Building Back Better: Department of Veterans Affairs

Barbara Lloyd McMichael’s monthly column examines the history of key government agencies and how they are “Building Back Better” under the Biden Administration.

Throughout the 2020 presidential campaign, candidate Joe Biden spoke often of America’s “sacred obligation to our veterans.” Biden, like all but one of the American presidents who have served in the 21st century, is not a veteran himself, but he refers proudly to his deceased son Beau Biden, a veteran who served for a year in Iraq as a member of the 261st Theater Tactical Signal Brigade, and who died a few years later of brain cancer. The tragedies that have shaped Joe Biden’s character are well-known and don’t need to be repeated here, but in temperament and personal experience, President Biden is well-suited to serve not only as the nation’s commander-in-chief, but also as its empathizer-in-chief, and he has repeatedly expressed his commitment to ensuring the well-being of veterans.

   To that end, Biden picked Denis McDonough to lead the Department of Veterans Affairs and this past February the appointment was confirmed by the Senate in an 87-7 vote. McDonough previously served as White House Chief of Staff during President Barack Obama’s second term, but he is only the second VA secretary never to have served in the armed forces. (Former President Donald Trump’s first appointment to head the VA, David Shulkin, was not a veteran either.) The new VA chief does have a thorough understanding of how the federal government ticks, however, and during his confirmation hearing McDonough asserted that he will be able to “unstick problems” that have been become tangled in bureaucracy.

   Of course, many of his predecessors at the VA had vowed to do the same. A quick tour through the history of America’s veteran-related policies demonstrates why “unsticking” may be easier said than done.

 

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   Over this country’s nearly 250-year history, generations of America’s service members have been called to duty in more than 90 armed conflicts. Along with the major wars that American schoolchildren learn about in their history classes, lesser-known conflicts such as the Quasi-War, the Barbary Wars, Operation Beleaguer and dozens more have engaged the U.S. military and resulted in American casualties.

   For the purposes of this exercise, however, we’ll focus on only the major military actions. 

   According to a report prepared for Congress by the Congressional Research Service, over 6000 American fighters sustained battle-related injuries during the American Revolutionary War and survived.  This made them eligible for benefits promised by the Continental Congress, but only about half of the survivors drew any pension and in the early years following the war those payments were left up to individual states. Once the federal government was reorganized under the U.S. Constitution, however, Congress took on the responsibility of making pension payments. 

    When the British-American conflict reignited in the War of 1812, another 4500 American soldiers, sailors and marines suffered non-mortal wounds. The U.S. government expanded its pension system, and Congress eventually established a Bureau of Pensions to manage the claims and payments of injured veterans.

   The Mexican War in the late 1840s resulted in a similar number of wounded veterans, but with the gradual passing of earlier generations of veterans, the workload of the Bureau maintained a kind of equilibrium.

   Then the Civil War broke out. Fought on a totally different scale, this conflict was a game-changer. Millions fought in that war and hundreds of thousands of soldiers died. Hundreds of thousands more were afflicted with non-mortal wounds.

   When the war ended, the federal government launched an effort to gather the remains of some 300,000 battlefield casualties and rebury them in 70 new national cemeteries. Congress also funded the building of soldiers’ homes to care for disabled veterans who had no one else to look after them.

   And the Bureau, accustomed to processing the accounts of a couple hundred new applicants annually, was suddenly socked in 1865 with more than 75,000 new applications for assistance. Those kinds of numbers persisted for many years to follow, augmented in part by Congress’s approval of additional pensions for surviving dependents to help address that brutal war’s aftermath. Adding to the burden was the detail Congress had gone into - legislators had delved into the minutiae, assigning different monetary values to a host of different injuries. If a veteran had had both his feet blown off in battle, for example, he could expect $20 monthly from Uncle Sam. Loss of eyesight rated five bucks more.

   These provisions introduced new complexities to the processing of a growing mountain of claims. The Bureau struggled to establish procedural clarity while also expanding capacity – it recruited physicians around the country to conduct examinations of the claimants in their localities. Blindness and missing feet were easy enough to confirm by a physical exam, but some other conditions were trickier to identify – or disprove. The whole process was susceptible to financial exploitation, political influence peddling, and racial and ethnic bias – but grappling with those consequences didn’t come about until decades later.

