ProgressOhio

She settled into her seat on a flight from Chicago to Columbus, taking a clearly stressful call on her cell phone. She hung up to get ready for our flight – looked at me – and said, “How come my son could lay his life on the line for this country – but he has to wait six months for an appointment at the VA for even a Band-aid?”

As we spoke, her despair and anger came into focus. She was a native Ohioan from Oklahoma with a slight Okie twang, on her way to visit her parent in the central Ohio area, and her son had served two tours of duty in Iraq. He was home now with her daughter-in-law and her grandson – but he was waking up with Post Traumatic Stress Disorder (PTSD) – night sweats and combat delirium. And her son could not get in to the VA hospital for at least six months.

In Ohio, the nation’s 6th largest concentration of veterans, a legislative committee found out in December that the state ranks 43rd in use of available services and 50th in the amount of disability pay. Legislation growing out of the study will create a new cabinet level department, but with little if any accountability measures over a cumbersome structure that has failed to deliver needed efficiencies for needy Ohio veterans.

So how bad will things get when Iraq and Afghanistan veterans begin to increase the need for services. At the federal level, in a March 6 AP article by Bradley Brooks in Baghdad he reports that:

• About 15 soldiers are wounded for every fatality in Iraq compared with 2.6 wounded for every fatality in Vietnam and 2.8 wounded for every fatality in Korea.
• 29,320 servicemen were wounded in action as of early March, but an additional 31,325 others have been treated for non-combat injuries and illnesses.
• The VA predicts it will treat 330,000 veterans from Iraq and Afghanistan in 2008 – a 14 percent increase over the 2008 estimate of $263,000 costing over $1.3 billion.
• The Bush budget requests $93.7 billion for the VA including $41.2 billion for medical care for veterans of all wars which is an increase of $2.3 billion.

In an article posted on opednews.com on March 5, writer Jason Leopold pointed out that VA officials estimate that 60,000 Iraq and Afghanistan veterans are returning with PTSD similar to what I’d heard all too personally on that flight to Columbus.

Leopold chronicled the story of a Marine veteran named Jonathan Schulze who was awarded two Purple Hearts in 2005 after a lengthy tour of duty in Iraq. On January 11, 2007, he sought treatment for PTSD when his parents drove him to the VA hospital in St. Cloud, Minnesota. He was not admitted and told to call back the following day. The VA told him he would need to wait at least two weeks to be admitted. On January 16, 2007, next to a photo of his one-year old daughter, he was found with an electrical cord around his neck in a friend’s basement at the age of 25.

Critics rightly point out that Veterans benefits at the national and state level are plagued with a systemic and political bureaucracy that puts care for veterans on the back-burner both at the national and Ohio levels.

Backlog at the VA

The VA has a backlog of over 400,000 pending medical claims and complaints – especially in mental health care.

In a rare Shadows kudos for U.S. Senator George Voinovich, he rightly points out in a letter to the Senate Budget Committee that the VA’s pending pension and compensation claims were up almost 6 percent from March of 2007 and that 27 percent of claims have been pending for more than 180 days, along with a 50 percent increase since 2003 in claims requiring a disability review which request increases in time and resources.

Voinovich said in his letter to Sen. Kent Conrad that the number of filed claims has increased 45 percent from 578,773 in 2000 to 838,141 in 2007.

At the time of Jonathan Schulze’s death, according to Veterans Today’s website, more than 200,000 veterans from Iraq and Afghanistan had been treated at VA medical facilities according to a Government Accountability Office analysis, which is three times what the VA had originally projected. The GAO study said more than one-third of the cases involved mental health conditions including PTSD, acute depression and substance abuse.

According to Leopold’s article, VA attorneys argued in court papers filed this past February that Iraq and Afghanistan veterans were not “entitled” to the five-years of free healthcare upon their return from combat, but instead their treatment was discretionary based on the level of funding available at the VA.

