Taking care of veterans now and in years past: The history of services for veterans and the challenges of meeting the complex physical and psychological needs of the men and women coming back from Iraq and Afghanistan today.

Guests

  • Thomas Pamperin, Lt. Col. (Ret.) deputy undersecretary for Disability Assistance, the Department of Veterans Affairs.
  • James Currie, Col. (Ret.) military historian and former professor of the National Defense University; currently director of the Office of Federal Relations at the National Association of State Treasurers.
  • Martin Schram nationally syndicated columnist for the Scripps Howard News Service and an author. His most recent book is "Vets Under Siege."

Transcript

  • 10:06:55

    MS. SUSAN PAGEThanks for joining us. I'm Susan Page of USA Today, sitting in for Diane Rehm. She'll be back on Monday. After the Civil War, the newly united federal government provided benefits for Union veterans, but Confederate soldiers were on their own. In the South, prosthetic limbs were major items in some states' budgets. Today, the men and women coming home from Iraq and Afghanistan have modern medicine and an array of services, but many have struggled to get treatment for PTSD. Joining me in the studio to talk about how services for American veterans have changed over time, military historian James Currie, journalist and author Martin Schram and Thomas Pamperin of the Department of Veterans Affairs. Welcome to "The Diane Rehm Show."

  • 10:07:44

    MR. THOMAS PAMPERINThank you.

  • 10:07:44

    MR. MARTIN SCHRAMThank you.

  • 10:07:45

    MR. JAMES CURRIEGlad to be here.

  • 10:07:45

    PAGEWe're glad to celebrate today's Veteran's Day with you in the studio. And we invite our listeners to join our conversation. You can call our toll-free number later in the hour, 1-800-433-8850. Or send us an e-mail at drshow@wamu.org. Or you send us a tweet or find us on Facebook. Well, this is Veteran's Day. We honor the men and women who have served in the U.S. military. And let's start with some good news. Tom Pamperin, this month, the Veterans Administration began issuing disability checks for veterans exposed to Agent Orange. How big a step is this?

  • 10:08:23

    PAMPERINThis is a very significant event. Secretary Shinseki, based upon an IOM study, determined that ischemic heart disease, Parkinson's and B-cell leukemias were related to exposure to herbicide. We have to date almost 160,000 claims that are related to that disability that we are processing. About 90,000 of those claims involved previously denied claims, where we are going to go back to the day that they first filed their claim. We anticipate that it will take approximately six to nine months to get through all of these claims.

  • 10:09:11

    PAGESo if we have listeners who are among those 90,000 veterans who had claims denied, do they need to do something to be eligible for these benefits?

  • 10:09:22

    PAMPERINNo, they don't. We have swept our databases to identify people who have previously been denied, and we'll be reviewing them individually. However, if a person is concerned that they might be overlooked, they can always send us a letter, and we will include them.

  • 10:09:44

    PAGEAnd how far back do these claims go? What period of time are we talking about?

  • 10:09:48

    PAMPERINThese claims originate from our first regulation on Agent Orange in 1984. There was a lawsuit in 1985 over that particular regulation, and so some of these claims can go back as far as '84. We believe that the average claim or the typical claim will go back about 12 years.

  • 10:10:11

    PAGESo, Marty Schram, this is good news for those veterans. It took a long time for it to happen.

  • 10:10:17

    SCHRAMWell, that's just what I was going to say. And first of all, let's give credit where it's due to Tom Pamperin, especially Gen. Shinseki for having understood the importance of getting it right finally. But for...

  • 10:10:31

    PAGEGen. Shinseki being the secretary of Veterans Affairs.

  • 10:10:34

    SCHRAMSecretary of Veterans Affairs, as Tom mentioned, and a fellow who was himself severely wounded in battle and understands those problems. They've finally gotten to the right place, but for years, decades, veterans were being turned down when they would apply for these -- for the same aid. And add up the money, and I'm sure that Tom and his colleagues have. How much were veterans owed that they should have been paid decades ago -- and who pays the interest on that, by the way -- but just the fact that they didn't get it. You know, in "Vets Under Siege," I wrote about the GAO reports over the years on all of these issues, and there was such a sameness to them from the '70s right on through to today. Every few years, they'd have another one.

  • 10:11:22

    SCHRAMAnd I also found some Mayo Clinic studies ages ago that showed that we think that Parkinson's onset is definitely linked to herbicides. If herbicides were used by farmers, and they have a genetic disposition toward Parkinson's, then it's more than likely that they will get Parkinson's. And so they understood it, but it took all these decades before it finally got up to become VA policy. Again, credit to the VA now for doing the right thing, but sad for those veterans who fought for our country that the right thing wasn't done for them. Many of them died before they could ever get the aid they deserved.

  • 10:12:06

    PAGEMarty has written in his book, which I think came out two years ago, in 2008...

