50,000 US wounded — what our $2.5 trillion has boght

March 13th, 2007

Below, we discover a gross “misunderestimation” of war wounded totals [... duh! Like the official US estimate of the numbers of Iraqi killed, perhaps?] Tammi Duckworth, the 2004 Dem candidate that lost a leg in Iraq, speaks about Vet affairs, her stay at Walter Reed and the huge cost of caring for the wounded in the future. New reports that PTSD has a grip on a full quarter of our troops, and most suffer one or more mental health problems — higher figures than even Vietnam. It’s worth noting that reporting these symptoms is not encouraged in the military — and it takes dramatic events to convince returnee’s that they need to get help. I think we’re looking at a “tip of iceburg” report, here.

Meanwhile, the Dubby orders another 4000 or so kids for Iraq and 3000 for Afghanistan.

Yes, sir — would you like fries with that?

It’s a nightmare that never seems to end, isn’t it. Bill Maher caught hell because he said that there would be a whole lot more people alive if Uncle Dick and Dubby weren’t — well, somebody had to say it!

Jude

Can We All Call It an Escalation Now?
Dan Froomkin, WaPo
3/12/07
http://www.washingtonpost.com/wp-dyn/content/blog/2007/03/12/BL2007031200711.html

Peter Baker writes in The Washington Post: “President Bush approved 8,200 more U.S. troops for Iraq and Afghanistan on top of reinforcements already ordered to those two countries, the White House said Saturday, a move that comes amid a fiery debate in Washington over the Iraq war.

“The president agreed to send 4,700 troops to Iraq in addition to the 21,500 he ordered to go in January, mainly to provide support for those combat forces and to handle more anticipated Iraqi prisoners. He also decided to send a 3,500-member brigade to Afghanistan to accelerate training of local forces, doubling his previous troop increase to fight a resurgent Taliban. . . .

“In Iraq particularly, the moves could fuel suspicions that a troop increase initially described as a temporary ’surge’ may grow larger and last longer than predicted.”

Robert Burns writes for the Associated Press: “President Bush’s troop buildup in Baghdad apparently will be bigger and more costly — and perhaps last longer — than it seemed when he unveiled the plan in January as the centerpiece of a new Iraq strategy.”

In Colombia yesterday, Bush bristled at the notion that he keeps upping the ante. “The troop announcement I made was over 20,000 combat troops,” he said.

And it’s true that in his Jan. 10 speech, Bush said “I’ve committed more than 20,000 additional American troops to Iraq.”

But in an official briefing earlier that same day, a senior administration official gave the exact — and apparently no longer operative — numbers: “What we’re talking about is — actually, it’s two Marine battalions in Anbar, which comes to 4,000 troops, five army brigades in Baghdad. Together, you total them up, it’s somewhere in the 21,000-22,000 total.” ++

50,000 US wounded. Not 21,000!!!
Maccabee
Mon Mar 12, 2007
http://www.dailykos.com/storyonly/2007/3/12/18949/0652

Andrew Stephen of the Newstatesman exposes a scandal as big as Abu Gharaib. C-17s filled with wounded soldiers that we are not allowed to see roar in every day, Critical Care Air Transports carrying gravely wounded soldiers to the states. The numbers of those wounded reported by the Pentagon and the VA do not mesh.

The extent of this deception will absolutely knock your socks off.

The actual number of the wounded is being hidden from the press, and from Congress. The cost to care for them is being hidden. The extent of the damage to US equipment and to replenish the equipment lost is far larger than we are being told.

Bilmes discovered that on 10 January the number of wounded listed on at the Veterans Administration dropped from 50,508 to 21,649. Bilmes says it’s tin-foil hat time. The outrageous lies they tell, the information they manipulate happens all under the radar, and completely unreported by a compliant and worthless mainstram press.

Yet the story of the US wounded reveals yet another deception by the Bush administration, masking monumental miscalculations that will haunt generations to come. Thanks to the work of a Harvard professor and former Clinton administration economist named Linda Bilmes, and some other hard-working academics, we have discovered that the administration has been putting out two entirely separate and conflicting sets of numbers of those wounded in the wars…

…Let me pause to explain those deceptive figures. Look at the latest official toll of US fatalities and wounded in the media, and you will see something like 3,160 dead and 23,785 wounded (that “includes 13,250 personnel who returned to duty within 72 hours”, the Washington Post told us helpfully on 4 March). From this, you might assume that only 11,000 or so troops, in effect, have been wounded in Iraq. But Bilmes discovered that the Bush administration was keeping two separate sets of statistics of those wounded: one (like the above) issued by the Pentagon and therefore used by the media, and the other by the Department of Veterans Affairs - a government department autonomous from the Pentagon. At the beginning of this year, the Pentagon was putting out a figure of roughly 23,000 wounded, but the VA was quietly saying that more than 50,000 had, in fact, been wounded.

