VA calculates war's true cost, one disabled veteran at a time
By GREG JAFFE | The Washington Post | Published: May 21, 2014
WASHINGTON — It had taken a while, but Army Staff Sgt. Sam Shockley had meticulously compiled a list of all of his war wounds, including his diminished memory, only to leave it sitting in his bedroom as he went rushing off to his appointment.
There was no time to go back and grab it. He would have to do the best he could.
"We'll start from the head and work our way to the bottom," Shockley told Reggie Washburn, a Department of Veterans Affairs benefits counselor who in the next few hours would help Shockley figure out the true cost of his war. "As long as I go from head to toe I'm pretty sure I'll remember all my points."
One year earlier, Shockley, then 25, was leading his squad through a field in southern Afghanistan when he stepped on a buried bomb that shot him into the air and sheared off his legs. Now, after 40 surgeries, he had come to the small VA office in Bethesda, Maryland at Walter Reed National Military Medical Center to start the process that would determine the monthly disability payments that he'll receive for the rest of his life.
War can be a series of cold calculations: the distance a bullet travels, the blast radius of a bomb, the number of minutes it takes to reach a soldier bleeding out on the battlefield. For wounded troops leaving the military, there is one more: the price paid for a broken body, a missing limb, a lost eye, a damaged brain.
The longest stretch of fighting in American history is producing disability claims at rates that surpass those of any of the country's previous wars. Nearly half of Iraq and Afghanistan veterans are filing for these benefits when they leave the military — a flood of claims that has overwhelmed the VA and generated a backlog of 300,000 cases stuck in processing for more than 125 days. Some have languished for more than a year.
"We're not where we need to be," President Barack Obama has said of the glut, which peaked last year at 611,000 claims. "But we're making progress." The backlog has become one of several issues that have drawn the ire of veterans and lawmakers, leading to calls for the resignation of VA Secretary Eric Shinseki.
How do you solve a problem that has been called a "national embarrassment," "a mess," and yet another instance of Washington "bureaucracy run amok"? If the backlog is going to be fixed, the solution will come one soldier at a time in small offices such as this one at Walter Reed.
"So we'll start with the head portion," Shockley said. "I know I had a ruptured eardrum."
"Is that the right ear?" asked Washburn. He sat behind a metal government-issue desk with a window overlooking Tranquility Hall, the dorm where Shockley lives with his fiancee while he learns how to walk on prosthetic legs and rehabilitates his body.
"Left ear," Shockley said. "It was a perforation."
Computer keys clacked as Washburn logged the information. A big cardboard box containing Shockley's medical records rested on the floor behind Washburn's desk.
"I guess we'll move on," Shockley said. "Concussion, obviously from the blast."
He continued down his body: One of Shockley's lungs collapsed when his chest cavity filled with blood. His lower back is chronically sore. There's scarring and nerve damage on his forearm. "I don't sweat too much right there, so I guess that's an advantage," he said. There's a metal plate in his wrist. He's missing parts of his middle and index fingers. There's a missing right testicle. One leg is gone one inch above the knee and the other just below the hip.
Shockley moved on to the less visible wounds. He sometimes suffers from migraines, though they have waned in recent months.
"Is that something you want me to list?" Washburn asked.
"Might as well," Shockley said.
He has trouble sleeping most nights, he said. The heavy narcotics he was given following his surgeries wreaked havoc on his digestive system. "I have a real sensitive stomach," he said. "I have to take nausea medicine every once in a while."
"How about memory loss?" asked Washburn, thinking of the concussion from the bomb blast and the forgotten list.
"Yeah, memory loss," Shockley said. "Quite a bit of short-term memory loss."
Shockley paused and ran through his wounds one more time quietly under his breath to make sure he wasn't forgetting anything important: "Arm, finger, lung. We got the lower back," he said. He shot a quick glance down at the place where his legs used to be. "I really can't say anything about knees or ankles," he said.
"Anything else you can think of?" Washburn asked.
Shockley paused. He looked around the room, and that's when he noticed an old picture of himself, poking out of a manila folder on Washburn's desk. The photo was taken during Shockley's first Army physical, before he had shipped off to basic training.
"Can I see that real quick?" he asked.
— — —
When the picture was snapped in 2005, Shockley was still a high school senior. In it, he's staring straight into the camera. His eyes are wide open. He looks young, uncertain and scared.
"That was the start of it," Shockley said of the moment, right on the edge of all that was to come for him. He was looking at the picture. Washburn, meanwhile, was seeing where this conversation was headed. Shockley was his third interview of the day, his 25th of the month and one of hundreds that he's done since coming to Walter Reed 18 months ago.
He has seen some troops grow angry in his office as they think about how their war injuries have changed their lives. "You don't understand the frustration," railed one Marine as he talked about being unable to open his car door wide enough in a crowded parking lot to load his wheelchair. Some troops choose to laugh. "Taco Bell tonight!" joked one when Washburn told him that his missing foot and ankle would earn him an extra $101.50 a month in disability payments.
