Vets return, but not always with healthcare

After serving 410 days in Iraq with the 1st Armored Division, Spc. Stuart Wilf came home to Colorado on Oct. 2. He changed his clothes, borrowed his mother's car, and went out with friends to celebrate.

On the way home, he fell asleep at the wheel and had a head-on collision with a tree. He survived, but since he was newly discharged, he had no health insurance.

"That was a mind-boggling thing to find out the first day he's out of the service," says his mother, Becky Wilf. "His bill was $54,000 just for the hospital. That doesn't include the surgeon."

Specialist Wilf is just one of thousands of veterans returning home from Iraq and Afghanistan who advocates contend are falling through the cracks of a federal system unprepared to deal with so many soldiers. After spending months in a war zone, many of the 170,000 soldiers who've returned home are struggling with their transition to back to civilian life - from coping with a maze of red tape and contradictory messages on healthcare to finding affordable housing and jobs with adequate incomes to accessing disability payments.

One of the biggest problems, according to advocates and a report by the Government Accountability Office, is a lack of resources to deal with battle fatigue, or posttraumatic stress disorder, as it's now called. Another is providing support for Reserve and National Guard troops, who make up 45 percent of the troops in Iraq.

"The bottom line is that the VA [Department of Veterans Affairs] wasn't prepared for the 33,000 troops that have come back and gone to the VA needing care," says Paul Rieckhoff of Operation Truth, a nonprofit advocacy group for veterans of Iraq and Afghanistan. "They're definitely not ready for the flood that's going to come back next year."

The VA disputes that and says it has ordered its services so that returning veterans will receive top-priority care. Last year, it announced that it would no longer be able to provide health services to veterans who make more than $26,000 a year (on average) and have no service-connected health problems. As a result, VA spokeswoman Cynthia Church says that what were once "unbelievable wait times" have been reduced. That allows the VA to treat returning combat veterans who were wounded or have service-related problems for free for two years.

"No veteran now waits longer than 30 days for their first appointment," she says. "In terms of access to facilities, we've got more than 158 hospitals and more than 800 clinics, and we contract with service providers in communities where there may be a need."

The VA's policy are less clear when it comes to vets like Wilf, who sustained injuries after he was discharged. He and his family spoke with four different VA representatives and were told that because his injuries were not combat related, he was ineligible for VA care.

After inquiries from reporters, the VA in Washington said that if Wilf had been enrolled in the VA system, he would have been eligible for treatment for noncombat problems because he had just returned from combat duty. But he would have to pay for a percentage of the cost if he were able, and he would not be a priority case. "Part of the problem is the way the law reads. It says it's mandatory to provide care for a condition possibly related to service, but doesn't really address treatment of an unrelated condition," says Gary Baker, head of the Eligibility Center at the VA.

Wilf has since filled out the application to enroll but is still waiting for it to be processed. In the meantime, the hospital where he was treated has forgiven most of the $54,000 bill because he was technically indigent. But he still has another $24,000 in related bills to pay.

Wilf was active duty, but some returning troops in the National Guard and Reserves have also found themselves without healthcare. When they were activated, they were eligible for Tricare, the Defense Department's health-insurance program, but they lost coverage when they returned home.

Last summer, however, Congress voted to extend Tricare coverage for 180 days after deactivation. And last month, it voted to extend the coverage again, this time allowing Guard and Reserve troops to receive a year of Tricare coverage for every 90 consecutive days they serve.

Mr. Rieckhoff of Operation Truth lauds Congress for the move, but he contends it's still not enough. He points to his own situation. He was on active duty and served as an infantry platoon leader in central Baghdad for 11 months. But now he finds himself in a job with no insurance. He was also told that the VA would treat only service-related injuries.

"The ironic part is that I'm drilling in the National Guard. It's not like I'm completely out of the military," he says.

A study done at Harvard University has found that almost 1.7 million veterans of all wars lack health insurance, an increase of 13 percent since 2000. More than one in three vets under the age of 25, like Wilf, have no health insurance.

"It's particularly offensive to send people off to war and not take care of them when they come home," says Dr. Steffie Woolhandler, a professor at Harvard Medical School and coauthor of the study.

The VA contends the number of veterans without healthcare coverage is far smaller. Ms. Church says 60 percent of those uninsured veterans would be eligible for care if they enrolled in the VA. The study's authors dispute that, noting that many have incomes higher than $26,000, live in areas where there are no VA services, or were unable to receive care due to long waiting lists.

Church charges that the study's authors are using the issue of uninsured vets to further a political agenda of creating a national health-insurance system.

Veteran activists discount that. "This is not a political issue; it's a soldier issue," says Steve Robinson of the National Gulf War Resource Center.

A Gulf War veteran, he retired from active duty in October 2001, applied for benefits in 2002, and has yet to be enrolled in the VA healthcare system. "What happens in Washington is that these important things get turned into political footballs to get kicked around," he says. "Then the issue doesn't get the attention it deserves."