Neurologic Injuries and Neuropsychiatric Disorders Likely to Increase Long-Term Medical Costs for Veterans

SALT LAKE CITY—The estimated total cost of the Iraq War is currently $3 trillion, with long-term medical care and disability benefits to veterans projected to cost about $700 billion, according to Linda J. Bilmes. With the inclusion of medical expenses for veterans with neurologic and neuropsychiatric disorders, such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), the costs of long-term medical care are likely to surpass the operating costs of the war, Ms. Bilmes reported at the 133rd Annual Meeting of the American Neurological Association.

Iraq War More Costly Than Previous Wars
The Iraq War is the most expensive conflict since World War II, noted Ms. Bilmes, who calculated the $3 trillion war estimate by assessing the short- and long-term budgetary, social, and economic expenses. Budgetary expenses include money appropriated to date, as well as future running costs, veterans’ medical and disability costs, military replenishment, and interest on money borrowed to finance the war. Social and economic costs, such as loss of life or loss due to serious injury and oil price increases, are war-related costs not paid for by the government.

Congress has thus far appropriated close to $900 billion for military operations in Iraq and Afghanistan, enhanced security at US bases, reconstruction, and foreign aid programs; 75% of this cost pays for military operations in Iraq. Per month, the cost of the war has increased from $4.4 billion to $15 billion since 2003. One of the major factors contributing to the rising monthly expense has been the increase in fuel costs. Another factor is the use of contractors—195,000 contractors are currently operating in Iraq, compared with 170,000 contractors in 2007. Many contracts were originally set up without the expectation of a long war; yet, the conflict in Iraq and Afghanistan has surpassed the length of World War I, World War II, and the Korean War. “Part of the scale of these costs and the injuries is simply the sheer length of time that we have been involved in this war,” said Ms. Bilmes, who is a Professor of Public Finance at the Harvard Kennedy School in Cambridge, Massachussetts.

Projected Disability and Health Care Benefits for Veterans
Veterans’ medical and disability costs, among the budgetary costs contributing to the $3 trillion estimate, may eventually total $700 billion, Ms. Bilmes noted. Stabilization, transport, and emergency care for a small number of patients have accounted for a significant portion of the medical expenses thus far. However, the financial burden is expected to be most significant in the future. “The long-term costs of treating veterans over the course of their lives and paying disability compensation are where the major costs come in,” Ms. Bilmes said. She pointed out that, compared with previous wars, there is currently better medical treatment in the field, a higher survival rate for soldiers with traumatic injuries, and more comprehensive medical treatment, diagnostic treatment, and rehabilitation, which has markedly increased costs.

In the Iraq War, 1.72 million troops have been deployed. Among 868,717 soldiers discharged, 288,000 have filed disability claims, and 347,000 were treated in Veterans Affairs (VA) medical facilities, of which 147,744 were treated for mental health disorders. Among Iraq and Afghanistan veterans, 33% have already filed disability claims, and more than 90% have been granted. A projected 45% of veterans will eventually file disability claims, of which about 89% are likely to be granted. Relating to medical costs, Ms. Bilmes’ Operation Iraqi Freedom/Operation Enduring Freedom model projects that the 35% of Iraq and Afghanistan veterans who use VA medical care initially will increase to 50%, assuming that one third will continue to use the VA as their long-term health care provider.

Veterans With TBI and PTSD
Although Ms. Bilmes’ initial model did not account for mild TBI, it did project 15% of disability benefits for the PTSD cohort. After the model was revised for the inclusion of patients with mild TBI, it was estimated that approximately 8% would seek treatment and file claims for mild TBI. The model also assumes that 85% of these patients would receive medical care for one year and 15% would receive care for five years. Thus, the financial burden of TBI and PTSD would add about $28 billion in long-term medical and disability costs and roughly $29 billion in social costs to the total estimate of the war.

