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Wounded and waiting

A slow medical evaluation process leaves many injured troops in limbo

Feb. 17, 2007 - 02:57PM   |   Last Updated: Feb. 17, 2007 - 02:57PM  |  
Pvt. Rob Van Antwerp, a 20-year-old wounded soldier in the Medical Hold Unit at Walter Reed Army Medical Center cuts the hair of fellow soldiers to pass the time in "Building 18", a housing facility near Walter Reed for Medical Hold patients during the Medical Evaluation process. Van Antwerp, a soldier with the 101st Airborne Division, was hit in a vehicle-borne suicide bomb attack in Bayji, Iraq in November, 5, 2005.
Pvt. Rob Van Antwerp, a 20-year-old wounded soldier in the Medical Hold Unit at Walter Reed Army Medical Center cuts the hair of fellow soldiers to pass the time in "Building 18", a housing facility near Walter Reed for Medical Hold patients during the Medical Evaluation process. Van Antwerp, a soldier with the 101st Airborne Division, was hit in a vehicle-borne suicide bomb attack in Bayji, Iraq in November, 5, 2005. (James J. Lee / staff)
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COL Ronald A. Hamilton, Commander, Medical Center Brigade, discusses the Medical Evaluation process at Walter Reed Army Medical center. December, 12, 2006. (James J. Lee / Times Staff) (James J. Lee / staff)
Pvt. Martin Jackson, a former 1st Armor Division soldier, injured his back in Balad, Iraq, running from a mortar attack. The 30-year-old patient from Montgomery, Ala. has been in the Medical Hold Unit at Walter Reed Army Medical for a year and says he is dissatisfied with the evaluation process and will leave the Army. (Military Times)
Col. Carlton A. Buchanan, deputy commander of the United States Army Physical Disability Agency says his agency usually dispenses with disability cases within 42 days. But because Walter Reed gets the most extreme cases, he says the process can take longer. (James J. Lee / staff)

Leaning over the sink in an almost-clean barracks bathroom across the street from Walter Reed Army Medical Center, Pvt. Robert Van Antwerp, 20, quickly sheared the hair of his new roommate into a fresh crew cut.

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Leaning over the sink in an almost-clean barracks bathroom across the street from Walter Reed Army Medical Center, Pvt. Robert Van Antwerp, 20, quickly sheared the hair of his new roommate into a fresh crew cut.

"This is what my dad does when he really wants to get to know someone," Van Antwerp said, referring to Lt. Gen. Robert Van Antwerp, head of the Army's Accessions Command. "He cuts hair. Now it's a family tradition."

His dad told him people reveal their deepest secrets while sitting in a barber's chair, he said. It builds that sense of camaraderie — of taking care of each other.

"I cut hair the whole time I was in Iraq," he said.

But as he cut, Van Antwerp revealed much more about himself than did his customer — who fell asleep in Van Antwerp's gentle hands.

A pale scar creates a deep furrow connecting Van Antwerp's eyebrows. Doctors replaced bone with titanium after he fractured his skull. Bare-chested as he trimmed, Van Antwerp has a deep, laddered line from beneath his sternum to at least the top of his sweatpants. A blast ruptured his spleen and ripped out his colon. Pushing up his left pant leg as he told his battle story, Van Antwerp showed where three ligaments tore away from his knee, and then pointed out the scar from his broken tibia.

Above his heart, the ranks and last names of two dead friends are etched in ink. But he calls a friend to ask their first names. Short-term memory loss arrived for Van Antwerp in the same attack that killed his buddies.

In Bayji, Iraq, a suicide bomber drove a vehicle beside the truck Van Antwerp drove for the 101st Airborne Division and set off an improvised explosive device, killing Pfc. Alex Gaunky and Spc. Vernon Widner on Nov. 17, 2005. Van Antwerp said he believes in one of the Army's oft-repeated mottoes: "No soldier left behind."

He will always carry his friends with him.

Yet when it was time for the Army to take care of him, one of its wounded warriors, Van Antwerp gave up before he even began. Rather than fight for a higher disability rating, he quietly signed for 20 percent — and no medical benefits — saying he knew he couldn't do better. He inherited his father's stubbornness, he said, and refused to ask anyone to pull strings based on his dad's rank. Then his first medical board counselor, the person who would help him make his way through the medical evaluation board system, left. The second, he said, "wasn't on the ball."

