This is Buffalo's Veteran's Park.
They have been putting up memorials here to America's veterans ever since the War of 1812, when this city was on the front line for the battle for what was then the frontier.
Many of the vets returning from today's front lines are coming back afflicted with Post Traumatic Stress Disorder.
This is a real disease, and its
psychological effects can
lead to broken families, homelessness, even suicide.
Now that's just one of a range of medical problems facing our returning vets, and
as producer Peter Meryash and I found, it's putting enormous pressures on an already-overburdened Veterans Administration.
Jeremy Lewis has done more than most to serve his country. Twelve years active duty in the Navy, 11 more in the Army National Guard. His missions have included rotations in Bosnia and more recently, he was in the thick of things in Iraq.
Last April, Lewis came home to Buffalo. If you just bump into him in the street, it seems he survived without a scratch. But that's deceptive.
He carries invisible scars from the war symptoms he first experienced while serving in Iraq.
Getting up every morning at three AM for no reason. I can't go back to sleep. I'm having a lot of trouble falling asleep. I can't stop my mind from thinking.
BRANCACCIO: Lewis is one of the wounded
and like thousands of others from this war so far, he's turning to the V.A. For help.
I walked in, told the triage nurse I need to see someone from mental health. And she said why. I said, "Well, I just got back from Iraq and I was seen by the Combat Stress Team. I think I'm having some flashbacks."
Did you get an official diagnosis?
My doctor diagnosed me in April with PTSD.
PTSD or Post-Traumatic Stress Disorder. Up-close combat face to face with death can bring on injuries just as crippling as a physical wound.
There's little doubt the V.A. can provide excellent psychiatric care. But critics and even the government's own reports say that for many, getting that care today can be difficult.
Every day we hear reports of deficits, reductions in V.A. medical facilities, health budgets, and veterans not being able to timely access the system. If you're sick, it does absolutely no good to be told to come back for an appointment, that they can schedule for you, in six or seven or eight months or even longer.
David Gorman is with Disabled American Veterans. Having served in the Vietnam War himself, he's worried things at the V.A. will only get worse.
It's been a problem. It's been exacerbated in recent years. It's now reaching the bursting point with the returning veterans.
BRANCACCIO: Veterans like Jeremy Lewis, who's struggling now with his memories from the war in Iraq.
You always had to keep your head on your shoulders. You knew every time you left the wire and went on a mission that you could come under attack or see someone who had.
BRANCACCIO: Sergeant Lewis served in a military police unit, its primary mission was to patrol a main supply route that ran into the Sunni Triangle. He was on constant alert for gunfire, car bombs and RPGs rocket propelled grenades.
And then one night
Suddenly there was a loud metallic thud. And I initially thought she hit a car with no headlights on. But what it was was an RPG. I think it grazed our brush guard in the Humvee then blew up. Explosion was absolutely deafening. Fireball entered the vehicle. The concussion threw my gunner against his grenade launcher. And it shattered my windshield. We shot back with grenade launchers, with machine guns. And then we regrouped and we started heading south. And 15 minutes later we were in another ambush.
BRANCACCIO: Lewis received the Army's Commendation Medal for Meritorious Service for leading his team through two ambushes without the loss of American life.
Every week there was something. Maybe twice a week there was something. A patrol came under fire-- the camp. We heard gunshots. We heard explosions constantly, 24/7. So you were constantly in that mindset of you're in danger.
Did you feel mentally prepared for that?
You get into a state of hyper vigilance where you can't sleep. Or you start not trusting things. You start being afraid of the dark. I don't think anyone can be prepared for that.
BRANCACCIO: So Lewis went to see the combat stress team
a medical unit set up in Iraq to help soldiers suffering from the intense stress in the field. He good-naturedly calls them "the brain rangers."
After a psychological exam, Lewis was given anti-depressant and anti-anxiety pills. But with a shortage of troops, he says, the military couldn't afford to send him home.
It's funny because they had told me that they didn't want me driving for three days while I was taking the medication to see how I reacted to it. No driving. But they still let me carry a gun.
BRANCACCIO: He returned to his unit which was soon rotated to a more secure base. But it took five long months before his unit could ship home.
In Buffalo, Lewis was back in a truck now as a driver his old civilian job.
But the battlefield came with him.
For about a month it went fine. Then I started to notice I was really getting nervous about time. I had to go from Buffalo, New York to Columbus, Ohio. It's about a five hour and 45 minute drive. And if I wasn't in Columbus by two o'clock I was starting to get really anxious and paranoid.