But earlier this month, the Undersecretary for Health at the VA admitted in court that veterans of Iraq and Afghanistan were entitled to free healthcare and that “there is no co-pay,” according to Leopold.

All of this bureaucracy was supposed to have gone away on October 25, 1988, when Ronald Reagan made the Department of Veterans Affairs a cabinet-level agency. But symbolism seems to have made little progress in the bureaucracy that a wounded soldier must navigate. Here in Ohio – let’s hope we have different results.

Bureaucracy and the Ohio Veteran’s benefit system – Why Ohio files fewer claims

More than any other bureaucracy, when it comes to the structure of Ohio veterans, you have the intersection of patriotism, politics, media image and most of all competing veteran structures that have impacted the way in which state-level veteran’s services are delivered.

The state has long had a Governor’s Office of Veteran’s Services which provides support and training to the various County Veterans Services offices. County offices have varying levels of funding, primarily because they are funded much like schools through property tax at a level of five-tenths of a mill. Because of the disparity of property wealth in different counties, the dollars to those programs vary widely.

When a County office files claims, they then use an outsourced system. Ohio does not employ its own service officers who follow Ohio veteran’s claims – instead traditionally that has been a function of the powerful and politically impactful Ohio veterans’ organizations even though 90 percent of Ohio veterans do not belong to these groups (but probably should given their effective lobby and access to services.)

During the recent Veterans Study Council meetings, a representative of the VA advised the Council that Ohio was at the bottom of the barrel in terms of the number of VA claims filed, the quality or completeness of the claims filed and the amount of money generated by approved claims.

Ohio has the 6th largest number of veterans in the United States an Ohio sub-committee of the Veterans Study Council was told in December. Yet Ohio ranked 50th at the time in the amount of disability pay received by injured veterans and 43rd in veterans’ use of services. In most veteran service categories, Ohio ranked among the bottom seven although recent numbers showed some improvement.

Services for Ohio veterans go through 88-county offices and are process in the VA regional offices. But the services rely on National Service Officers (NSO) given free office space by the VA and paid for by Ohio taxpayers but staffed by the various Veterans service agencies. In 2006, Ohio spent over $1.5 million dollars spread among the:

• American Legion, $302,328
• Am vets, &287,919
• Veterans of Foreign Wars, $246,615
• Disabled American Veterans, $216,308
• Vietnam Veterans of America,$185,954
• Marine Corp League,$115,972
• Catholic War Veterans,$57,900
• Meritorious Order of the Purple Heart, $56,377
• Army Navy Union, $55,012
• Jewish War Veterans $29,715
• American Ex P.O.W., $25,030

In a nutshell, when a claim is received in the VA regional office from the county offices for veterans’ services, it is assigned to one of the National Service Officers (NSOs) who is there to act as the advocate for the veteran before the VA. That is why in essence, Ohio has outsourced the advocate role to these traditional groups.

But in reading the Subcommittee reports of the Veterans Study Council it becomes clear that a veteran is at the mercy of the resources of the County in which they live and the efficiency of the veterans organization they choose to track and advocate their claims. There appears to be little if no accountability on the process for follow through.

What is disturbing is that after working with the various county veterans’ offices and advocates, as well as the national groups on a comprehensive study that identified these concerns, State Sen. Bob Spada rushed to the table with S.B. 289 which made no recommendations to fix the VA claims processing system but did recommend that “the several veterans’ organizations” should get more support.

The issue that has gotten headlines is the recommendation for a cabinet-level Veterans’ Service Department – much as Ronald Reagan garnered headlines in 1988. But the symbolism of a department has not necessarily diminished the bureaucratic problems at the federal level. The question remains, will Ohio fall into the same PR trap?

While the Strickland Administration’s push for the cabinet-level department is not necessarily a bad sign – if anything it is needed, the legislation written by Sen. Spada appears to have very little impact on the processing of claims which appears to be the real problem for Ohio’s veterans. Instead it deals mostly with changing a Governor’s office into a Governor’s department. In fact, just this week representatives of Governor Strickland on the panel informed some concerned veterans that the legislation creating the new department would likely not include increased oversight of the county and NSO (veterans group) system.

