The Failing of Medical Resources for America's Iraq and Afghanistan Conflict Veterans - Term Paper Example

The Failing of Medical Resources for America's Iraq and Afghanistan Conflict Veterans The United States' “War on Terror” has resulted in a series of deployments of American military service members to the Middle Eastern nations of Iraq and Afghanistan. As of January of 2011, more than thirty thousand American troops have been wounded in combat in or around Iraq alone. Those injuries which took place in or around Afghanistan add nearly another ten thousand to this number of wounded troops (Iraq Coalition Casualty Count, n.p.). It has been projected by some that close to fifty percent of current Middle East conflict veterans will seek medical treatment from the Veterans Administration. More than sixty percent of these injured veterans will seek short-term treatment, defined as medical care that lasts less than five years, but the other approximately forty percent of them will remain in the Veteran's Administration health care system for the rest of their lives (Patsner, n.p.). Unfortunately for these brave men and women, the resources available to treat injured and disabled veterans are currently severely lacking in quality. There are many reasons for the current situation. Among them are the sheer number of injured veterans returning from these conflicts and the cost of treating them, the type of injuries that are returning home, the number of veterans already in the system that also require care, the inadequacy of the existing system to handle patient transfers when a veteran moves from one part of the system to another, and the lack of preparedness by primary care physicians outside the Veterans' Administration system to deal with war-related injuries. Many Americans are aware of the extremely high costs of the Middle East conflicts, as these operations have resulted in a continuous presence of American military members in that theater since the September 11, 2001 World Trade Center attack. As of the end of the 2010 fiscal year, the United States federal government had spent seven hundred and fifty-one billion dollars in Iraq and three hundred thirty-six billion dollars in Afghanistan (Belasco, p. 1). However, many people are not aware of the costs incurred after the injured veterans of these conflicts return home. One projection states that the costs of life-long medical care, disability benefits, and social security and pension benefits for veterans of the current Iraq and Afghanistan conflicts could eventually total over seven hundred billion dollars, which is more than the overall cost for the first five years of the conflict (Patsner, n.p.). Additionally, up to forty-five percent of Gulf War veterans may apply for long-term disability benefits. Over eighty-eight percent of those applying will be at least partially eligible to receive some form of disability payments. These disability claims could potentially add another three hundred fifty-five billion dollars to the total cost of health care for injured veterans of the Iraq and Afghanistan conflicts (Patsner, n.p.) The Department of Defense and the Veterans' Administration have been ill-prepared to deal with the flood of injured service members and veterans returning from these conflicts. In 2001, before the current Middle East operations had begun, the number of backlogged Veteran's Administration cases was near one hundred thousand. As of April 2008, the number of unprocessed cases had jumped to over six hundred thousand. This means that not only are the currently returning veterans not being treated efficiently, resources are being re-directed from older veterans and reducing their access to care as well (Kenneth & Burris, 2330-39). This backlog of untreated cases, as well as the complexity of the application process for use of the Veterans' Administration medical resources, can lead to more issues of aggravated injuries for those veterans that are not adequately and quickly treated for their injuries. Due to the lack of screening as veterans separate from active duty, minor injuries from regular combat activities such as carrying or running while in heavy gear often go unnoticed at first. Failure to have pain from this type of injury treated, however, can later lead to chronic pain syndrome, a condition in which the sufferer continues to feel the pain of the injuries even though the tissue itself has long since been completely healed (Afterdeployment.org, n.p.). It is estimated that up to one in five, or twenty percent, of the troops fighting in Afghanistan or Iraq will report significant limitations to their cognitive abilities after suffering an injury to the head or face. Unfortunately, the resources available to combat traumatic brain injuries of this type are limited due to cost and the high demand for these services. Additionally, many veterans are hesitant to seek help for this type of injury due to the social stigma attached to mental illness and brain dysfunction (Kim, n.p.). The same issues of cost and social stigma exist for veterans suffering from post-traumatic stress disorder. The military culture encourages resiliency and strength, and despises weakness. For many military veterans, reporting symptoms of irritability, anxiety, or fear, which are key diagnostic criteria