They Don’t Seem to Get Better…

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That might be one conclusion to be drawn from this wrenching chart in a new Congressional Budget Office report on how the Department of Veterans Affairs is handling wounded troops suffering from post-traumatic stress disorder and traumatic brain injury. The chart shows that nearly all the troops afflicted with both ailments remain under the VA’s care after four years of care. In contrast, only 42% of the troops seeking VA care with neither diagnosis were still under VA care after four years’ treatment.

Vets suffering from PTSD and/or TBI are likely treated longer because “those patients might have had more clinically complicated conditions that took longer to resolve. In addition, those patients’ more intensive initial use of services might have predisposed them to continue pursuing care,” the study says. “Because of their conditions, moreover, some patients could also have had limited opportunities for employment, a common source of alternative health care options.”

The CBO does good work gathering shards of data from all over the world and trying to make sense of it. But it does not make policy recommendations, so it doesn’t grade the VA’s work. Instead, it lays out its findings so that others – primarily Congress – can do so.

But it does contain data rarely seen by normal folk:

Of all the nearly 500,000 post-9/11 troops seen by the VA for health care, 103,500 (21%) had PTSD, 8,700 (2%) had TBI, and 26,600 (5%) had both. About 358,000 (72%) post-9/11 vets treated by the VA had neither.

Troops with a diagnosis of PTSD (which cost the VA $8,300 for the first year of treatment), TBI ($11,700) or both ($13,800), cost the VA about five times as much to treat as troops without PTSD or TBI ($2,400).

The Veterans Health Administration (VHA), which is the VA branch that cares for ailing vets, spent more than half its funding between 2004 and 2009 on post-9/11 troops with PTSD and/or TBI. The new government term for such troops is OCO – for Overseas Contingency Operations – personnel (kind of lacks the ring of the wars in Afghanistan and Iraq). Notes the study:

During fiscal years 2004 through 2009, VHA spent $3.7 billion for the first four years of treatment on the OCO patients analyzed by CBO. CBO estimates that VHA spent 60 percent of that sum ($2.2 billion) on patients with PTSD, TBI, or both. The group with neither a PTSD nor a TBI diagnosis— the largest group, with more than 350,000 patients—had the highest total costs: $860 million in treatment year 1 and about $1.5 billion in total costs from 2004 through 2009… Total spending in those years for the PTSD patients was almost as high ($1.4 billion), although the PTSD group had many fewer patients.

Such costs remain a small slice of the VA’s health-care budget. In 2010, the VA spent only $2 billion of its $48 billion health-care budget on post 9/11 vets.

“A great deal of uncertainty surrounds the prevalence of PTSD and TBI within the OCO population and, hence, the number of veterans with those conditions that DoD, VHA, and other health care providers may encounter in the future,” the study says.

So how much will these conditions ultimately cost the nation? “Projecting the future costs of treating veterans with PTSD and TBI requires estimating both the number of patients with those conditions who will seek VHA’s [the Veterans Health Administration, which is the VA branch that cares for ailing vets] care and the costs per patient that VHA will incur,” the study concludes. “Because the research community has not reached a consensus about the prevalence of those conditions, such projections would be highly uncertain.”