After the War – Public Health Campaign

BG (Ret) Stephen N. Xenakis, M.D.

President Obama opened his State of the Union address paying tribute to our military and invoking the miracle of post-World War II America. Indeed, in a perfect world, the example would apply after every war and now. But, dreams and hopes aren’t the reality of today’s veterans.

It doesn’t take much imagination to conjure the specter of a generation of homeless and injured men and women sleeping on park benches. Indeed, they are already appearing. The Army is accelerating “administrative discharges,” which is a bureaucratic way of saying that soldiers are dismissed for misconduct and drug abuse in growing numbers. Once heroes, many may not even be eligible for VA benefits.

We have heard heartrending tales about PTSD, traumatic brain injury, suicide, or homicide. Then, there are the realities – the economics of trimming budgets, global dangers, and stubborn unemployment.

DoD is a complicated web of budget, readiness, equipment, and personnel, to say the least. “Administrative discharge” is one of many insidious consequences of downsizing and budget cuts. Follow the money, and a smaller defense budget leads to rationalizations about keeping a “quality force.” Those rationalizations morph into almost immoral mistreatment of those who have served and who are now suffering as a direct result of their past service.

It has happened before. Twenty years ago after Desert Shield/Storm the euphemistic term was “rightsizing” the military. In order to “rightsize” the “wrong sized,” broken or injured soldiers who were not able to “perform” had to leave the military.

Today, the men and women will be getting out of uniform at one of the worst economic downturns in recent history. They cannot find jobs. Unemployment among veterans is twice the rate of their fellow Americans. Many struggle to adjust and learn new skills. The hardship can be unbearable, and 18 veterans a day commit suicide.

Our nation’s track record of caring for our veterans is neither consistent nor impressive. The soldiers from World War I, victims of “shell shock,” fell on hard times. During the Great Depression, they occupied tents in front of the White House and were driven off the lawn by the Army Chief of Staff, General Douglas MacArthur. Those who returned from Korea came home to recession and logjams in the VA that General Omar Bradley had to tackle. Many soldiers returning from Vietnam suffered from posttraumatic stress and the effects of Agent Orange. Too many were homeless, and felt “forgotten.”
The exceptions were returnees from World War II. The country welcomed them with victory celebrations and allocated immense resources towards health, housing, and education.

This generation will not be so lucky. Misconduct, violence, and substance abuse are rising, and suicides are the highest in 10 years. Administrative discharges have accelerated. Those who receive an “other than honorable” discharge are not eligible for VA benefits. Those who qualify face challenges simply gaining access to the VA. Nearly 40% of the 2.5 million men and women who have deployed over the past decade suffer with “invisible wounds” from blast concussions and intense stress at a projected cost of $635 B.

Healthcare reformers talk about prevention and early intervention. They understand that effective disease prevention requires touching at-risk patients before they become too impaired and burdensome.

We have the tools to actively reach into communities, identify the at-risk veterans, “eligible” or not, suffering and impaired, and engage them before going downhill. Assessing and triaging all soldiers to either the VA or home medical clinics before leaving military service, no matter what their personal circumstances might be, is the necessary first step. We can avoid their ending up in the courts and jail, where a year costs a minimum of $30,000.

The overall costs to the country, in direct healthcare dollars, lost productivity, and law enforcement, can be contained with better prevention, early identification, and smart intervention. Effective outreach programs require imagination, coordination, and collaboration between agencies – the VA, DoD, and state sponsored MEDICAID – an aggressive campaign to break through bureaucratic barriers, enact judicial diversion programs, assist employers with medical services at the work sites, and expand drug and alcohol treatment. That is the responsibility of the President and Congress. No doubt there are competing priorities. But, the alternative of temporizing and ignoring the historical precedents should not be an option. By helping our veterans now, we are making a smart investment in our future and living up to our moral responsibility to help those who were injured in the service of their country.

BG (Ret) Stephen N. Xenakis, M.D. retired from the U.S. Army after 28 years of active service as a medical officer. He is the Founder of the Center for Translational Medicine, a nonprofit dedicated to improving and providing treatments for soldiers and veterans