Taking Care of Our Wounded Warriors

In this second inaugural address, Abraham Lincoln challenged a divided nation to "bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and orphan." This is still the operating principle of the Department of Veterans Affairs (VA), which is charged with providing veterans with health care and disability compensation. Yet over our history, honoring this commitment has been easier to say than do. A recent court decision from the federal appellate court in San Francisco holds that VA delays in mental assessments and adjudication of disability claims violate the constitutional rights of veterans. Although it would have been preferable if Congress or the president had taken action, the court was right to step in when the other branches of government did not.

The case started when a group of veterans sued the VA. They presented evidence that it takes the VA an average of four years to fully provide mental health benefits owed to veterans. Fewer than half of VA patients received same-day mental health evaluations, with some having to wait as long as two months before they got a counseling session. Even when suicidal, it can take a veteran several weeks to get a first appointment at the VA. And lawyers presented emails showing that high-ranking VA officials were aware of yet sought to keep quiet the high suicide rates of veterans under VA care. Much of this is a result of the huge influx of veterans from the wars in Iraq and Afghanistan, many of whom suffer from post traumatic stress disorder. Noting that 18 veterans a day commit suicide, the court was explicit in finding that these delays were a contributing factor to the high veteran suicide rate.

Unfortunately, mental illness is still more stigmatized and less understood than physical injuries. This is not new: it dates back to the treatment of veterans from the Civil War, where the veterans' pension system systematically undervalued mental injuries sustained in conflict. Especially at the highest levels, the VA has made admirable strides in recognizing and treating mental illnesses like post traumatic stress disorder, but its administrative machinery still has a ways to go to catch up. The increased stigma of mental illness is not unique to veterans. While laws like the Americans with Disabilities Act have broken down barriers in society for people with physical disabilities, individuals with mental disabilities are still the most discriminated against and have had the hardest time getting and keeping jobs, even when they are qualified to do so.

So what to do? Ideally, Congress or the president would step in and remedy the situation. After all, Congress created the VA, and the president oversees its administration. The court was clear that this would have been the best course. But most of these problems have been years in the making. Veteran health care, disability compensation systems, and job training programs have been relentlessly criticized for their lack of integration, chronic underfunding, and poor administration. These problems have been exacerbated by the current conflicts, which were not adequately planned and budgeted for by the federal government.

Although Congress and various presidents have paid lip service to protecting veterans, they have not exercised forceful leadership to fix these issues. The court was absolutely correct about its obligation to intervene "when the political branches have so completely and chronically failed to respect the People's constitutional rights.... The VA's unchecked incompetence has gone on long enough; no more veterans should be compelled to agonize or perish while the government fails to perform its obligations." When Congress creates rights for veterans - as it has here - and the government systematically fails to make those rights meaningful, it can and does violate the veterans' rights to due process of law.

Critics will no doubt cry "judicial activism" in the court's decision to step in, if need be, and oversee structural reform in how the VA delivers its services. Having an unelected federal judge make complex decisions in a sprawling organization like the VA is certainly not a first choice, especially in a nationwide case like this. But unfortunately, it is far too easy for the political branches of government to talk about how important it is to support veterans, while not providing the needed resources or oversight to see the job through. It is a shame on our national conscience that veterans are dying while waiting for what they have been promised. The court was right to take action.