What Bilmes had discovered was that the tally of US fatalities in Iraq and Afghanistan included the outcome of “non-hostile actions”, most commonly vehicle accidents. But the Pentagon’s statistics of the wounded did not. Even troops incapacitated for life in Iraq or Afghanistan - but not in “hostile situations” - were not being counted, although they will require exactly the same kind of medical care back home as soldiers similarly wounded in battle.

A backlog of 400,000 cases are clogging up the Veterans Administration (expected to reach 874,000 by years ende), and this figure is being hidden from the press. It’s not just wounded soldiers who are being mis reported. The amoun of equipment that is being destroyed that will need to be fixed is exponentially higher than the government is reporting. Bilmes, a Harvard MBA, calculates that the amount of money being dumped down the drain could provide free medical insurance for every uninsured American for decades, and implement the 9/11 commission reports and secure Social Security for three generations.

To draw attention to her academic findings, Bilmes wrote a piece for the Los Angeles Times of 5 January 2007 in which she quoted the figure of “more than 50,000 wounded Iraq war soldiers”. The reaction from the Pentagon was fury. An assistant secretary there named Dr William Winkenwerder phoned her personally to complain. Bilmes recalls: “He said, ‘Where did you get those numbers from?’” She explained to Winkenwerder that the 50,000 figure came from the VA, and faxed him copies of official US government documents that proved her point. Winkenwerder backed down.

Matters did not rest there.

The VA is supposed to be independent from the Pentagon. Yet it is run by Robert James Nicholson a GOP Republican Party chairman. So another Bush crony is caught lying his ass off, not just about the war, but about the very subject of the Walter Reed scandal: the cost of the war. The cost that will extend far beyond this generation of Americans. Almost half of all veterans from the first Gulf War reported to Vas for help and many are still receiving it. We are now seeing a long term, deeply felt repercussions of head injuries, broken marriages, unemployment, alcoholism, and outright poverty.

The right wing press has either supported this deception or turned a blind eye or simply missed the boat altogether. The WSJ boastd in 2002 that a short successful war in Iraq would guarantee low oil. When the war began, the cost of a barrel of oil was $23. Today it is over $50.00. The additional cost of oil might have more to do with oil supplies than the Iraq war. But the increased costs in oil are not just paid here at the gas pump, tanks and Humvees also need an addition estimated $150 billion of oil. Add that to the miscalculation.

The end of the story if far from being told. But it seems that under every rock we see another scandal, another lie, another deception. I asked in a diary posted a few days ago how bad would this get? A lot of cynics said as bad as I could imagine. We may never know how much this war costs. How many ways can you say – worse than anyone imagined? ++

Iraq: the hidden cost of the war
Andrew Stephen, Newstatesman.com
12 March 2007
http://www.newstatesman.com/print/200703120024

America won’t simply be paying with its dead. The Pentagon is trying to silence economists who predict that several decades of care for the wounded will amount to an unbelievable $2.5 trillion.

They roar in every day, usually direct from the Landstuhl US air-force base in the Rhineland: giant C-17 cargo planes capable of lifting and flying the 65-tonne M1 Abrams tank to battlefields anywhere in the world. But Landstuhl is the first staging post for transporting most of the American wounded in Iraq and Afghanistan back to the United States, and these planes act as CCATs (”critical care air transport”) with their AETs - “aeromedical evacuation teams” of doctors, nurses and medical technicians, whose task is to make sure that gravely wounded US troops arrive alive and fit enough for intensive treatment at the Walter Reed Army Medical Centre, just six miles up the road from me in Washington.

These days it is de rigueur for all politicians, ranging from President Bush and Ibrahim al-Jaafari (Iraq’s “prime minister”) to junior congressmen, to visit the 113-acre Walter Reed complex to pay tribute to the valour of horribly wounded soldiers. Last Christmas, the centre was so overwhelmed by the 500,000 cards and presents it received for wounded soldiers that it announced it could accept no more.

Yet the story of the US wounded reveals yet another deception by the Bush administration, masking monumental miscalculations that will haunt generations to come. Thanks to the work of a Harvard professor and former Clinton administration economist named Linda Bilmes, and some other hard-working academics, we have discovered that the administration has been putting out two entirely separate and conflicting sets of numbers of those wounded in the wars.