for post-traumatic stress disorder, would be seen as a sign of weakness. Without work by the military to reduce the stigma attached to this disorder, veterans will continue to go untreated, possibly until the disorder has grown into a much worse and much more dangerous psychological condition (American Pain Foundation, nip.). The number of Middle East conflict veterans diagnosed with post-traumatic stress disorder increased by eight thousand veterans per year in the years 2003 to 2005. Studies have shown that up to forty percent of recently retired veterans of the Middle East conflicts show signs of some level of post-traumatic stress disorder (Patsner, n.p.), and up to twenty-five percent of recently returned veterans are suffering some form of serious mental condition (Seal et al., “Mental Health Disorders", 476-82). The Veterans' Administration, however, is not designed to handle the type of long-term continuous psychiatric care that sufferers of post-traumatic stress disorder and other psychological conditions require (Patsner, n.p.). This is particularly pronounced if the veterans live in small towns or rural areas that are far from Veterans' Administration facilities, a coverage gap that is predicted to continue to grow (West & Weeks, p. 9). Due to this increase in demand for Veterans' Administration mental health services, there was a thirty-seven percentage reduction in mental health visits available to veterans per year. While federal funding to treat post-traumatic stress disorder has since been drastically increased, the Veterans' Administration is still not meeting and still cannot meet current demand for their mental health services (Rosenheck & Fontana, p. 1720). For example, a 2004 study of 3,600 Iraq and Afghanistan conflict veterans found that over nine percent of veterans returning from Afghanistan deployments and seventeen percent of those returning from Iraq deployments met screening criteria for major depression, generalized anxiety disorders, or post-traumatic stress disorder (Reeves, 182-91). An added barrier to the Veterans' Administration's ability to provide proper care is the treatment itself. The current proven treatment for post-traumatic stress disorder takes at least ten to twelve weekly visits, and even when the Veterans' Administration attempts to provide treatment that follows those recommendations, fewer than ten percent of newly-diagnosed post-traumatic stress disorder sufferers complete the entire course of treatment (Seal et al., “VA Mental Health Services Utilization”, p. 5-16) As a result of this lack of proper treatment, due to the increasing rates of post-traumatic stress disorder and other mental disorders in the veteran population, veterans have a suicide rate that is two to three times that of the suicide rate in the general population. This high rate of suicide is still found among those veterans who have applied for and even received mental health treatment from the Veterans' Administration (Wortzel et al., p. 82-91). The primary correlating condition with suicidal thoughts among veterans, unsurprisingly, was a diagnosis of post-traumatic stress disorder, even without any other co-morbid psychiatric conditions or substance abuse issues (Wiley-Blackwell, n.p.) Veterans without post-traumatic stress disorder may still be at such a high risk for depression and suicide due to having abnormally traumatic war-time experiences combined with long-term pain from combat injuries. This becomes much more difficult to treat because it is almost impossible for the treating physician to determine if the chronic pain is the cause of a veteran's depression symptoms or if the chronic pain is a symptom of depression. Consequently, the needs of these patients are often overlooked or inefficiently treated (American Pain Foundation, n.p.). Compounding the problem of providing treatment to so many wounded service members, when veterans move from one part of the military health care system to another, their records and other information often fail to move with them. As a result, lapses in treatment may occur while the paperwork is found and correctly transferred. In the worst cases, veterans may fail to receive continuing treatment at all, falling through a crack in the system when their records are forgotten or permanently lost. Service members who return from active duty are first treated under the Department of Defense by a military physician, then sent on to the Veteran's Administration after being separated from the military, and finally are sent on to the community health care system in their local area if they are deemed not to need specific treatment from the Veterans' Administration. This multitude of transitions from practitioner to practitioner can be especially difficult for a mental health patient, who must repeatedly forge and re-forge the levels of trust necessary to work successfully with a psychiatrist, psychologist, or therapist (Wortzel et al., p. 82-91). In addition to the issues with lost paperwork and gaps in coverage when veteran patients are transferred between medical practitioners and between medical systems, many of the veterans are transferred from the military medical system to inadequately prepared community medical care providers. This happens especially when veterans are released from