- The Washington Times - Monday, October 4, 2004

Veterans Affairs hospitals are gearing up for a surge in mental-health disorders and other medical problems in the coming years, as U.S. combat troops return from Iraq and Afghanistan.

Already, the Department of Veterans Affairs (VA) has sent letters to 168,000 returning troops, informing them of the range of care available through the government.

“These are people who served in the military but who have been discharged, so now they are ours,” VA spokesman Phil Budahn said.

Services available include psychiatric and psychological programs at each outpatient clinic, including counseling and other group and individual therapy, increased substance-abuse programs, and even beds in community centers for veterans who are homeless.

For the first time, the VA has opened offices on each military base to make it easier for troops to find assistance.

To date, 28,000 of the 168,000 troops who served in Iraq and were discharged have sought care at at least one VA facility. As for those who served in Afghanistan, 44,000 are eligible for VA services, and 4,300 have sought them.

“Needs have included everything from spinal-cord injuries to flu shots,” Mr. Budahn said.

About 5,400 of the 28,000 Iraq veterans treated have been diagnosed with mental disorders. That compares with about 1,200 of those who served in Afghanistan, he said.

More than a third of Iraq vets found to have mental illnesses have been diagnosed with post-traumatic stress disorder, a condition that came to notoriety among Vietnam veterans. Post-traumatic stress disorder often is marked by nightmares or flashbacks after a life-threatening incident and can lead to severe depression and suicide.

“We know the number of PTSD cases we’ve seen so far is low, since it usually takes two years to manifest” symptoms of that disorder, Mr. Budahn said.

Dr. Mark Shelhorse, VA acting chief consultant for mental health, said the disorder can take years, even decades, to develop. At this point, he said, only 1 percent of Iraq veterans and almost 0.4 percent of Afghanistan veterans have been diagnosed with the condition.

“But veterans of guerrilla conflicts, where there is a greater incidence of unexpected bombs” and other terror, “often have a 10 percent risk of PTSD over their lifetimes,” Dr. Shelhorse said. In some cases, onset of the condition is delayed until a veteran experiences another traumatic event in his life, he said.

Dr. Shelhorse noted that post-traumatic stress disorder plagued veterans of World War II and other wars before Vietnam.

“But they called it combat stress or shell shock,” he said.

At a meeting of defense writers this week, VA Secretary Anthony J. Principi, who served in Vietnam, noted that mental disorders in veterans sometimes lead to homelessness. Because of that, he said, the VA has paid for 10,000 beds in community centers across the nation for those with no place to live.

In wars before Vietnam, beds in VA hospitals often were taken up by paralyzed veterans, multiple amputees and others requiring long-term care.

“But today just about everybody, including those with very serious spinal injuries, wants to go back home. So the emphasis now is on returning them to their families and communities,” Mr. Budahn said.

Figures show of the veterans of Iraq or Afghanistan who have sought care from the VA, 160 had “major amputations,” which means they lost one or more arms, legs or feet.

“We’ve also had 35 spinal-cord injuries, and under 10 veterans who are totally blind [from injuries sustained in one of those conflicts]. We don’t track blindness in one eye,” he said, adding that the U.S. military “tends to hold on to” severely wounded soldiers longer than it did in other wars.

“That’s better psychologically, since many [severely wounded soldiers] are determined to get back to active duty,” he said.

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