The Veterans Affairs health-care benefits system is complex and difficult to navigate, said John Waterbrook, benefits advisor at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center.
Making it more so, in 1993 Congress authorized a ``means test'' as a way to determine if a veteran has private financial ability to shoulder some or all of the costs involved with medical services.
When the VA decided to open enrollment to its health-care system in 1996, it was unprepared for the flood, said Mark Olanoff, national legislative director for The Retired Enlisted Association.
Millions of veterans came on board, many seeking relief from high health-care costs, he said. ``Once the word was out, guess what people did? They signed up. And the VA was not staffed to handle 10 million people,'' he said.
Even those eligible for Medicare didn't bother to enroll in that program. ``The military told them they didn't need it _ `You have the military''' Olanoff said.
With the massive influx, officials slotted people into eight distinct Priority Groups _ or categories _ defined by various factors, including length of military service, income, origin and severity of health problems.
The Secretary of the VA has the power to curtail enrollment in any category at any time, Olanoff warned.
What happened after 1996's open enrollment still happens today, he said. ``The waiting periods became horrendous ...
the backlog was tremendous.''The primary reason is VA medical center doctors insist on a complete workup before prescribing medication, even if they have paperwork from a non-VA physician, he said.
``They have safety concerns, and they don't want to be sued for bad drug interactions, quite frankly.''Most people do not understand the boundaries of care within the VA system, Olanoff said. ``Service-connected'' includes injuries and illnesses that can be tracked to occurring or originating while the patient was in uniform.
Over time, VA rules and laws have changed when medical conditions have been proven to be linked to military service.
Agent Orange exposure in Vietnam is a case in point, Olanoff said. Soldiers who were exposed to it are found to have higher incidences of diabetes as a result of the toxin sprayed to defoliate trees to better reveal enemy troops.
``It took years for the government to own up about Agent Orange'' and begin shouldering the costs of treating its symptoms, Olanoff said. ``We have a whole bunch of dead Vietnam vets who didn't get a dime.''WWII veterans had their own war-related issues. For example, beriberi, a vitamin deficiency disease that can damage the heart and nervous system, was contracted by many prisoners of war because of poor diet, Olanoff said, adding that other illnesses have been traced to the extreme stress POWs were under.
The agency has done its homework about how soldiers are impacted by the environment they were in and the dates relevant to it, said Olanoff. ``You can't just go back 20 years before that date and claim something.''
Service-connected health issues are treated at no cost for veterans, no matter what their circumstances, he said.
Nonservice-connected health problems include symptoms of aging and issues that evolve from lifestyle.
Those are not guaranteed VA medical treatment, nor should they be, Olanoff believes.
``The Retired Enlisted Association doesn't believe every vet should get (free) health care,'' he said. ``It was never intended to be that way.''The soldiers returning from Iraq are granted two years of health care at government expense, giving them time to file claims and get decisions on them, Olanoff said.
While he can appreciate the reasoning, ``this will overload the system,'' he said. Unlike after WWII, this generation will be able to obtain information and spread the word via Internet, virtually ensuring every Iraq War veteran goes in for evaluation, Olanoff believes.
With an estimated 30 percent returning from this war with signs of Post Traumatic Stress Disorder, the VA has underestimated _ again _ the number of people who are going to be using its system, he said.
Olanoff said it is fortunate President Bush pushed for increased spending for veterans, but even more so that the Senate recognized his figures were not high enough, asking for another $23 million to be tacked on.
The House of Representatives, which will have final vote, believes $21 million more will be sufficient, Olanoff said. ``But it's clearly more than the president asked for.''