This might sound like chicanery by George W Bush and his cronies - or characteristic incompetence - but Bilmes and Professor Joseph Stiglitz, the Nobel laureate economist from Columbia University, have established not only that the number wounded in Iraq and Afghanistan is far higher than the Pentagon has been saying, but that looking after them alone could cost present and future US taxpayers a sum they estimate to be $536bn, but which could get considerably bigger still. Just one soldier out of the 1.4 million troops so far deployed who has returned with a debilitating brain injury, for example, may need round-the-clock care for five, six, or even seven decades. In present-day money, according to one study, care for that soldier alone will cost a minimum of $4.3m.

However, let us first backtrack to 2002-2003 to try to establish why the administration’s sums were so wildly off-target. Documents just obtained under the Freedom of Information Act show how completely lost the Bush administration was in Neverland when it came to Iraq: Centcom, the main top-secret military planning unit at Donald Rumsfeld’s Pentagon, predicted in its war plan that only 5,000 US troops would be required in Iraq by the end of 2006.

Rummy’s deputy Paul Wolfowitz was such a whizz at the economics of it all that he confidently told us that Iraq would “really finance its own reconstruction”. Rumsfeld himself reported that the administration had come up with “a number that’s something under $50bn” as the cost of the war.

Larry Lindsey, then assistant to the president on economic policy at the White House, warned that it might actually soar to as much as $200bn - with the result that Bush did as he habitually does with those who do not produce convenient facts and figures to back up his fantasies: he sacked him.

From official statistics supplied by the non-partisan Congressional Budget Office, we now know that the Iraq war is costing roughly $200m a day, or $6bn every month; the total bill so far is $400bn. But, in their studies, Bilmes and Stiglitz consider three scenarios that were not even conceivable to Bush, Rummy, Wolfowitz et al back in 2003. In the first, incurring the lowest future costs, troops will start to be withdrawn this year and be out by 2010. The second assumes that there will be a gradual withdrawal that will be complete by 2015. The third envisages the participation of two million servicemen and women, with the war going on past 2016.

Estimating long-term costs using even the second, moderate scenario, Bilmes tells me: “I think we are now approaching a figure of $2.5 trillion.” This, she says, “includes three kinds of costs. It includes the cash costs of running the combat operations, the long-term costs of replenishing military equipment and taking care of the veterans, and [increased costs] at the Pentagon. And then it includes the economic cost, which is the differential between reservists’ pay in their civilian jobs and what they’re paid in the military - and the macroecono mic costs, such as the percentage of the oil-price increase.”

Let me pause to explain those deceptive figures. Look at the latest official toll of US fatalities and wounded in the media, and you will see something like 3,160 dead and 23,785 wounded (that “includes 13,250 personnel who returned to duty within 72 hours”, the Washington Post told us helpfully on 4 March). From this, you might assume that only 11,000 or so troops, in effect, have been wounded in Iraq. But Bilmes discovered that the Bush administration was keeping two separate sets of statistics of those wounded: one (like the above) issued by the Pentagon and therefore used by the media, and the other by the Department of Veterans Affairs - a government department autonomous from the Pentagon. At the beginning of this year, the Pentagon was putting out a figure of roughly 23,000 wounded, but the VA was quietly saying that more than 50,000 had, in fact, been wounded.

Casualty conspiracy

To draw attention to her academic findings, Bilmes wrote a piece for the Los Angeles Times of 5 January 2007 in which she quoted the figure of “more than 50,000 wounded Iraq war soldiers”.

The reaction from the Pentagon was fury. An assistant secretary there named Dr William Winkenwerder phoned her personally to complain. Bilmes recalls: “He said, ‘Where did you get those numbers from?’” She explained to Winkenwerder that the 50,000 figure came from the VA, and faxed him copies of official US government documents that proved her point. Winkenwerder backed down.

Matters did not rest there. Despite its independence from the Pentagon, the VA is run by Robert James Nicholson, a former Republican Party chairman and Bush’s loyal political appointee.

Following Bilmes’s exchange with Winkenwerder - on 10 January, to be precise - the number of wounded listed on the VA website dropped from 50,508 to 21,649. The Bush administration had, once again, turned reality on its head to concur with its claims. “The whole thing is scary,” Bilmes says. “I have never been conspiracy-minded, but watching them change the numbers on the website - it’s extraordinary.”

