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More than any other war in U.S. history, the conflict in Iraq has provoked a surge of concern for soldiers returning home bearing the psychological burdens of battle.

From the war's first days, veterans groups, mental health organizations and some members of Congress have claimed that the Department of Veterans Affairs (VA) is unprepared to treat the tens of thousands of U.S. soldiers likely to come back with post-traumatic stress disorder (PTSD), a debilitating psychological condition.

A new federal report indicates that those fears are not unfounded. On Feb. 16, the Government Accountability Office (GAO), the investigative arm of Congress, released a report criticizing the VA for failing to improve its PTSD services, even when confronted with numerous reforms suggested by its own special committee on PTSD. The report follows a five-month investigation by the GAO that looked at whether the VA had implemented 24 of 37 recommendations made last year by the special committee on PTSD, a group of VA doctors who report annually to the VA.

The GAO concluded that the VA had not fully addressed any of the 24 recommendations, which run the gamut from hiring regional PTSD coordinators, to developing credentialing standards for PTSD clinicians, to establishing PTSD screening and referral systems. Specifically, the GAO report found that the VA had met 14 recommendations only partially and left 10 completely unmet; nearly half of those were longstanding since 1985. The GAO also determined that the VA had no plans to address the majority of recommendations until at least 2007.

"This report confirms my concerns about the VA's capacity and ability to meet the rising demand of veterans seeking mental health services," Rep. Lane Evans, D-Ill., ranking Democrat on the House Veterans Affairs Committee, said in a Feb. 16 statement. "It is inconceivable that the VA has yet to even name a PTSD coordinator in each of its health networks as recommended by the Special Committee."

Evans, a Vietnam-era veteran, asked the GAO to investigate last May after growing frustrated with what he felt was the VA's dawdling at improving its PTSD services.

National mental health organizations and veterans groups have long warned that such services were being overwhelmed by an emerging population of psychologically troubled veterans and an ever-tightening budget. In 2004, at the behest of former VA Secretary Anthony Principi, the VA began drafting a mental health strategic plan that involved reinforcing PTSD programs by 2007, but at an estimated cost of $1.65 billion not yet in the agency's budget. Publicly, the VA worried about a potential strain on services, but has insisted that it's ready for the estimated 16 to 30 percent of soldiers likely to return from Iraq and Afghanistan with some psychological trauma.

Not surprisingly, the VA adamantly refuted the GAO's findings. "They've taken a negative stand on what this agency does, and the report discounts all the wonderful accomplishments we've made with regard to PTSD," says Dr. Mark Shelhorse, the VA's acting deputy consultant for patient care services for mental health. According to Shelhorse, seven of the recommendations the GAO categorized as partially met have been fully satisfied, including providing PTSD screenings for new veterans. He also says the VA allocated $15 million out of its 2006 $28 billion budget for additional PTSD and substance-abuse programs, and was placing teams of PTSD experts in locations with a high density of veterans.

For Rep. Evans, however, the VA's response is part of the problem. "What troubles me most about this latest GAO report is the VA's hyper-sensitive posture," Evans wrote in a Feb. 18 e-mail to this reporter. "VA leadership seems unwilling to accept that GAO has found areas where improvements are necessary."

Cynthia Bascetta, director of veterans health care issues for the GAO, says she, too, was surprised at the VA's reaction and that the agency needs to do a better job of prioritizing, given that wars in Iraq and Afghanistan have made the task of addressing mental health gaps pressing. While estimates have varied, the VA now says 6,400 veterans from Iraq and Afghanistan have sought help for PTSD since those wars began, but the GAO questioned whether that number is accurate. Regardless, the PTSD rate is expected to rise substantially as more soldiers return home, and the GAO urged VA brass to speed all of the recommended improvements cited in its report. The agency plans a follow-up investigation this year.

Because the VA disagrees, it has 60 days to draft a response to the Senate Committee on Homeland Security and Governmental Affairs. The GAO issued an earlier report in September, proposing that the VA update its data-keeping methods for PTSD veterans; the VA concurred. Says Bascetta, "The VA's mental health plan, which is still only in draft form, is set for 2007 or later. But this looks to be a serious problem right now."


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