Veterans Hospitals Struggle to Treat Brain Injuries
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JUDY WOODRUFF: For many of the U.S. service personnel injured in the ongoing wars in Iraq and Afghanistan, the wounds are easy to see. But a surprising number of those returning from the front have scars that aren’t visible.
INJURED SOLDIER: It’s a long journey.
JUDY WOODRUFF: While better medical care and body armor are keeping more fighters alive, traumatic brain injury has become a signature wound of the Iraq war. In a special report last night aired on ABC, former anchor Bob Woodruff focused on traumatic brain injury as a serious and widespread problem.
BOB WOODRUFF, Former Anchor, “World News Tonight”: On Jan. 29, 2006, while reporting from Iraq, my cameraman, Doug Vogt, and I were wounded by a roadside bomb. I nearly died.
JUDY WOODRUFF: Woodruff was injured by the Iraqi insurgents’ weapon of choice: the improvised explosive device, or IED. He praised the treatment he received afterwards.
BOB WOODRUFF: I am standing here tonight because I got the best military and civilian medical care in the world.
JUDY WOODRUFF: But Bob Woodruff said he has learned that all veterans with traumatic brain injury, or TBI, may not be receiving that same level of care at many of the veterans’ hospitals around the country.
INJURED SOLDIER: TBI is new, and the V.A. hospitals know nothing about it…
BOB WOODRUFF: The veterans and their families I spoke to said the V.A. isn’t fully prepared to care for brain-injured veterans once they return home.
WOMAN: Brain injuries is a part-time job for them.
WOMAN: You know, I had no idea what we were walking into, that it was going to be so minimal.
JUDY WOODRUFF: The exact number of veterans with traumatic brain injury is difficult to pin down. Several estimates found that between 10 to 20 percent of the 1.5 million veterans returning from the wars in Iraq and Afghanistan suffer a traumatic brain injury; other estimates put that number even higher.
The U.S. Department of Veterans Affairs disputes those estimates.
In his report, Bob Woodruff asked the secretary of veterans affairs, Jim Nicholson, about the discrepancy between the 23,000 wounded listed by the Department of Defense and larger numbers found in a V.A. document.
JIM NICHOLSON, U.S. Secretary of Veterans Affairs: So I think Americans are always very surprised to know the number of amputations, for example, which is fewer than 600 in total.
They’re probably also surprised to know that, you know, 200,000 come to the V.A. for some kind of medical treatment. That’s probably more than they think.
BOB WOODRUFF: You’ve got mental disorders, 73,000; diseases of nervous system, 61,000. These are huge numbers beyond the 23,000.
JIM NICHOLSON: A lot of them come in for — for dental problems. Others come in for a lot of the, you know, the normal things that people — people have. We’re providing their health care. Some, I suppose, are because of their service over there, but they weren’t evacuated for that.
JUDY WOODRUFF: Bob Woodruff’s report came a week after problems were brought to light at the Walter Reed Army Medical Center in Washington, D.C. A Washington Post report detailed substandard conditions and questionable outpatient care.
And just to clarify, I am not related to Bob Woodruff.
Getting to the root of the problem
JUDY WOODRUFF: For more now on diagnosing and treating traumatic brain injury, we get two separate views. In a moment, we will hear from the secretary of veterans' affairs.
But first, we turn to Paul Rieckhoff. He's an Army National Guard lieutenant who led a platoon in Iraq in 2003 to 2004. He's now executive director of Iraq and Afghanistan Veterans of America, an organization that advocates on behalf of troops who are still serving.
Paul Rieckhoff, welcome. We have said that it's hard to get the exact numbers of soldiers and Marines with traumatic brain injury. Why is it so hard?
LT. PAUL RIECKHOFF, Iraq and Afghanistan Veterans of America: Well, it's very difficult right now because the V.A., until I think yesterday, has not been screening for traumatic brain injury. And, most importantly, the Department of Defense is not screening for traumatic brain injury.
So people coming back from Iraq, anyone who has been in the vicinity of a blast or a roadside bomb is at risk for traumatic brain injury. And unless we screen all of them coming home, we really have no accurate projections about how many people are affected.
We know that the V.A. has seen a few thousand already, but we have no idea how many other folks are roaming the streets of America right now with memory problems, with potential brain damage that haven't even been diagnosed.