What Bilmes had discovered was that the tally of US fatalities in Iraq and Afghanistan included the outcome of “non-hostile actions”, most commonly vehicle accidents. But the Pentagon’s statistics of the wounded did not. Even troops incapacitated for life in Iraq or Afghanistan - but not in “hostile situations” - were not being counted, although they will require exactly the same kind of medical care back home as soldiers similarly wounded in battle. Bilmes and Stiglitz had set out, meantime, to explore the ratio of wounded to deaths in previous American wars. They found that in the First World War, on average 1.8 were wounded for every fatality; in the Second World War, 1.6; in Korea, 2.8; in Vietnam, 2.6; and, in the first Gulf war in 1991, 1.2. In this war, 21st-century medical care and better armour have inflated the numbers of the wounded-but-living, leading Bilmes to an astounding conclusion: for every soldier dying in Iraq or Afghanistan today, 16 are being wounded. The Pentagon insists the figure is nearer nine - but, either way, the economic implications for the future are phenomenal.

So far, more than 200,000 veterans from the current Iraq or Afghanistan wars have been treated at VA centres. Twenty per cent of those brought home are suffering from serious brain or spinal injuries, or the severing of more than one limb, and a further 20 per cent from amputations, blindness or deafness, severe burns, or other dire conditions. “Every person injured on active duty is going to be a long-term cost of the war,” says Bilmes. If we compare the financial ramifications of the first Gulf war to the present one, the implications become even more stark. Despite its brevity, even the 1991 Gulf war exacted a heavy toll: 48.4 per cent of veterans sought medical care, and 44 per cent filed disability claims. Eighty-eight per cent of these claims were granted, meaning that 611,729 veterans from the first Gulf war are now receiving disability benefits; a large proportion are suffering from psychiatric illnesses, including post-traumatic stress disorder and depression.

More than a third of those returning from the current wars, too, have already been diagnosed as suffering from similar conditions. But although the VA has 207 walk-in “vet centres” and other clinics and offices throughout the US, it is a bureaucracy under siege. It has a well-deserved reputation for providing excellent healthcare for America’s 24 million veterans, but is quite unable to cope with a workload that the Bush administration did not foresee.

The unknown unknowns

There is now a backlog of 400,000 claims from veterans and waiting lists of months, some of which “render . . . care virtually inaccessible”, in the words of Frances Murphy, the VA’s own deputy under-secretary for health. Claims are expected to hit 874,000 this year, 930,000 in 2008.

Casualties returning from Iraq meanwhile outnumber other patients at Walter Reed 17 to one, and many have to be put up at nearby hotels and motels rather than in the hospital beds they desperately need. Suicide attempts are frequent; often the less wounded end up having to care for the more seriously wounded.

Since I researched this piece, the Washington Post has published a series of articles outlining the chaos at Walter Reed and elsewhere. Undercover reporters found soldiers suffering from schizophrenia, post-traumatic stress and other brain injuries, occupying rooms infested with mice and cockroaches. The ensuing furore resulted in the sacking of the general in charge. Even Bush says he is “deeply troubled” by these “unacceptable” conditions at Walter Reed, but his government has carefully avoided the issue of how much it will cost to put right these wrongs. The failure to look after returning, often traumatised troops leads to yet further hidden costs to the US economy: the consequences of unemployment, family violence, crime, alcoholism and drug abuse, for example.

The projected $2.5trn price tag also includes the costs of replacing and replenishing military equipment in use. Nearly 40 per cent of the army’s equipment, according to the Washington Post, is currently deployed in Iraq; as long ago as March 2005, Rumsfeld conceded that tanks, fighting vehicles and helicopters were wearing out at six times the normal rate.

Significant quantities of equipment are being destroyed, too. The Washington Post reported last December that the army alone has lost more than 280,000 major pieces of equipment in the combat zones; the Army Times reported as long ago as February last year that 20 M1 Abram tanks, 50 Bradley fighting vehicles, 20 Stryker wheeled combat vehicles, 20 M113 armoured personnel carriers, 250 Hum vees, hundreds of mine-clearing vehicles and the like - plus more than a hundred aircraft, most of them helicopters - have been lost. Those figures have increased considerably since then as fighting has intensified. Add something between $125bn and $300bn for these unanticipated long-term costs, say Bilmes and Stiglitz.

Yet another gargantuan White House miscalculation was over the price of oil. Before his departure, Larry Lindsey told the Wall Street Journal in September 2002 that “the successful prosecution of the war would be good for the economy”; the WSJ echoed his thoughts in an editorial the same day, arguing that “the best way to keep oil prices in check is a short, successful war on Iraq”. In 2002, the average cost of a barrel of oil was $23.71; today, it is hovering around $50. Dick Cheney’s chums in firms such as his own Halliburton - or ExxonMobil, Shell, BP and Chevron - have profited enormously, but Bilmes estimates that even if only $5 of the oil-price increase can be attributed to the Iraq war, that alone adds $150bn to the cost of war.

There are also countless imponderables that add to the bill. The deployment of hundreds of thousands of reservists depletes the economy. At present, 44 per cent of US police forces, for example, have members deployed as reservists in Iraq, and their duties have to be performed by others in America; the same goes for firefighters, medical staff, prison wardens.

