Two years after my discharge from the Navy in 1977 I was doing undergraduate work at the University of Oregon. While there I was a member of a campus veterans group. We did a lot of advocacy on behalf of Vietnam and Vietnam era veterans, on issues that back then were still unknown, such as Agent Orange exposure and Post Traumatic Stress Disorder.

One thing I took away from that was that while most people were happy to talk about the sacrifices of veterans it was, in the end, mostly talk. When it came to actually doing something or putting their money where their mouth was, most people, rather like Dick Cheney’s famous excuse for avoiding the draft, had better things to do.  In short, as the classic mordant military humor puts it, nothing is too good for our boys in uniform so that’s what we’ll give them, nothing. 

Still, I had some minor hope that in the future, if only because the VA would never again want to be perceived as incompetent and ineffectual as it was back then that it and the regular military would do somewhat better in the future.

And, to be fair, some good things did happen in the intervening years. The VA set up its Vet Center program for Vietnam vets, slightly better educational benefits programs were instituted for active duty forces, and PTSD was recognized as a legitimate medical illness to name a few improvements.

Then the Walter Reed Army Medical Center neglect scandal happened, resulting from a series of allegations of unsatisfactory conditions and management at the Walter Reed Army Medical Center (WRAMC) in Washington, D.C. culminating in two articles published by the Washington Post in February 2007. Cases of outpatient neglect, were reported as early as 2004, but generated substantial public and media attention only with release of the Post exposé.

It all seemed dreadfully familiar. There was the usual outrage, both genuine and feigned, on the part of the public and Congress and pundits; calls for action, investigations, establishments of commissions to study the problems, recommendations for improvement, et cetera, ad nauseum.

Indeed, less than a week after the article, new Defense Secretary Robert Gates visited Walter Reed and said those responsible would be “held accountable.”

“I endorse the decision by Secretary of the Army Fran Harvey to relieve the Commander, Major General George W. Weightman of the Walter Reed Army Medical Center. The care and welfare of our wounded men and women in uniform demand the highest standard of excellence and commitment that we can muster as a government. When this standard is not met, I will insist on swift and direct corrective action and, where appropriate, accountability up the chain of command.

So, let’s fast forward to the present and see how we are doing three years later. Let’s just look at a few articles from this month.

USA Today reported April 1 that the Department of Veterans Affairs has no way of determining long-range health care costs for the veterans of the wars in Iraq and Afghanistan, a federal study on the wars’ impact released Wednesday shows.

The next day USA Today reported that soldiers who say they killed enemy troops in combat, are at greater risk of suffering combat stress and having emotional problems, according to a new study.

Those soldiers often pay a profound psychological and emotional toll, according to Shira Maguen, a staff psychologist at the San Francisco Veterans Affairs Medical Center, and lead author of the study on soldiers and post-traumatic stress disorder. Of nearly 2,800 soldiers surveyed, 40% reported killing or being responsible for somebody’s death in Iraq.

Also that day the San Antonio Express-News reported that Fort Hood has had at least nine questionable deaths among young soldiers in the first three months of 2010, more than half of them confirmed suicides, despite Army efforts to reverse a trend linked to war in Iraq and Afghanistan.

The deaths of five GIs assigned to the post this year have been confirmed as suicides, with another suspected of killing himself. That’s about half the number for all of 2009, when 11 GIs committed suicide. Fort Hood, the biggest post in the Army as the year began with 46,500 troops, had a suicide rate of 26 per 100,000 people from 2006 to 2008, far above the civilian rate of 14.06 per 100,000.

The New York Times reported April 25 that Fort Carson’s Warrior Transition Battalion, a special unit created to provide closely managed care for soldiers with physical wounds and severe psychological trauma, is far from being a restful sanctuary. “For many soldiers, they have become warehouses of despair, where damaged men and women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse.”

See the predictable Pentagon response taking exception to the NYT article here here.  Yet bear in mind that the Pentagon official in charge of the wounded warrior program said Sunday he has been forced to resign, as the military continues to struggle with how best to care for troops injured in combat.

Noel Koch said in an e-mail that he was asked to step down by Clifford Stanley, the undersecretary of defense for personnel. Koch had been serving as the deputy undersecretary of defense for wounded warrior care and transition policy.

The same day the Associated Press reported that Authorities believe that 21 soldiers from Fort Campbell, Kentucky killed themselves in 2009, the same year that the Army reported 160 potential suicides, the most since 1980, when it started recording those deaths. The number of patients being treated at the behavioral health clinic at the base hospital has increased by 60 percent, from 25,400 in 2008 to nearly 40,000 in 2009.

And finally, but surely not last, this morning USA Today reports that the Pentagon effort to consolidate two premier hospitals for treating wounded troops has more than doubled in price and is so rudderless that an independent review and a bipartisan group of legislators say the care could suffer.

The cost of closing Walter Reed Army Medical Center, replacing it with a larger complex at the National Naval Medical Center in Bethesda, Md., and building a hospital at Fort Belvoir, Va., has risen from $1 billion to $2.6 billion, Pentagon records show.

Correcting the problems raised by Congress will cost another $781 million, according to a Pentagon report released Monday. And improvements must wait until after the new Bethesda facility — named the Walter Reed National Military Medical Center — is finished in September 2011, the report says.

The independent review last year found that, without improvements, the center would lack an adequate number of operating rooms and some would be too small to accommodate the latest surgical technology. There would not be enough single-patient rooms, critical for controlling infections.

The center will not be “world-class” as Congress envisioned, legislators say. “Wounded warrior care will suffer,” they wrote to the Pentagon in a January letter made public last week.

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