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Care for Brain-Injured Veterans Carries High Financial, Emotional Costs

April 12, 2007 at 6:30 PM EDT

SUSAN DENTZER, NewsHour Health Correspondent: Among the wounded from Iraq and Afghanistan, there are miraculous recoveries, like that of brain-injured ABC newsman Bob Woodruff.

BOB WOODRUFF, ABC News Reporter: I’m standing here tonight because I got the best military and civilian medical care in the world.

SUSAN DENTZER: But far more common than Woodruff’s case are the traumatic brain injuries that don’t end in miracles. Take 23-year-old Joseph Youn (ph).

MOTHER OF INJURED SOLDIER: OK, watch this, all right? It’s OK? If it’s OK, thumbs up. Come on, Joe. All right.

SUSAN DENTZER: Youn was an Army sergeant in Iraq when he was hurt in a suicide bombing two years ago. Penetrating shrapnel forced removal of part of his brain.

MOTHER OF INJURED SOLDIER: He’s doing very well today.

SUSAN DENTZER: Brought back to the U.S., Youn nearly died several times. One close call came last year, when he acquired a dangerous heart infection while recuperating at a private rehabilitation hospital.

Near death, Youn was transferred to the Veterans’ Health Administration hospital in Manhattan. He’s been an inpatient here for the entire past year.

DR. MICHAEL SIMBERKOFF, Veterans Affairs Medical Center, New York: Joe, how do you feel? Feel good?

SUSAN DENTZER: Dr. Michael Simberkoff, medical chief of staff at the VA hospital, told us Youn has made progress over the past year.

DR. MICHAEL SIMBERKOFF: He was bed-bound, really uncommunicative, and really almost incapable of, you know, recognizing individuals or responding to stimuli. And he’s now getting physical therapy on a daily basis, occupational therapy, some speech therapy, as well.

SUSAN DENTZER: The VA has told Youn’s parents that he can stay at the hospital indefinitely, but that it will also pay to support his care if they choose to take him home or transfer him to a private facility. Whatever the case, his care will clearly cost millions of dollars over his lifetime.

Meanwhile, Youn’s parents, naturalized U.S. citizens from South Korea, are overwhelmed about what to do next.

MOTHER OF INJURED SOLDIER: I don’t know what to do. I can’t leave him here. Who’s going to take care of him? Every single day, my family is crying, really, every single day.

'Unprecedented number' of wounded

SUSAN DENTZER: As the conflicts in Iraq and Afghanistan drag on, the number of severely wounded Armed Forces personnel continues to climb. Now, in the wake of revelations about chaotic outpatient care at Walter Reed Army Medical Center, there's renewed focus on whether the nation is adequately prepared for the rising tally or for the staggering costs and other burdens of caring for the severely wounded.

Linda Bilmes is a professor of public finance at Harvard's Kennedy School of Government who's studied war-related costs.

LINDA BILMES, Harvard University: For every person who's actually been killed in this war, there are 16 wounded and injured, and this is an unprecedented number. In Vietnam, for example, there were 2.6 injuries for every fatality, and in Korea there were 2.8.

SUSAN DENTZER: Among the worst ones are the traumatic brain injuries like Youn's. The VA estimates that up to 1,600 Iraq and Afghanistan veterans with TBI are being cared for in the VA system.

MOTHER OF INJURED SOLDIER: You're not sleeping today.

MICHAEL MASON, Brain Injury Case Manager: So one of the other things that you might want to do with regards to your mother-in-law...

SUSAN DENTZER: Michael Mason is a professional brain injury case manager. He reported on these devastating war wounds for a recent article in Discover magazine. He says costs begin at the moment of injury, when Armed Forces medical personnel spring into action.

MICHAEL MASON: If you were in America, what would it cost for you to have 20 people rush to you at the site of your injury, whisk you away, and within 10, 15 minutes, you would be at a level-one trauma center, where you could have up to 10 surgical specialists operating on you simultaneously? That's unheard of; the cost of that would be exorbitant.

Long-term costs

SUSAN DENTZER: Bilmes says the long-term costs follow when Armed Forces personnel are discharged from active duty and file claims for disability benefits from the VA.

LINDA BILMES: In Vietnam, for example, a typical veteran who was claiming a disability claimed for maybe three different conditions. Now, a veteran typically claims for five different disabling conditions, but there have been 50,000 claims that have been received in the last few months for eight or more disabling conditions.

SUSAN DENTZER: The long-term costs of those disability benefits will vary, says Bilmes, depending how long the conflicts in Iraq and Afghanistan go on and how many veterans file for disability. But she says the costs over 40 years in today's dollars could reach $75 billion to $150 billion, and even those sums could pale next to outlays for veterans' health care.

LINDA BILMES: Assuming that 50 percent of the Iraq and Afghan veterans claim health care benefits at the Department of Veterans' Affairs medical facilities, which is the same number that was claimed in the first Gulf War, then you can anticipate in today's dollars a cost of somewhere between $300 billion and $600 billion of health care costs for these veterans.

SUSAN DENTZER: Dr. Michael Kussman is acting undersecretary for health for the VA. He agrees the long-term costs will be considerable, but says that, on average, the newly returned veterans cost less than older vets from previous wars who are now battling costly chronic disease.