A major expense that complicates treatment for TBI and PTSD is the disability process. “When troops are injured and [after] they come back, when they are … most vulnerable, they have to face both within the Department of Defense (DOD) and the VA a very complicated process of securing the paperwork that will enable them to get disability status and to get treatment in some cases,” Ms. Bilmes commented. The disability process involves a medical stabilization process, an acute care stage, and military evaluation to determine whether the soldier is fit for duty. The system is appropriate for soldiers with a physical disability, Ms. Bilmes noted, but not for those who have had a TBI or PTSD complications. Compounding this issue is the backlog of more than 400,000 pending disability claims at the VA. It takes 177 days to process an initial claim and 657 days to process an appeal; 14% of claims are appealed, a 5% increase since 2003.

Ms. Bilmes concluded that veterans returning from Iraq and Afghanistan with PTSD or TBI are likely to encounter long treatment delays and bureaucratic conflicts during the initial period after the trigger incident. Delayed treatment may lead to slower recovery and increased medical, disability, and social costs, which may eventually exceed the operating costs of the war. However, she believes that many problems can be corrected. She has proposed 17 specific reforms, including a more seamless transition between the DOD and VA, particularly for patients with TBI and PTSD. “A key recommendation I have made is to shift the ‘presumption,’ so that veterans with a TBI or concussive event are presumed to have been injured during active duty. This would mean they no longer had to prove that their injuries resulted from warfare—and it would change the basis of the entire veterans’ process.”

SALT LAKE CITY—The estimated total cost of the Iraq War is currently $3 trillion, with long-term medical care and disability benefits to veterans projected to cost about $700 billion, according to Linda J. Bilmes. With the inclusion of medical expenses for veterans with neurologic and neuropsychiatric disorders, such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), the costs of long-term medical care are likely to surpass the operating costs of the war, Ms. Bilmes reported at the 133rd Annual Meeting of the American Neurological Association.

Iraq War More Costly Than Previous Wars
The Iraq War is the most expensive conflict since World War II, noted Ms. Bilmes, who calculated the $3 trillion war estimate by assessing the short- and long-term budgetary, social, and economic expenses. Budgetary expenses include money appropriated to date, as well as future running costs, veterans’ medical and disability costs, military replenishment, and interest on money borrowed to finance the war. Social and economic costs, such as loss of life or loss due to serious injury and oil price increases, are war-related costs not paid for by the government.

Congress has thus far appropriated close to $900 billion for military operations in Iraq and Afghanistan, enhanced security at US bases, reconstruction, and foreign aid programs; 75% of this cost pays for military operations in Iraq. Per month, the cost of the war has increased from $4.4 billion to $15 billion since 2003. One of the major factors contributing to the rising monthly expense has been the increase in fuel costs. Another factor is the use of contractors—195,000 contractors are currently operating in Iraq, compared with 170,000 contractors in 2007. Many contracts were originally set up without the expectation of a long war; yet, the conflict in Iraq and Afghanistan has surpassed the length of World War I, World War II, and the Korean War. “Part of the scale of these costs and the injuries is simply the sheer length of time that we have been involved in this war,” said Ms. Bilmes, who is a Professor of Public Finance at the Harvard Kennedy School in Cambridge, Massachussetts.

Projected Disability and Health Care Benefits for Veterans
Veterans’ medical and disability costs, among the budgetary costs contributing to the $3 trillion estimate, may eventually total $700 billion, Ms. Bilmes noted. Stabilization, transport, and emergency care for a small number of patients have accounted for a significant portion of the medical expenses thus far. However, the financial burden is expected to be most significant in the future. “The long-term costs of treating veterans over the course of their lives and paying disability compensation are where the major costs come in,” Ms. Bilmes said. She pointed out that, compared with previous wars, there is currently better medical treatment in the field, a higher survival rate for soldiers with traumatic injuries, and more comprehensive medical treatment, diagnostic treatment, and rehabilitation, which has markedly increased costs.

