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Treating the whole veteran

Op-ed: Treat the whole veteran, VA, not just parts of him.

A proposal for reforming veterans health care under discussion would limit the mission of VA health care facilities and clinics to focus only on service-related injuries and illnesses, rather than the overall health of veterans. While this may sound reasonable, unfortunately, for many veterans — especially disabled veterans — such a plan could lead to lower quality of care and worse health outcomes.

Should this proposal become law, VA doctors could only treat one very specific aspect of a veteran's medical needs. For any other health condition not directly caused by military service, the best the doctor could do is refer the veteran to the private sector to seek treatment on their own. That is not quality care.

Best practice in medical care is coordinated care that treats the whole patient within an integrated health care system; it is holistic and preventive, not piecemeal and cafeteria-style. That's why over two decades ago the VA health care system evolved from primarily providing specialized in-patient care to becoming a full-spectrum provider.

Under the cost-cutting proposal to keep VA care limited to conditions caused by military service, veterans could make an appointment at VA for treatment of conditions caused by military service, but would be forced to find private providers for every other medical issue they experience. For example, a veteran seen at VA for PTSD or amputations could not be treated for related conditions such as depression or diabetes. That is the very definition of fractured health care. And the result will be little or no coordination of care, more over-treatment or under-treatment for medical conditions, and, ultimately, poorer health care outcomes for veterans.

Furthermore, if the number of veteran patients seen by VA doctors drops there is a corresponding drop in the development and maintenance of professional skills that doctors and clinicians need to provide quality care. This would inevitably lead to hospitals and clinics having to cut back on the number of services they offer due to either quality or cost concerns, and some VA hospitals and clinics would likely have to close because they no longer had the critical mass of veteran patients needed to maintain a safe, high-quality facility. For disabled veterans who rely on the VA, the result would be longer travel or waiting times to find VA care that they have earned and deserve. That's simply not acceptable.

The answer to ensuring veterans have timely access to VA care is not to reduce the number of patients in the VA health care system. Instead, VA needs to realistically assess the services and needs of veterans in each community to ensure that its resources are properly aligned when and where needed. This will require better strategic planning and budgeting processes and new accountability systems, such as an independent audits to ensure money is wisely spent to deliver quality care to veterans.

The men and women who served this country deserve the highest standard of care, and that means treating the whole veteran, not just a legally defined set of service-connected conditions. That's why Disabled American Veterans (DAV), representing nearly 1.3 million veterans of all generations, is setting the record straight on this and other simplistic ideas that would be bad for veterans.

Garry J. Augustine, a Vietnam-era combat-wounded Army veteran and Maryland resident, is executive director of DAV's Washington Headquarters. His email is

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