VA Care as Workers’ Comp

Rick Weidman, Executive Director for Government and Policy Affairs at the Vietnam Veterans of America, is a leading defender of the VHA who notes, with wry understatement, that “the military is a collection of very dangerous occupations.”

The best-known hazards of military service are encountered in combat, of course. Enlisted men and women assigned to frontline duty in Iraq, Afghanistan, or elsewhere have returned with gunshot wounds, lost limbs, traumatic brain injuries, PTSD or MST (military sexual trauma), and respiratory problems from burn-pit exposure.

During noncombat duty, even more military personnel suffer job-related injuries or illnesses similar to those experienced by millions of blue-collar workers in civilian life.

Most American workers who get hurt on the job or develop an occupational disease soon become familiar with the shortcomings of our fifty-state system of workers’ compensation. Benefit levels are too low. Private employers fight their claims. Rehabilitation services are fragmented and managed by private insurers. Workers who get approved treatment for specific work-related conditions may not be able to return to work. At some point, this deprives them of job-based medical coverage for themselves and their families. So even successful workers’ comp claimants can end up in personal bankruptcy due to unpaid bills for other care.

In contrast, veterans who qualify for VHA medical benefits, due to their low income or service-related condition, land on an island of socialized medicine within our larger system of private insurance and for-profit health care providers.

After getting a disability rating based on a particular service-related illness or injury, a veteran enters the VHA system and becomes eligible for unrelated treatment, then or later — from hip replacements to cancer surgery and hospice care.

Like residents of the UK covered by the National Health Service, VHA patients get the benefit of an integrated national network of public hospitals and clinics. All VHA doctors, nurses, and therapists are salaried, not paid on a “fee for service” basis. About a third of the VHA’s 300,000 staff members are veterans themselves. This helps create a unique culture of empathy and solidarity between patients and providers that has no counterpart in American medicine.

Healing Shattered Minds

Due to the fact that the DoD is not the most safety-minded employer in the world, many VHA patients have medical conditions attributable to the military’s own failure to provide them with adequate protective equipment or even hazard exposure warnings.

In their new book Shattered Minds: How the Pentagon Fails Our Troops with Faulty Helmets, investigative reporters Robert H. Bauman and Dina Rasor describe how most troops deployed to Iraq and Afghanistan were never issued relatively inexpensive helmet pads that would have better shielded them from the impact of Improvised Explosive Devices (IEDs) and the risk of traumatic brain injuries (TBIs).

As Bauman and Rasor report, service members had to order state-of-the-art pads at their own expense or get help modifying their helmets from a nonprofit group called Operation Helmet. The authors estimate that supplying troops with properly engineered helmet pads could have prevented between 300,000 and 400,000 TBIs.

A more common, less serious, service-related complaint of VHA patients is hearing loss and tinnitus. That’s because almost every branch of the military exposes enlisted men and women to high levels of noise. In the Air Force and Navy, there’s the constant roar of jet engines. In the Navy, there’s the metallic clanking that rebounds through the echo chamber of a submarine or other naval vessels. You don’t have to deploy to the Middle East to be deafened by explosions. Just going through basic training with the US military’s own ordinance can be enough to ensure diminished hearing capacity later in life.

Similarly, infantry training leads to musculoskeletal problems because it involves hauling around sixty- to one hundred-pound packs that place an excessive burden on necks, shoulders, knees, backs, and ankles.

Veterans also bring signature issues from particular eras. In Vietnam, draftees and enlisted men were exposed to Agent Orange. Other Cold War–era soldiers and sailors found themselves involved in chemical warfare experiments, nuclear weapons testing, and base cleanups with little personal protection. Troops sent to liberate Kuwait came back with symptoms of “Gulf War Syndrome.” Veterans of multiple tours of duty in Iraq and Afghanistan were often exposed to lung-damaging and cancer-causing toxic burn-pits. Insurgent use of IEDs in those two countries has led the VHA to become a leading center of research on and treatment of traumatic brain injuries suffered by thousands of troops and professional football players, who now arrange to have their brains sent to the VHA for postmortem verification of their condition.

