DAYTON -- The Department of Veterans Affairs spends more today in inflation adjusted dollars than it did after World War II and the Vietnam War, when millions of troops returned from the battlefield, according to federal budget figures.
By the next fiscal year, the VA budget is projected to rise 58 percent since 2009 to $152.7 billion, more than double the $70.9 billion spent in 2005, agency figures show.
At the Dayton VA, spending has risen to a projected $285.3 million this year compared to $131.2 million in 2001.
Two factors more than any others have driven health care costs higher at the Dayton VA Medical Center, officials said. Aging Vietnam veterans who have more health needs as they grow older, and the return home of thousands of veterans from the battlegrounds of Iraq and Afghanistan.
"It's the number of veterans returning from the war, but it's also the conditions they are returning with," said Dr. William J. Germann, Dayton VA chief of primary care service and a retired Air Force brigadier general. "There are a number of veterans coming back dysfunctional and as a result may not be able to hold a job."
Straining under the national debt, budget cutters have slashed billions in federal spending and ordered unpaid furloughs of hundreds of thousands of Department of Defense civilian employees, but the VA's spending has more than doubled in little more than a decade and keeps climbing.
"It's a tricky issue because you want to make sure we are keeping our compact with men and women who have served and been in harm's way ... but you also recognize we're not doing those men and women a service if we're not spending that money wisely," said Stephen C. Ellis, vice president of the non-partisan Taxpayers for Common Sense in Washington, D.C., and a former Coast Guard officer.
'Overwhelmed' with new claims
The more than 3 million veterans since the first Gulf War in 1991 who have entered the VA ranks have overwhelmed the system, said Dr. Chrisanne Gordon, a Marysville rehabilitative physician.
"I do feel the system is overwhelmed," Gordon said. "I would say overwhelmed and slow to respond."
She's worked with the Dayton VA to link Iraq and Afghanistan veterans to civilian medical centers. The mostly teaching hospitals have advanced technology to detect traumatic brain injury a normal MRI does not locate, she said.
"I really believe there needs to be collaborative effort between VA and the civilian medical community," she said. "My belief is in the civilian world we are more accountable and we react quicker."
The number of veterans and visits have climbed dramatically at the Dayton VA and community clinics in Springfield, Middletown, Lima and Richmond, Ind.
Both figures show why costs have jumped.
Five years ago, the VA treated 32,858 veterans who accounted for 360,946 visits at a cost of $588 per visit. Under Dayton VA projections, those numbers will rise to 36,691 veterans making 470,151 visits at a cost of $607 per visit.
"This has never happened before so the workload has increased exponentially," said Margaret I. Kruckemeyer, a retired Dayton VA nurse practitioner and former president of the Nurses Organization of the VA, a national advocacy group. "You are going to have issues and all of our people who have served their country especially in war zone, come back with scars. ... You never have a veteran with a pure problem. They have a multitude of problems, and that's costly."
Kruckemeyer said the nation has an obligation to meet the health care needs of veterans who risked their lives in combat.
"If we spend trillions of dollars to send our men and women who volunteer to do whatever Congress tells them to do on behalf of freedom, then they come back wounded and you can't see some of the scars, it just seems like there's a disparity," the former Army nurse said.
Her husband, William C. Kruckemeyer, was a helicopter pilot in Vietnam. Today, the Beavercreek couple said, he lives with the legacy of exposure to the herbicide Agent Orange, which was sprayed by U.S. troops throughout Vietnam.
His health has worsened because of auto-immune related conditions that have affected four major organs. Kruckemeyer, who uses a wheelchair, has had extensive treatments at the VA.
"I was fortunate enough to have my wife as my advocate so I could get in and move around" the VA health system, he said. " ... I could see where a fellow or a gal who has come back and has not had the benefit of somebody that knows the ropes and where to go and how to get there, that can be a real problem."
Christopher P. Wilson, of Bellbrook, is one of the new veterans who has come to the Dayton VA from the battlefield. The 27-year-old served as an Air Force machine gunner on a Humvee at Camp Bucca in Iraq where he lived through mortar and IED attacks.
Since the military police officer left the Air Force last November, he said he's sought treatment at the Dayton VA for PTSD, anxiety and depression. Before he left the Air Force, he was diagnosed with post-traumatic stress. But he had to wait a year for the VA to reach the same conclusion, he said.
"I went to the VA and the doctor basically told me without a diagnosis from them the military diagnosis means nothing," he said. Today, he receives counseling, but expressed frustration over the four months he said it took to schedule a medical appointment to change a prescription.
Like many other veterans, he's also waited months on a VA disability claim filed with the Veterans Benefits Administration regional office in Cleveland. The married father of two young children is enrolled in business college courses and looks for work.
"It puts a lot of stress on the family going just from being in the military and getting out to being on deployment to trying to find work," he said. "It would be nice to have the extra money. My wife is having to work now and I'm trying to find a job and juggle day care."
The homefront cost of war
Despite the rising costs for the VA, U.S. Sen. Sherrod Brown, D-Ohio, said spending on veterans' needs has bipartisan support in Congress.
