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‘Major Overhaul’

The secretary of Veterans Affairs discusses budgets, data theft and the health problems affecting soldiers returning from Iraq and Afghanistan.

By Dan Ephron
Newsweek
Updated: 1:00 p.m. CT Oct 8, 2006
http://www.msnbc.msn.com/id/15186412/site/newsweek

Oct. 8, 2006 - Jim Nicholson, the secretary of Veterans Affairs, has been in the news lately for all the wrong reasons. Last week, congressional investigators from the Government Accountability Office found that the VA underestimated the cost of caring for veterans of Iraq and Afghanistan by billions of dollars. In May, Nicholson’s administration was embroiled in a data theft ordeal when a laptop containing the personal details of more than 26 million veterans and active-duty troops was stolen.

Nicholson, a Vietnam veteran and Republican Party activist, was appointed to the job by President Bush at the start of last year. He spoke to NEWSWEEK’s Dan Ephron recently about data theft, security and the health problems affecting returning Iraq and Afghanistan vets. Excerpts:

NEWSWEEK: How did your administration miss the budget mark by so much?
Jim Nicholson: Because of the Byzantine budgeting process of our government, you compute, submit and defend the budget about two years in advance of when you enter the budget cycle ... This shortfall occurred in the ’05 budget cycle. That was put together in early ’04 and the final numbers it used were from ’02. Well, we weren’t at war in ’02 and therefore because we were [at war later] and our needs increased as a result of it, a shortfall resulted in the system.

So if you were now trying to project your needs for next year, you’d use numbers from ’03?
I’m now projecting for the ’08 budget and I’m using ’05 data … That’s the numerical case upon which the model is based. Do we apply some common sense and intuitive judgment? We are now. But that’s the basic model and you have to have something like this when you’re dealing with an enormous system … And it’s been very accurate, by the way, but it missed it for ’05 because it was predicated on numbers from ’02, which was pre-war.

How many veterans of the wars in Iraq and Afghanistan have sought treatment and other help at VA hospitals and clinics?
We have seen about 188,000 of these people, and that’s out of almost 600,000 who’ve been discharged. To me, that’s not a surprisingly high number. It’s about a third of them. And all of the returning guard and reserve personnel are eligible for our services even though they haven’t been discharged.

What do they seek help for?
It’s a variety of things. Some of it is dental, some of it is skeletal, muscular, mental. It’s a whole array. I think I’d be correct in saying it’s mostly for back problems and dental problems.

What percentage come in for emotional trauma, things that might look like posttraumatic stress disorder [PTSD]?
The number is 29,000, so I think it’s about 16 percent. That’s [as] of last month.

How was it that the budget for brain trauma was cut in a period when soldiers are surviving attacks more and more but suffering from brain trauma caused by explosions?
I was in Iraq last month again for the purpose of assessing the continuum of health care from the time a soldier is injured through the evacuation process, when they come to us. It’s astonishing how good both the armor protection and the battlefield care and evacuation are. As a result of that, many of these people who are coming back severely injured, would be coming back in body bags in any other previous engagement, including Vietnam. So we get these people who are alive but seriously injured and we have reacted in a spectacular way. We’ve set up these polytrauma centers … we’ve aggregated the medical disciplines in one place to take of them. If they’re suffering from blast injuries, limb problems, burns, blindness, we have the experts together in these centers to take care of all of that so they don’t have to be moved around. We’re now opening 17 more of them … Our ’07 budget request includes a total of about $3.2 billion for mental health, which is $340 million above last year.

Out of an overall budget of what?
For ’07, which will start one Oct. 1 … the budget will be in the neighborhood of $80 billion, which will be up from $70 billion in this current fiscal year.

Some National Guardsmen and reservists worry that they have a two-year window to seek help for trauma and if they miss that window—if PTSD symptoms occur later, for instance—they won’t be eligible. Is that fair?
We’re being very aggressive, very robust in our outreach to these people, seeing that they’re all briefed. We were just briefing them at post deployment about all they’re entitled to and things to look out for in themselves, but we realized their concentration levels were not high at that time. They were more fixated on getting back with their families and their communities, so what we’re doing now is bringing them back together 30 to 45 days after postdeployment and rebriefing them on all that’s available for them. As veterans, our vet centers will always be available to them. After the 24 months, if some service-connected disability presents itself, they’ll be taken care of.

Most veterans of Vietnam, the war you fought in, were not received well by the public when they returned home because of the contentiousness of that war. How does that compare with the situation today?
In my little hometown they called out the National Guard company for me to inspect as a way of honoring me [when I came back from Vietnam]. It was a Saturday night, the armory was filled with people. I then went back to West Point, and I was going to graduate school in New York City at Columbia, at which time I wore civilian clothes. But if I had been wearing my uniform they would have spit on me. So that was very discouraging to me to see the reaction in the civilian population and the lack of understanding and appreciation for what we were going through over there. I would point out the distinction today. Whereas there is considerable disagreement in this country about this war, there is virtually no disagreement about these warriors. I get on airplanes and some of these young people get on the plane in uniform and the people break out in applause.

What effect does that have on the emotional trauma soldiers might end up experiencing down the road?
I think intuitively that … an awful lot of my comrades who came back from Vietnam were never affirmed, and they’d been through hell and that contributed to some of their psychological, mental problems—that they had no feeling of appreciation or understanding or affirmation for what they’d just been through for their country. And I think with some, that had an indelible impact.

Another difference between the two wars: in Vietnam soldiers for the most part did one tour of duty. Now, soldiers are being sent back to Iraq three or four times. What’s the long-term implication in terms of emotional trauma and how do you build that into the planning?
We don’t have any evidence-based studies on this. We’re going to continue to look at that as we treat veterans. If you think about World War II, for example, people went out and were deployed [for years]. I know World War II veterans who didn’t see their spouses for four years … What was the effect of that versus having these intervals of deployment? I don’t know, but those are things we’re looking at and want to know more about.

What are you doing to prevent more data theft?
We’ve engaged a company to do a constant analysis of that [stolen] data to see if there are any trends that show that it had been compromised and is being used. We’re also in a major overhaul in this department … We’re allowing employees only to have VA-owned computers. Everything that possibly can is going to be encrypted. We’re going to do background investigations on people who have access to data here. The man who took this computer home against our policies, and had been doing it for three years, he’d been working here for 34 years and had not had a background investigation in 32 years. So the model of classified documents, where people have to have background investigations and clearances, we’re doing similarly here because we have to know who it is we’re entrusting with information about our veterans … We’re in a major overhaul of information security.