    Meanwhile, Congress continued to broaden the scope of pension eligibility over the next few decades.

   The 20th century saw more expansion and reforms. The Sherwood Act of 1912 awarded pensions to all veterans of the Mexican War or Civil War (on the Union side) when they reached the age of 62 – whether or not they were sick or disabled. This meant another exponential increase of veterans on the pension rolls.

   World War I brought about the establishment of vocational education for veterans, a new Public Health Service, and war risk insurance. These were eventually consolidated into a Veterans’ Bureau, but the Bureau of Pensions and the homes for disabled soldiers were still left as separate entities.

   Finally in 1930, President Herbert Hoover used an executive order to bring all of the veteran-related agencies under the umbrella of a newly formed Veterans Administration.

   The Great Depression delivered an extra dose of despair to veterans, who were promised bonuses by the federal government – payable twenty years out. Hungry and fed-up at the same time, veterans marched on the Capitol to demand more timely payment. A riot ensued, and the upshot was that Congress began paying more attention to veterans’ issues.

   By the time World War II happened, legislators were proactive in designing a comprehensive benefits package to assist the 16 million service members who would be returning home after the fighting was over. The 1944 G.I. Bill of Rights was transformational – it provided vets with funding for education, unemployment compensation, and access to federally guaranteed home, business and farm loans that required no down payment.

   Wars in Korea and Vietnam followed in quick succession, which meant more tinkering with veterans’ benefits. With every war, veterans brought along a new set of issues, which prompted more research into the development of prosthetic devices, and the presumptive service connection to a range of maladies relating to radiation exposure (World War II veterans) and Agent Orange (Vietnam veterans). Post-military medicine was becoming very sophisticated, but it came at the price of many service members’ shattered lives.

   With major conflicts boiling up decade after decade, as well as a surprisingly sizable number of 19th century veterans, or their pension-eligible dependents, still living well into the 20th century (and beyond – the last American to collect a Civil War pension only passed away in May of last year), the result was that by the mid-20th century, a whopping one-third of all Americans were eligible for veterans’ benefits. Veterans advocates called for elevating the VA to Cabinet-level status, in essence to give so many people in so much need a seat at the table. That happened in 1989 during Ronald Reagan’s presidency, when the Veterans Administration became the Department of Veterans Affairs.

 

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   Today the Department of Veterans Affairs is the United States’ second biggest federal department in terms of discretionary spending. It oversees America’s largest health care system, and also offers a broad array of other services: education benefits, vocational training, home loans, social services, adaptive sports, cemetery burials, and much more.

   Despite all this, our nation’s aspiration to provide its retired warriors with care and support for the rest of their days is not being fully achieved.

   Some examples:

• Women veterans are the fastest growing group of veterans right now, but the VA’s gender-specific medical care has not kept pace – from maternal care services to the growing recognition that military sexual trauma (MST) exists and that veterans who are survivors of sexual assault are entitled to professional help.
• Veteran homelessness is a national scourge – after serving their country, when vets come home they end up accounting for over 10 percent of the adult homeless population across the nation.
• Substance abuse is another problem, particularly when it is tied in with post-traumatic stress disorder. According to the VA’s National Center for PTSD, about 1 in 10 veterans who served in Iraq or Afghanistan have a problem with alcohol or other drugs.
• Veteran suicides are an ongoing crisis. In recent years, the overall suicide rate among veterans has been about one and a half times higher than the rate for non-veteran Americans, with the suicide rates of women veterans more than twice as high. Annual veteran deaths by suicide outnumber annual combat deaths in the military by a ratio of nearly 280:1.
• Then add the VA’s notorious backlog problems into the mix. During Obama’s time in office, a whistleblower called attention to the disgracefully long wait times for veterans seeking medical attention through the VA. The national scandal compelled then-VA Secretary Eric Shinseki to resign.