Then there are the future illnesses that may well unfold. For instance, nobody knew that the notorious Agent Orange defoliant, used by the US in Vietnam from 1961-71, would turn out to have had carcinogenic and other effects on US troops. Today, there is mounting evidence that exposure to depleted uranium - used for firing anti-tank rounds from US M1 tanks and A-10 attack aircraft - can cause cancer, diabetes and birth defects. Many veterans are returning to the US with their health apparently in ruins from adverse reactions to anti-anthrax injections and/or consumption of experimental pills to counter chemical warfare agents. The long-term costs of looking after the likes of them make the cost of the actual war dead pale by comparison: spouses of deceased soldiers receive a “death gratuity” of $100,000. Troops are also given the opportunity to take out subsidised life insurance policies for up to $500,000 for dependants. In the dispassionate way economists assess such things, Bilmes and Stiglitz estimate the additional cost to the economy of the death of a young soldier - typically 25 years old - to be $6.5m.

Bilmes has become a marked woman to the Bush administration. She was invited to participate in a VA seminar on the cost of war, to be held on the last day of this month - but then was suddenly uninvited. She is no raving lefty, though, and her economic credentials are unimpeachable: she was responsible for an annual budget of $9bn in the Clinton-era commerce department. Like none other than George W Bush, she, too, holds an MBA from Harvard.

It is sobering to think how the money going down the drain in Iraq could otherwise have been spent. “For this amount of money, we could have provided health insurance for the uninsured of this country,” Bilmes tells me. “We could have made social security solvent for the next three generations, and implemented all the 9/11 Commission’s recommendations [to tighten domestic security].”

That kind of list goes on: the annual cost of treating all heart disease and diabetes in the United States would amount to a quarter of what the Iraq war is costing. Pre-school for every child in America would take just $35bn a year. In their main paper, Bilmes and Stiglitz come up with an even more intriguing possibility: “We could have had a Marshall Plan for the Middle East, or the developing countries, that might have succeeded in winning hearts and minds.”

What a historic triumph that would have been for Bush. Instead, his legacy to generations of Americans will be a needless debt of at least $2.5trn, what his own defence secretary describes as a four-way civil war in Iraq, dangerous instability in the Middle East, and increasingly entrenched hatred of the United States throughout the world. Alas, we are likely to hear the daily roar of those C-17s as they approach Andrews Air Force Base for years to come.
The unknown price that Britain is paying

No one is counting the long-term costs of caring for injured British troops, reports Sam Alexandroni

The cost to Britain of the Iraq war, according to the Ministry of Defence, will hit £5bn at the end of this financial year. This is the figure given for direct spending on fuel, ammunition, repairs and transport; the real bill is certainly much bigger. The greatest of the uncounted costs is the financial and human toll the war is taking on the mental and physical health of British personnel serving in Iraq.

The government has not attempted to calculate the long-term cost of caring for the injured, and official statistics offer little guidance. Four thousand eight hundred personnel have been evacuated from Iraq on medical grounds but only 144 were classified as “seriously” or “very seriously” injured. What about the rest? Nobody in the MoD or NHS was able to say how many personnel who served in Iraq are being treated in Britain, or how many will require long-term medical care. The treatment costs of servicemen at NHS hospitals such as Selly Oak in Birmingham - home to the Royal Centre of Defence Medicine - are passed on to the MoD, which in turn bills the Treasury Reserve, but once a patient leaves the armed forces, ongoing treatment is paid for by the NHS.

Mental health offers similar uncertainties. So far, 2,123 troops who served in Iraq have been diagnosed with mental health problems, 328 with post-traumatic stress disorder (PTSD); but cases take 12 years on average to surface and there is no sure cure. “We won’t know for many years after the Iraq war is over how many former servicemen are suffering from psychological problems,” says Toby Elliot, chief executive of the charity Combat Stress. “The MoD doesn’t provide all the funds we need by a long way. We have to make up 40 per cent of our funding ourselves, and that’s a problem.”

Nor has anyone tried to quantify the indirect economic effects. The surge in the price of Brent crude oil from $31 a barrel at the start of 2003 to $60 today has been driven largely by increased demand, but Middle East instability affects the market and “Iraq has been factored in for years”, according to the oil analyst Jean-Luc Amos. The extent to which the Iraq war has exacerbated the domestic threat of terror and made Britain less safe remains similarly ungauged. Then there are other costs barely considered. In 2002 a study commissioned by Ken Livingstone, the city’s mayor, estimated that war in Iraq would cost the London economy £1bn in lost tourism alone, though there has been no post-invasion follow-up.