  • 10:12:10

    SCHRAMIn 2008.

  • 10:12:11

    PAGE...about a pattern of delay and deny by the VA. Do you think that's fair, Tom? Has the VA been too reluctant to recognize the health costs for veterans who have served on things like Agent Orange?

  • 10:12:26

    PAMPERINI can clearly understand how people can feel that way. I believe, however, that it is not an accurate characterization of the VA. The process of establishing presumptive disabilities for herbicide exposure are covered by the Agent Orange Act, and it expressly requires that we contract with the Institute of Medicine every two years to review the literature to determine whether or not there are disabilities that the literature says are related to exposure to herbicide. And Parkinson's, B-cell leukemias and ischemic heart disease have never -- the IOM ranks the literature as evidence of a causal effect, evidence of a limited suggestive effect, no evidence and evidence of no association. And it was only two years ago or a year-and-a-half ago when ischemic heart disease and B-cell leukemias were identified by the IOM as related.

  • 10:13:37

    PAGEJim Currie, you're a military historian. You've written about this whole continuing debate threaded through our entire history as a nation, debate over veterans' benefits. Tell us about it. Talk about the benefits for veterans, for instance, of our first war, the Revolutionary War.

  • 10:13:54

    CURRIEThank you, Susan. The Revolutionary War, like, I think, every war we've ever fought, was fought by people who weren't professional soldiers. And after the war was over, there was some public understanding that there had to be some recompense for the suffering that they endured, for the wounds they suffered, for the widows and orphans they left behind. In the revolution, the first thing they did was issue warrants for land. They were going to offer these veterans frontier land, way out on the frontier, and depending on your rank, you got anywhere from 100 acres up to 1,000 acres.

  • 10:14:31

    CURRIEThe problem was that these warrants were not immediately redeemable. And the veterans decided they needed money then, so they sold them to speculators for pennies on the dollar. And, of course, many of them just simply didn't want to move to the frontier anyway out there where the Native Americans were -- had set up their homes and go out there where it wasn't particularly nice living. So that was kind of a pattern, I think, that the benefits didn't exactly go to the people who deserved them.

  • 10:14:57

    CURRIEThey went to other people. And this pattern may have continued through the years in some respects. Same kind of benefits were given to veterans of the war of 1812, in the Mexican War in the form of land grants, 160 acres each. In the 1850s, they passed a law which gave 160 acres to every veteran of those wars. The big benefits didn't really start until the Civil War, and that was when the doors were opened for benefits and...

  • 10:15:25

    PAGEBut not open for everyone, right? Not open to people who sought -- fought on the side that lost.

  • 10:15:31

    CURRIEWell, that's right. They didn't fight for the United States. They fought for the Confederate states, and the law was very specific on that. If you were a Confederate veteran, you had to get your benefits from the state. And you pointed out that in some of the Southern states, the provision of artificial limbs to ex-Confederate soldiers was a very large item on the budget. I've actually seen one account that in the state of Mississippi, it was actually the largest item one year in the budget. This was at a time when state budgets were not very large, when they didn't provide a lot of the things that we take for granted today. The last Revolutionary War widow -- just, I thought, was a little point of interest -- received her benefits in 1906. The last Confederate widow is probably still living. There was a -- and, Tom, you may know about that.

  • 10:16:22

    PAMPERINActually, there are no surviving widows, but there are two children of Civil War veterans who are still receiving benefits from VA.

  • 10:16:33

    CURRIEThat's interesting. The last Confederate widow -- I read a story -- died in 2004. And then, when she died, somebody else came forward and said, no, I'm a Confederate widow, too. And what happened was that very young women in the 1920s, and even into the 1930s, married these very old men who had fought in the war. The last Union widow died sometime ago. I think the last Confederate widow may still be alive and is out there somewhere, maybe collecting state benefits.

  • 10:17:02

    PAGEDid it leave some scars in the aftermath of the Civil War to have this federal coverage, federal benefits only for those who fought on the Union side?

  • 10:17:12

    CURRIEWell, it did. And I think it was one of those things that could have been used to bring the two sides together, but people in the north were not about to vote benefits for people who fought against the Union during the war. And they left it up to the Southern states to do that. By the 1880s, the pension benefits were the largest item in the U.S. budget.

  • 10:17:38

    PAGEWow. And the Veterans Administration, when was it established, Tom?

  • 10:17:42

    PAMPERINThe Veterans Administration was established in 1933. Prior to that, it was the Pensions Bureau, and it became the Department of Veterans Affairs in 1988.