And I think the thing that concerns me most is Secretary Nicholson's tone. He doesn't seem to appreciate the magnitude of what these veterans are facing. We're talking about debilitating, lifelong injuries.
One of the soldiers profiled last night, his wife talked about the substandard care she got when she got down to the localized VAs. The local VAs are not ready for traumatic brain injury. And I think that's what the blockbuster piece from Bob Woodruff and ABC revealed last night.
JUDY WOODRUFF: Are you saying -- let me just step back. Are you saying that the Defense Department wasn't prepared for these injuries, the Veterans Affairs Department was not prepared for these injuries and the number of injuries?
LT. PAUL RIECKHOFF: Yes, I'm saying that our country in general is unprepared. The Department of Defense, the Department of V.A., they're all unprepared for the over 1.6 million veterans who have been through Iraq and Afghanistan, are going to be coming home with injuries, traumatic brain injury.
One in three returning veterans will face post-traumatic stress disorder or other mental health issues. We've got a flood of people coming home. And the president's new budget actually proposes cuts to the V.A. budget for 2009 and 2010. There are caps after that.
They're introducing co-pays and trying to double the prescription costs for veterans. They're actually cutting prosthetics research in the future. And in a time of war, this is really unconscionable. And it shows that the administration and the V.A. is right now unable to accurately project for future demand or meet the demand we have right now.
JUDY WOODRUFF: Well, I just want to put out one number out there. Today, we were told by the secretary of Veterans' Affairs Office, 319 veterans have been diagnosed with -- I'm sorry, with traumatic brain injury. There's a number.
LT. PAUL RIECKHOFF: They said how many?
JUDY WOODRUFF: Three hundred and nineteen.
LT. PAUL RIECKHOFF: I think that number is extremely conservative. That may be the number they've treated so far, but I think that that's really the tip of the iceberg.
And I think we have the larger question about whether or not resources have been allocated, whether or not the V.A. is understanding the magnitude and the scope of what's facing our veterans coming home.
And you saw Secretary Nicholson last night. He said, "Well, some of them come in for dental work." This is not dental work. This is amputations, traumatic brain injury. These are serious wounds. And these folks aren't getting the care they need at Walter Reed, right in the backyard of the capital, or in the localized VAs.
And I think what America is finally starting to understand is that this is a serious problem, it's a growing problem, and we've only started to scratch the surface with these recent reports from ABC and the Washington Post and others.
Suggestions for improvement
JUDY WOODRUFF: Paul Rieckhoff, what are you saying needs to happen? Is this a matter of more money? I mean, you mentioned that the Bush administration, the president's new budget is proposing cuts. Of course, Congress is part of that decision-making process, too. What are you saying needs to happen?
LT. PAUL RIECKHOFF: Well, I think it's a combination. I mean, it can start with oversight.
Of the money allocated to the V.A. for mental health last year, according to a recent GAO report, only about 50 percent of it actually got down to the local VAs. So we need to ask some very tough questions. We need to investigate where the existing money is going and why it's not getting down to those local VAs?
But I think, in general, we are short of where we need to be. The independent budget, which is put together by leading veterans organizations and mental health care workers, project that we're billions of dollars short of where we need to be to meet existing demand and to project for future demand.
So we really need a newfound urgency in this country to understand that veterans' issues need to be a priority. The president, in his State of the Union address, recently talked about the tens of thousands of troops that we're going to surge into Baghdad. But he didn't talk at all about how we're going to care for them when they come home. And we need that type of presidential attention to these issues every day of the year.
JUDY WOODRUFF: You serve in the military. You are still in the Army National Guard. You talk to people in the military and veterans offices all the time. What are you saying? I mean, are you saying they don't care? What are you suggesting?
LT. PAUL RIECKHOFF: I think there are a lot of people who work very hard and care very deeply in Walter Reed and also in the V.A. hospitals around the country. But what we consistently hear is that they're under-resourced.
And it seems as though the secretary, Nicholson, really doesn't have his ear to the ground. He doesn't seem to be getting down to the lowest level to talk to the families that you saw profiled in the ABC piece.
He's not getting down to the vet centers, the local PTSD and mental health outreach centers, that are crying for additional resources, that are saying they're coming close to being overwhelmed. He's not listening to the veterans that we talk to, that talk about increased wait times.