That no one in the British government has even attempted these calculations is worrying, but perhaps any cost-benefit analysis of the war misses the point. “In the end, if the Iraq war had brought the Iraqis a better life and us greater security, then - whatever the costs - it would seem ‘worth it’,” says Sir Lawrence Freedman, professor of war studies at King’s College London. “Because it has been such a screw-up, then, even at a lower level of calculated costs, it seems like a waste.”

Iraq War: Key Dates
Research by Sarah O’Connor

20 March 2003 US and Britain invade

1 May 2003 Bush announces “mission accomplished”
13 December 2003 Saddam Hussein is captured
28 April 2004 Images of US troops abusing prisoners emerge from Abu Ghraib
November 2004 US assault on Fallujah insurgents
30 January 2005 Eight million Iraqis vote in elections
July 2006 Deadliest month in Iraq: 3,438 civilians are killed
30 December 2006 Saddam Hussein is executed
10 January 2007 Bush announces 21,500 troop surge to Iraq
21 February 2007 Blair announces the withdrawal of 1,600 British troops

Iraq 2007 by numbers
Research by Rebecca Bundhun

l57,805 minimum number of Iraqi civilians reported killed since the 2003 invasion, according to the Iraq Body Count website
33% of Americans in a March 2007 poll approved of George Bush’s Iraq policy
80 US soldiers killed in Iraq last month
7,100 number of UK troops currently in Iraq
135,000 number of US troops currently in Iraq
134 number of British soldiers killed in Iraq
21,500 additional troops Bush plans to deploy in the “troop surge”
28 percentage of Americans in the March poll who said the US will probably or definitely win the war ++

`Cost of war’ too much for Walter Reed, vet says
Durbin asks to put Duckworth on panel
Jeff Long, Chicago Tribune
March 12, 2007
http://www.chicagotribune.com/features/health/chi-0703120189mar12,1,1154242.story

Tammy Duckworth saw young soldiers that were horribly wounded in Afghanistan and Iraq come home to fight other battles against the bureaucracy at the troubled Walter Reed Army Medical Center in Washington.

Sometimes they got lost in the system–or in their own depression–and never showed up for therapy.

The overworked staff didn’t always have time to find out whether there was a problem, said Duckworth, a National Guard major who lost her legs in combat.

“We called them the missing patients,” she said. “There was nobody keeping track of where they were.”

Duckworth spent 13 months at Walter Reed after a rocket-propelled grenade struck the helicopter she was co-piloting near Baghdad in November 2004. Her husband, Bryan Bowlsbey, also a National Guard major, was with her during her long months of rehabilitation.

“He wasn’t going to put up with any bureaucracy,” she said. “But it’s really different for the 19-year-old who has a brain injury and six months in the Army. He doesn’t understand the system.”

Duckworth was a congressional candidate last year and now is the director of the Illinois Department of Veterans Affairs. U.S. Sen. Dick Durbin (D-Ill.) has asked President Bush to appoint her to a commission that will look into allegations of poor care and dilapidated conditions at Walter Reed.

The commission also will do a comprehensive review of care provided to the wounded by the U.S. Department of Defense, which runs Walter Reed, and the U.S. Department of Veterans Affairs.

Duckworth said it is important to appoint a recently wounded veteran to the commission, someone who has been through Walter Reed or other military hospitals and can provide firsthand knowledge of the system and its flaws.

She said she would welcome the appointment so she could find out whether military hospitals and VA facilities are getting everything they need.

“I would be honored to serve because it’s about taking care of my buddies,” she said.

Duckworth said she knows from experience what is needed for the country to take care of its wounded warriors.

“I am exactly the kind of patient that is taxing the military medical system and will drain the VA resources,” she said. “If that is the cost of the war, then the American people should be told that is the cost of the war.”

Duckworth, who praised the doctors, nurses and staff at Walter Reed, said she sailed through with relative ease, other than the grueling work of rehabilitation. About 100 outpatients were being treated when she was there, compared with roughly 700 now.

A social worker and a therapist made sure her accommodations were comfortable at Fisher House, the outpatient home where she lived for nine months. She was told where she was supposed to be and when.

“It’s like living in your very rich relative’s house,” she said of Fisher House.

According to published accounts, some wounded soldiers said they received little guidance about life as an outpatient and had to get around the sprawling 113-acre Walter Reed complex on their own after their discharge from the hospital.

“My social worker had probably 30 or 40 patients,” Duckworth said. “He’s probably taking care of hundreds now. When he was taking care of me, he was already working a 70-hour week. I can’t even imagine what his workweek is like now.”

Duckworth said she noticed some signs of maintenance problems at Walter Reed.