Then if I saw a dead deer on the side of the road or something like that, I'd always try to move over thinking there was a bomb under the deer. And if traffic got heavy, it wasn't comfortable because one of the ways they ambush you is to block you into traffic. So I started feeling this hyper anxiety coming back, the hyper vigilance.
And you were aware this was sort of weird.
I knew that I shouldn't be feeling this because of based on seven years of experience I never felt this before.
BRANCACCIO: So Lewis has turned to the V.A. For help
like thousands of others vets around the country.
The V.A. has been at the forefront of post traumatic stress treatment. Doctor Bruce Kagan is a leading psychiatrist in the field.
DR. BRUCE KAGAN:
In general, the treatments are highly effective. And people who undergo the treatment generally report significant improvement in symptoms, and in functioning.
BRANCACCIO: But Dr. Kagan, whose views are his own and not the V.A.'s, is worried about what lies ahead.
DR. BRUCE KAGAN:
I think we are coming up upon a potentially very large wave of new veterans who need treatment, and who could stretch us very thin.
BRANCACCIO: Cutbacks have been felt across the country efficiency and better out-patient care says the V.A.
At the veterans hospital where Dr. Kagan works in Los Angeles, California, for instance,
over the past 10 years, the number of inpatient psychiatric beds has been cut from 366 to 90.
And vets with a mental crisis no longer can go to the hospital's specialized psychiatric emergency room. Instead they're now sent to the V.A.'s regular E.R.
Critics say such cuts have come at a bad time that is to say, during war time.
Nationally, the V.A. Will be seeing a flood of PTSD patients. Last year, more than a quarter of a million veterans were treated for the condition. By next year, 60,000 more patients are expected.
Dr. Jonathan Perlin is the Under Secretary for Health at the Department of Veterans Affairs.
Does the V.A. have the resources to meet the needs of current veterans as well as the new veterans coming back from Iraq and Afghanistan?
DR. JON PERLIN:
Absolutely. Nearly one out of every $3-- in all of VA's budget goes to the care both for physical and mental health needs of patients with mental illness. So the resources are absolutely substantial.
BRANCACCIO: Tell that to Jeremy Lewis. He had to wait two months for his first appointment at the V.A. Hospital in Buffalo. And since then, the appointments have been few and far between.
I'm gonna see a therapist from what I've been told once a month with a therapist and once every three months with my primary care doctor. So it doesn't seem like they have the resources to do more. Or--
It sounds like you could use more.
And both doctors told me I should be getting more. But they said that we just don't have the money in our budget to do this anymore. We've taken so many cuts in the past two years. We can't give you the therapy as frequently as we'd like to give it to you. We can only work with what we've got. So I'm kind of stuck.
DAVID BRANCACCIO: The V.A.'S own committee on Post-Traumatic Stress Disorder found last year that "
PTSD services are lacking in many V.A. medical centers and are severely limited at community based outpatient clinics."
The report concluded: "unfortunately, V.A. does not have sufficient capacity" to meet the PTSD "needs of new combat veterans while still providing for veterans of past wars."
The V.A.'s own special committee on PTSD has found that there are insufficient resources to meet the growing needs in this area.
DR. JON PERLIN:
This, by the way, is a committee that reports to me. It makes recommendations to the Undersecretary for Health. And. in fact, they have identified that we've actually met the expectations on a majority of the areas that they made recommendations. And we're working together to create a bold, ambitious mental health strategic plan to make further improvements. Toward that end in 2005. We've identified $100.1 million for additional care, including your areas such as PTSD, outreach to our newest combat veterans of Operation Iraqi Freedom and Enduring Freedom. And in substance use disorders. And so this is an area we will continue to invest in. But we have the resources there.
Actually talked to a veteran. Came back from Iraq just last year. Unfortunately, suffering from Post Traumatic Stress Disorder. He has the diagnosis now.
DR. JON PERLIN:
Took him two months to get an appointment at the V.A. And then he's being seen for his mental health condition once a month. He's being seen by a doctor every few months. His doctors think this isn't enough. They feel frustrated. They've expressed this to him that he needs to be seen more regularly. But that there aren't the resources to meet that need.
DR. JON PERLIN:
Well, you know, I appreciate hearing about this incident. And, if you share details I will take care of this immediately. But, overall, the goal is to make sure that, that patients are seen timely and with the frequency necessary.
BRANCACCIO: There are different ways to cast the numbers. The V.A. told us according to the most recent data
in most cases, veterans waited 30 days or less for a primary or specialty care appointment.
but that still leaves more than 300,000 appointments where veterans had to wait longer than 30 days.
And after a few years of significant improvement, the waiting list is starting to grow again.