"The Army is trying to give you the lowest amount of money possible," he said. "A lot of people are appealing, but I'll be going to [the Department of Veterans Affairs]. I want to go home."

Van Antwerp is one of thousands of wounded troops rushed from the war zone for health care and then stranded in administrative limbo. They are at the mercy of a medical evaluation system that's agonizingly slow, grossly understaffed and saddled with a growing backlog of cases. The wounded soldiers, sailors, airmen and Marines are stuck in holding companies awaiting hearings and decisions on whether they will continue their military service or be discharged, and if so, at what level of benefits — if any.

In 2001, 10 percent of soldiers going through the medical retirement process received permanent disability benefits. In 2005, with two wars raging, that percentage dropped to 3 percent, according to the Government Accountability Office. Reservists dropped from 16 percent to 5 percent.

Soldiers go to VA to try for more benefits, but the department had a staggering 400,000-case backup on new claims in fiscal 2006, according to VA.

For that reason, Van Antwerp faces another wait at VA. Cases there have an average of a one-year wait. And this is important because it may take a while before Van Antwerp, who must carry a notebook to remember his daily chores, can make his way back to the work world.

Perhaps more important, many of the soldiers leaving Walter Reed face post-traumatic stress disorder. Studies have shown that if soldiers receive treatment within a year, they fare much better.

Van Antwerp has been a patient at Walter Reed since November 2005. He is one of 704 outpatient soldiers who are injured or ill and are waiting to make their way through the red tape of the medical evaluation board process at the medical center, according to officials there. The board determines if the soldiers will remain in the Army, or if they will receive a lump-sum separation payment, medical retirement with benefits for life, or nothing at all. They remain in the medical hold unit until their paperwork is complete.

A soldier goes before a physical evaluation board if a medical evaluation board — a team of doctors — determines he is not able to do his job because of his injury. The physical evaluation board then determines again if the soldier should stay in the military and, if not, how much the Defense Department will compensate the soldier. If the soldier receives a disability rating of 30 percent or higher, he gets a disability retirement check based on years of service, rank and the rating percentage. He and his family will also receive medical benefits for life. If the rating is lower than 30 percent, he gets a one-time severance payment.

Since the wars in Iraq and Afghanistan began, the number of soldiers wading through the paperwork, physicals and appointments has doubled at Walter Reed. According to a Defense Department directive, it should take a total of 120 days from start to finish, but the average stay for Walter Reed soldiers is 270 days. The soldiers navigate a complicated system with the help of counselors with little more experience — or rank — than they have, and who lack training, according to a March 2006 Government Accountability Office report.

On March 2, 2006, Col. Robert Norton, deputy director, Government Relations, for the Military Officers Association of America, told the Senate Committee on Veterans Affairs that since October 2003, medical evaluation boards have averaged 67 days and physical evaluation boards have taken between 87 and 280 days.

"Taken together, the convalescence, [medical evaluation board] and [physical evaluation board] processes appear to average between nine and 15½ months for Army soldiers," he said.

‘We're trying to do what's best'

But Col. Ronald Hamilton, commander of the medical center brigade at Walter Reed, beamed when asked about the work done through the medical evaluation board.

"I think it's being handled extremely well," he said. "There are some outliers, where it takes longer than we would expect it to, but we're not saying, ‘You're at 365 days — we need to process you out.' We're trying to do what's best for each soldier."

He came to Walter Reed in June and said he's proud of the work being done, though he acknowledged changes need to be made to handle the influx of wounded troops. Officials "didn't anticipate the amount of patient care" the war would bring, he said. The Defense Department has reported 11,116 service members wounded in action from October 2001 to Feb. 10, 2007, who were not returned to duty in theater.

Army-wide, the Government Accountability Office reported that the physical evaluation board caseload grew from 7,218 physical evaluation board cases in fiscal 2001 — before the wars began — to 13,748 cases in fiscal 2005. The number of soldiers waiting to go through the process nationwide averages 5,000.

Col. Andy Buchanan, head of the Physical Disability Agency, which handles the soldiers' cases, said disability cases spend an average of 37 to 42 days within the Physical Disability Agency. Because Walter Reed receives the extreme cases — multiple injuries, amputations and head injuries — the process can take longer.

"It is a really fair process," Buchanan said. "I don't think we rush people through. I don't think we let them sit around."