There was a cockroach in her hospital room once, and she saw mice at Mologne House, another building where outpatients and their relatives live. Some of Duckworth’s family stayed at Mologne House during her rehabilitation.

She said she doesn’t think that “Building 18,” described in recent news stories as a dilapidated wreck with mold in the walls and holes in the floors, was in use when she was at Walter Reed.

Duckworth said she wanted to know whether the former lodge was opened too soon because of the constant stream of wounded soldiers arriving from Afghanistan and Iraq. She also wants to find out whether contracting out janitorial services led to the poor conditions there.

At the same time, Duckworth said she wonders whether funding decreased for Walter Reed facilities after the military medical complex was listed for closing in 2005. Funding should have increased as the number of patients grew, she said.

Meanwhile, she said, some of the paperwork required of recently wounded vets can be overwhelming, and there are too few people around to walk them through it.

For example, a properly filled out “post deployment survey” can be crucial for vets years after they get out of the service. Properly describing combat conditions might be critical in awarding benefits later for such things as post-traumatic stress syndrome.

Duckworth said many young wounded soldiers and their families don’t understand how important that information is. She and her husband tried to help others with their forms during her time at Walter Reed, but she worries about others who have no such guidance.

She also saw cases where soldiers were still getting combat pay after arriving at Walter Reed. When the military discovered the accounting error, it began deducting large amounts from the soldiers’ pay to make up the difference. And that left the soldiers and their families in a bind.

“That’s the kind of stupid stuff that was going on,” Duckworth said.

She praised the VA hospitals in Illinois, saying she visited Hines VA Hospital twice a week for rehabilitation while campaigning for the 6th Congressional District seat. Her busy schedule hasn’t allowed time for rehab work over the last few months, she said.

But Hines and other VA hospitals in Illinois, such as those located in rural areas, seem underfunded, Duckworth said.

Although it’s the largest VA hospital in the state, Hines has no one on staff who can adjust her high-tech prosthetic legs, according to Duckworth, who said she has to return to Walter Reed for such help.

Funding for the VA, she said, needs to increase because of an unprecedented boom in demand as Vietnam War and Korean War vets get older and as wounded soldiers return from today’s war on terror.

“I don’t think it’s ready to handle what’s coming,” Duckworth said. ++

Veterans fight the war within
Study finds post-traumatic stress disorder diagnoses are on the rise
Jeremy Manier and Judith Graham, Chicago Tribune
March 13, 2007
http://www.chicagotribune.com/news/nationworld/chi-0703130170mar13,1,2642076.story

It was the specter of down-and-out Vietnam veterans at the Hines VA that made Iraq veteran Chris Packley despair of his own recovery.

Packley, 24, a former Marine, served with a sniper team that was featured in Marine Corps Times and Soldier of Fortune. He returned from Fallujah in 2004 with post-traumatic stress disorder.

“It started before I came home,” Packley said. “I told the psychiatrist about it, but he didn’t care or do nothing.”

Packley couldn’t sleep more than 45 minutes a night. In his dreams, he saw people get shot and saw himself shooting. A scene with two Iraqis holding two children in front of them as human shields would stir him awake, sweating.

Some forms of therapy have been shown to help ease the symptoms of the disorder. One of the more successful techniques is called prolonged exposure therapy, in which trauma victims talk about their experiences repeatedly with the goal of reducing the emotional response linked with the events.

Yet according to a report last month by the American Psychological Association, less than 20 percent of military behavioral health personnel have been trained to provide therapies such as prolonged exposure that professional review groups have identified as the best treatments for the disorder.

While that figure is low, it’s similar to the low proportion of non-military psychologists who are trained in the best techniques, said Dr. Matthew J. Friedman, executive director of the VA system’s National Center for post-traumatic stress disorder in White River Junction, Vt. Friedman said the VA has training projects under way to increase proficiency.

Although the VA says it is increasing spending on mental health, veterans services organizations maintain that such services are underfunded. In November, the Government Accountability Office found that the agency had failed to spend more than $100 million that had been newly allocated for post-traumatic stress disorder and other conditions in the previous two fiscal years.

Help can’t come soon enough for soldiers such as Packley, who after his war experiences started drinking heavily, taking drugs and getting into fights. He received an other-than-honorable discharge and in 2005 returned to Morris, Ill., where he grew up.

Packley now works full-time at an oil refinery and is engaged, but he gets sweaty palms when he goes to the supermarket–an open space with lots of strangers and hiding places. He still thinks he’s not getting the care he needs, and sometimes he wonders if his generation will fare better than the Vietnam vets he met at Hines.

