'Surge home' overwhelms Veterans Affairs clinics

With many soldiers returning from Iraq and Afghanistan, the Department of Veterans Affairs has seen treatment requests and disability claims soar.

When he got home from war, Rey Leal's biggest problem was that he couldn't sleep as he tried to free himself of the images of combat in Iraq.

"My thing was turning off that movie in my head," says Mr. Leal, a former marine and now a student at a college in south Texas. Ultimately, he sought mental-health assistance at a Veterans Affairs clinic in the Rio Grande Valley. But he found navigating the bureaucratic tangle a strain: He waited a month or more for appointments with the sole psychologist there.

With hundreds of thousands of veterans like Leal trying to get help, the VA is experiencing an unprecedented demand for its services.

Among the roughly 2 million people who have deployed, there are some 300,000 cases of post-traumatic stress disorder (PTSD) and thousands more of traumatic brain injury, according to a RAND report last year. And in the past decade, the number of disability claims that the VA processes has skyrocketed.

Even with a heavy infusion of funding – a 50 percent increase since 2006 – the VA has been hard-pressed to meet veterans' needs. President Obama has outlined yet more funding, but the question remains: Will a new generation of vets get the resources and help it is likely to need from the VA for years to come?

"The surge home has begun," says Patrick Campbell, a top official at the Iraq and Afghanistan Veterans of America, an advocacy group, and himself a veteran of the National Guard.

The VA has tried to keep up with the demand, dramatically increasing the number of mental-health professionals and counselors over the past four years. More than 17,500 mental-health personnel are across the VA system.

The VA is also hiring more personnel for claims. It increased its processing staff by about 58 percent between 2005 and 2009. It's done this for good reason: The number of claims that the VA closes out annually has increased 60 percent since 1999 – from 458,000 to about 729,000 in fiscal year 2008, the Government Accountability Office reported last month. At the same time, the number of claims that are in "pending" status – claims that have not yet been resolved – has increased some 65 percent to about 343,000, the report said.

"It is indeed a mess. They are indeed in a hole," says a staffer on Capitol Hill familiar with the VA issues, who asked not to be named because he wasn't authorized to speak publicly on the subject.

The surge in claims is the result of a confluence of events – not just the wars in Iraq and Afghanistan. While the increase comes in part from recent vets, it is also from older vets, chiefly from the Vietnam War. And the number of claims per person has shot up. For example, many of those making claims were forced from service for any number of medical reasons. That can change the perceptions these people have about their military service – and may lead to more claims, according to the congressional staffer.

Other reasons for the claims surge: Disqualified claims are going through an improved appeals process. And the VA has launched an aggressive outreach program to find vets of all ages who are eligible for assistance.

"I don't doubt that everybody who works at the VA wants nothing else than to help veterans," says Leal. "Are they being given the tools to do that? That is another question."

Mr. Obama has vowed to answer that question in the affirmative. With an aim to revamp the VA, its services, and its culture, he is requesting a 15 percent bump in funding for the agency this year – the biggest single-year increase in 30 years, according to the VA's website.

"We are not going to abandon these American heroes," Obama said Aug. 17 in Phoenix at the annual convention of the Veterans of Foreign Wars. "We are going to do right by them. We will fulfill our responsibility to our veterans as they return to civilian life."

Under Obama's plans, the VA will expand eligibility to more than half a million vets by 2013 who previously did not qualify for VA benefits. The agency will also broaden "proven" homeless programs for those vets at most risk.

Still, it will take time for the improvements to make a difference. Clint Van Winkle, also a former marine, realized he had issues relating to his deployments to Iraq. Having left the service, he didn't find a warm welcome when he sought help at the VA office near his home in Phoenix in 2004.

"You can kind of expect the lines," Mr. Van Winkle says. "Being in the military, that didn't bother me so much. It was the attitude."

According to Van Winkle, who wrote about a veteran's return home in "Soft Spots," the VA was and remains ill prepared for the number of vets who need mental-health care.

"It was kind of a really cold diagnosis: 'You have PTSD. Come back in a month,' " he recalls.

Ultimately he was able to get counseling, but for each visit, he would be assigned a different doctor. Eventually, he gave up with the appointments. Now he awaits the outcome of various compensation claims relating to his service. That's been going on for a year.

"I just want people to understand what we're going through when we come home," says Van Winkle, now a graduate student in Wales. "We're going to come back as different people. Even if we look the same, we're different."