The Bolduc Brief: Military Leaders and Congress Negligent in Providing Care to Service Members and Veterans

Introduction:

Military senior leaders continue to fail our service members when it comes to ensuring their mental, physical, and spiritual health is taken care of due to combat and training injuries. The same can be said for the Department of Veterans Affairs and all federal departments that have anything to do with the post-service welfare of our service members and their families. The U.S. Congress in both houses and on both sides of the aisle are also negligent in ensuring that the federal departments do their job efficiently and effectively for our veterans. Less than 18% of Congress has military service of some type. https://www.pewresearch.org/short-reads/2022/12/07/new-congress-will-have-a-few-more-veterans-but-their-share-of-lawmakers-is-still-near-a-record-low/. The Secretary of the VA is not a veteran. He loses credibility with veterans because he is not a veteran. Veterans have grown weary of elected officials and political appointee non-veterans, thinking they know what veterans and their families need.      

The lack of oversight at the senior levels and the ineffective bureaucracies have created a situation that has negatively impacted the health of our service members, veterans, and their families. Those working at the lower levels of the bureaucracies do their best to help our service members, veterans, and their families. The fault lies in the senior levels due to political, bureaucratic, and organizational ineffectiveness.

The promise to our service members, veterans, and their families have not been met since the inception of veteran affairs. Nearly every member of Congress, the President, and senior federal leaders have as their platform the care of our service members, veterans, and their families. So, why are we having substantial problems with healthcare transition, suicide rates, homelessness, jobless rates, and incarceration?

The establishment of the Veterans Administration came in 1930 when Congress authorized the President to “consolidate and coordinate Government activities affecting war veterans.” The three component agencies became bureaus within the Veterans Administration. In 1988 the Veterans Administration became the Department of Veterans Affairs. President Ronald Reagan elevated the VA to a Cabinet-level executive department on October 15, 1988.

The Department of Defense’s responsibilities for our service members and their families are clear-cut, based on tradition, and the responsibility of military leaders. Then, why do they continue to fail our service members and their families? Contrary to Department of Defense statements, the DOD ensures our veterans and their families are cared for. DOD responsibility does not end when the service of the service member completes their military service obligation or retires.

One of the most significant issues is that the Department of Defense and the Department of Veterans Affairs continuously fail to coordinate and transfer records to ensure our veterans have a seamless transition into civilian life. Military senior leadership, veteran affairs senior leadership, appointed civilian oversight, and Congress continuously pat themselves on the back for all the programs they have made available to service members, veterans, and their family members. Unfortunately, the programs are poorly executed inside these political and bureaucratic entities.

It is important to understand that a service member serving in one of the five branches of our Armed Forces, either on active duty, the national guard, or the Reserves, falls into the following veteran categories: disabled veterans, recently separated veterans, campaign badge veterans, and armed forces service medal veterans when they transition to veteran status. Researching the quality of care of our service members, veterans, and their families is challenging. The problem is the political and organizational bureaucratic spin on making alarming statistics look good. It is not uncommon for the government to put lipstick on a pig to make themselves look better. There is a program for everything, and you can’t swing a dead cat without hitting a program or band-aid legislation. The first thing political, military, and veteran administrations promote is the programs, legislation, and money in place. The problem with this top-down approach is that at the bottom, the veteran, the service member, and their family continue to receive inadequate services because of a broken bureaucratic system.

After 33 1/2 years of military service, participating in our nation’s most demanding training and combat operations has taken its toll on my health. I will highlight a few health challenges resulting from a lifetime dedicated to being a Soldier. My Eighty-one months serving in designated combat zones around the world did take a toll on my health. The physical and mental experiences of war have consequences that many in our society do not understand. After thousands of hours of training and deploying to the most environmentally unsafe places in the world, I have experienced health issues that many in our society cannot relate to. I have had a bilateral hip replacement from a bomb blast in Afghanistan and three disks in my neck replaced from a helicopter crash in Afghanistan.