  • 10:17:56

    PAGEWe're talking with Lt. Col. Thomas Pamperin. He's a deputy undersecretary for Disability Assistance at the Department of Veterans Affairs. He's a Vietnam War veteran. And Marty Schram, a nationally syndicated columnist for the Scripps Howard News Service and an author, his most recent book is "Vets Under Siege." And also, Col. James Currie, retired from the U.S. Army, a military historian and former professor of the National Defense University. He's now director of the Office of Federal Relations at the National Association of State Treasurers. We're going to take a short break. When we come back, we'll talk about whether the changes in the midterm elections are going to signal any changes in the debate over the services and benefits provided for today's veterans. And we'll take your calls. Our phone lines are open, 1-800-433-8850. Stay with us.

  • 10:20:03

    PAGEWelcome back. I'm Susan Page of USA Today, sitting in for Diane Rehm. With me in the studio, James Currie, a military historian, Marty Schram, author of a book called "Vets Under Siege" and Tom Pamperin, deputy undersecretary for Disability Assistance at the Department of Veterans Affairs. And we're spending our first hour today talking about services and benefits and debates involving veterans in honor of Veteran's Day. We thank all the veterans in our audience for their service to our country. Here's an e-mail from Marian, who writes us, "PTSD, formerly known as battle fatigue, has a long and controversial past. Gen. Patton felt it was nothing more than cowardice in the face of the enemy and got into considerable hot water for slapping a soldier who was having nervous problems and had deserted his outfit." Well, Tom Pamperin, talk to us about what the current attitude is toward post-traumatic stress disorder.

  • 10:20:56

    PAMPERINPost-traumatic stress disorder has been recognized as a disability that can be service-connected since the early '80s. What's interesting is that the majority of hospital beds at World War II -- or correction -- in World War I in Great Britain were due to combat stress. And the first Diagnostic and Statistical Manual, the manual used by psychiatrists and psychologists, DSM-1, clearly had that identified as a recognized disability. And VA paid for what is now PTSD following World War I.

  • 10:21:37

    PAMPERINHowever, in the late '40s, DSM-2 was published, and the diagnostic code was removed from the lexicon. And therefore, from the late '40s until 1983, it was physically impossible to have a service medical record with a diagnosis of post-traumatic stress, combat stress, battle fatigue, shell shock or any of those. So when it was re-established, VA published regulations that recognized the disability. And at that time, we were attempting to bridge the gap of the period for those soldiers who did not have an in-service diagnosis.

  • 10:22:21

    PAMPERINAnd we established a policy that was -- had two factors. Certain veterans -- those with Valorous Awards, Combat Infantryman Badge, burial detail people -- were presumed to have been exposed to stress and therefore, if they had the diagnosis, were granted. Those who did not, we required evidence of an in-service stressor.

  • 10:22:46

    PAGEYou mean like an incident that they survived.

  • 10:22:48

    PAMPERINAn incident. Absolutely.

  • 10:22:49

    PAGEYeah...

  • 10:22:50

    PAMPERINAnd many of those veterans, particularly since it was years in the past, could not remember the specific time. It was a very long process. It frequently took upwards of a year of doing research to find anything about that. And approximately half of those people who applied were ultimately denied benefits. However, the psychiatric community has redefined things. And today, the psychiatric community recognizes that mere presence in a combat theater, in and of itself, is sufficient stressor to cause PTSD. Because of this, earlier this year, we revised our regulation so that if a veteran, due to the nature and circumstances of their service, has PTSD and a psychiatrist says that it is consistent with that service, we will grant service connection.

  • 10:23:52

    PAGEI noticed that the statement put out by Gen. Shinseki in honor of Veteran's Day says this, "On this Veteran's Day, I take this opportunity to reinforce the VA's message that PTS and PTSD are treatable." It reflects a different attitude, doesn't it, Marty?

  • 10:24:07

    SCHRAMWell, it certainly does, and this is yet another incident where we have an example of how we have to take a look at the regime since Gen. Shinseki has come into office as secretary at the VA and the changes that have occurred that are good for veterans, in that they're fair for veterans. You know, I wrote in my book about an example, such as an MP, military policeman from Florida, Eric Adams. And he was a fellow who was leading these truck convoys through the roadways of Iraq -- about as dangerous as you could find -- in a little van without a seatbelt, by the way. It was a rented van. That's all they had for them -- and big semis behind him. And a bomb exploded in front of his truck, and he slammed on the brakes and was hit from the rear by a big semi. And other things like that happened.

  • 10:25:02

    SCHRAMWhen he came back, he applied for, among other things, benefits for PTSD. And he was first told by an adjudicator, who is someone in Atlanta -- he never gets to meet the person or know who they are -- that you don't have PTSD. And he said, oh, my record shows that I do. It was two VA psychiatrists who had certified to it. Take a look at page so-and-so, et cetera. And then the adjudicator came back again and said, denied because, yes, you have PTSD, but there is no known stressor. That's what Tom was talking about. He couldn't remember. Was it the bomb that blew up in his face? Or was it knowing about that little boy from Baghdad who got run over by a convoy that had orders not to stop because it could be an ambush?

