Veterans' Health Care for Mental and Environmental Illnesses Under Attack
In recent years, both Republicans and Democrats in Congress have backed privatization of services provided by the Veterans Health Administration (VHA). As part of the Department of Veterans Affairs (VA), the VHA serves about nine million patients and operates the largest public healthcare system in the country.
Since 2015, billions of dollars have been diverted from VHA care to private doctors and for-profit hospitals who treat veterans in costlier and less effective fashion. This cannibalization of the VHA budget began under President Obama, escalated during the Trump era, and continues under Joe Biden.
Up until now, few Republicans, or their allies like the Koch Brother-funded Concerned Veterans for America (CVA), dared to attack the VA-run Veterans Benefits Administration (VBA), a sacred cow even for conservatives. Nearly six million veterans currently receive payments for service-related medical conditions that left them partially or totally impaired; among them are 1.3 million men and women who served in Iraq and Afghanistan. Their total compensation, plus pensions, costs the public about $110 billion per year.
Publication of a new book, touted by Trump’s last VA Secretary, signals that any ceasefire over veterans’ benefits has ended inside the Beltway. In Wounding Warriors: How Bad Policy is Making Veterans Sicker and Poorer, (Ballast Books), Daniel Gade, a retired US Army lieutenant colonel and former Trump Administration official, has teamed up with an ex-Wall Street Journal reporter, Daniel Huang, to demand major “entitlement reform” at the VBA. The authors--who are definitely not critics of the military-industrial complex--denounce what they call a “disability industrial complex.” They argue that monthly checks from the VBA foster a costly and unhealthy culture of dependence among veterans—and should be sharply restricted, not expanded.
Robert Wilkie, the Republican operative who helped expand VHA outsourcing while serving as VA chief until last year, has joined the call for benefit cuts from his own new perch at the Heritage Foundation. At a Veterans Day event with Gade in November, Wilkie accused his former agency of being overly “focused on getting veterans checks and not getting them well and getting them back into society.” Like Gade, he claimed that veterans service organizations encourage former military personnel “to play disability”—with the result being that too many non-combat veterans are getting undeserved compensation.
In Wounding Warriors, Gade and Huang argue that VA disability ratings have been “misapplied to mental health disorders like PTSD, which have been repeatedly demonstrated to improve with effective therapies.” In their view, such ratings are “an appropriate designation” only “for veterans with disabilities that are truly static and unlikely to improve — amputations, spinal cord injuries, etc.” The “only veterans for whom employment is not a reasonable option are those few whose brain injuries are truly devastating and impossible to overcome.” As for the rest, including those who may be suicidal, “we pay veterans to be sick and then we wonder why we have so many sick veterans.”
A Decision to Thrive
Gade himself earned two Purple Hearts, a Bronze Star, and the Legion of Merit during 20 years of service, that included combat duty in Iraq. In 2004, he was so severely wounded that he spent a year in a military hospital recovering and lost his right leg. As one account of Gade’s career explains, “while his new, serious disability was life-changing, he decided to thrive.” While still in the military, he earned both masters and doctorate degrees in public administration and spent six years on the faculty at West Point, before retiring in 2017. He’s been a professor at American University’s School of Public Affairs in Washington, DC. and will now be heading Virginia’s Department of Veterans Services, under newly- elected Republican governor Glenn Youngkin.
In his book, Gade displays little sympathy for poor and working-class soldiers who didn’t get the tax-payer funded educational or job opportunities he enjoyed as an officer and, subsequently, faced a harder transition to civilian life. According to Gade, too many veterans, who lack a “truly static” disability liked his own amputated limb, “are diverted from paths of self-sufficiency and shuffled down paths of dependency and dysfunction.”
Such criticism of his former comrades has multiple historical echoes from the last two centuries. As Richard Severo and Lewis Milford note in their book, The Wages of War (Simon & Schuster) hundreds of thousands of demobilized Union soldiers had great difficulty supporting themselves and their families after the Civil War. Only the severely disabled were eligible for care in a few newly created soldiers’ homes.
Nevertheless, the Army and Navy Journal, a military publication, advised veterans to avoid becoming “dirty loafers” if they wanted to succeed in civilian life. Those who developed “new muscular habits,” rather than succumbing to personal despair and reliance on charity, would eventually find jobs and housing; those who sought any special help would end up fatally dependent on it.
In 1890, soldiers who served in the Grand Army of the Republic were finally awarded pensions not tied to death or disability resulting from active duty. But this legislative victory was not universally applauded. Even the Nation magazine bemoaned the fact that “the ex-Union soldier is . . . a helpless and greedy sort of person, who says that he is not able to support himself and whines that other people ought to do it for him.”
Of course, back then, there was hardly any social safety net for poor or disabled persons, other than private charity or local “poor houses.” Throughout the 20th century, as the U.S. finally developed a modern welfare state that better protected its most vulnerable citizens, conservatives have seized on any instance of fraud or abuse, real or imagined, that might discredit public assistance and trigger calls for benefit cuts.
By the 1970s, no domestic bogeyman—actually a woman, usually non-white—was more popular on the Right than the proverbial “welfare queen.” Echoing welfare fraud exposés in the mass media, California Governor Ronald Reagan made tall tales about such grifters a staple of his presidential campaigning in the 1970s. During one oft-repeated speech, he claimed that a single female defrauder—never identified by name or race, of course—was raking in $150,000 worth of Social Security, Medicaid, food stamp, and welfare benefits every year. (According to Reagan, she was also collecting veterans benefits on “four non-existing deceased husbands.”