My diagnosis of posttraumatic stress and two traumatic brain injury treatments have lifelong challenges. I have had more than 500 jumps out of numerous types of aircraft, numerous repelling, and fast rope repetitions out of Blackhawks and chinooks taking its toll on my body. I have traveled too many miles to count under an 80-to-100-pound rucksack in the mountains, cold weather, desert, jungle, and other environments. I have experienced challenges with the bureaucratic system, but overall, I am grateful for the healthcare I received in the military and the healthcare I received as a veteran. I am thankful for all those that work hard to ensure our service members and veterans have the care they need. Unfortunately, this is not a universal opinion and experience of all our service members, veterans, and their families. In the five years that I have been retired, I have met many service members and veterans that have yet to receive the proper healthcare, and looking at the statistics on healthcare, we need to catch up big time.

Discussion:

Instead of service members and veterans having quality health care in common, they, unfortunately, have inadequate treatment in common. I consider service member, veteran, and family suicide the rock-bottom response to a failing system. The fact that it is so indicates the failure of the medical and mental health approaches. According to the CDC, suicide was the second leading cause of death for people ages 10-14 and 25-34 and among the top 9 leading causes of death among people aged 35-44, 45-54, and 55-64. In 2020, nearly 46,000 suicide-related deaths occurred while many more people thought about or attempted suicide – critical risk factors for future suicide.

Among Veterans and non-Veterans alike, mental health and substance use are significant contributors to suicide risk. Still, CDC data show that there are also other important risk factors to consider when implementing prevention strategies. Economic insecurity, housing insecurity, isolation, and stress contribute to suicide.

In my opinion, The CDC’s comprehensive strategy to prevent suicide is another bureaucratic approach that will not impact the reduction of suicide. The Department of Defense and Veteran Affairs is implementing the CDC’s approach. Until there is real progress in both those departments by the senior leadership to effectively deal with suicide issues among our service members and veterans, nothing will be accomplished. https://www.cdc.gov/washington/testimony/2022/t20220615.htm

Some generations get benefits others do not get. The most egregious is to our Vietnam veterans. Our most recent veteran service era continues to receive inadequate services. The most frustrating experience for our veterans is navigating the system. The Veteran Affairs website reports that 75 percent of all initial applications for VA benefits are denied. As of June 2021, the average time for the VA to issue a decision on VA benefits is 134.4 days. If your application is rejected and you want to complete the appeals process, it will take approximately 125 days for a Supplemental Claim or Higher-Level Review and more than one year for a Board Hearing. According to the Department of Veterans Affairs, the most recent data I could find, over 623,000 pending claims and 154,000 rating-related claims are backlogged. There were 155,769 backlogged claims in the legacy appeals system.

Since 9/11, military suicides dwarf the number of soldiers killed in combat. The research, compiled by the Costs of War Project at Brown University, found an estimated 30,177 active duty personnel and veterans who have served in the military since 9/11 have died by suicide, compared with 7,057 killed in post-9/11 military operations. The figures include all service members, not just those who served in combat during that time—the size of three U.S. Army Divisions worth of men and women have committed suicide (https://www.nbcnews.com/news/military/9-11-military-suicides-dwarf-number-soldiers-killed-combat-n1271346).

According to a report published by the United States Department of Veterans Affairs (VA) in 2016, which analyzed 55 million veterans’ records from 1979 to 2014, the current analysis indicates that an average of 20 veterans die from suicide daily. In 2020, adjusting for population age and sex differences, the suicide rate for Veterans was 57.3% greater than for non-Veteran U.S. adults. What Increases Risk for Military Suicide? Studies show that military personnel are more likely to make a suicide attempt or die by suicide if they are experiencing intense emotional pain. This includes depression and trauma (such as posttraumatic stress). https://www.apa.org/monitor/2022/11/preventing-veteran-suicide, https://www.military.com/daily-news/2021/04/05/military-deaths-suicide-jumped-25-end-of-2020.html. The treatment of mental health issues of our service members becomes even more critical before they become veterans. Failing to address this on active duty will only exacerbate the problems for veterans and their families. 

