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Federal Insider  Friday, June 24, 2005
2005 Deficit Angers Senate Republicans, Advocacy Groups

By Thomas B. Edsall
Washington Post Staff Writer
Friday, June 24, 2005; Page A29

The Bush administration, already accused by veterans groups of seeking
inadequate funds for health care next year, acknowledged yesterday that it is short
$1 billion for covering current needs at the Department of Veterans Affairs this year.

The disclosure of the shortfall angered Senate Republicans who have been voting down Democratic
proposals to boost VA programs at significant political cost. Their votes have brought the wrath of the
American Legion, the Paralyzed Veterans of America and other organizations down on the GOP.

"I was on the phone this morning with Secretary of Veterans Affairs
Jim Nicholson, letting him know that I am not pleased that this has
happened," said Sen. Larry E. Craig (R-Idaho), chairman of the Senate
Veterans Affairs Committee. "I am certain that he is going to take
serious steps to ensure that this type of episode is not repeated."

The $1 billion shortfall emerged during an administration midyear
budget review and was acknowledged only during lengthy
questioning of Jonathan B. Perlin, VA undersecretary for health,
by House Veterans Affairs Committee Chairman Steve Buyer (R-Ind.)
at a hearing yesterday.

"We weren't on the mark from the actuarial model," Perlin testified.
He said that the department has already had to use more than $300
million from a fund that had been expected to be carried over to the
fiscal 2006 budget, and that as much as $600 million for planned
capital spending will have to be shifted to pay for health care.

At a noon news conference yesterday, Sen. Patty Murray (D-Wash.),
a member of the Senate Appropriations subcommittee covering
veterans affairs and the lead sponsor of Senate Democratic efforts to add $1.9 billion to the VA budget,
accused the Bush administration of unwillingness "to make the sacrifices necessary to fulfill the
promises we have made to our veterans."

In a rare display of bipartisanship on the polarized issue of veterans spending, Craig appeared with
Murray at the news conference and said he agreed with many of her comments.

Murray cited an April 5 letter written by Nicholson to the Senate in a bid to defeat her amendment: "I can
assure you that VA does not need emergency supplemental funds in FY2005 to continue to provide
timely, quality service that is always our goal," he had said.

Murray aides said they obtained a draft copy of the midyear review in early April, suggesting that the
department knew of the budget problems at the time Nicholson wrote the letter.

VA spokesman Terry Jemison refused to release a copy of the document, saying, "We don't provide
information about pre-decisional budget passback and midyear reviews."

Nicholson issued a statement yesterday: "The health care needs of America's veterans are among VA's
highest priorities. Working with our partners in Congress, I'm confident that VA's budget will continue to
provide world-class health care to the nation's veterans."

Craig and other Senate and House Republicans declined to say how much the fiscal 2006 budget would
be raised above the level proposed by the administration. They said any attempt to supplement the
current fiscal 2005 appropriation will have to await more detailed information on the shortfall this year.
Craig said he plans to hold a hearing next week on VA funding needs.

Sen. Kay Bailey Hutchison (R-Tex.), chairman of the Senate Appropriations subcommittee on military
construction and veterans affairs, said she had just been informed of the $1 billion fiscal 2005 shortfall.

"We can never fall short on our promises to those who have sacrificed
so much," Hutchison said.

The House has already approved a $68.1 billion Department of Veterans
Affairs appropriation for fiscal 2006 that has been sharply criticized by
the American Legion, the Paralyzed Veterans of America and the Disabled
American Veterans.

Richard Fuller, legislative director of the Paralyzed Veterans, said the money problems this year and
next were obvious to anyone visiting VA clinics and hospitals.

"You could see it happening, clinics shutting down, appointments delayed," Fuller said.

Joseph A. Violante, legislative director of the Disabled American Veterans, said Perlin's testimony
yesterday confirms the veterans' assessment that the administration is "shortchanging veterans."

The Bush administration and House Republicans have been the main focus of anger among veterans
organizations.

Their "policies are inconsistent with a nation at war," said Steve Robertson, legislative director of the
American Legion. They violate the basic military value of "an army of one, teamwork, taking care of each
other," he said.

The administration and Congress, Robertson said, are promoting policies that "subdivide veterans into
little groups, the ones that 'deserve' and the ones who 'don't deserve.' "

Veterans groups are particularly angry with Buyer, who was specially chosen by the House leadership to
chair the House Veterans Affairs Committee to keep spending down. Buyer was selected to replace Rep.
Christopher H. Smith (R-N.J.), who had alienated House leaders by pushing for high levels of spending
on veterans programs.