As the bill stands now, after months of study and data about the problems of veterans services, a Legislative Service Commission analysis of the new departmental functions that Sen. Spada included in the bill are limited to:

• Developing telephone answering services and a website.
• Outreach efforts at conferences and fairs.
• Advertising services in print, radio and television.
• Broadly calling for the development and improved benefits and services for veterans.
• Searching for administrative policies to unify funding, delivery and accountability of policy with no formal recommendations.
• Maintaining a cordial relationship with both the VA and several veterans’ organizations.
• And adds the Ohio Veterans’ Home Agency and the Ohio War Orphans Scholarship Board to the Department.

You can’t help but think that if this were education funding or other pet peeves of Columbus conservatives, Ohio’s Broad & High crowd would be preaching on the legislative floor for more accountability on how Ohio taxpayer money is being spent in classrooms – on the outcomes-based budgeting that conservatives around Capitol Square preach like a Buddhist mantra.

But it is not.

This is about veterans, and veterans are about the flag and neither liberal nor conservative legislators will take on such a bureaucracy borne from the battlefields of returning vets who spawned the complicated relationships of such diverse organizations in the first place.

No one including Shadows is arguing about the role and need for these veterans organizations to exist and flourish. But in fact, these veterans’ organizations do need prodding and accountability for processing veteran claims as any outsourced service should.

Ohio grants for the NSO officers in VA regional offices should be monitored and judged based on information that looks at the per capita amount of veterans here and in other states and sets up a compliance report with oversight by the new Ohio Department of Veterans Affairs.

It seems logical and in-line with all other Ohio government expenditures that the department should exercise oversight and tracking of all VA claims. That is the surest path away from a bottom ranking in services to Ohio veterans.

If Ohio will not hire its own compliance officers at the VA regional office, which given the clout of veterans groups is politically dead on arrival, at the very least the various service organizations that provide NSO services should be monitored by the newly created department based on:

• Number of claims filed, starting at the county level, and continuing through the NSO level;
• Completeness and accuracy of claims;
• Average time to resolve claims;
• Average dollars paid out to Ohio veterans per capita;
• Communication and reporting with county offices from the NSO regarding claims status.

Certainly some who are active in veterans’ services groups who receive money from the State of Ohio may bristle at this opinion and couch these views as an unpatriotic attack on soldiers who have paid their dues to their nation.

But the fact of the matter is that this is not a debate over liquor licenses and bingo permits at the local lodge – these issues involve serious veterans’ needs and claims involving their everyday lives.

If the process is outsourced to these organizations – then so be it. But to not hold the same accountability standards on services for these veterans paid for by Ohio taxpayer dollars is benign legislative neglect of the stewardship of Ohio tax dollars.

S.B. 289 seems to be a rushed piece of legislation – the kind of thing legislators take and run with in an effort to wrap the flag around themselves in the next election cycle.

But the stark reality is that true patriotism would wrap that flag around a wounded veteran, a homeless veteran, a jobless veteran, a mentally troubled veteran – to expedite services, not worry about the politics of veterans group funding and future political support.

Save the politics for Novembers this year and in future years.

It’s time to set-aside politics and figure a way to get a Band-aid to our veterans – without all of the bureaucracy. Our national system is bad enough – there is no excuse for a state the size of Ohio to lag so far behind so many smaller states in providing services to veterans.

It’s time to streamline the process and make those within the system accountable here in Columbus and in Washington D.C. This shouldn’t be about politics, it should be about the lady sitting next to me’s very poignant question last month, “How come my son could lay his life on the line for this country – but he has to wait six months for an appointment at the VA for even a Band-aid?”

Being able to solve that question would be a cabinet department worthy of the seat at the Governor’s table.