In the Iraq War, 1.72 million troops have been deployed. Among 868,717 soldiers discharged, 288,000 have filed disability claims, and 347,000 were treated in Veterans Affairs (VA) medical facilities, of which 147,744 were treated for mental health disorders. Among Iraq and Afghanistan veterans, 33% have already filed disability claims, and more than 90% have been granted. A projected 45% of veterans will eventually file disability claims, of which about 89% are likely to be granted. Relating to medical costs, Ms. Bilmes’ Operation Iraqi Freedom/Operation Enduring Freedom model projects that the 35% of Iraq and Afghanistan veterans who use VA medical care initially will increase to 50%, assuming that one third will continue to use the VA as their long-term health care provider.

Veterans With TBI and PTSD
Although Ms. Bilmes’ initial model did not account for mild TBI, it did project 15% of disability benefits for the PTSD cohort. After the model was revised for the inclusion of patients with mild TBI, it was estimated that approximately 8% would seek treatment and file claims for mild TBI. The model also assumes that 85% of these patients would receive medical care for one year and 15% would receive care for five years. Thus, the financial burden of TBI and PTSD would add about $28 billion in long-term medical and disability costs and roughly $29 billion in social costs to the total estimate of the war.

A major expense that complicates treatment for TBI and PTSD is the disability process. “When troops are injured and [after] they come back, when they are … most vulnerable, they have to face both within the Department of Defense (DOD) and the VA a very complicated process of securing the paperwork that will enable them to get disability status and to get treatment in some cases,” Ms. Bilmes commented. The disability process involves a medical stabilization process, an acute care stage, and military evaluation to determine whether the soldier is fit for duty. The system is appropriate for soldiers with a physical disability, Ms. Bilmes noted, but not for those who have had a TBI or PTSD complications. Compounding this issue is the backlog of more than 400,000 pending disability claims at the VA. It takes 177 days to process an initial claim and 657 days to process an appeal; 14% of claims are appealed, a 5% increase since 2003.

Ms. Bilmes concluded that veterans returning from Iraq and Afghanistan with PTSD or TBI are likely to encounter long treatment delays and bureaucratic conflicts during the initial period after the trigger incident. Delayed treatment may lead to slower recovery and increased medical, disability, and social costs, which may eventually exceed the operating costs of the war. However, she believes that many problems can be corrected. She has proposed 17 specific reforms, including a more seamless transition between the DOD and VA, particularly for patients with TBI and PTSD. “A key recommendation I have made is to shift the ‘presumption,’ so that veterans with a TBI or concussive event are presumed to have been injured during active duty. This would mean they no longer had to prove that their injuries resulted from warfare—and it would change the basis of the entire veterans’ process.”

SALT LAKE CITY—The estimated total cost of the Iraq War is currently $3 trillion, with long-term medical care and disability benefits to veterans projected to cost about $700 billion, according to Linda J. Bilmes. With the inclusion of medical expenses for veterans with neurologic and neuropsychiatric disorders, such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), the costs of long-term medical care are likely to surpass the operating costs of the war, Ms. Bilmes reported at the 133rd Annual Meeting of the American Neurological Association.

Iraq War More Costly Than Previous Wars
The Iraq War is the most expensive conflict since World War II, noted Ms. Bilmes, who calculated the $3 trillion war estimate by assessing the short- and long-term budgetary, social, and economic expenses. Budgetary expenses include money appropriated to date, as well as future running costs, veterans’ medical and disability costs, military replenishment, and interest on money borrowed to finance the war. Social and economic costs, such as loss of life or loss due to serious injury and oil price increases, are war-related costs not paid for by the government.

