The surge from past eras comes even as more soldiers than expected are returning home from Iraq and Afghanistan in need of care. With hundreds of thousands of troops still deployed, the VA already provides disability payments to nearly 200,000 veterans from the current conflicts, a number that is expected to balloon during the next 30 years.
The unanticipated crush of claims is exacerbated by the VA's antiquated compensation system, which hasn't been overhauled since 1945. Cumbersome and heavily bureaucratic, the system requires a mountain of paperwork, is based on diagnoses that lag far behind medical advances and runs on a computer system that is so outdated it can't accurately verify whether veterans were deployed.
The problems have led to a backlog at of least 500,000 claims -- some veterans groups say it's as high as 1 million -- that threatens the well-being of veterans with ailments ranging from brain injuries and back problems to cancers and mental disorders.
The Tribune's analysis of 200,000 claims in the backlog shows that nearly half take longer than 120 days, with thousands of claims languishing for two years or more.
The compensation process entails so much paper that many claims have been misplaced or even accidentally shredded by employees.
"Sometimes, I feel like they're playing mind games," said Mario Cifuentes, a 28-year-old Iraq War veteran from Chicago's Northwest Side. "I file a claim, they deny me and say I can reopen another, but I have to file the same paperwork all over again."
"I'm done," said Michelle Wilmot, an Iraq war veteran from Boston. "The first time I called they asked me to prove I was in the military. I sent in the paperwork they asked for and they told me the same thing. 'Prove you were in the military.' What's the point?"
"It's such a catastrophic disaster," said Paul Sullivan, a Persian Gulf veteran and former VA analyst who runs Veterans for Common Sense. "The system is broken."
Instead of working toward building a new system, however, Congress has approved hundreds of millions of dollars in recent years to hire thousands of new employees to process claims, a temporary fix that's added more overhead to what is already one of the largest bureaucracies in the federal government.
The backlog of claims is expected to grow before it shrinks, however, as experienced employees are pulled off the line to train new ones. The VA says the backlog won't be eliminated until 2015.
Meanwhile, the system's fundamental flaws remain -- and the costs keep rising.
Among the findings from the Tribune's analysis of more than 3 million disability claims approved by the VA:
--By the end of 2009, more than 3 million veterans were receiving compensation, a 24 percent increase since 2003. The total costs, meanwhile, grew from $19.5 billion to more than $34 billion.
--The psychological toll of war now accounts for more than a third of the $24 billion spent last year compensating veterans from the Vietnam, Persian Gulf and "global war on terror" eras, more than any other category. Yet studies have shown that the current system is ill-equipped to handle claims related to post-traumatic stress disorder and other conditions, adding to delays and forcing veterans into the even lengthier appeals process.
--The unpredictability of war has led to devastating illnesses that cost U.S. taxpayers billions every year. By the end of last year, more than 300,000 Vietnam-era veterans were receiving nearly $2 billion in disability payments for illnesses associated with Agent Orange and other dioxin-laden herbicides used to defoliate jungles and destroy enemy crops during the war. Those costs are expected to increase by billions of dollars as the VA expands the list of illnesses associated with the chemicals.
The result is that some who have "borne the battle" die before their claims are processed while others are shortchanged by a system that wasn't built to deal with wounds veterans face today.
"Are we appropriately compensating veterans? The answer to that is really no," said Lonnie Bristow, a former president of the American Medical Association who chaired a 2007 Institute of Medicine study on the VA's compensation system. "It's not for a lack of good intent; it's because they are using a screwdriver and hammer to make a jet fighter."
eric-shinseki-michael-michaud-veterans-040910.jpgView full sizeAssociated PressVeterans Affairs Secretary Eric Shinseki, right, speaks at news conference during a tour of the Togus Department of Veterans Affairs Medical Center in Augusta, Maine, Friday, April 9, 2010. Shinseki came at the invitation of U.S. Rep. Michael Michaud, D-Maine, left, the chairman of the House Veterans' Affairs Subcommittee on Health.Under current VA Secretary Eric Shinseki, a decorated Vietnam veteran and retired Army general, the agency has begun to acknowledge some of the problems and announced last month that for the first time in its history it would streamline the claims process for Vietnam veterans suffering from newly approved illnesses related to Agent Orange.
The VA said it was making the move because its computer system "is likely to break" as a result of the estimated 200,000 additional claims.
The VA's acting undersecretary for benefits, Mike Walcoff, said the Obama administration has fought for an unprecedented increase in funding to tackle problems facing the agency. He said the agency is working on multiple fronts, including developing a paperless computer system, improving communication with the military and developing pilot programs to streamline the claims process.