Another problem for service members and their families on active-duty struggle is feeding their families three meals a day. This has enormous consequences for the stability of military families. Likewise, our veterans struggle with putting food on the table, homelessness, and joblessness https://www.csis.org/analysis/solving-food-insecurity-among-us-veterans-and-military-families, https://responsiblestatecraft.org/2022/06/08/why-are-military-families-struggling-to-put-food-on-the-table/. To me, this is a national embarrassment. Those who serve our country should not struggle to feed their families. 

There are many challenges that veterans face after they leave the military. Unemployment, relationships with themselves, Homelessness, Physical Handicaps, unresolved Mental Health issues, and addiction impact the high incarceration rates. They may face health problems, employment issues, and struggles around accessing their benefits—immediately after service and in the years to come. Challenges Veterans Face When Leaving the Military.

There are over 630,000 homeless people in America. Sixty-seven thousand four hundred ninety-five are veterans. It amazes me that in today’s society, over 1 in 10 homeless people in America are veterans. There are various reasons for such a large percentage of the homeless being veterans. The U.S. Department of Veterans Affairs estimates that 131,000 veterans are homeless on any given night, and approximately twice that many experience homelessness over a year.

High veteran unemployment could be caused by poor health, selection, employer discrimination, skills mismatch, or job search. Research shows that 43% of veterans leave their first civilian job within their first year, and 80% leave before the end of their second year, citing a lack of opportunity for career advancement and personal development. https://www.rand.org/pubs/research_reports/RR284.html

The unemployment rate is exacerbated by a poor transition from the military and getting lost in their transition to being a veteran. Another huge problem is veteran incarceration. Let me be clear; if a veteran breaks the law, they need to be punished by the law. However, the point I am making here is that their incarceration may be due to a failed veteran support system. More than 180,000 veterans are incarcerated in the country’s jails and prisons, according to the most recent available data, which is a decade old. https://www.nbcnews.com/news/crime-courts/commission-will-study-veterans-are-likely-non-veterans-get-trouble-law-rcna44326 One in three of the nation’s 19 million veterans report having been arrested and jailed at least once, and more than 181,000 are behind bars. Former service members comprise nearly 8% of those in state prisons and 5% of the federal prison population. I suggest that the DOD and the VA must re-look at the systems and processes that contribute to the high incarceration rates of veterans.    

After looking at this problem for over five years, the root cause of the difficulties for healthcare with our service members, veterans, and their family members is ineffective leadership. Fixing these problems requires the direct involvement of senior leaders. Another program, more money, and more legislation will not work. It is time to stop using our service members, veterans, and their families as political pawns and fix the systemic problems within the bureaucracy.

Conclusion:

Since 2015, as a general officer, on active duty and in retirement, I made public my struggles with posttraumatic stress and traumatic brain injury. This was the beginning of a roller coaster journey that, on the one hand, was positive and, on the other, very negative. I intended to drive change inside an organization failing service members and their families. At Special Operations Command-Africa, as the Commanding General, we created a very effective program dealing with physical, mental, and spiritual health. https://www.nytimes.com/2016/10/08/world/africa/donald-bolduc-ptsd.html 

This program directly addressed and treated our service members for their physical, mental, and spiritual health issues. I did it alongside my service members. I protected the service member and ensured they got their treatment. Suicidal ideations were reduced, and alcohol and drug incidents were significantly reduced. Sexual harassment in the workplace was reduced to ZERO.