  • 10:25:53

    PAGEAnd so would that happen today if in this -- if the same case arose?

  • 10:25:57

    SCHRAMTom, what do you think?

  • 10:26:00

    PAMPERINWe're a large organization. And our policy is that, no, that would not happen.

  • 10:26:06

    SCHRAMThe denial would not happen.

  • 10:26:07

    PAMPERINDenial would not happen. The...

  • 10:26:10

    SCHRAMThat's good.

  • 10:26:10

    PAMPERINThe, you know -- but it is a large organization. They are fact-specific claims. And one thing I would say is that the Congress has been -- in face of the very large increase in claims because of the war and the economy and other things -- has been good to VA. And what that means is that five years ago, there were 7,500 people across the country adjudicating disability claims. Today, there are nearly 13,000. We are an organization with a lot of enthusiastic, smart, dedicated young people, but with relatively limited experience. And when you're filing a claim with VA, I strongly encourage that you contact one of the national service organizations -- the VFW DA, The American Legion, or your state Department of Veterans Affairs or your county Veterans Service Officer -- to help you with your claim.

  • 10:27:14

    PAGEWhat's your perspective on this, Jim? Give us some historical context.

  • 10:27:16

    CURRIEYeah, let me -- thank you, Susan. I think one of the changes today is that it is no longer considered disgraceful to suffer from PTSD or shell shock or whatever you want to call it. In previous wars, it was regarded as sort of unmanly, and that was what -- you mentioned George Patton. I think that was part of his ethos. It was part of his approach to war. My father was a World War II veteran. He was a B-17 pilot, and they were under incredible stress as they flew those bombers over enemy territory and everything. But after the war, he never wanted to talk about it. He never wanted to revisit it, and I think that's one of the big changes today.

  • 10:27:57

    CURRIEIn my previous position at the National Defense University, I taught military officers who had had two and three and even four deployments to Iraq and Afghanistan. And one of the things they told me was when you're in those combat zones, you never can relax. You're always under stress. You're always under pressure. And most of these were the commanders of the units, so they had not only the responsibility for themselves, but for the people in their units as well. And for them, it was a year's deployment if they were Army, at least. And they never, ever could get over it until they got back.

  • 10:28:32

    CURRIEAnd yet many of them were reluctant to go and accept the kind of psychological help they got because they were afraid it would hurt their military careers if they did. And that's one thing that I'm not sure we have overcome entirely yet. If you have that on your record, does it then result in your security clearance being threatened? Does it result in maybe less promotion opportunities for you? Because, after all, there are a lot of people who don't have those things on their record.

  • 10:28:58

    SCHRAMBoy, that's a great point, Jim. Because it also goes on to -- as servicemen and women go out to the civilian workforce, and they have the same concern. I dedicated my book to my father-in-law, George C. Morgan and his family. He was a World War II veteran, like your father. And he was -- he landed at Normandy, was in the Battle of the Bulge and the bridge at Remagen, and he helped liberate the Buchenwald concentration camp. He came back, and they said that -- well, you have battle fatigue.

  • 10:29:28

    SCHRAMAnd so he had a very short period of treatment in a hospital, and then he was out. His life would have been a lot better under today's rulings of the VA, the enlightened approach that medicine is taking in. And hopefully, we in America will catch up to the medicine and understand that we need to respect veterans in the civilian workforce and everywhere because of this -- what could be an illness that has to be dealt with.

  • 10:30:02

    PAMPERINAnd what's important for people who have post-traumatic stress is to know is that the modern therapies do work. And for most people, you are able to re-adjust and continue with your life. You may have some problems, to be sure, but it is not something that dooms you to failure for the rest of your life.

  • 10:30:25

    PAGEWell, Jim mentioned that soldiers in Iraq and Afghanistan are under constant stress. So when they come back, what proportion of the current day veterans from those wars are diagnosed with PTSD or seek treatment?

  • 10:30:40

    PAMPERINWell, today's modern warriors are an incredible cohort. Historically, about 10 percent of any cohort apply for and receive benefits from VA. Those who have returned from the current combat theaters, whether they be active component or demobilized reserving guard, have applied for disability benefits from VA at the rate of 35 percent. And of those people who have applied, about 98 percent had been awarded service-connection for something. Post-traumatic stress is the third most commonly claimed and awarded benefit for returning war veterans.

  • 10:31:26

    PAGEAnd what are the first two?

  • 10:31:28

    PAMPERINThe first two are hearing loss and some back problems.

  • 10:31:34

    PAGESo that's a tripling of the classic...

  • 10:31:36

    PAMPERINYes.