"When I look at our situation and see what we have to do, I realize that we can't just add more people," he said. "We have to ask ourselves what we need to make this better. Everybody here recognizes we have a long way to go."
But some of the issues facing the VA lie outside the agency's control, the Tribune found.
Disability payments for veterans of the Vietnam era, which ended 35 years ago, cost the VA $15 billion in 2009 alone. That price tag, which doesn't include the cost of providing health care, is expected to continue climbing during the next 15 years. Experts now say the cost of compensating veterans after the shooting stopped in Southeast Asia eventually will surpass the cost of actually fighting the war.
Lawmakers rarely take such costs into consideration when determining war funding. Since 2001, Congress has approved $944 billion to fund the global war on terror, and less than 1 percent was set aside to care for veterans, according to the Congressional Research Service.
From the beginning of the current wars, the Bush administration woefully underestimated the number of veterans who would seek disability compensation, forcing the VA to play catch up just as an aging veteran population added to its workload.
When U.S. forces invaded Iraq in March 2003, officials estimated that about 50,000 soldiers fighting in Iraq and Afghanistan would eventually seek disability benefits from the VA. Seven years later, about 500,000 veterans from those wars have put in claims, and the VA already provides more than $1 billion in compensation benefits to 180,000. A recent Institute of Medicine study found that claims from the current wars won't peak until 2040.
"Good grief, the numbers are huge even if you look at the present," said Linda Bilmes, a professor at Harvard's Kennedy School of Government who has spent years studying war costs. "You quickly realize that you are going to pay a lot more after the war then you do during it -- at least double. So the government is not really presenting the true cost of war."
Where broken bones and bullet wounds once dominated the VA's compensation system, veterans like Mario Cifuentes are fueling it today with invisible ailments that affect their ability to work, maintain relationships and adjust to civilian life.
Cifuentes, a machine-gunner with the Army's 2nd Infantry Division, returned from the Iraq war with hearing loss after spending 15 to 18 hours a day patrolling the streets of Baghdad and searching homes of suspected insurgents for weapons.
Cifuentes spent a year and three months in Iraq during the surge that sought to turn the tables on insurgents, resulting in some of the war's heaviest fighting. A sniper's bullet once came within inches of taking his life, he said. Soldiers in his unit, Chaos Company, rarely slept and were on constant edge because of improvised explosive devices, or IEDs.
"When those things went off, the force was so strong the vehicles would shake," he said. "I think the IEDs are what made me lose my hearing."
He began receiving disability benefits, but soon realized that hearing problems weren't the only thing plaguing him. He started having horrific nightmares of being blown up or shot by a sniper.
VET_MENTALHEALTH.jpgView full sizeSix months later, Cifuentes put in a claim for post-traumatic stress disorder, or PTSD. He spent about an hour with a VA therapist who told him he had mild anxiety disorder, he said. The VA upped his compensation as a result.
Soon after, he began hallucinating. "I started having visions," he said. "It's very scary. I think I'm standing at a guard post or something back in Iraq but really I'm standing on the corner."
Cifuentes said he also started suffering from sleep disorders, including narcolepsy and sleep paralysis. He often feels drowsy during the day and has rapidly lost muscle tone to cataplexy, a rare condition usually brought on by emotional stress that involves sudden attacks of weakness.
He said he's gone through a battery of tests to support his claim but is worried the VA will not agree that his problems are related to his military service. "I told them it didn't start happening until I got back, but they say they need evidence," he said. "I don't know how I can prove it."
Cases like Cifuentes' have contributed to an increase in the number and complexity of ailments that veterans are seeking to be compensated for, compounding the crush of claims overall.
In 2003, the average number of diagnoses for which Vietnam veterans were compensated was 2.88. Seven years later, it's up nearly 20 percent to 3.41. For Iraq and Afghanistan veterans, the average is 4.07; for veterans of the Persian Gulf era it's more than 5.
The increases are due in part to advances in emergency medicine and evacuations. The ratio of injuries to casualties in Iraq and Afghanistan is 9-to-1, compared with 3-to-1 during Vietnam and 2-to-1 during World War II, according to the Institute of Medicine. And where it once could take 45 days to evacuate wounded soldiers to the U.S., it now takes just three days.
The volume and complexity of claims flowing into the VA's antiquated system has left thousands of veterans stranded and, in some cases, is driving away veterans who need help.
Cifuentes says he still suffers from PTSD symptoms but isn't planning to fight with the VA for help with that particular issue.
"They say I need more evidence," he said. "But it gets old. I don't like talking about it.