A New Mission
During Gade’s 2020 campaign for the US Senate in Virginia, his Reagan-like stance against hand-outs to the undeserving drew 44% of the vote. Perhaps unsurprisingly, in addition to supporting Social Security privatization and “entitlement reform” of VA disability pay, Gade strongly opposed universal health coverage, free higher education modeled on the GI bill, and student loan forgiveness (as “an immoral transfer of risk”).
After his failed electoral bid, Gade formed the New Mission PAC to support other Republicans who want “to better serve our nation’s veterans.” In Georgia, his PAC did voter turn-out among veterans for incumbent Senators Kelly Loeffler and David Perdue, who were defeated a year ago by Democrats Raphael Warnock and Jon Ossoff, respectively. Among Gade’s many reasons for opposing Warnock and Ossoff is that they’re part of a “political left… deeply invested in the VA’s system of ‘enlistment-to-grave’ care as a prototype for single-payer healthcare.”
Sadly, most liberals and leftists actually pay little attention to the VA as a positive model for broader health care reform. So Gade and Huang are forced to direct most of their fire at the decidedly non-left leaning veterans service organizations (VSOs) which seek improved VA benefits for their membership.
The VSOs function much like associations of injured workers and unions have throughout U.S. labor history. At the local level, they help individuals pursue claims for compensation and healthcare, while seeking legislative changes benefiting larger classes of veterans like victims of Agent Orange during the Vietnam War or post-9/11 veterans exposed to toxic burn pits. Gade and Huang argue that this membership service and related lobbying makes the VSOs “enablers” of a “victim mentality” among former military personnel.
Longtime advocates for veterans like Steve Robertson and Paul Sullivan reject this characterization of their work. Robertson is an Air Force veteran and a forty-year member of the American Legion who served as its national legislative director. During Bernie Sanders’ tenure as chair of the Senate Veterans Affairs Committee, he was the committee’s staff director. He remains active in Legion Post 290 in Stafford, Virginia, where he serves as benefits officer.
Robertson supports efforts by the VA’s inspector general to deal with any cases of fraud or abuse. But, in his experience, the real problem is that “generations of seriously disabled veterans didn’t want to go to the VA for benefits because they felt they weren’t as badly off as some other veterans and didn’t want to take money away from someone they considered more deserving. The VSOs don’t help them get benefits they don’t deserve, they help vets get the benefits they have definitely earned.”
Paul Sullivan served as an Army cavalry scout in the 1991 Gulf War and now belongs to the Legion, Veterans of Foreign Wars, and the Disabled American Veterans. As past executive director and now national vice chair of Veterans for Common Sense VCS), he has been a key advocate for former soldiers exposed to toxins in Middle Eastern war zones over the past three decades.
Between 1990 and 1991, an estimated 697,000 service members developed what’s known as “Gulf War illness” or “Gulf War syndrome,” after being exposed to widely used pesticides and/or releases of the nerve agent sarin. As described in one VA advisory committee report, “This complex of multiple concurrent symptoms typically includes persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems, and other chronic abnormalities not explained by well-established diagnoses.” According to the report’s authors, “No effective treatments have been identified for Gulf War illness and studies indicate that few veterans have recovered over time.“
As Sullivan notes, and VCS argued in a report to Congress last year, the “VBA routinely and improperly denies 80% or more of the veteran disability claims for toxic wounds, thus blocking entry to urgently needed healthcare at the VHA.” Sullivan has personally assisted many such frustrated claimants, who fill out multiple forms and provide detailed medical evidence to claims processors and doctors who often work for outside contractors, not the VBA itself. Too many veterans experience what he calls “an adversarial, complex, and burdensome claims nightmare.”
Between 2007 and 2020, the VBA approved only 2,828 burn pit–related disability claims out of 12,582 filed. Under pressure from Congress and the VSOs, the VA announced last August that it would consider asthma, rhinitis, and sinusitis as being presumptively related to exposure to particulate matter from burn pits in Iraq, Afghanistan, and other countries.
By Veterans Day, 2021, in response to further lobbying from VSOs, members of Congress and public figures like Jon Stewart, a champion of burn pit victims, the VA announced that it was piloting a “comprehensive military exposure model” to consider more possible links between active duty environmental hazards and later medical conditions. “We are seeking more information from veterans, more evidence from more sources, and looking to take every avenue possible to determine where a potential presumptive illness based on military service location may exist in a more expedient and holistic manner,” VA Secretary Denis McDonough declared. He further encouraged all veterans “who may have been impacted to file a claim even if it was previously denied,” a remedial step considered necessary, but insufficient by burn pit compensation campaigners.
To overcome a growing number of backlogged claims – more than 600,000 to be exact – the Biden Administration has hired and trained 2,000 new VBA employees.None of these steps will be cheered, of course, by the authors of Wounding Warriors whose thesis is that veterans without visible proof of the costs of war shouldn’t be adding to them by filing claims for physical or mental disabilities.
Gade and Huang are the tip of the spear for a renewed right-wing assault on the VA, as one of the few models of public healthcare provision that we have. Their book is indicative of a new willingness by right-wing ideologues to go after a sacrosanct group in American society, veterans and their families. Not content with trying to gut welfare state programs that benefit millions of non-veterans, these conservatives are now targeting former soldiers, who are often poor or working class and similarly dependent on publicly funded services.
(Steve Early and Suzanne Gordon are co-authors of a forthcoming book, from Duke University Press, called Our Veterans: Winners, Losers, Friends and Enemies on the New Terrain of Veterans Affairs. They can be reached at Lsupport@aol.com)