And he's not addressing the fact that, right now, there are tens of thousands of claims that are backlogged at the V.A., waiting to be addressed. It's clear to everyone that the resources aren't there, and we need to address them immediately. And we need to talk about how we're going to fix them in the future.
JUDY WOODRUFF: To be realistic, Paul Rieckhoff, we are talking about a lifetime of care for many of these returning soldiers and Marines with traumatic brain injury.
LT. PAUL RIECKHOFF: Absolutely. A soldier like the one profiled last night, who was shot in the head, is going to require a lifetime of care and treatment. It's going to be expensive.
But when this soldier raised his right hand and promised to defend our country overseas, he assumed that the care was going to be there when he got home. And his family assumed that that care was going to be there when he got home. I assumed that that care would be there.
And the reality is that, right now, America is not holding up their end of the bargain to our heroes. And when they come home, they deserve whatever care they need to try to make them whole again and that will properly honor the service that they've given.
JUDY WOODRUFF: All right, Paul Rieckhoff joining us. He is the head, the executive director of Iraq and Afghanistan Veterans of America. Thank you very much.
LT. PAUL RIECKHOFF: Thank you, ma'am.
The VA perspective
JUDY WOODRUFF: And now, a response from the U.S. secretary of veterans affairs, Jim Nicholson.
Mr. Secretary, thank you very much.
JIM NICHOLSON: Good to be here, Judy.
JUDY WOODRUFF: Pretty tough words, not only from Paul Rieckhoff, but also from others who are looking at what the Veterans Administration and the Department of Defense are doing. And they add it up, and they say you're not serving these veterans who gave so much to this country.
JIM NICHOLSON: Well, I would start where Paul left off, by talking about these veterans. I mean, they're the greatest people in our society. And my wife and I visit with wounded veterans every week. And I travel around the country visiting veterans' centers, and not just the veterans, but their families.
And I know what they're going through. So nobody cares more about our veterans than I do and the 235,000 people at the V.A.
The V.A. is a very big and a very good organization, the likes of Harvard Medical School, ABC News has said it's the best health care system in the United States. It is unarguably the largest, but it also has its challenges.
And the things that have been brought to light on these veterans that we've just seen and talked about are unacceptable. They're unacceptable.
We see over a million veteran patients a week in our system of health care. That's veterans coming back from the war in Iraq, Afghanistan, we even have a few World War I veterans. So it's very large, and we've got some things that have come to light that we have got to make sure, because any one of these cases is unacceptable to me, because I know the pain and suffering that these people go through.
JUDY WOODRUFF: You're saying it's top, it's first-rate medical care, and yet Mr. Rieckhoff and others are pointing out there's not the screening. We're here tonight principally to talk about traumatic brain injury, but there's not the screening for these soldiers and Marines when they come out of Iraq and Afghanistan, and not the screening when they leave active duty and become veterans.
JIM NICHOLSON: Well, that's a point, and it was that there was not the screening. As Dr. Scott said last night on the program, this is an evolving medical science. And not very much is known about traumatic brain injury.
Most of what was known in this country was out of incidents of athletes, and so everybody is learning as we go.
What we are doing now at the V.A. is, we're going to screen every veteran, every returnee from the combat zone for brain injury, every one of them. And those that we've detected with traumatic brain injury come into the finest polytrauma brain treatment centers in the world that we have.
Then, after they become more stable, we put them out into 17 regional centers, but a lot of them want to go home. You can't blame them for that, especially after they get relatively stabilized.
What we have to do now is make sure that, when they go out to the next level and are being served by a V.A. medical facility, that there we have the trained clinicians, the case workers, and everybody that gives them the attention and the continued therapy that they need to progress.
Changes to come
JUDY WOODRUFF: But, Mr. Secretary, there have been reports going back, by our account, over a year, in some cases two years, noting that there are high numbers -- there were high numbers of soldiers and Marines coming out of Iraq and Afghanistan with what appeared to be traumatic brain injury, and there weren't the facilities to treat them. This is not a new problem.
Why is the screening just starting now?
JIM NICHOLSON: Well, first of all, the facilities, these really wonderful facilities, these polytrauma centers, they've been in place for more than two years. And they do a phenomenal job. And all the disciplines are there, for burn, amputations, brain injuries, and so forth.
We've now added 17 more. As I said, we are -- this is an evolving phenomenon of brain injury. And he projected a number. I don't know what the number is.