Congress has thus far appropriated close to $900 billion for military operations in Iraq and Afghanistan, enhanced security at US bases, reconstruction, and foreign aid programs; 75% of this cost pays for military operations in Iraq. Per month, the cost of the war has increased from $4.4 billion to $15 billion since 2003. One of the major factors contributing to the rising monthly expense has been the increase in fuel costs. Another factor is the use of contractors—195,000 contractors are currently operating in Iraq, compared with 170,000 contractors in 2007. Many contracts were originally set up without the expectation of a long war; yet, the conflict in Iraq and Afghanistan has surpassed the length of World War I, World War II, and the Korean War. “Part of the scale of these costs and the injuries is simply the sheer length of time that we have been involved in this war,” said Ms. Bilmes, who is a Professor of Public Finance at the Harvard Kennedy School in Cambridge, Massachussetts.

Projected Disability and Health Care Benefits for Veterans
Veterans’ medical and disability costs, among the budgetary costs contributing to the $3 trillion estimate, may eventually total $700 billion, Ms. Bilmes noted. Stabilization, transport, and emergency care for a small number of patients have accounted for a significant portion of the medical expenses thus far. However, the financial burden is expected to be most significant in the future. “The long-term costs of treating veterans over the course of their lives and paying disability compensation are where the major costs come in,” Ms. Bilmes said. She pointed out that, compared with previous wars, there is currently better medical treatment in the field, a higher survival rate for soldiers with traumatic injuries, and more comprehensive medical treatment, diagnostic treatment, and rehabilitation, which has markedly increased costs.

In the Iraq War, 1.72 million troops have been deployed. Among 868,717 soldiers discharged, 288,000 have filed disability claims, and 347,000 were treated in Veterans Affairs (VA) medical facilities, of which 147,744 were treated for mental health disorders. Among Iraq and Afghanistan veterans, 33% have already filed disability claims, and more than 90% have been granted. A projected 45% of veterans will eventually file disability claims, of which about 89% are likely to be granted. Relating to medical costs, Ms. Bilmes’ Operation Iraqi Freedom/Operation Enduring Freedom model projects that the 35% of Iraq and Afghanistan veterans who use VA medical care initially will increase to 50%, assuming that one third will continue to use the VA as their long-term health care provider.

Veterans With TBI and PTSD
Although Ms. Bilmes’ initial model did not account for mild TBI, it did project 15% of disability benefits for the PTSD cohort. After the model was revised for the inclusion of patients with mild TBI, it was estimated that approximately 8% would seek treatment and file claims for mild TBI. The model also assumes that 85% of these patients would receive medical care for one year and 15% would receive care for five years. Thus, the financial burden of TBI and PTSD would add about $28 billion in long-term medical and disability costs and roughly $29 billion in social costs to the total estimate of the war.

A major expense that complicates treatment for TBI and PTSD is the disability process. “When troops are injured and [after] they come back, when they are … most vulnerable, they have to face both within the Department of Defense (DOD) and the VA a very complicated process of securing the paperwork that will enable them to get disability status and to get treatment in some cases,” Ms. Bilmes commented. The disability process involves a medical stabilization process, an acute care stage, and military evaluation to determine whether the soldier is fit for duty. The system is appropriate for soldiers with a physical disability, Ms. Bilmes noted, but not for those who have had a TBI or PTSD complications. Compounding this issue is the backlog of more than 400,000 pending disability claims at the VA. It takes 177 days to process an initial claim and 657 days to process an appeal; 14% of claims are appealed, a 5% increase since 2003.

Ms. Bilmes concluded that veterans returning from Iraq and Afghanistan with PTSD or TBI are likely to encounter long treatment delays and bureaucratic conflicts during the initial period after the trigger incident. Delayed treatment may lead to slower recovery and increased medical, disability, and social costs, which may eventually exceed the operating costs of the war. However, she believes that many problems can be corrected. She has proposed 17 specific reforms, including a more seamless transition between the DOD and VA, particularly for patients with TBI and PTSD. “A key recommendation I have made is to shift the ‘presumption,’ so that veterans with a TBI or concussive event are presumed to have been injured during active duty. This would mean they no longer had to prove that their injuries resulted from warfare—and it would change the basis of the entire veterans’ process.”