But he said the system is complex, and talked about ways he hopes to improve it: Easy-to-understand pamphlets that break the process down, a requirement that doctors say specifically why a soldier is being rated a certain way rather than a simple "unfit for duty," and a five-day required "adjudicator course" for everyone involved in the process.

An Army official who requested anonymity proposed that part of the problem may be that soldiers just don't understand what part of the system they're in: They think they're in the medical evaluation board process, but they're actually still in recovery.

The soldiers say that's not the case.

In a classroom at Walter Reed Army Medical Center, the first sergeant for the medical holding company lined up three soldiers to talk about their experience with the physical evaluation board. Soldiers going through the physical evaluation board process report to the medical holding company for accountability, to be assigned jobs that work with their injuries, and to have a first sergeant and company commander who can speak up for them when they're having problems.

In August 2004, as Spc. Karl Unbehagan, 29, reported to his new unit at Fort Benning, Ga., he developed intense migraine headaches. Doctors told the infantry soldier he was not used to the humid weather. A couple of months later, they ran a CAT scan.

"I had a tumor in the third ventricle of my brain," Unbehagan explained, pointing to the shunt that runs from the scar on his head down to his stomach to relieve the pressure in his brain. "They realized it had nothing to do with the weather."

The physical evaluation board rated him at zero percent, saying the tumor was a pre-existing condition. Unbehagan has been in the Army for four years, and his doctors found no proof the tumor existed before he joined, he said.

Rather than face the civilian world with no benefits, he talked with a free counselor from Disabled American Veterans who told him how to fight the discharge, reclassify as an electronics and satellite repair specialist, and stay in the Army. The process took eight months, which he spent in the medical hold company.

His board was restarted three times: First, his medical profile was lost. Then, somebody forgot to counsel him — a required part of the process. And finally, no one made his file active after he changed his job field, so no one saved him a slot at the repair school, he said.

Spc. Cari Uyttewaal, 24, is an operating-room technician who had been stationed at Walter Reed before beginning her physical evaluation board process. About a year ago, she began having back problems. Doctors discovered she had a herniated disc and recommended she be processed out of the Army because she could not stand for the 10-hour shifts required in the operating room.

But even a soldier who works in the system didn't make it through without mishap.

"After five months, nothing had been done," she said. "So my first sergeant transferred me [to the medical hold company] and said it would move faster."

It took an additional five months before she accepted her informal physical evaluation and a 10 percent disability rating.

Pfc. Martin Jackson, 30, spent 16 months in Iraq as a supply sergeant with 4th Brigade, 27th Infantry Battalion. Two years ago, while running from a mortar round in Balad, Iraq, he tripped and twisted his leg.

"I thought it was just an ankle sprain," he said. "One day I woke up and just couldn't move."

He had twisted his spine. Now the soft-spoken soldier cannot sit or stand for too long, or lift anything over 10 pounds, which limits his work as a supply clerk.

He has spent two years at Walter Reed going through rehabilitation and waiting for his discharge, which means he hasn't lived with his wife of 10 years for more than three years.

"She's been talking about a divorce," he said. "I just signed [my rating] so I could go home and be with my family."

He said his physical evaluation board counselor was another private first class. "She didn't know what she was doing," he said. "Sometimes I had to tell her what was going on."

The Army awarded him 20 percent disability — no medical retirement for his war injuries, and no insurance for his family.

"It's frustrating when you know the love you used to have for the military, and then you lose that," he said. "This is their job: It shouldn't take months to give a person the same percentage you gave someone else with the same injury last week."

Buchanan said cases can take longer if a soldier presents new information about his case, or if he asks to continue on as a reservist, or if his rank changes. But those tasks, he said, are outside the Physical Disability Agency's realm.

"We're implementers of policy," he explained. "We walk a fine line, and we do make errors. But we have a fine quality assurance system that keeps the rates way down."

About 30 percent of all cases are reviewed, he said. He explained which cases: all general officers, anyone rated for PTSD and anyone who doesn't concur with his rating.

But that doesn't take into consideration the everyday soldier who signed his rating without realizing he could talk to a lawyer, without understanding that doctors make mistakes, and without having read the thousands of pages of policy that apply to medical disability evaluation boards.

Fewer resources

Part of the problem is that the system is understaffed.