  • 10:31:36

    PAGE...historic rate of seeking disability benefit. Does that mean that this war is tougher on soldiers? Or does it mean that soldiers are more -- feel more able and willing to go and seek some help?

  • 10:31:47

    PAMPERINWell, I think they're more willing and able to seek help. You know, as both DOD and VA says, it takes a warrior to seek help. And -- but on the other hand, I think the American people have to appreciate that after nine years of fighting two wars with somebody else's kids, that where deployment -- where many of these soldiers have been deployed three, four and five times, that this is a consequence of that kind of exposure to combat. It is unprecedented, I think, in the history of America.

  • 10:32:25

    PAGEDo you think there is still something of a stigma to seeking help for post-traumatic stress disorder?

  • 10:32:35

    PAMPERINProbably. I think there are a lot of people in America who -- and in the world who consider mental health issues to be not real injuries, not real consequences. They're something you should stand up, shake yourself up and get a hold of yourself, but they happen to people. They are real, and we need to care for them.

  • 10:33:05

    PAGEI'm Susan Page, and you're listening to "The Diane Rehm Show." We're taking your calls. Let's talk first to Linda. She's calling us from San Antonio, Texas. Linda, you're on the air.

  • 10:33:17

    LINDAHi, there. My name is Linda. I'm a 100 percent service-connected disabled veteran. I'm also a military psychologist, and I have a quick question and a quick comment for you. First, going back to service members who were denied benefits due to illness from Agent Orange exposure, what is happening for the families of those whose service members are now deceased? Will they retroactively receive all the money that should have been awarded to their active duty or retired service member?

  • 10:33:46

    LINDASome of those families continue to live in poverty -- abject poverty. Some of them have been patients of mine. My second comment is the system is horribly dysfunctional. I currently work for the Air Force, and I write medical evaluation reports on a very routine basis for service members who are going to be medically retired. And it's an extremely thorough evaluation. And as soon as that happens, they go right over to the VA, and the VA system redoes the entire process, often taking months or even years -- in my own case -- to get that accomplished.

  • 10:34:20

    LINDAIt wastes a whole bunch of time. I also noticed that the individuals in the VA system who review the records from the compensation and pension providers make terrible mistakes. They overlook things. They misunderstand things. They misinterpret things, and they leave things out. And what that means is unnecessary repeat visits to doctors and many, many, many months of delay before the service member receives a nickel. And it's also very costly. As a taxpayer, I resent that. So those are my comments.

  • 10:34:51

    PAGEI...

  • 10:34:52

    LINDAAnd I'll take the answers off air.

  • 10:34:54

    PAGELinda, thank you very much for calling. And thank you for your service. May I ask where you served?

  • 10:34:59

    LINDAExcuse me?

  • 10:35:00

    PAGEYeah, may I ask where you served, where you were deployed?

  • 10:35:04

    LINDAI have not deployed. However, I spent four years at Fort Polk, La., at the Joint Readiness Training Center, which is about as close as you can come to real live deployments. We have real-life horrible injuries and real-life casualties in the training environment quite routinely. And I was the mental health officer responsible for orchestrating everything that needed to be done after such an event would take place.

  • 10:35:30

    PAGEAll right.

  • 10:35:31

    LINDAAnd I could talk for hours about that, but that's a different topic.

  • 10:35:34

    PAGEAll right, Linda. Thank you very much. Well, Tom, let me give you a chance to respond to Linda's point.

  • 10:35:37

    PAMPERINAbsolutely. I think this is a good news story. And particularly when Sec. Shinseki came in, he tasked the agency to be forward-looking, results-oriented and veteran-focused. And as a consequence of that -- first, the Agent Orange issue. To the extent that a veteran had previously filed a claim and been denied, that claim -- even though the veteran is deceased -- will be reviewed. And if compensation is payable, it will be paid to a qualifying surviving spouse.

  • 10:36:13

    PAMPERINThat's somebody who has not currently remarried. If there is no spouse, a minor, helpless, or school child. If there are none of them, we will search for a family member who we can pay those benefits to. Now, what's really important is for those people who died of these disabilities without ever having filed a claim with this, their spouses should file a claim for Dependence Indemnity Compensation. They will not get retroactive benefits, but if they died from these disabilities, they would be entitled to that benefit.

  • 10:36:47

    PAGEBut these benefits that were denied and might now be approved are -- do they go -- are they retroactive?

  • 10:36:51

    PAMPERINYes. Yes. Yes.

  • 10:36:52

    PAGEYeah...

  • 10:36:53

    PAMPERINNow, with regard to the caller's experience with the disability evaluation process, as a result of the events of Walter Reed, the Department of Defense and VA joined together, and I was honored to be the co-lead of the development of a revised disability evaluation system. In that system, which is currently at 27 locations -- going to 28 more, and will be at all military installations by the end of this 2011 calendar year -- when a person is referred to the DES system, we work with VA -- DOD and produce a rating for them.