   Seeking to alleviate the problem, Congress passed Veterans Choice legislation that allowed veterans to seek compensated care outside of the VA system. But midway through the Trump years, the whistleblower who’d made the initial charge regarding wait times was back with another complaint: a new backlog had developed – of vets waiting to see doctors outside the system.

   By 2019, the VA was tapping the brakes on the Veterans Choice program and transitioning to a new scheme.

   Last year, the Trump administration rolled out another initiative to try to streamline the VA’s billing and administrative services. Senior Trump adviser and son-in-law Jared Kushner was an enthusiastic proponent of the $16 billion Electronic Health Records Modernization project. But the preliminary deployment of EHRM at VA facilities in Spokane and Las Vegas quickly hit some potholes.

   Employees in those facilities who have had a chance to work with the new system are asking tough questions about EHRM’s design, user-friendliness and management structure. The system is currently under review.

At McDonough’s confirmation hearing in February, Senators on both sides of the aisle expressed frustration with the VA’s various glitches over time, and McDonough pledged to set things right.

   “The VA has a proud history of data science,” he said, striking an optimistic tone and elaborating on the way digital records might be used to track and measure benefits, and to guide veterans to lifelong services offered by the VA.

   But when some Senators pushed back, saying that without getting up-to-date data, they couldn’t make informed decisions about funding, McDonough agreed that the reporting lag was “maddening” and he pledged that as VA Secretary he would “marshal data, get it consumable, and have it inform policy now.”

   As part of the Biden administration’s emphasis on inter-departmental collaborations, McDonough has already teamed up with Defense Secretary Lloyd Austin to meet with survivors of MST and listen to their stories in order to work on strategies for prevention, abuser accountability, and effective treatment and healing services for the survivors. He also has been in discussions with Housing and Urban Development Secretary Marcia Fudge to make sure there is active coordination between their two departments as they work to find solutions for housing chronically homeless vets. And McDonough has been touring VA facilities across the nation to learn from staff and the veteran clientele about what’s working well – and what isn’t.

   But the fact is, some veterans are so disenchanted with the VA they have simply ceased to engage with it. And for a percentage of those – no one knows quite how large a percentage – that disaffection with the Department of Veterans Affairs extends to disgruntlement with the federal government overall. In the violent siege of the Capitol earlier this year, the participation of veterans was clearly evident. As a bureaucrat, not a veteran, McDonough needs to understand that the VA is faced with something far beyond a public relations problem. It is existential.

   So there’s a long road ahead.

   On the bright side, the SAVE LIVES Act that President Biden signed into law on March 24 included entrusting the VA with expanded capacity to deliver the COVID-19 vaccine to all veterans – whether or not they’re officially enrolled in the VA’s health care system – as well as their spouses and caregivers. Before March 24, the VA had fully vaccinated almost 1.6 million individuals. One short month later, the VA has ramped up to administer over 5 million shots of the vaccine.

   Other federal funding has been approved to upgrade VA resources and facilities and, more immediately, to help veterans with unemployment assistance and health care copayments.

   Biden has been pumping out relief via executive order, too. He renewed a Trump-era order that delays collecting debts from veterans. (His predecessor had allowed that to lapse before he left office.) Biden also repealed Trump’s ban on transgender Americans joining the military. And he raised the minimum wage to $15 for federal contractors, which is expected to have a positive impact on boosting the morale and job stability of the nursing assistants and food service workers who work in VA facilities, which should translate to better service given to the veterans.

   The East Wing of the White House also is getting in on the action. First Lady Jill Biden has resurrected the Joining Forces initiative that she’d worked on with Michele Obama ten years ago. She’s been traveling to military bases around the country to listen to the concerns of military families. Dr. Biden said she wants to focus on the well-being of military and veteran families by encouraging the employment of military spouses, providing military families with better access to quality child care, and supporting the children of military families by figuring out ways to enhance their classroom experience.

   “Military families are as critical to our national defense as a rudder is to a ship,” she said.

   To take that metaphor one step further, it looks like the Biden Administration intends to have an all-hands-on-deck approach when it comes to Building Back Better for people who are serving or have served our country.  To do any less would be a breach of promise.

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Barbara Lloyd McMichael is a freelance writer living in the Pacific Northwest.