Buyer recently sparked new controversy in an interview published by the American Legion Magazine in
which he said the department should concentrate on serving a "core constituency," and he disputed
assertions that "all veterans are veterans and all veterans should be treated the same."

The Indiana Republican has defended the House's fiscal 2006 spending levels for veterans, contending
that VA health care would actually grow by $1.6 billion under the House legislation.


American Legion National Commander Thomas P. Cadmus countered that nearly $1 billion of the $1.6
billion increase would be achieved by cutting other medical accounts: $533 million from the medical
administration account, $417 million from medical facilities and $9 million from medical and prosthetics
research.

Yesterday, Buyer called on the Senate to "drill down" into VA money problems to determine the
legitimate needs for fiscal years 2005 and 2006

In addition to their unhappiness with spending levels, veterans groups are bitter over the changes
initiated by the Republican leadership in the jurisdiction of appropriations subcommittees. VA funding
was shifted from the subcommittee that includes housing and NASA programs to the subcommittee on
military quality of life and Veterans Affairs and related agencies, which forces the Veterans Affairs
Department to compete for limited funds with such programs as Defense Department health care,
military cemeteries and military construction.

"The American Legion is not about to write Congress and say 'take away from DOD heath care' [in order
to boost VA funding]. That's completely unacceptable," Robertson said.

The veterans lobby has already beaten back two controversial Bush administration proposals: a $250
enrollment fee for veterans joining the health care system and an increase in the prescription
co-payment, from $7 to $15.

Leaders of the American Legion, the Paralyzed Veterans and the Disabled American Veterans all noted a
striking partisan division in Congress on veterans issues, with Democrats giving them much more
support than Republicans.

Traditionally, Violante said, "Republicans have been supportive of defense," but he said Bush
administration policies and votes in the House and Senate suggest that the GOP does not view the care
of veterans as "a continuing cost of war."

In the 2004 election, exit polls showed that voters who had served in the military were decisively more
Republican than those who had not. President Bush carried the one out of five voters who had served
by 16 percentage points, 57 to 41, while Sen. John F. Kerry (D-Mass.) barely won those who had not
served, 50 to 49.

The Bush administration's priorities are "a little bit different now and veterans aren't a priority," Violante
said. He described this as "terrible -- I think it's unconscionable."
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Link to the full story:
http://www.washingtonpost.com/wp-dyn/
content/article/2005/06/23/AR2005062
301888.html?referrer=email
Sen. Larry E. Craig (R-Idaho), head of the Veterans
Affairs Committee, says at a briefing: "I was on the
phone . . . with Secretary of Veterans Affairs Jim
Nicholson, letting him know that I am not pleased"
about a $1 billion shortfall in VA funds for health
care. To his left are Democratic Sens. John D.
Rockefeller IV, Patty Murray and Ken Salazar.
Photo Credit: By Yuri Gripas -- Associated Press
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From the News: S. Florida VA hospitals brace for a wave of post-traumatic stress cases
Posted By Ray McIntyre On 31st March 2005 @ 05:43 In Articles & Studies | No Comments