  • 10:37:34

    PAGEWe're going to continue our conversation, our discussion about the duplication issues that Linda raised. But first, we're going to take a short break. We hope you'll stay with us.

  • 10:40:02

    PAGEBefore the break, we were talking about PTSD in the very current context. Jim Currie, tell us about -- this was an issue even in the period after World War I.

  • 10:40:13

    CURRIEIt was. If you go back and you read accounts of what the soldiers in the trenches were subjected to as they were incessantly bombarded with heavy artillery, they would climb out of those nasty trenches and go across what was called no man's land through the barbed wire and around the shell holes and being shot at the entire time. And it -- on the Western Front, they went for four years that the front never moved. Hardly at all did it ever move. And they were just day and night subjected to this. It was incessant. It never stopped. It's a wonder that all of them didn't come down with what was then called shell shock. And I suspect a very large percentage of them actually did have shell shock.

  • 10:40:54

    PAGEI wonder if historians have gone back to look at the mark that left on a generation. Do you know if there's been studies on...

  • 10:41:02

    CURRIEWell, I don't know specifically about studies on it. But I can tell you that after World War I, there were a lot of studies of veterans who were subjected to it. The treatment was largely getting them away from large amounts of noise and putting them out in country sanitariums and having them recover gradually like that. Mental health treatment was not as advanced as it is today. But you did have many, many veterans, an entire generation of them who were undoubtedly affected very adversely by their service there.

  • 10:41:33

    PAGEAnd, of course, that affects their families, their communities -- a real ripple effect. Let's talk to Samuel. He's calling us from Lane, S.C. Samuel, hi. Thanks for joining us on "The Diane Rehm Show."

  • 10:41:44

    SAMUELThanks for taking my call. I have a question for your guest concerning Agent Orange and PTSD and during the Vietnam era. I served in Vietnam in 1970. Then I went to the VA Hospital -- I think it was in '84 -- in Fort Lauderdale. They did testing for Agent Orange, and I went through one appointment. And then my next appointment, they cancelled and told me I was not qualified. But I served in an area where Agent Orange was heavily used then. And I'm curious about the -- can I re-file today? And I would like for one of your guests to answer that for me 'cause I served in (word?) -- I guess it would be considered Area 72.

  • 10:42:38

    PAGEAll right. Samuel, thank you so much for your service to the nation. Let's go to our guest from the VA. Tom Pamperin, what should Samuel do?

  • 10:42:46

    PAMPERINSure. First of all, the -- with Agent Orange, although it was generally known where it was sprayed in Vietnam, it's not completely known. But more fundamentally, because of the movement of soldiers around the country, we can't definitively say a person was or was not in a defoliated area. As a consequence, VA created a regulation that anyone who served in country or on the inland waterways of Vietnam is presumed to have been exposed to Agent Orange, and therefore, all of the presumptive disabilities would accrue if you served in country. If the caller has one of the 13 disabilities that have been associated with Agent Orange, he should absolutely file a claim with us at this time, and it will be reevaluated.

  • 10:43:44

    PAGEAll right. Samuel, thanks for your call. Marty.

  • 10:43:46

    SCHRAMInterestingly, though -- and I know Tom would agree with this -- that that VA ruling, which was an excellently timed ruling, it was pushed for by senators and representatives alike. The VA went for many, many years denying claims, rather than -- on the grounds that you couldn't -- that a service man or woman couldn't point to the specific time or place they were at in a timely fashion after Agent Orange had been sprayed and so on and so forth. And finally, after decades of this, the VA finally said, okay.

  • 10:44:20

    SCHRAMWe'll just say, if you were there, you're presumed to have been exposed. Now, we'll move on, which was a sensible thing. But why did it take years for the VA to get there, is the question that I keep asking. Like, why didn't the VA take the initial position and say, you know, this is common sense. We're going to say you're exposed, and we can help these veterans on day one with the benefits that we're now saying they earned retro -- but not even retroactively.

  • 10:44:49

    PAMPERINWell, you know, you're right. There isn't any doubt that VA was slow to react to the experience of the Vietnam veteran, but the fact is, we did. It took a long time. I believe with the VA of today, particularly under Secretary Shinseki's direction, we are forward-looking. And while we can't undo the past, we can make sure that in the future, we are more responsive to returning warriors.

  • 10:45:23

    PAGEWe've gotten several e-mails from listeners wondering if this new Congress elected -- what, just two weeks ago, or not even that long ago -- will have an effect, have an impact -- the fact that Republicans have won control of the House, will they have an impact on veterans' benefits? Here's an e-mail from Jim -- James, writing us from Baltimore saying, "Will the new Congress consider reducing or eliminating survivors' benefits?" And, of course, we see headlines in the newspapers today about efforts by -- proposals by the leaders of a debt commission to have cuts in a lot of programs, although not specifically veterans programs. Marty, what do you think the new Congress -- what impact will that have?

