An estimated 125,000 Iraq and Afghanistan veterans with other than honorable discharges, many suffering from post-traumatic stress disorder (PTSD) and brain injury, continue to be denied access to Department of Veterans Affairs' (VA) health services, including mental treatment, and only "baby steps" are being taken to address the issue, according to one longtime activist.
Those veterans with other than honorable discharges – not including dishonorable or bad conduct discharges – are more likely to have mental health problems and end up homeless, with addictions, unemployed or interacting with the criminal justice system, Kristofer Goldsmith, one of the founders of High Ground Veterans, a campaign group, said.
Reluctance by politicians and the public to spend more money on timely veteran care is at the root of the failure to act, Goldsmith added.
But the public pays at the back end, through Medicaid, homeless services, prisons, and the loss of potentially productive members of the society, Goldsmith told Patient Daily.
Those so called "bad paper" discharges are any that are other than honorable, running from less than honorable, where a veteran leaves after often minor infractions, to bad conduct and dishonorable discharges, the lowest levels that include those convicted of felonies while serving.
A veteran who served in Iraq, Goldsmith received a general discharge in 2007, which allows him access to some benefits but not others. This happened after he attempted to commit suicide just ahead of another deployment to Iraq. He was coming to the end of his contract at the time, but the Army invoked stop-loss, which allows for an extension during a war.
Congress did pass a law in late 2016 requiring Military Review Boards to take into account PTSD and brain injuries when deciding whether to change a veteran's status to honorable. But advocates for veterans say it can take months or even years for decisions to be made.
VA Secretary David Shulkin announced in March that service personnel with any other than a dishonorable discharges that go directly to a VA emergency room must be treated if they are in mental health distress and may be at risk for suicide or other adverse behaviors.
But Goldsmith said this was mere window dressing as anybody that turns up at a VA emergency room, including civilians, and is suicidal must be treated.
He added, "Baby steps, We are moving at a snail's pace, but moving in the right direction."
Emily Blair, who manages veteran affairs for the National Alliance on Mental Alliance, disagrees that Shulkin has not acted in the best way he is able.. She believes he has done all he can with the authority he has, and it is now up to Congress to act decisively and comprehensively.
Shulkin ordered that veterans with other than honorable discharges – not including those who left dishonorably or after bad conduct – be allowed access to 90 days of emergency mental health care at a VA facility. This can be extended a further 90 days on appeal by a medical doctor.
"It is a positive move in the right direction," Blair told Patient Daily. "Secretary Shulkin has made it one of his top priorities to reduce, decrease, and eventually diminish veteran suicides." It is estimated 20 veterans a day commit suicide.
"Congress needs to act," Blair said. "Mental care cannot be treated in a vacuum, and they need access to primary care, to doctors." Her organization is asking that Congress change the law to give the veterans at least access to primary care. She noted some members were working hard to make changes, including U.S. Rep. Mike Coffman (R-CO) and U.S. Sen. Chris Murphy (D-VT).
"Scientific research shows the quicker you can get any individual into treatment the better," she added,
In a study published last year, Swords to Plowshares, a support group, reported an estimated 125,000 Iraq and Afghanistan veterans, or 6.5 percent of those who served, are being denied care due to “bad papers," those not including dishonorable or bad conduct discharges.
"Providing benefits costs money, and no one wants to pay for it," Goldsmith said. "People do not want to pay for veterans' benefits. I have reached the stage where I am aware of the fact that when it comes to the care of veterans, the taxpayers do not care."
Costs are rising, and with so many Vietnam veterans now aging, more are going to need hospital care or to see a doctor more often.
There is deep reluctance to add more cost by signing off on care for those with other than honorable discharges, Goldsmith said.
"These are ones with PTSD, traumatic brain injury, survivor's guilt, and are more likely to be homeless or unemployed," he added.
Goldsmith served from 2004 to 2007 and did a tour of duty in Iraq in 2005. His main job was to document, by camera, everything that happened during patrols, including victims of Shia-Sunni violence.
He began suffering from PTSD after returning from Iraq.
"It got worse and worse and I attempted suicide," said Goldsmith, who was at that point coming to the end of his active duty contract.
But the Army invoked stop-loss, which allows active duty extensions in times of war, and the suicide attempt happened just ahead of another deployment to Iraq.
"I had a stellar career, excelled in every way," Goldsmith said. "I went from being that guy to being other than honorably discharged." He was discharged 10 years ago.
"This affected me personally, but (I) came to realize this is not a me problem, this is a systematic problem," Goldsmith said, explaining why he was moved to become an activist.
The Fairness for Veterans Act, passed by Congress in December 2016, requires a Military Review Board to take into account PTSD and brain injuries when assessing whether to change a veteran's discharge record to honorable. Previously, the board could do so, but was not required.
Goldsmith has been turned down twice for VA educational benefits, and he has been waiting a year to hear news about his third attempt.