Most importantly, confidence in leadership was at an all-time high. When the service member and their family trusted their leadership, they went for help. When the leadership cut through the red tape, the service member went for help. As a veteran, Sharon (my wife) and I have continued to try and make changes to improve the care of our service members, veterans, and their families. We volunteered to support veteran organizations. We shared our struggles to bring hope to others. We traveled the country to speak at events to promote awareness. We assisted hundreds of veterans in working through the complicated VA system. We spent time on the phone and met in person with veterans considering suicide. I ran for the US Senate in New Hampshire to fix the VA system and hold DOD accountable for caring for our service members, veterans, and their families as a critical tenet on my platform. Sharon and I did not point fingers; we tried and continued our efforts to make a change. 

While the VA is rooted in noble intentions, it has been plagued with problems for years. The VA has faced reports of excessive and contradictory spending, allegations of inadequate health care, a massive backlog of benefits claims, and top leadership that cannot make the right changes. https://www.americanprogress.org/article/challenges-facing-department-veterans-affairs-2021/

In the past decade, DOD has experienced many of the same challenges confronting the nation’s healthcare system–increasing costs, uneven access to healthcare services, and disparate benefit and cost-sharing packages for similarly situated categories of beneficiaries. DOD is also facing unprecedented problems with suicide, divorce, alcohol and drug issues, and increased sexual harassment in the workplace. DOD has committed tens of millions of dollars to research how to deal with these issues effectively.

The latest study lists the top five leading causes of death in the US Military as suicide, transport deaths, other accidents, combat, and cancer. https://top5ofanything.com/list/17336211/Causes-of-Death-in-the-United-States-Military A 2023 DODIG report lists its number 6 priority as protecting the health and wellness of service members and their families. In the report, DODIG describes providing for the health and well‐being of Service members and their families as critical to recruitment, retention, readiness, and bolstering trust and confidence in the DoD. The DoD must ensure adequate healthcare personnel staffing and provide comprehensive care to women in deployed and non‐deployed settings. The DoD must also work toward eliminating the stigma surrounding mental health and substance abuse care and reducing Service member suicides. Additionally, addressing healthcare matters that impact women may affect how long women stay in the military or whether they volunteer to join. https://www.dodig.mil/reports.html/Article/3219066/fy-2023-top-dod-management-challenges/ After reading the report, I conclude that the status quo with remain in effect, and suicide will get worse. 

The Heritage published a report on military readiness. The findings should concern all Americans. I was not surprised by the findings. As currently postured, the U.S. military is at growing risk of being unable to meet the demands of defending America’s vital national interests. It is rated as weak relative to the force needed to defend national interests on a global stage against actual challenges in the world as it is rather than as we wish it were. This is the logical consequence of years of sustained use, underfunding, poorly defined priorities, wildly shifting security policies, exceedingly poor discipline in program execution, and a profound lack of seriousness across the national security establishment, even as threats to U.S. interests have surged. https://www.heritage.org/military-strength/executive-summary

Despite the efforts of the DOD to better understand the barriers to care that service members face regarding mental health diagnoses and treatment, DOD continues to have a huge problem. This problem is increasing and not decreasing. Despite the benefits of seeking mental health care, approximately 60-70 percent of military personnel who experience mental health problems do not seek mental health services. Studies show that the service member does not trust the medical mental health system. The service member believes they will lose their job and clearance and suffer career-ending consequences. Failure at the senior civilian and military is the problem. Blaming subordinates, failing to take accountability and responsibility, and leading by example are wrong and will not fix the problem. 

Policymakers need to know that their failure to hold federal departments and agencies accountable and responsible for their failures is their failure. This has resulted in an inefficient and ineffective bureaucratic system that cannot provide physical, mental, and spiritual care to our service members, veterans, and their families.

It is time for a change, but unfortunately, service members, veterans, and their families continue to hear this clarion call only to experience “No Change.” They do not believe it, and this has had dire consequences. Everything will remain the same if we elect the same people, appoint the same people, and fail to hold them accountable and responsible for their actions. There is plenty of money, enough programs, and enough people that want this fixed. Yet, we continue to fail our service members, our veterans, and their family members. 

Donald C. Bolduc