Counting the Walking Wounded

Lawrence M. Wein

The American troops in Iraq daily face the risk of death or injury — to themselves or their fellow soldiers — by homemade bombs and suicide attackers. So it is not surprising that post-traumatic stress disorder is a common problem among returning soldiers. But how many, exactly, are affected?

This question is key to determining how large an investment the Department of Veterans Affairs needs to make in diagnosing and treating the problem. The United States Army’s Mental Health Advisory Team, which conducted a survey of more than 1,000 soldiers and marines in September 2006, found that 17 percent suffered from P.T.S.D. Similarly, a Rand study put the number at 14 percent.

But these estimates do not take into account the many soldiers who will eventually suffer from P.T.S.D., because there is a lag between the time someone experiences trauma and the time he or she reports symptoms of post-traumatic stress. This can range from days to many years, and it is typically much longer while people are still in the military.

To get a better estimate of the rate of P.T.S.D. among Iraq war veterans, two graduate students, Michael Atkinson and Adam Guetz, and I constructed a mathematical model in which soldiers incur a random amount of stress during each month of deployment (based on monthly American casualty data), develop P.T.S.D. if their cumulative stress exceeds a certain threshold, and also develop symptoms of the disorder after an additional amount of time. We found that about 35 percent of soldiers and marines who deploy to Iraq will ultimately suffer from P.T.S.D. — about 300,000 people, with 20,000 new sufferers for each year the war lasts.

Consider that only 22 percent of recent veterans who may be at risk for P.T.S.D. (based on their answers to screening questions) were referred for a mental health evaluation. Less than 40 percent of service members who get a diagnosis of P.T.S.D. receive mental health services, and only slightly more than half of recent veterans who receive treatment get adequate care. Those who seek follow-up treatment run into delays of up to 90 days, which suggests there is a serious shortage of mental health professionals available to help them.

Proper P.T.S.D. care can lead to complete remission in 30 percent to 50 percent of cases, studies show. Thorough screening of every soldier upon departure from the military, immediately followed by three to six months of treatment for those who need it, would reduce the stigma that is attached to current mental health referrals. The Rand study estimates that treatment would pay for itself within two years, largely by reducing the loss of productivity. This is the least we can do for our veterans.

Lawrence M. Wein is a professor of management science at the Stanford Graduate School of Business.

Did You Know 200,000 Vets Are Sleeping on the Streets?

New American Media

SAN FRANCISCO – Roy Lee Brantley shivers in the cold December morning as he waits in line for food outside the Ark of Refuge mission, which sits amid warehouses and artists lofts a stone’s throw from the skyscrapers of downtown San Francisco.

Brantley’s beard is long, white and unkempt. The African-American man’s skin wrinkled beyond his 62 years. He lives in squalor in a dingy residential hotel room with the bathroom down the hall. In some ways, his current situation marks an improvement. “I’ve slept in parks,” he says, “and on the sidewalk. Now at least I have a room.”

Like the hundreds of others in line for food, Brantley has worn the military uniform. Most, like Brantley, carry their service IDs and red, white and blue cards from the Department of Veterans Affairs in their wallets or around their necks. In 1967, he deployed to Vietnam with the 1st Cavalry Division of the U.S. Army. By the time he left the military five years later, Brantley had attained the rank of sergeant and been decorated for his valor and for the wounds he sustained in combat.

“I risked my life for this democracy and got a Bronze Star,” he says. “I shed blood for this country and got the Purple Heart after a mortar blast sent shrapnel into my face and leg. But when I came back home from Vietnam I was having problems. I tried to hurt my wife because she was Filipino. Every time I looked at her I thought I was in Vietnam again. So we broke up.”

In 1973, Brantley filed a disability claim with the federal government for mental wounds sustained in combat overseas. Over the years, the Department of Veterans Affairs has denied his claim five separate times. “You go over there and risk your life for America and your mind’s all messed up, America should take care of you, right,” he says, knowing that for him and the other veterans in line for free food that promise has not been kept.

On any given night 200,000 U.S. veterans sleep homeless on the streets of America. One out of every four people — and one out of every three men — sleeping in a car, in front of a shop door, or under a freeway overpass has worn a military uniform. Some like Brantley have been on the streets for years. Others are young and women returning home wounded from Iraq and Afghanistan, quickly slipping through the cracks.

For each of these homeless veterans, America’s promise to “Support the Troops” ended the moment he or she took off the uniform and tried to make the difficult transition to civilian life. There, they encountered a hostile and cumbersome bureaucracy set up by the Department of Veterans Affairs. In a best-case scenario, a wounded veteran must wait six months to hear back from the VA. Those who appeal a denial have to wait an average of four and a half years for their answer. In the six months leading up to March 31st of this year, nearly 1,500 veterans died waiting to learn if their disability claims would be approved by the government.

There are patriotic Americans trying to solve this problem. Last month, two veterans’ organizations, Vietnam Veterans of America and Veterans of Modern Warfare, filed suit in federal court demanding the government decide disability claims brought by wounded soldiers within three months. Predictably, however, the VA is trying to block the effort. On December 17, their lawyers convinced Reggie Walton, a judge appointed by President Bush, who ruled that imposing a quicker deadline for payment of benefits was a task for Congress and the president-not the courts.

President-elect Barack Obama has the power to end this national disgrace. He has the power to ensure to streamline the VA bureaucracy so it helps rather than fights those who have been wounded in the line of duty. He can ensure that this latest generation of returning veterans from Iraq and Afghanistan does not receive the bum rap the Vietnam generation got. Let 2008 be the last year thousands of homeless veterans stand in line for free food during the holiday season. Let it be the last year hundreds of thousands sleep homeless on the street.