DR. MICHAEL KUSSMAN, Department of Veterans Affairs: We do spend about $5,800 per year per veteran. But if you look at the cost for these new veterans, and I'm not talking about the ones that are severely injured needing polytrauma and things like that, but on the average we're spending under $3,000 a year for those veterans, because most of them are coming for things that aren't very costly to the system.

SUSAN DENTZER: Health costs for the severely wounded, however, are a different story. Consider Marine Sergeant Eddie Ryan, age 23. Ryan was in Iraq when he was shot in the head by friendly fire from an Army tank two years ago. He's now living at home in rural Ellenville, New York.

JULIE FINEMAN, Physical Therapist: And breathe. Breathe.

SUSAN DENTZER: As is common among the severely brain injured, Ryan lost much of his motor control. He now works regularly with physical therapists like Julie Fineman to try to restore it.

JULIE FINEMAN: We're going to roll over. Are you ready?

EDDIE RYAN, Injured Soldier: No!

JULIE FINEMAN: He's made a lot of progress since I've worked with him since August. Progress from this point on tends to be slower.

SUSAN DENTZER: Ryan's mother, Angie, describes his many challenges.

ANGIE RYAN, Mother of Injured Soldier: He has an occasional seizure here and there, a lot of frustrations. He screams a lot, and that's due partly because of the injury. Part of it is due to spasms and pains he gets in his legs and arms.


Gaps in coverage

SUSAN DENTZER: Although the VA initially encouraged his family to place Eddie Ryan in an assisted care, it eventually agreed to pay for a range of services so he could live at home. The VA told us those outlays for Ryan now run about $228,000 a year.

Additional one-time payments for prosthetics, housing and a brain injury insurance payment totaled almost $182,000.

Harvard Professor Bilmes told us that, if the VA's support for Eddie Ryan stays relatively constant over the next 40 years, the costs of his care alone could reach anywhere from $8 million to $17 million.

But as much as the nation will spend on care of the severely wounded, many experts make the argument that it should be spending even more. That's because large care gaps remain, both within the VA and in the broader community.

Dr. John Booss recently retired as the VA's national director for neurology, overseeing much of the care of brain injury patients. The VA has been a national leader in caring for TBI since the first Gulf War.

DR. JOHN BOOSS, Former Director of Neurology, VA: One of the things that the VA does very well -- and, in all candor, much better than the private sector -- is in continuity of care. From preventative services through acute care, through chronic care, long-term care, and rehabilitation, so I think, in many ways, the VA is really a standard in that kind of care and delivery.

SUSAN DENTZER: But even Booss thinks the VA could still stand to shore up some services; that includes preparing for long-term side effects of brain injury, like epilepsy.

DR. JOHN BOOSS: There has been a reduction in epilepsy services in the VA over several years. There should be a system of sophisticated epilepsy centers which can do monitoring and also surgery as needed. And the possibility of having private providers in areas underserved by VA needs to be looked into very carefully.

VA's responsibility

SUSAN DENTZER: Partnering with more private health care providers may be more urgent than ever, since many servicemembers have been recruited from rural communities far from urban centers. Eddie Ryan's home is in the Catskills, for example, nearly two hours from the nearest VA hospital in Albany, New York. So the VA contracts with a private agency to line up private therapists and health aides.

But both the VA and the Ryans told us it's been a struggle for the private agency to find enough caregivers who meet the family's preferences. The Ryans say they had to push to get the VA to agree to pay for services of a music therapist to help Eddie with his memory and speech. The VA has now agreed to do that. Now the Ryans want coverage for a massage therapist, as well.

Chris Ryan is Eddie's father.

CHRIS RYAN, Father of Injured Soldier: He's not getting what he needs. We're even paying out of pocket, you know? And my wife has all the bills, and we're doing as much as we possibly can through, you know, people who are putting out fundraisers for Eddie. And we're spending up to $800 a week.

SUSAN DENTZER: Brain injury case manager Mason told us a key underlying problem in such cases is a shortage of health professionals caring for all brain injuries. That's not just the wounded from Iraq and Afghanistan, but also the estimated 1.2 million brain injuries that take place in the U.S. each year.

MICHAEL MASON: I think America in general wasn't aware of the challenges that brain injury survivors have been facing for decades. They just have not been able to get the care that they need.

SUSAN DENTZER: To help plug the gaps, Dr. Kussman told us the VA has now set up 21 so-called polytrauma centers with expertise in brain injury around the country.

DR. MICHAEL KUSSMAN: To be able to get closer to where the patients were going so they don't have to travel as far, we've also put polytrauma treatment teams in all of our VA medical centers that have a special expertise to at least evaluate and do the physical therapy, coordinate with tele-medicine and tele-health to get this expertise as far forward and close to where the veterans live.

SUSAN DENTZER: More specifics on what's needed to improve care for the seriously injured may emerge from government commissions, created after the disclosure of problems at Walter Reed.

Meanwhile, Congress is now weighing emergency spending bills that would add $3.5 billion for health care to this year's budgets at the Defense Department and VA. They include more support for victims of brain injury, as well as for amputees.

JIM LEHRER: Next week, an independent panel is expected to call for better treatment for severely brain injured patients. That panel is headed by two former secretaries of the Army that was appointed by Defense Secretary Robert Gates.