By Mike Clary
Staff Writer
Posted March 28 2005


    They may be home from the war in Iraq, yet they are not home free.
    Replaying gory scenes of death and destruction, some combat veterans are unable to sleep for more than minutes at
a time. Some fight anger and anxiety with alcohol and drugs. Depression is common. Almost all bear invisible scars.
Michael Culmer, 25, who manned a 120 mm mortar for the U.S. Army outside Ramadi, survived his tour of duty by
becoming numb, feeling no emotion even when his commanding officer took a fatal shrapnel wound to the head. Now
back in his hometown of Miami, “I just want to get off meds and feel like the person I was,” he said.
    As more soldiers return from the war zone, some from second tours of duty, mental-health counselors with the
Veterans Affairs Department in Broward, Palm Beach and Miami-Dade counties are bracing for a growing tide of men
and women suffering from post-traumatic stress disorder.
Months after running high-risk supply convoys across the desert, James Nappier of Loxahatchee finds himself on the
lookout for roadside bombs while driving the streets of Palm Beach County, tensing at the wheel when a fast-moving
vehicle approaches from the rear, just as he did in Iraq.
    “I’d like to say I’ll be the old me again, but I realize I’ve changed for life,” said Nappier, 46, whose Seabees unit, Naval
Mobile Construction Battalion 14, lost seven men. “I feel different from other people.”
    Days past the second anniversary of the U.S. invasion of Iraq, some costs of the war are clear. More than 1,500
American service members have been killed, more than 11,000 have been wounded and the nation itself remains deeply
divided over whether the war was worth waging.
    Other, less visible, costs are mounting as well. With some experts estimating that up to 17 percent of those who see
duty in Iraq and Afghanistan may suffer from post-traumatic stress disorder, six of seven VA treatment centers in the
United States say they will be unable to serve all those who need treatment, according to the Government Accounting
Office study. The U.S. Department of Veterans Affairs has increased the treatment budget by $100 million.
    In South Florida, both the Miami VA Medical Center, which serves Miami-Dade, Broward and Monroe counties, and
the West Palm Beach VA Medical Center in Riviera Beach have applied for federal grants to beef up counseling staffs.
“For the next year, we will be able to handle the numbers,” said Dr. Maria Llorente, the Miami VA’s chief of psychiatry.
“But we will feel the pinch.”
    In testimony earlier this month before the House Appropriations Committee, U.S. Army Gen. John P. Abizaid of Central
Command warned, “We know that a casualty of war can as much be a psychological patient as a young man or woman
that has lost their arm or leg.”
    Counselors at the two South Florida VA hospitals, several satellite clinics and the VA-run Vet Centers in Palm Beach,
Broward and Miami-Dade counties have launched aggressive campaigns to reach veterans who need help. “If vets don’t
come in now, they will come in later when in crisis,” said Patrick Murphy, a counselor at the Miami Vet Center who
organized a job fair at the center this month that drew 71 people.
    “We are reaching a lot of guys. But you have to wait them out until they are ready.”
    Indeed, more than 20 years after the American Psychiatric Association defined as post-traumatic stress disorder what
in World War II was known as “battle fatigue” or “shell shock,” many combat veterans remain reluctant to admit a need
for psychological help. “Compared to the time of the Vietnam War, there is more awareness now,” said Jerry Troyer, a
Vietnam veteran and PTSD program manager at the Riviera Beach VA hospital. “Still, the idea of going for mental-health
care while on active duty does not go over well.”
    Yet almost everyone who has served in Iraq — a combat zone where there are no safe havens — shows some post-
traumatic stress disorder symptoms, counselors agree. “Lots of death, lots of issues to handle,” said Bobby White, a
Vietnam veteran who directs the Fort Lauderdale Vet Center.
    Not all combat vets seek treatment, of course. Cory Cunningham, 25, who served a year in Iraq with the 124th
Infantry Regiment of the Florida National Guard, said he has adjusted to civilian life without counseling. Yet, he added: “I
tend to notice vehicles speeding up on me in rear-view mirror. And I tend to be a little more aware of my surroundings.”
Out of work for several months, Cunningham, of Palm Beach Gardens, said he has volunteered to return to active duty.
He is due to leave for Afghanistan next month.
    Those who do seek help often have no choice. Culmer, who enlisted in the Army just before Sept. 11, 2001, spent
months with the 1st Infantry Division, conducting house-to-house searches and firing mortar rounds at the enemy from
Camp Junction City outside Ramadi. “I felt like I was starring in my own movie — invincible, not scared, just numb,” he
said.
    But after flying into a rage he directed at follow soldiers, Culmer was relieved of his gunner duties.
    Honorably discharged this month, Culmer is attending barber college, repairing his marriage and, with his father, a
Vietnam veteran, attending weekly group-therapy session at the Veterans of Foreign Wars Post 8195 in Hollywood. He
also is set to begin psychotherapy at the Miami VA.
    Tall, muscular and articulate, Culmer is physically whole. But he knows he has been hurt by the war and left with a
world of unfocused anger. “Sometimes I feel like a different breed, a different species of person,” he said. “The war
opened another eye in me. I see the world differently.”
    Nappier, too, has been wounded.
    The May 2004 rocket attack that left him with severe nerve damage to his right leg and arm killed five Seabees, all
friends, from his West Palm Beach reserve unit. While taking antidepressants to calm his anxiety, his days are filled with
physical therapy and worry.
    “Not a day goes by that I don’t think about the friends I lost,” said Nappier, who worked as a water-well driller before
going to Iraq. “I have a lot of guilt about what happened. “And now I have a sister over there. So I worry about her, too.”
Mike Clary can be reached at mwclary@sun-sentinel.com or 561-243-6629.

Article printed from GNIF Brain Blogger: http://brainblogger.com
URL to article: http://brainblogger.com/2005/03/31/from-the-news-s-florida-va-hospitals-brace-for-a-wave-of-post-
traumatic-stress-cases/