But I know that we need to be alert to it, screen for it, and then be able to treat it, whatever it is, because he is right. People that raise their hand and go off to serve our country and are injured as a result of that service, either mentally or physically, are entitled to the best health care that this country can provide. And that is at the V.A., and that's what the people of this country want.
JUDY WOODRUFF: Again, we saw -- there was a report over a year ago, quoting a physician at Walter Reed -- now, again, this is active duty -- telling the reporter, "There is a distressing number of patients there who are not getting adequate screening and care. Many doctors," he said, "know little about traumatic brain injury and are prone to making the wrong diagnosis."
This is not new, is my question?
JIM NICHOLSON: Well, it is quite new. I mean, I can't speak for Walter Reed, which is a Department of Defense facility. But the number that you used there for people that have had acute brain injury has been 312 people. And they have come to these centers that we established for that. Now, I'd like, if I could...
JUDY WOODRUFF: But out of 200,000 troops that have come out of Iraq and Afghanistan, it's hard for people to believe only 320 or so have been diagnosed with this.
JIM NICHOLSON: Well, that's the number that has been diagnosed with very acute brain injury. I'd like, if I could, to clarify that 200,000 number, because that was quoted kind of out of context.
But 206,000 people that have come to the V.A. are people who have come back from the combat zone, and that is people for all reasons, but they were not the people that, you know, have been -- who are wounded in theater.
JUDY WOODRUFF: They were not all necessarily severely injured.
JIM NICHOLSON: That's about 26,000, I think about half of those very seriously wounded. This is the number of people, because this grateful country of ours is giving these people, the National Guardsmen and Reserve, the right to come to the V.A. now for health care. And that is new.
So they come for all reasons, general medical maintenance. I mentioned that some do come for dental. Some come for a vision problem or hearing or an orthopedic problem. That's the total of those that have come to us. And now, as I said, we're going to screen everyone that comes to us for brain injury.
JUDY WOODRUFF: But just to wrap up here, stepping back, you're the head of the Veterans Administration. To hear this flood now of stories, criticism, just the comments from Mr. Rieckhoff, who's described as a political independent, this is not a political vendetta in any way.
JIM NICHOLSON: Well, I hope it's not.
JUDY WOODRUFF: Being as critical, does it make you angry? I mean, how are you feeling about all this? What do you want to say to everyone who's watching you right now, saying, "Why is it like this?"
JIM NICHOLSON: Well, it's absolutely unacceptable for any one of these young people and their families to have to endure those circumstances that we saw. And we're going to fix this.
We're taking steps, as we speak, literally, to make sure that no one falls through the cracks. I said it's big, it's good. Over a million people a week that we see. But if one -- if one -- is not being well-treated, especially a young combatant, that is unacceptable, and that just breaks my heart.
And I know -- I know a lot of these people, you know, that have been injured. My wife and I make a point of visiting with them regularly as we travel around the country and here in Washington, so we're going to fix this. We're going to take some drastic steps.
What you haven't asked me about is also the waiting times on claims. It is too long; it is too complicated. And I am going to engineer a way to expedite that for these young people that are coming back from the war, because it's taking too long.
JUDY WOODRUFF: But there are people who are saying this war has been going on four years. These reports have been out there. Why did it take this long for you and others in the administration to act?
JIM NICHOLSON: Well, I will say that, you know, a lot of good work has gone on. And you and anybody else, you can go out and talk to a lot of veterans who give high praise to Walter Reed or Bethesda or the V.A. for their care. Most of them will say that.
But, unfortunately, that is not the case in every one. And there's this confluence, it looks like, of these cases that have come to light. And, you know, out of this, good will come, because we can improve the system. It's good, but it's not perfect.
And so we're hard at it to get it that way, because they deserve no less. They're really the best people from our society. They've volunteered to go defend us and our freedom in this war on terrorism.
And the president is extremely supportive. Our budgets have gone up 77 percent since he became president. My budget that I'm testifying tomorrow on, we're asking for a 10 percent increase. It's at $87 billion. So, you know, we will have the resources, and we have the will, and we need to make these corrections that are absolutely needed.
JUDY WOODRUFF: Secretary of Veterans Affairs Jim Nicholson, we thank you very much for coming in to talk with us.
JIM NICHOLSON: Thank you.