  • 10:46:01

    SCHRAMWell, I think they're going to be moving to do what the voters wanted them to do in a general sense, which is to say, let's balance the budget. Let's stop the runaway deficit spending and so on. That said, will it affect the VA budget as far as benefits to men and women who earned them overseas? And I have a concern that it might, and I say it for this reason. We don't know who's going to be the new chairman of the Republican-controlled House Committee on Veterans Affairs. And we don't know what other pressures will be on it.

  • 10:46:39

    SCHRAMBut we do know this, we know that if the VA has determined that some man or woman who fought deserves and earned benefits, there's an obligation and a promise that we, as citizens, made when we sent them to fight our battles, so that we and our kids and grandkids don't have to because they're fighting them. We've got to pay what we're owed, and we can mothball old ships and planes when we send younger planes into war 'cause they can do it better. But we don't dare mothball the men and women who fought for us. And I'm afraid that might happen because if funds are finite, cuts will be made. And that's a breaking of a promise, a solemn pledge.

  • 10:47:24

    PAGEJim.

  • 10:47:26

    CURRIEMy guess is that the only remaining third rail in politics -- now that Social Security is no longer the third rail that you can't touch, based on the deficit commission's recommendations that have just come out -- is going to be serviced-connected disabilities. I don't understand who the new chairman of the Veterans Committee may be in the House. But I think anyone who proposed cutting benefits for service-connected disabilities as opposed to veterans' benefits generally, which could see some cuts and could -- there could be some increases, for example, in payments for TRICARE insurance and that sort of thing. I'm going to predict that that's not going to happen even as anything else in the budget is cut.

  • 10:48:07

    SCHRAMAnd just very quickly on that point. There are many ways to cut without it looking like cuts. And one way that the VA wound up using for many years was just to delay before you deny. And every year that goes by, and years go by and decades go by, and you look at the cases and the appeals -- it's decades actually goes by. There are decades that you don't get reimbursed for again. And especially when a veteran dies, the case dies with the veteran, and that's money you just don't get. That was that point that Linda made, and it's valid, too. So there's lot of ways to cut without the cut ever showing up as a cut, Jim.

  • 10:48:44

    PAGETom, you're shaking your head.

  • 10:48:45

    PAMPERINI would like to reassure America's veterans, however, that historically, we're on track this year to do 1.3 million disability determinations. Historically, that translates into between a 10 and a 13 percent appeal rate every year, so we get 130 to 180,000 appeals. Of that number, though, only about 5 percent take the long roll that the last commenter just described of going to a formal appeal. About 10 percent of those that go to a formal appeal are eventually granted.

  • 10:49:27

    PAMPERINBut I do think that the secretary has made a commitment that by 2015 we will have a workload inventory where no case is more than 125 days old. Right now, it takes us about 161 days to do a disability determination. We are focused on getting to there, and one of the ways we get to there is through technology, enhanced training and better partnerships with our stakeholders.

  • 10:50:01

    PAGEYou know, Jim, we've all heard stories of Vietnam veterans returning and not receiving the honor to which they deserved. And we know that when today's veterans come back, I think they get a better reception. Talk about the degree to which Americans' attitudes toward a war affect what veterans can expect, both in kind of a personal honor and also in benefits, after the war is over.

  • 10:50:25

    CURRIEWell, you're absolutely right about that. The irony, of course, with Vietnam veterans returning was that so many of them were draftees. They were there involuntarily fighting in that war. They were what we used to call draft-motivated volunteers. So they came back to, not the parades and the honors, but people calling them nasty names and that sort of thing. You're absolutely right. I think you've hit upon the key. It is the way the war itself was viewed.

  • 10:50:53

    CURRIEWorld War I was the war to end all wars. The veterans came back to parades. World War II was the great fight against the Nazis and the fascists, and the veterans came back to parades and honor. The GI Bill was passed, which created largely the American middle class, I would say, by allowing so many veterans to go to school and to buy homes. The veterans coming back today from Iraq and Afghanistan are all volunteers. We haven't had a draft for many, many years, and they're honored as they should be for their service.

  • 10:51:23

    CURRIEA lot of it had to do with the aberration, I would say, of Vietnam, which was -- probably next to the Mexican War -- the most unpopular war we have ever fought, and I think the veterans saw that. It's interesting, I was thinking about Rudyard Kipling as I was thinking about this program and his famous poem "Tommy," where he says, "For it's Tommy this, an' Tommy that, an' 'Chuck him out, the brute!" But it's 'Savior of 'is country,' when the guns begin to shoot." And I think, you know, we've regarded our veterans more largely as saviors of the country than otherwise.