“You talk to them and you think, this system didn’t do nothing for them after all these years; what’s going to happen to me?” Packley said.

The physical risks of war may end when a soldier leaves the battlefield, but new research indicates the mental toll of the wars in Iraq and Afghanistan is continuing to build, creating a psychological health crisis with no end in sight.

Some experts believe the rate of post-traumatic stress disorder, the most common mental health problem among veterans, may even begin to exceed that seen among those who fought in Vietnam. Among the reasons cited: Many soldiers are enduring multiple tours of duty and more are surviving severe wounds than ever before.

A study of more than 100,000 veterans who have sought medical care since returning from war shows that nearly one-quarter have mental health problems. Half of those–more than 13,000 people–were diagnosed with post-traumatic stress disorder according to the report to be published Tuesday in the Archives of Internal Medicine. The disorder affects less than 4 percent of the general public.

The unpredictable aspects of combat in Iraq seem to take a mental toll similar to what Vietnam soldiers experienced, said Dr. Chirag Raval, a psychiatrist in the Army Reserves who served in Iraq and is medical director for the mental health intensive case management program at the Hines Veterans Hospital.

“There is no front line to this war,” Raval said. With hand-propelled rockets, mortars and improvised explosive device attacks “there is no true safe place in Iraq. You can be anywhere, even on your base, and still not be safe.”

More than a generation after 15 percent of Vietnam vets returned with post-traumatic stress disorder, the illness generally carries less of a stigma and has better-defined standards of treatment. But many veterans and researchers say the shame of mental illness persists in military ranks, and soldiers often avoid reporting their symptoms in hopes of preserving their careers.

Meanwhile, significant barriers remain for soldiers who seek psychological care after they return from service, according to several recent studies and congressional hearings.

On military bases there are shortages of psychologists and psychiatrists and long waits for appointments. Relatively few military mental health professionals have been trained in recommended post-traumatic stress disorder treatments. And when evidence points to the disorder, only 22 percent of soldiers get referrals, a report by the Government Accountability Office found last year.

Although most observers say the Department of Veterans Affairs’ system has improved, specialized services for vets with post-traumatic stress disorder tend to be concentrated at major medical centers and are hard to access in smaller cities or rural areas. Clinics’ limited hours may coincide with the work week, when many vets can’t get away from their jobs.

Officials with the VA say they are working to improve the situation. Michael Kussman, the VA’s acting undersecretary for health, told Congress on Thursday that the VA was boosting mental health spending and would improve access “by expanding mental health services in community-based outreach clinics … as well as enhancing both PTSD and substance abuse specialty care services.”

The experience of post-traumatic stress disorder varies, but most patients find themselves unable to stop reliving traumatic episodes, often through nightmares, flashbacks or an intense feeling of anxiety prompted by an ordinary sound or event that recalls the painful experience.

Psychologists did not officially recognize the condition until 1980, in the wake of the Vietnam War. In fact, experts said Iraq and Afghanistan are the first major conflicts in which American researchers have tracked the disorder among veterans as the war continues.

The study to be published Tuesday drew on a confidential database of 103,788 veterans who sought care at VA health facilities between September 2001 and September 2005.

The 25 percent rate of mental problems among those soldiers is higher than that found last year in a study of all veterans who served in Iraq and Afghanistan, and researchers say their observations also indicate diagnoses are climbing.

“It does look like there is indeed an upward trend, and it’s scary,” said Dr. Karen Seal, a physician at the San Francisco VA Medical Center and lead author of the new research.

More than half of the veterans who had a psychological diagnosis had two or more distinct mental problems. Seal said it’s common for returning veterans to suffer both post-traumatic stress disorder and depression, which can make the individual conditions more challenging to treat.

One surprising result was that veterans younger than 25 were nearly three times more likely to have the disorder than veterans older than 40.

“You have a young population possibly not getting treatment for these conditions, and going on to have chronic mental illness,” Seal said. “It’s potentially a big public health problem.”

Getting post-traumatic stress disorder sufferers to acknowledge their condition is a challenge, Seal said–in part because the military is “a very macho culture, not one that supports being weak or crying at the pop of a balloon.”

The direst fear is some Iraq veterans will develop the same long-term problems as many Vietnam vets, including mental health-related substance abuse and homelessness. ++

“So keep fightin’ for freedom and justice, beloveds, but don’t you forget to have fun doin’ it. Lord, let your laughter ring forth. Be outrageous, ridicule the fraidy-cats, rejoice in all the oddities that freedom can produce. And when you get through kickin’ ass and celebratin’ the sheer joy of a good fight, be sure to tell those who come after how much fun it was.”
~ Molly Ivins, 1944 - 2007

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Entry Filed under: Political Waves