Some, such as Shockley, want to talk, turning appointments that could take 30 minutes tops into something much longer.
"I didn't know what was going on," he said, still looking at the photo. "You're like cattle, moving along the big, long lines."
"No sleep, right?" said Washburn. His voice was easy and encouraging, an invitation to keep talking.
"It didn't really get any better, but you get used to it," Shockley said. "The bad thing is that I made it past all of the lower ranks. I made it to right where life starts to get a little better in the military."
On the day he stepped on the hidden pressure plate, triggering the explosion, Shockley was walking point, sweeping the path in front of his squad with a handheld metal detector. As the most experienced soldier, he figured that he had the best chance of finding any buried bombs.
"The decision I made I'd never take it back," he said. "If it wasn't me, it would've been somebody else."
"That's right," said Washburn.
"I was probably the lightest one in my platoon," he said.
"Really?" said Washburn.
"Yeah. The lightest. If I had triggered it, everyone else would have triggered it. That's for sure," Shockley said. "So it was definitely good that it was me."
As Shockley handed the picture back, his shirt sleeve slid up his arm, revealing a tattoo of a battlefield cross — empty boots, a rifle and a helmet. He got it to honor one of his fellow soldiers.
"I would've rather stepped on it than anyone else," Shockley said, repeating something that he'd said to himself so many times over the past year that it had almost become a mantra.
Shockley had been sitting across from Washburn for almost an hour, and his lower back was beginning to throb. The incision from his last surgery, just two weeks earlier, was starting to sting. He grabbed a low-dose Oxycontin pill from the pouch hanging from the front of his wheelchair and placed it on his tongue. He didn't have any water, so he snapped his head back with a practiced jerk, and the pain pill slid down his throat.
— — —
In the year since the explosion, Shockley had come to know people throughout Walter Reed, including the military doctors upstairs who had operated on him so many times and who sometimes wondered about the lives they were now able to save. Advances in combat medicine were keeping alive soldiers and Marines who would have bled out on the battlefield only a few years earlier. Some were surviving with three and even four missing limbs. In Afghanistan, the doctors had debated whether they should even be saving these troops. What kind of lives could they lead?
Today, these doctors ask different questions: How will these veterans cope when pressure sores force them back into their wheelchairs? What will happen to their battered bodies as they age? Will they grow depressed or despondent?
In the small VA office, Shockley offered one answer. "I always think it could be worse," he said.
His list of wounds now done, Shockley rattled off a list of blessings and accomplishments. "I would say I came out of this with my head on my shoulders," he said. "I came to terms with what happened to me early on." He had served three tours of Iraq and Afghanistan and had been promoted faster than many of his peers. Most important, he had made it home alive. "That's one thing I'm glad of," he said. "I'm glad I didn't die in that hell."
Washburn finished up the last of Shockley's paperwork as Shockley talked about some of the things he hoped to do in the years ahead: Get married. Go back to school. Maybe he'd find a career in the private sector and retire at 50 to an island in the Caribbean. "That's where I want to be," he said.
Washburn nodded and then began telling Shockley about the benefits he would be receiving. He would almost certainly be judged 100 percent disabled, entitling him to a minimum monthly payment of $2,858. He'd also receive special monthly compensation. "That's something we pay above the basic monthly rates because of your amputations," Washburn said.
Special monthly compensation payments vary widely and can be tough to estimate. The loss of a single foot, hand or eye is worth $101.50 a month. Two missing legs can generate an additional payment of about $1,000-$1,300 a month. Missing arms are worth an extra $1,600-$1,800. The highest rate of disability compensation — typically reserved for veterans requiring near-constant assistance — is $8,179 a month.
Washburn passed Shockley a spreadsheet with the categories and rates.
"You know there was another thing I kind of forgot to mention," Shockley said, fumbling a bit to find the right words. "I know on my . . . We talked about the . . ." He paused and took a breath. "It was complete damage to that testicle region," he said. "One testicle made it through, but I am completely infertile."
"Okay," Washburn said.
"I can never have kids, you know," Shockley said. "I would put that down because that's big. I just recently found that out."
"Okay," Washburn said. "I can definitely add that on there."
Washburn hit print on his computer and handed Shockley the final list. Shockley signed and dated it while Washburn explained the next steps. In a couple of weeks, Shockley would be examined by a series of VA doctors who would assess the severity of the wounds on his list and compile a "narrative summary" of his condition. A VA claims processor in Seattle would review the doctors' reports, along with Shockley's military medical files, and propose a disability rating.
The entire process, if everything went smoothly, would take about six months, Washburn said. Whenever it was complete, Shockley would return to Washburn's office for one last meeting.
There, Shockley would learn exactly how much his war was worth, and the VA backlog would consist of one less soldier.
Army Staff Sgt. Sam Shockley learns to balance and walk with prosthetic legs during physical rehabilitation at Walter Reed National Military Medical Center in Bethesda, Maryland, on May 9, 2014. Shockley lost his legs and sustained other injuries to a bomb blast in Afghanistan.
MATT MCCLAIN/THE WASHINGTON POST