Nation faces billions in long-term care costs for wounded troops

By Bob Brewin

April 18, 2008

The United States must prepare to provide lifetime care for troops severely wounded in combat operations in Afghanistan and Iraq, the Navy's top doctor warned this week. And an independent study released on Thursday concluded that the country also faces a steep mental health care bill for dealing with combat stress.

In the study, the RAND Corp. estimated the costs of dealing with stress issues and psychological illnesses of combat troops at $6.2 billon for just the first two years after those troops return home. That includes direct medical care costs, the price of lost productivity and suicides. The study is the first nongovernmental assessment of the psychological needs of veterans who have served in Afghanistan and Iraq.

Meanwhile, Lt. Gen. Eric Schoomaker, the Army's surgeon general, told reporters at the Pentagon on Thursday that treatment of troops with amputations or severe burns could dramatically improve during the next few years through research efforts led by the new Armed Forces Institute of Regenerative Medicine. The institute, backed by more than $250 million in funding, will grow new cells from a wounded individual to repair burned flesh or replace digits lost in combat, akin to "a salamander growing a new tail," Schoomaker said.

Schoomaker said at the briefing that all the services are seeing troops survive with more severe wounds than any time in history as a result of improved body armor, better trained combat medical personnel and a speedier aeromedical evacuation system. The Military Health System can transport a wounded soldier from the battlefield to a stateside hospital in 24 hours.

Until recently, Defense had estimated the survival rate from combat wounds in Afghanistan and Iraq at 92 percent, compared to 81 percent in Vietnam and 75 percent in World War II. But Terry Jones, a spokesman for the Military Health System, told Government Executive that new data shows the survival rate for those wounded in the current conflicts has edged up to 97 percent.

With such survival rates, "we have become victims of our own success," Vice Adm. Adam Robinson, the Navy's surgeon general, told a Senate Appropriations subcommittee on Wednesday. Severely wounded soldiers will need a lifetime of care, Robinson said.

Robinson said in the past, Defense has been responsible for acute care and the Veterans Affairs Department has handled long-term sustained care. The question the nation now faces, he said, is how to meld the two. According to the RAND report, as of January 2008, a total of 30,721 troops had been wounded in action in Iraq and Afghanistan, with approximately 3,000 of them suffering from severe wounds and illnesses, including amputations, serious burns, spinal cord injuries, blindness and traumatic brain injuries.

The RAND report said another 300,000 U.S. troops suffer from major depression or post-traumatic stress from serving in the wars in Iraq and Afghanistan, and 320,000 have brain injuries.

RAND said there was a "large and largely unmet need for psychological services" by troops.

Almost half the troops who brought their mental problems to the attention of a mental health professional in the past year did not receive even minimally adequate treatment, RAND reported. And 60 percent of troops who experienced traumatic brain injuries had not been evaluated for the condition.

Schoomaker said at the subcommittee hearing on Wednesday that soldiers who are potentially suicidal sometimes have to wait as long a week to 10 days to receive help. He emphasized that suicide prevention is not just medical matter, but a command issue. Troop commanders and noncommissioned officers need to deal with potential suicides as part of a comprehensive Army approach to the problem, he said.

"Our policy is that patients in crisis will be seen immediately," Cynthia Vaughn, Schoomaker's spokeswoman, told Government Executive. "Routine behavioral health cases will be assessed within seven days. If follow-on specialty care is warranted, patients will be seen within 28 days."

Army Col. Loree Sutton, a psychiatrist and chief of the newly created Defense Center of Excellence for Psychological Health and Traumatic Brain Injury in Arlington, Va., told a Pentagon press briefing on the RAND report that Defense has "come a long way, … but we've got a long way to go" when dealing with combat stress issues.

Sutton said the department has dramatically increased the number of mental health professionals to deal with the problem.

She said Defense is halfway to its goal of hiring an additional 1,000 mental health professionals. Insurers supporting the Military Health System's TRICARE health care plan have added another 3,000 such specialists to their networks. Also, the Veterans Affairs Department has boosted its mental health staff by 4,000 and the Public Health Service has assigned 200 mental health professionals to work with Defense.

By Bob Brewin

April 18, 2008