The Army, The Department of Veterans Affairs, and Miscommunication

Back on January 29th, NPR aired a story that claimed that the Army had taken steps to keep Veterans Administration workers from helping soldiers with their Army disability paperwork. Since then, there have been some new revelations, including a document that indicates that the Army Surgeon General was at best ignorant of all the facts, and at worst dishonest, when he was first interviewed by NPR. After listening to the NPR stories, and (more importantly) reading the documentary evidence they presented, I think that their report clearly illuminates some serious problems with the care of wounded troops. These problems are serious. They need to be addressed very quickly. But they're not necessarily the same problems that NPR decided to focus the bulk of their attention on.

The story began with a January 29th report by NPR correspondent Ari Shapiro. Shapiro reported on allegations that a group from the Army had told Veterans affairs workers at Ft. Drum to stop helping soldiers contest portions of the Army paperwork that can determine how the Army rates the soldier's medical condition. The paperwork in question is referred to as a "narrative summary", and is a detailed description of the soldier's medical condition.

A narrative summary is usually written by a doctor assigned to the same unit as the soldier, based on the entire medical history of the person involved. This document is an absolutely critical part of the Army's medical separation process. The wording of this document has a great deal of influence over how disabled the Army considers the soldier to be. That, in turn, determines whether the Army will medically discharge or medically retire the soldier. The distinction between "discharged" and "retired" is the difference between whether the soldier gets a one-shot severance package or a lifetime of retirement benefits. In short, it's a high-stakes document.

It's not at all unusual for a soldier to contest portions of their narrative summary, and it's not unusual for them to need help doing it. The medical separation process is long and complex, and the outcome of the process is going to have an effect on the soldier for the rest of their life. In their position, I'd want help, too. According to Ari Shapiro's NPR story, soldiers at Ft. Drum, New York, were not getting as much help as they used to. From the original January 29 story (transcription and any errors therein mine):

The man from VA told the class that the VA used to help soldiers with Army medical paperwork, but some Army folks didn't like that. The VA instructor told the group that an Army team from Washington complained to the VA regional office in Buffalo. THe instructor said these Army officials saw soldiers from Ft. Drum getting higher disability ratings because of the VA's help. So the Army told the VA 'knock it off'. Stop helping Ft. Drum soldiers describe their Army injuries. And the VA did what it was told.

Shapiro took these allegations to the Army, and couldn't find anyone who knew anything about them. In fact, a spokesperson for the Army Surgeon General told Shapiro that there was nothing in any Army policy that would prevent anyone from being allowed to help soldiers navigate the disability process.

Shapiro concluded his initial report with some speculation about why the Army might not want the VA to help soldiers get through the Army's disability rating process:

The Army said it could not put us in touch with the Tiger Team members, so we have no way of knowing their motivations. But we do know this: higher disability ratings cost the Army money.

NPR's initial report caught - and rightly so - the attention of several members of Congress, including both the Republican representative whose Upstate NY district includes Ft. Drum and New York Senator (and Presidential candidate) Hillary Clinton. They promptly contacted Army Surgeon General Eric Schoomaker. Schoomaker, apparently after contacting at least one member of the team who visited Ft. Drum, told these elected officials that NPR was wrong, and that the team had not told the VA to stop counseling soldiers.

Thursday, NPR reported that they had obtained a document that contradicted the Surgeon General's denials. The document in question is a memorandum that was written by one of the VA workers present at the meeting. The memo was written the day after the meeting, and provides a detailed sketch of who said what. The document is available as a pdf file on NPR's website, and since I'll be referring to it frequently, you might want to download a copy - if only to make sure for yourself that my version of what the document says is accurate.

According to this document, Col. Becky Baker of the Army Surgeon General's office did tell the people at the meeting, which included workers from Ft. Drum, the VA regional office in Buffalo, and the Army Surgeon General's office, that the VA needed to stop counseling soldiers on some of their Army medical paperwork:

VBA should discontinue counseling MEB soldiers on the appropriateness of DOD MEB/PEB ratings and findings. There exists a conflict of interest. This activity should go to any Service Organization. MOPH at Fort Drum should assume this responsibility immediately.

On the surface, this does appear to clearly contradict the Army's account of the situation. After talking with someone familiar with the Army's MEB process, though, I'm not so sure that it actually does. The original story said that the Army told the VA to stop helping soldiers get through the Army's disability rating system. Specifically, you'll recall, it said that the VA had been forbidden from helping soldiers contest the narrative summary document, which is written early in the process. What this seems to say is that the Army told the VA that they shouldn't tell troops whether or not they thought that the Army's final rating and determination were appropriate.