Veterans’ Suicide Risk

Combat veterans often suffer from mental health issues, like PTSD. Even men now in their eighties or nineties, who witnessed nightmarish scenes of death and destruction many decades ago in Korea or World War II, seek VHA help for disturbed sleep today. Veterans who suffer from mental and behavioral health problems — whether acquired in or exacerbated by military service — are more prone to substance abuse, particularly opioid use if chronic pain is involved.

They also become a bigger suicide risk. An estimated twenty veterans a day kill themselves, although three-quarters of those have never been to the VHA for treatment. Between 2006 and 2015, the number of veterans receiving specialized mental health care at the VHA rose from 900,000 annually to 1.6 million, a reflection of the ongoing collateral damage from never-ending foreign wars.

VHA caregivers are trained to identify and treat these very specific wounds of war. Every VHA employee receives training on how to better recognize and assist patients who are suicidal. Thousands of VHA mental health providers are taught the latest evidence-based treatments for PTSD. (Outside the VHA, only 30 percent of private sector providers use such treatments). And primary care providers and specialists alike recognize the kind of diseases produced by toxic exposures, such as Agent Orange–related diabetes or burn-pit-created respiratory problems.

The VHA ranks with Kaiser Permanente as one of the most heavily unionized health care systems in the country. The American Federation of Government Employees (AFGE), National Nurses United (NNU), the Service Employees International Union (SEIU), and the Machinist-affiliated National Federation of Federal Employees (NFFE) have more than 120,000 members serving veterans. Thanks to this union presence — currently under attack by the White House — veterans’ hospital management pays more attention to the kinds of occupational hazards that are rampant in health care work, particularly in nonunion facilities.

For example, the VHA was the first — and may be one of the only US health care systems — to install the kind of lift equipment that helps nursing staff avoid debilitating and often career-ending back, neck and shoulder injuries.

Due to the troubled and occasionally violent behavior of some patients, the VHA also goes to great lengths to ensure a safe workplace for its mental health care providers. (Unfortunately, as documented in a recent Intercept report, the overly aggressive behavior of some Veterans Affairs police officers is not contributing to a safer work environment.)

Less Than Honorable?

VHA eligibility rules are also in need of reform. Congress has allowed the Pentagon to give hundreds of thousands of veterans other than honorable discharges, making them ineligible for VHA care. In some cases, soldiers have been discharged for active duty misconduct related to PTSD or brain injuries — yet they, more than anybody, need later treatment.

Congress has also left the Veterans Benefits Administration (VBA) consistently understaffed and overburdened. VBA is the separate agency that determines whether former military personnel have actually suffered from an occupational illness or injury — and to what degree of disability. After veterans leave the service, they encounter far too many eligibility determination disputes and delays before they can become VHA patients.

But most constructive critics of the VHA know that further underfunding and expanded outsourcing of care is not the answer. That’s why union-represented VHA staff and their labor and veteran organization allies are blowing the whistle on Trump’s privatization push. On June 5, hundreds of activists around the country participated in protest rallies, press conferences, or informational picketing as part of a “National Day to Save the VA.”

As Vietnam veteran Skip Delano points out, our “private-sector health care system does not have the capability or the capacity to meet the needs of veterans. They will be sent to providers who may know little or nothing about their special problems and may fail to diagnose critical conditions like PTSD, Agent Orange, or burn-pit exposure, or military sexual trauma, to name only a few.”

A former postal worker, coal miner, and New York city teacher, Delano has decades of experience with good, union-negotiated medical coverage. Nevertheless, he believes that, for many patients pushed out of the VHA, “private sector care will be less veteran-centric, of lower quality, require longer wait times, and end up with many veterans getting lost in the system because of poor care coordination and lack of accountability.”

Now a VHA patient himself and a key organizer of VFP’s “Save Our VA” campaign, Delano spends much of his time reminding fellow veterans about the need for solidarity with their own caregivers. According to Delano, if Trump succeeds in weakening federal employee unions, VHA staff will be stripped of legal protections they need to be effective patient advocates and privatization foes.

“Without that collective voice, doctors, nurses, and other healthcare professional will have far less ability to speak out on behalf of veterans,” he warns.