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As we celebrate Veterans Day this week, what specific improvements can be pursued to ensure that veterans are getting the quality care they need?

Contributors Respond

Tom Tarantino

Tom Tarantino

Chief Policy Officer, Iraq and Afghanistan Veterans of America (IAVA)

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Too often, veterans and servicemembers fall through the cracks of a complicated network of healthcare support. Treatment and care begun at the Department of Defense (DoD) or the Department of Veterans Affairs (VA) are often continued through other government agency or in the private sector. Frustrated by seemingly endless red tape or other barriers to receiving care, many veterans just give up, significantly jeopardizing their health.

The first critical step to creating a continuity of care for veterans is to ensure that military healthcare records are smoothly transferred to the Department of Veterans Affairs. Early in 2013, the Department of Defense announced that it would start performing exit physicals in the hopes of identifying service-connected injuries and illnesses and transferring that information to the VA to aid both in transitioning care and decreasing the time to claim service-connected disabilities. While this will provide an important snapshot of the health of a service member, more important is the need for an interoperable medical record to ensure a seamless transition of care between the two agencies. This is an initiative that has been languishing with these two agencies for years.

However, getting the information to the VA is just the first step. The VA and DoD should then work together to ensure that there is a smooth continuity of care for servicemembers as they transition to life as a veteran. For example, the DoD and VA should both use the same prescription drug formulary. Right now, many servicemembers start using a prescription while still in the military. Then, when they are transferred to the VA, they do not have the option of using the same prescription drug, or may be required to use a different generic, and this can interrupt their care.

The VA and the DoD have a long way to go to ensuring that more veterans aren’t lost in the transfer between the two departments. But as we look towards what our healthcare system should look like for veterans on Veterans’ Day, we must aim to give servicemembers and veterans long-term, integrated care.

Tom Berger

Tom Berger

Executive Director, Veterans Health Council

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The Veterans Health Administration (VA) has made some significant progress in its efforts to improve the quality of health care for America’s veterans. For example, it should be commended for its system-wide adoption of evidence-based cognitive behavioral treatment modalities for Post-Traumatic Stress Disorder (PTSD). In addition, the development of various web-based program applications and outreach campaigns reflect improvements in the VA’ effort to reach veterans to ensure they are getting the care they need. 

But while these efforts are laudable, the VA has much more work to do.

There are still too many reports of veterans not being able to access mental health services in a timely fashion.  Over the past two years, several Inspector General (I.G.) reports concluded that the VA does not have a reliable or accurate method of determining whether they are providing veterans timely access to mental health care services and that the VA is unable to make informed decisions on how to improve the provision of mental health care to veteran patients due to the lack of meaningful access data. And in several extreme cases reported in the media, lack of immediate access to mental health services has resulted in veteran suicides. 

In addition, VA grants disability claims for military sexual trauma-related PTSD at significantly lower rates than other PTSD claims, according to an ACLU report released on November 7th.  Women veterans are disproportionately denied compensation based on PTSD, as they are more likely to file military sexual trauma-related PTSD claims, but male survivors who file military sexual trauma-related PTSD claims face particularly low grant rates compared to female veterans who file MST-related PTSD claims.

And according to a May 2013 article in the Colorado Springs Gazette, an investigation showed that as the military downsizes, the number of soldiers discharged for minor misconduct had surged 25 percent since 2009. The investigation showed many troops had so-called "invisible injuries" including post-traumatic stress disorder and traumatic brain injury that could have caused their bad behavior. But they were discharged in ways that stripped them of veterans benefits, leaving some struggling and others homeless. In addition, The Gazette showed that the Pentagon's medical commander wrongly assumed troops are being screened to ensure that no one with invisible injuries is unfairly kicked out. In fact, Army screenings do not look at the connection between a soldier's injury and his or her misconduct.

One solution is for Congress to direct the Government Accountability Office (GAO) - the investigative arm of Congress - to look at the following four issues:  1. Whether the armed forces have processes in place to assess the impact of combat injuries on conduct and how the military ensures that the processes are followed; 2) Whether commanders, junior officers and noncommissioned officers have proper training to recognize these injuries in troops; 3) Whether troops discharged for misconduct get treatment for combat injuries before being kicked out and how many are barred from receiving Veterans Affairs benefits as a result of misconduct discharges; and 4) Whether troops are informed they will lose VA benefits if they agree to leave the military in lieu of trial by court-martial, a process known in the Army as Chapter 10.