all of its veterans.

Awaiting Death
For many veterans, the problem is not one of good treatment but rather awaiting treatment. Wait lists have been increasing across the nation and people are taking notice. Hundreds of veterans attempt to schedule doctor’s appointments and are put on waiting lists. These lists can cause patients to wait months for a regular visit. What’s worse is that once these first visits happen it could be months before the patients are seen again and treated. Tragically, new evidence is coming forward showing that, due to the long waits, veterans are dying.[7] Documents released by the hospital even comment that if the veterans had been seen earlier cancer could have been identified at earlier stages and possibly treated through removal of cancerous tumors or cells. As a result, by the time the veterans are diagnosed, if they even get diagnosed, the cancer has already progressed to a point that is harder to manage and is likely to result in death.

What’s Not Working and What Can Be Done
The problem of wait time is currently being addressed but not in a successful manner. The Florida state government tried to rectify this problem by allocating one million dollars for the treatment of veterans. The hospital in turn only used one third of that allocation for veterans and declined to be interviewed about what happened with the money.] After the additional funding, the waiting lists actually got larger rather than decreasing.[8] This is not the only state with a problem either, upon further research it was found that several hospitals around the country have waiting lists for appointments and some hospitals are even trying to cover up the amount of people on the lists. Transparency of veteran related treatment by hospitals and medical centers should be the first step in truly solving this problem. Rather than finding out there are secret waiting lists through investigative reporting, hospitals and medical centers that treat veterans should have to be completely transparent with the VA. That’s not to say that they should be transparent with the media or the public. With this knowledge the VA can begin to address the problem and governments can allocate the necessary funds to rectify the issue. Options such as hiring increased staff or opening up new offices could be explored with these increased funds. These funds would also have to be monitored to an extent. With what can be learned from the issue in Florida, the VA should monitor the money that is allocated for veteran treatment.

[1] Stephen J. Cozza, Care of Military Service Members, Veterans, and Their Families. 2014, xxx.
[2] “About VA.” History. http://www.va.gov/about_va/vahistory.asp.
[3] Cozza, 55.
[4] Ibid., 75.
[5] Karin M. Nelson, Gordon A. Starkebaum, and Gayle E. Reiber, “Veterans Using and Uninsured Veterans Not Using Veterans Affairs (VA) Health Care.”Public Health Reports 122.1 93–100. 2007. Print.
[6] Rani A. Hoff, and Robert A. Rosenheck. “The Use of VA and Non-VA Mental Health Services by Female Veterans.” Medical Care: 1524-533. 1998.

[7] A Fatal Wait CNN + Keeping them Honest: Deadly Wait CNN
[8] Keeping them Honest: Deadly Wait CNN

 

For Further Reading
Federal Benefits for Veterans, Dependents and Survivors. 2010 ed. Washington, D.C.: Department of Veterans Affairs, 2010.
Schultz, Howard, and Rajiv Chandrasekaran. For Love of Country: What Our Veterans Can Teach Us about Citizenship, Heroism, and Sacrifice. New York: Random House LLC, 2014.