The document goes on to detail a number of other things that Col. Baker said. Taken together, they seem to contradict Shapiro's initial suggestion that the Army didn't want the VA helping the troops because they didn't want to shell out more money:

• She said that an organization other than the VA should step in to help troops determine whether the Army's ratings were appropriate.
• She said that the VA and Ft. Drum's clinic should make arrangements to have the VA complete the physical disability examination on behalf of the Army, in a way that would meet both sets of requirements.
• She said that the VA and Ft. Drum's medical people should work together to take applications for State Disability benefits for seriously disabled soldiers.
• She said that the VA should try to get all soldiers enrolled for VA healthcare before they leave the service.
• She said that the VA and the Army should work together to make sure that the VA is kept up to date on the Army's separation process, so that they could start the VA benefits process at the earliest possible time.
• She said that an idea presented by one of the VA people at the meeting - have a disability rating specialist from the VA act as an advisor to the Army's evaluation board when the time came to assign a disability rating - was a very good one, would not require changing any existing regulations, and could be done immediately.

Taken as a whole, all this suggests that the goal was not to screw over the troops. If anything, it was exactly the opposite - to try and get things set up so that soldiers had an easier time moving through the Army's disability rating process and into the VA's process. Based on everything that's in the document, it seems likely that Army Surgeon General Eric Schoomaker was probably right when he told NPR's Shapiro that the situation at Ft. Drum involved a "miscommunication" between the people who were at the meeting.

At the same time, it's clear that whatever the intentions of those at the meeting might have been, the end effect was that in the end, the troops got hosed, and for almost a year nobody noticed that it had happened. The list of those who are responsible for the hosing is not short. In no particular order, it includes:

The people present at the meeting, both Army and VA: The VA people wrote up a memorandum that outlined their understanding of what happened at the meeting, and apparently decided that there was no need to show it to the Army people who were there. The Army people apparently didn't follow-up to make sure that everyone was clear on the conclusions reached at the meeting, either. When there's no follow-up from either side, it's very easy for a miscommunication to go unnoticed.

The VA and the Army officials in charge of the disability rating process at their respective agencies: The Ft. Drum meeting in question took place shortly after last year's Walter Reed scandal hit the news. At the time, there was a lot of talk about getting the VA and the military to set up things so that the two different disability rating processes would work together smoothly, simplifying the process for the troops involved. It's wartime, and a lot of troops are moving through both systems right now, but the efforts to get the systems in line are moving forward - if at all - at a glacial clip.

Congress: It's called "oversight", people. That's supposed to mean more than holding widely-publicized hearings on the scandal du jour. It's also supposed to involve doing things like following up to make sure that the problems you find during the course of those hearings actually get fixed. Even if that's not as sexy and doesn't net as many votes.

The President: There's a hell of a lot of responsibility that goes along with being the "decider", especially if you're a "wartime decider". Very little of that responsibility involves landing jets on aircraft carriers. You're also supposed to be doing things like making sure that when two or more of the agencies that you are responsible for are having problems working together, the problems get solved. That's not accomplished by just saying, "Hey, Gatesy, VA-dude, go fix that thing." You also need to wait a little while, and say, "Hey, Gatesy, VA-dude, did the two of you-all ever fix that thingy I told ya to take care of? Yeah? Cool. What'd ya do about it?"

The President: If you're going to fight a war, don't try to do it on the cheap. Give the people who are fighting it and the people who have fought it the resources that they need. This hasn't happened. As expensive a disaster as the entire war in Iraq has been so far, it should really have cost more than this President has spent. If he wants to make sure that problems get fixed, he has to make sure that the people who are supposed to fix them have all of the resources that they need. The military and the VA do not.

Congress: If you want to make sure that the troops who have been hurt as a result of this war get everything that they need and are entitled to, you should do a better job of making it clear that your unwillingness to fund the war itself does not include an unwillingness to pay for the consequences of the war. One way to do this might be to separate out funds for injured troops and veterans from the rest of the "emergency" budget requests, and vote on them separately.

VA and military leadership: You are not just responsible to the President. You also have a responsibility to the people who you are supposed to serve. If you are not being given everything that you need to provide those people with everything that they are entitled to, you need to tell people about it. Even if you get fired.

The story that NPR is reporting right now - the Army shafts injured troops, and their Surgeon General either doesn't know or is lying about what happened - is a good story, but it isn't the most accurate or the most important. More attention needs to be focused on the broader problems that sit at the root of this problem. That's supposed to be one of the things that the media does, and it's one of the reasons that they've got the Constitutional protections that they do.

(Hat tip to reader Keith Barkley, for bringing the story to my attention.)