As of March, more than 40,000 veterans will have to wait six months or more for a non-emergency visit almost a three-fold increase from last May.
That's tough news for a patient suffering with PTSD
where quick and consistent treatment can make all the difference.
DR. BRUCE KAGAN:
Obviously, one wants to have the availability for veterans to come in, and be seen in a relatively short period of time, and to be treated relatively rapidly. And- relatively intensively. You know, most of the psycho-therapeutic treatments require one or two sessions a week with a therapist.
DAVID BRANCACCIO: But critics charge the resources are not there. Veteran advocates are angry at congress for not providing enough funds.
They say the 100 million dollar increase in next year's mental health care budget is not nearly enough to keep up with medical inflation and the thousands of new veterans seeking care.
What's more, it falls far short of the nearly 1.7 billion dollars the V.A. itself projected in this briefing document that it will need to cover the gap in mental health care funding by the end of 2007.
I know for a fact that veterans hospitals all across America today are using their capital budgets and dollars from their equipment budgets to just keep the lights on and to pay salaries. They're eating their seed corn. They're going to hurt the quality of care for veterans.
BRANCACCIO: Democratic Congressman Chet Edwards is fighting for more money for veterans. He sits on two committees which oversee the V.A.'s budget and spending.
He's also fighting to keep the V.A. from closing a hospital in his home district in Texas. Its specialty psychiatric care.
You couldn't pick a worse time for reducing capacity for V.A. mental healthcare services considering we have so many tens of thousands of veterans coming back from Iraq and Afghanistan who need that care. If we're going to go to war and ask Americans-- young Americans to fight those wars, we have a moral obligation as a country to not forget them when they return home.
BRANCACCIO: But some are forgotten.
We're still picking up the pieces after Vietnam. We have people that lived in cardboard boxes for the last 20 years that we're just bringing in now. So we don't want that to happen this time.
DAVID BRANCACCIO: Toni Reinis and her colleague John Keaveney run New Directions Inc. a long-term drug and alcohol treatment program in Los Angeles that serves more than 800 homeless veterans a year.
They're dealing with what happens when veterans don't get the right care.
The veteran needs to be able to take care of themselves somehow. And if they're not sleeping or if they're angry and anxious, they may turn to drugs and alcohol in order to help themselves. So rather than getting the kinds of treatments that they need in a timely and adequate-- in an adequate services that they need it's unfortunate that we might-- we may lose some. They may just filter through the cracks.
BRANCACCIO: It's been estimated that half a million veterans are homeless at some time during the year
76 percent of them with substance abuse or mental health problems.
To keep these men and women from falling further through the cracks, New Directions tries to get their lives back on track
providing food, shelter, mental health care and rehab.
They help veterans find work with job training in food services or the construction business.
For all they do, new directions says it gets only about 27 dollars a day per veteran from the V.A.
Money is critically short.
If the Veterans Administration is not able to provide those services, New Directions will provide them. We'll go to foundations and we'll beg, borrow and steal in order to be able to have a comprehensive program.
BRANCACCIO: And the needs are only expected to grow.
THE NEW ENGLAND JOURNAL OF MEDICINE reported that up to seventeen percent that's one in six of Iraq veterans surveyed suffer from "major depression, generalized anxiety, or PTSD."
And those findings are conservative: "it may simply be too early to assess the eventual magnitude
" the JOURNAL cautioned, since it can take years before PTSD or other psychological problems develop.
Here in Buffalo, Jeremy Lewis is already struggling. He takes medicine for his psychiatric condition that prevents him from long-haul truck driving, his livelihood. For him it's now also a financial crisis.
So what are you supposed to do, Jeremy, if you can't drive the truck?
You could do other jobs. You just can't drive. So you go from making $700, $900 a week and you start looking for anything basically.
So did you look around?
Yeah. But it's kind of a double edged sword because they ask, "Why'd you leave your current job?" Do you be honest and tell them, "Well, I'm being treated for Post Traumatic Stress Disorder and I can't drive due to medications." Or do you lie to them and tell them, "Well, I just didn't feel comfortable anymore." I don't think it's very wise to lie to an employer in an interview. But it's not very smart to tell the truth either. So you're kind of stuck.
BRANCACCIO: It took five months for Lewis to be formally diagnosed by the V.A. with PTSD. He's now filed for veteran's disability
but he's been told it could take until next year before he sees his first disability check.
What are you living on right now as you and I are talking?
I got about $8.00 in the bank left. If I need money, my friends are always willing to give. My sister-- she's paying the bills at my house and her house now. So-- basically I'm living off of my friends. That's the bottom line.