After the fighting

With Virginia already eighth in the nation in the number of veterans living here, the commonwealth can expect that number to increase by more than 50,000 in the next 20 years, according to the Virginia Department of Veterans Services.

The increase is expected to put a strain on long-term care for veterans.

According to a Veterans Administration estimate earlier this year, 807,326 veterans were living in Virginia as of September 2007, with an estimated 23.8 million veterans nationwide.

Studies from DVS show that Virginia needs at least three more care centers and one more veterans cemetery, but that was before new VA models forecast the number of state veterans peaking at 823,348 in 2011 before making a slow decline.

Earlier this year, Virginia established the Wounded Warrior program, which is expected to be fully operational in early 2009. With budget cuts looming statewide, Virginia will be challenged to deal with the physical and psychological scars resulting from veterans’ service.

“There’s absolutely no simple answer to that,” said Anne Atkins, director of communications for the Virginia Department of Veterans Services. “There’s not one step that we can take to resolve that. It’s got to be a careful balancing of the budget, reviewing services that maybe we can eliminate that aren’t being used as much.”

Woodrow Wilson Rehabilitation Center last week concluded a conference on increasing awareness of combat stress-related issues and brain trauma injuries affecting veterans and their families.

Rick Sizemore, Woodrow Wilson director, said the goal is to connect various groups and services so that veterans have a reliable place to which they can turn.

“The Wounded Warriors network brings everybody that we can bring into the state network so that there’s no wrong door,” Sizemore said. “So the veteran walks into a church, [the pastor] knows about all the resources that are available. If a veteran walks into an emergency room, the doctor knows about all the array of services that the veteran can potentially access.”

A September 2008 Rand Corporation study noted that more than 1.64 million troops have deployed in combat in Afghanistan and Iraq since October 2001.

The study estimates that about 300,000 of those individuals suffer from post-traumatic stress disorder or major depression, and 320,000 experienced a probable traumatic brain injury.

Just under half of those who reported a probable TBI had not been evaluated by a physician. Meanwhile, about half of those with PTSD or major depression had sought treatment.

“Even when individuals received care, too few receive quality care,” according to the Rand study. According to the study, barriers to treatment included fears about confidentiality breaches and the impact on future employment. Veterans also expressed concerns about the side effects of drug therapies.

Lisa Jaycox, a senior behavioral scientist and clinical psychologist with Rand, said estimates to treat the “invisible costs” of war are “very conservative” due to other problems that occur from PTSD and depression.

“From the societal perspective, there’s a case that we should aggressively roll out the state-of-the-art treatments to as many people as possible as quickly as possible to stem the costs to society,” Jaycox said.

With conservative estimates at $6.2 billion to treat PTSD and depression in veterans over a two-year period, she said if everyone who needed treatment for those conditions received it, overall costs would drop by $1.7 billion.

“There’s a savings in terms of fewer suicides and increased productivity at work,” Jaycox said.

One-year costs for traumatic brain injury ranged from $591 million to $910 million for moderate or severe cases.

Jaycox agrees that veterans’ care will be needed from multiple agencies, not just the VA and the Department of Defense. She said the Department of Health and Human Services is also concerned about the number of veterans who will need mental health care.

“It’s a very bad time to be asking for money,” Jaycox said, “but on the other hand, it would be very prudent to invest money in treatment now because we know from Vietnam and other conflicts that the longer we wait, the more complex the problems are.”

Veterans Day

* Commemoration ceremony, 2:30 p.m.: The Fishburne Military School community will hold a commemoration on their Quadrangle, along with a wreath-laying ceremony. Lt. Col. John Epperly, who commanded the 3rd Battalion, 116th Infantry Battalion during its deployment to Iraq, will be the guest speaker.

* Car wash, 8 a.m.-6 p.m. – Car Lovers’ newest location in Waynesboro, in front of Martin’s Grocery, will be giving complimentary car washes for veterans.