active duty without any obvious medical or psychological needs, and so are not treated under the Department of Defense system or the Veterans' Administration. Many primary care physicians will be seeing large numbers of new veteran patients with combat-related mental health disorders, including post-traumatic stress disorder (Reeves, 182-91). Since the military does not perform any kind of mandatory psychiatric evaluation of separating service members, many of these post-traumatic stress disorder cases will go undetected for long periods of time after the veterans return home (Patsner, n.p.) Unfortunately, many of the country's primary care physicians are not sufficiently educated to efficiently diagnose or treat cases of post-traumatic stress disorder, and often miss the diagnosis in their Middle East veteran patients. One study found that primary care physicians recognized post-traumatic stress disorder in only forty of the eighty-six patients who were identified with this diagnosis by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, or DSM-IV. This equates to those physicians correctly diagnosing post-traumatic stress disorder just over forty-six percent of the time (Reeves, p. 182-91). Even when the disorder is correctly identified, the veteran then must be referred to a community mental health provider, and those veteran patients who are treated within the community health system have an even lower chance of completing an entire twelve-week course of treatment (Seal et al., p. 5-16). The unfortunate condition of the current health care system is not limited to veterans. However, as those veterans are the men and women who keep the country safe, more is owed to them than mediocre treatment, significant delays, and mountains of paperwork. In order to escape this crisis, the problems of increasing cost, lack of community physician preparedness to deal with war-related conditions, the existing Veterans' Administration treatment backlog, and the gaps in medical treatment during patient transfer must all be solved. Especially important is the need to educate primary care physicians and veterans on psychological disorders, especially post-traumatic stress disorder, that can result from war-time experiences, as these are the most common conditions in the returning veterans and often the most difficult ones to diagnose and treat. Education and a subsequent reduction in the stigma associated with such disorders would go a long way toward increasing patient reporting of these conditions, as well as increasing patient compliance with psychological treatment regimens. References Afterdeployment.org. Physical Injury. National Center for Telehealth and Technology, n.d. Web. 6 Mar. 2011. American Pain Foundation. Exit Wounds: A Survival Guide to Pain Management for Returning Veterans and their Families. American Pain Foundation, 30 Oct. 2009. Web. 5 Mar. 2011. Belasco, Amy. The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9/11. Washington D.C.: Congressional Research Service, 2010. Web. 5 Mar. 2011. . Kim, Chol Daniel. "REVIEW OF SELECTED 2008 CALIFORNIA LEGISLATION: MILITARY AND VETERANS: TRAUMATIC BRAIN INJURY SCREENING FOR THE ARMED FORCES." McGeorge Law Review 40.449 (2009). LexisNexis. Web. 4 Mar. 2011. Iraq Coalition Casualty Count. iCasualty.org, n.d. Web. 5 Mar. 2011. . Patsner, Bruce. "Healthcare Costs for Our Gulf War Veterans: The Looming Disaster." Health Law Perspectives. University of Houston Law Center, Apr. 2008. Web. 4 Mar. 2011. Reeves, Roy R. "Diagnosis and Management of Posttraumatic Stress Disorder in Returning Veterans." The Journal of the American Osteopathic Association 107.5 May (2007): 180-81. Web. 5 Mar. 2011. Rosenheck, Robert A., and Alan F. Fontana. "Recent Trends In VA Treatment Of Post- Traumatic Stress Disorder And Other Mental Disorders." Health Affairs 26.6 Nov. (2007): 1720-27. Web. 4 Mar. 2011. Seal, Karen H., Daniel Bertenthal, Christian R. Miner, Saunak Sen, and Charles Marmar. "Mental Health Disorders Among 103 788 US Veterans Returning From Iraq and Afghanistan Seen at Department of Veterans Affairs Facilities." Archives of Internal Medicine 167.512 Mar. (2007): 476-82. Web. 6 Mar. 2011. Seal, Karen H., Shira Maguen, Beth Cohen, Kristian S. Gima, and Thomas J. Metzler. "VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses." Journal of Traumatic Stress 23.1 Feb. (2010): 5-16. Wiley. Web. 6 Mar. 2011. Shay, Kenneth, and James Burris. "Setting the Stage for a New Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Summary of the 2008 VA State of the Art Conference: The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade" Journal of the American Geriatrics Society 56.122 Dec. (2008): 2330-39. Wiley. Web. 5 Mar. 2011. West, Alan, and William B. Weeks. "Physical and Mental Health and Access to Care Among Nonmetropolitan Veterans Health Administration Patients Younger Than 65 Years." The Journal of Rural Health 22.1 (2006): 9-16. Wiley. Web. 4 Mar. 2011. Wiley - Blackwell. "Post-Traumatic Stress Disorder Primary Suicide Risk Factor For Veterans." ScienceDaily 26 August 2009. 6 March 2011 . Wortzel, Hal S., Ingrid A. Binswanger, C. Alan Anderson, and Lawrence E. Adler. "Suicide among incarcerated veterans." Journal of American Academy of Psychiatry and the Law 37.1 (2009): 82-91. Web. 4 Mar. 2011. Read More