  • 10:51:58

    PAGEI'm Susan Page, and you're listening to "The Diane Rehm Show." We're taking your calls, 1-800-433-8850. Let's go to Mike. He's been holding on for a while from Yorktown, Va. Mike, thanks for holding.

  • 10:52:11

    MIKEYes. Thank you for taking my call. This is directed mostly to the gentleman from the VA. I've experienced the VA's delay and deny as well. I put in a claim for my mother who, ultimately, had Alzheimer's disease and died in a local facility. My father who was a World War II combat veteran -- we were going to use his eligibility for it on the survivor's aide and dependents benefits. Through a third party, I applied for her claim. It took over a year-and-a-half to even get someone to come out and evaluate her.

  • 10:52:37

    MIKESubsequently, she died. And I've been told by the VA representative, who continually told me that newer claims were being put in front of mine, that at that point, even after getting one of the local congressman involved, that I couldn't apply for benefits anymore. They had no interest in helping me. None. They kept shining me on, and, you know, here I sit. And it's a money issue -- it's money we would have inherited out of the hundred thousand-plus we spent on her care.

  • 10:53:07

    PAGEWell, Mike, I'm so sorry for your mother's ailment. And we thank you for your father's service. And I'll give Tom a chance to respond.

  • 10:53:13

    PAMPERINWell, Mike, I would appreciate it if you would give me -- give the station your contact information, and I'll call you tomorrow to check that out. If you had filed a claim with the VA, there -- that claim needs to be adjudicated. And if there is an accrued benefit, the rules for accrueds, generally other than Agent Orange, are a little bit different. But some of that money may be available.

  • 10:53:42

    PAGESo, Mike, you hold on, and our screener will get back and get that information from you. Marty.

  • 10:53:47

    SCHRAMYes. I was just going to say that in researching my book over the years and then most recently, one thing I did notice is that every time you Google Tom Pamperin's name, he'd served -- he served us for a number of years. And every time there's a controversy, who winds up on Capitol Hill having to handle the tough question and be asked about it was always Tom. And he hadn't done it, but he was sitting there trying to explain it. And I was always thought that he must have viewed his job as akin to being an Olympic javelin catcher after a while.

  • 10:54:17

    SCHRAMBut, in fact, it does bring up something that's -- one thing that we really can change in mind -- that I would say maybe actually in fact -- there's a mindset among the younger people, I think, at the VA who are adjudicators who may not be as experienced as you'd like them to be, Tom. And they're just there and doing their job maybe for the first time, dealing with veterans' issues and don't know -- even know veterans maybe. And veterans tend to feel that this had become a Department of Veteran's Adversaries too often. I think in recent years, since the new regime especially, that has significantly changed.

  • 10:54:53

    SCHRAMBut the VA is going to stand for anything, why not change the name or at least change the mindset to -- from a Department of Veteran's Adversaries to what you really want it to be, which is the Department of Veteran's Advocates? And let the VA consider its job to say, we know you served. We know where you were. We'll put together the best case we have for you. And let's take a positive approach instead of a negative approach. The problem here is if we pay the vets what we really owe them, it gets to be costly.

  • 10:55:22

    PAMPERINWell, I've worked for the VA for 38 years. And I've always thought I was a veteran's advocate. In fact, if you look in Title 38, it's on case...

  • 10:55:31

    SCHRAMOh, I think you were. I don't think there's any doubt about that.

  • 10:55:34

    PAMPERINIt's -- VA is unique in that the secretary not only administers a program but has a duty to assist to help approve claims and has a responsibility to be an advocate for veterans.

  • 10:55:46

    PAGEAnd, you know, in the wars we're fighting now, we know that we're able to save soldiers who would have died in previous conflicts. How much impact has that had on the VA today?

  • 10:55:57

    PAMPERINWell, there are a number of articles in today's Washington Post. The front page is on 4 persons, but it has a significant effort. We have federal recovery coordinators that care for them. We give them -- those who are most seriously injured, extremely expedited, personalized care, and we are trying to do the best by them.

  • 10:56:21

    PAGETom Pamperin from the VA, Marty Schram, author of "Vets Under Siege," and Jim Currie, military historian. I want to thank all three of you for joining us this hour on "The Diane Rehm Show." On this Veteran's Day, we also thank and honor the veterans who may be listening and their families. Thank you for your service. I'm Susan Page of USA Today, sitting in for Diane Rehm. Thanks for listening.

  • 10:56:43

    ANNOUNCER"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Susan Nabors, Denise Couture and Monique Nazareth. The engineer is Tobey Schreiner. Dorie Anisman answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales. Call 202-885-1200 for more information. Our e-mail address is drshow@wamu.org, and we're on Facebook and Twitter. This program comes to you from American University in Washington. This is NPR.

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