On Feb. 17, 2005, Lt. Gen. Franklin Hagenbeck, former deputy chief of staff for personnel, told the House Committee on Government Reform that the Army did not have nearly the resources it had during the Vietnam War. He said the Army processed 15,000 cases in 2004 with three physical evaluation board systems and a total of 70 employees.

"The last time we had that many cases was in 1972, when [we] processed 19,000 cases," he said. "At that time, there were six [physical evaluation boards] across five states and the District with a total of 260 employees."

Buchanan said that number has grown to 95 employees since the hearing, though he is only authorized 61.

Opportunities for trouble

The wait can cause other problems.

On Christmas Day, six soldiers spent their time at Walter Reed picking up trash, mopping floors and emptying garbage.

"I was planning to go home for the holidays," said Spc. Ruben Villalpando, who dropped from sergeant rank when he came up hot for marijuana on a urinalysis while at Walter Reed. "There's a 100 percent urinalysis policy for med hold."

In other words, every soldier in the medical hold company is tested for drugs.

The other five soldiers also came up hot, he said. Not only did Villalpando lose his holiday, the reduction in rank means that if he does receive a disability payment, it will be lower than it would have been a month before.

Ray Parrish, director of the military counseling service for Vietnam Veterans Against the War, helps soldiers through the medical and physical evaluation boards and has worked as a counselor since his days as a soldier. The long wait can be a problem, he said, especially for soldiers suffering from PTSD. Those soldiers have a tendency to self-medicate, as well as act out in anger.

"During that six- to eight-month wait, you're just sitting around," Parrish said. "It's quite literally an opportunity to get in trouble."

And soldiers discharged with other-than-honorable stamped on their DD214s can't get benefits from VA.

Randy Reese, national service director for Disabled American Veterans, also works with soldiers going through the process. He said he understands why they take the first rating they get: "They're in the hospital for a long time away from their friends," he said. "A lot of people will do whatever they have to do to get back home, and they're missing out on a whole world of retirement benefits that could be available to them."

Villalpando arrived at Walter Reed after forcing a fistful of antidepressants down his throat. While Villalpando was in Iraq in May 2005, his cousin, Marcos Omar Nolasco, was electrocuted in a faulty shower in Baghdad.

"He came back from a mission, and he took a shower, and he got electrocuted," Villalpando said, surrounded by his own artwork and a Morrissey poster at the barracks across the street from Walter Reed. "It did a good number on me. I was so close to him. I spent the remainder of my tour on antidepressants."

The 7th Field Artillery, 1st Infantry Division, soldier said he attempted suicide to try to get help after falling into a depression.

Now his end term of service date has passed — he was to get out in August — and still he sits at Walter Reed.

In his case, there have been clerical errors, such as a mistyped Social Security number that meant his paperwork had to be processed again, he said.

"This place gets so depressing," he said. "I'm frustrated. I'm tired. I'm angry. I want to go home."

Navigating the medical boardsThe medical evaluation process can be confusing, but understanding it can mean the difference between staying in the military or being kicked out, as well as getting medical benefits after being discharged — or not.

Here's how the process works:

* A physician evaluates the soldier's injury or disease.

* The doctor's report initiates the medical evaluation board process. At least two doctors informally decide whether that soldier can return to duty. If so, he goes back to work — process over. That's all supposed to happen within 30 days of the first diagnosis, according to Army regulations.

* If not, the medical evaluation board doctors forward their evaluation of the solder deemed not fit to return to duty to the physical evaluation board. The soldier selects a counselor, either from the Army or a civilian provided by the Disabled American Veterans. Without the soldier present, the physical evaluation board conducts an informal assessment. Three voting members — a combat arms colonel, a personnel management officer and a physician — look at the evidence and decide whether the soldier is fit for duty. If so, the soldier is returned. If not, the board assigns that soldier a disability rating, based on injury- or disease-specific factors.

* If the disability rating is at least 30 percent, the soldier gets medical benefits for life as well as the same percentage of base pay.

If it is lower, the soldier receives a one-time severance payment, calculated by multiplying his number of years in service by his monthly pay and then doubling the total.

* The soldier then talks with his counselor about whether he should accept the recommendations or request a formal hearing. The government does not argue its case against the soldier — the board is there to hear the evidence from the soldier.

If the soldier is still not satisfied, he can appeal to the Physical Disability Agency — the Defense Department's oversight agency.

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