More veterans today have arrived home with injuries that soldiers died from in past wars, they're receiving more costly and sophisticated care and the rise in veterans' claims for exposure to Agent Orange have pushed costs upward. But the expense is justified as long as the Veterans Benefits Administration makes progress to reduce a claims backlog, he said.
"I think (the cost) can be sustained because I think it needs to be," he said. "... We can't be penny wise pound foolish on this."
While much of the federal government hasn't escaped budget cuts, U.S. Sen. Rob Portman, R-Ohio, said the decision to exempt the VA from the budget sequester was "the right one."
"We need to have every VA employee on deck to serve our veterans," he said in a email in response.
Still, he said, while the priority on veterans' spending was justified, "some of this funding could be spent more efficiently. We need to focus on that as we work to solve the VA's challenges and that effort will only become more critical as the VA's budget continues to feel the pressure of our unsustainable debt and deficit."
U.S. Rep. Mike Turner, R-Dayton, voted against the sequester and also opposes imposing it on the VA. "Exempting the VA from the effects of sequestration is necessary to ensure veterans and their families continue to receive the services, care, and the assistance that they have earned and deserve," he said.
The Dayton VA has hired new staff, bought medical equipment, and expanded programs to treat returning veterans for post-traumatic stress disorder, traumatic brain injury and expand mental health care services, among other priorities. It opened a women's health care center to treat the fastest growing segment of veterans, according to Dayton VA Medical Director Glenn A. Costie.
The Dayton VA plans to open a new multi-million dollar magnetic resonance imaging (MRI) machine to meet demand. They've also focused on housing homeless veterans, another VA priority.
Rising costs peak
In 1947, two years after the end of World War II, the VA spent a post-war high of $87 billion, according to a Congressional Research Service report released last year. VA spending reached a post-Vietnam peak of $76.9 billion in 1976, the research service said. Both budgets were adjusted for inflation and compared to 2011 dollars.
This fiscal year, the VA will spend $138.5 billion. That number includes $66.4 billion in entitlements, such as disability pensions, and housing vouchers, and an expected $61 billion in discretionary spending on health care, among other areas.
"Spending on veterans' benefits and services has certainly grown at a much faster rate than other areas of the budget," Todd Harrison, a senior fellow at the Center for Strategic and Budgetary Assessments in Washington, D.C., said in an email. Congress sets veteran benefits based on formulas that don't require annual appropriations. "These benefits are an entitlement for the people who qualify, and the spending is essentially on autopilot. To change the level of spending, Congress would have to change the criteria for determining who qualifies and what benefits they will receive."
VA spending will keep rising, he predicted. "I don't think it is likely Congress will make substantial reforms in this area of the budget due to the political consequences involved," Harrison wrote. "No one wants to be seen turning their backs on veterans, especially as the military is winding down two protracted wars."
Kimberly Frisco, a Dayton VA spokeswoman, said the VA has a two-year budget, and the agency can't predict what might happen to spending after 2014.
VA accountability on spending
Even so, Congressional critics have demanded more accountability from the VA with the surge of cash.
The VA nationwide has been subjected to congressional criticism for lavish spending on conferences, bonuses given to some VA senior executives a congressional critic contended weren't linked to performance, and a persistent claims backlog that has bedeviled the Veterans Benefits Administration.
"VA doesn't have a money problem," said U.S. Rep. Jeff Miller, chairman of the House Veterans Affairs Committee, said in a statement to this newspaper. "It has a management problem. Whether it's funding, staffing, or information technology tools, Congress has given the VA everything it has asked for to overcome perennial challenges such as its mountain of backlogged disability benefits compensation claims. ... For its part, VA has failed to deliver the backlog results department officials have been promising for years."
Despite record VA spending on medical and mental health care, the agency has struggled to "curb the epidemic of veterans suicides and to stop the emerging pattern of preventable deaths and serious patient safety issues at VA medical centers around the country," Miller said.
"But perhaps there is no better illustration of VA's management failures than the department's ongoing executive bonus scandal which calls into question whether VA leaders even know the meaning of the word accountability," Miller said.
Miller's website pointed to a Dayton VA case involving unsanitary practices at the dental clinic, among other cases across the nation: Former Dayton VA Medical Center Director Guy B. Richardson collected an $11,874 bonus in 2010 while the center's dental clinic was under investigation for unsanitary practices by a former dentist over 18 years, the Dayton Daily News has reported.
Costie, who took over the position when Richardson departed to another VA job, said his bonus was tied to "clear metrics" and approved through "a chain of command" of higher-ranking managers who evaluated his performance. Costie was paid a total of $186,829, including a $10,380 bonus, through late August, according to data released under a Freedom of Information Act request.
The claims backlog has brought focused criticism from Congress, even as the agency has reported progress to reduce the problem.
VA spokeswoman Nicole Alberico noted the agency completed a "record-breaking" 1 million claims in each of the past three years, but the number received continues to exceed what's processed. The VA has a goal reduce the number of claims beyond 125 days to zero by 2015 with a 98 percent accuracy rate.
House Speaker John Boehner, R-West Chester Twp., said "more transparency and more accountability" is needed on the issue.
"While I applaud the renewed efforts to address disability claims in Ohio that have been pending more than two years, I have serious concerns that they will be just another Band-Aid covering the larger problem: the system, is broken and needs to be fixed," Boehner said.