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Caring for Iraq veterans

The first in a series of occasional editorials on wounded veterans returning from Iraq.

It's hard to imagine that a Veterans Administration nursing home catering largely to septuagenerians would be the ideal place for a severely wounded 30-year-old Iraq vet to recuperate. But sadly, this happens, according to Jeremy Chwat, spokesman for the Wounded Warriors Project. That's because the system that the Veterans Administration has developed to care for severely wounded Iraq veterans -- through no readily apparent fault of the VA itself -- is still being built.

According to VA figures, about two-thirds of the 17,004 service members injured in Iraq as of mid-March suffered blasts from improvised-explosive devices, the hallmark enemy weapon of this war. Of those, around 60 percent have some degree of traumatic brain injury. Many have suffered amputations, sometimes multiple, paralysis and damage to or loss of sight and hearing. Such injuries are occurring at historically disproportionate rates in this war owing to the prevalence of improvised-explosive devices, the use of live-saving body armor and the introduction of medical techniques to treat injuries which in previous conflicts were often fatal. The result is a generation of veterans with a new set of needs, including prosthetics and intense regimens of therapy, to suit the injuries.

The timeline of government action on behalf of the severely wounded gives a sense of where we currently are. Only late in 2004 did Congress mandate that the VA create "polytrauma" centers to treat severely wounded veterans returning from Iraq and Afghanistan. The idea was to centralize and concentrate care in a more systematic fashion than was previously possible. In June of last year, the VA designated four facilities in Richmond, Va., Palo Alto, Calif., Tampa, Fla., and Minneapolis, Minn., as polytrauma centers. More are planned, but at present, these four are tasked with handling most or all of the severely injured service members coming out of Iraq. A number of "Level II" facilities to handle recovering veterans after the polytrauma centers are not operational yet.

A serviceman severely wounded by an improvised-explosive device can spend anywhere from a few weeks to two years in the chain of facilities the military and VA have designated for that purpose. The service member is typically treated immediately in Iraq under emergency conditions, flown to Germany for stabilization, and then to Walter Reed Medical Center in Washington or one of a handful of other facilities to begin the recuperation process. He or she continues recuperating at one of the four polytrauma centers. After that, any number of arrangements happen.

In the case Mr. Chwat recounted, the Army veteran in question spent part of his recovery housed with two World War II vets and one Korea vet; it goes without saying that his needs were quite different from those of his elderly roommates. The Iraq vet had lost an arm and suffered severe brain damage in an improvised-explosive device blast; he was hardly able to speak at first.

This story says nothing of the care the veteran in question received. Care ranges from excellent to mediocre to poor, depending on facilities, treatment programs, doctors and the specifics of each case. But it points to the fact that America's medical infrastructure to handle the unique needs of Iraq veterans is still being developed.

Congress should ensure that the Department of Veterans Affairs has everything it needs to make the Level II facilities a reality, expand the number of polytrauma centers and monitor the establishment of both. The need is immediate -- so immediate, in fact, that we think Congress should also consider whether a crash program to rush the needed infrastructure into existence might be warranted. The severely wounded returning from Iraq have made staggering sacrifices for the nation. They deserve no less.

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