PROVIDENCE, R.I. [Brown University] —In recent years, public understanding of military veterans’ needs has been shaped largely by reporting on post-traumatic stress disorder, traumatic brain injuries, suicide rates and poor conditions at the Walter Reed Army Medical Center. But for the great majority of the veterans of post-9/11 wars, a persistent and profound need is for the social services that will help them transition back to civilian life.
That is the assessment of the newest study by the Costs of War project based at Brown University's Watson Institute for International and Public Affairs, which uses research to create dialogue about the human, economic and political costs of the post-9/11 wars in Iraq and Afghanistan and the related violence in Pakistan and Syria.
In the new Costs of War study, “US Military Veterans’ Difficult Transitions Back to Civilian Life and the VA’s Response,” Anna Zogas, a researcher at the University of Washington, focuses on the difficulties the newest generation of post-combat veterans face as they reintegrate to civilian life. The study surveys research on veterans’ transitions to assess data, reveal patterns of need and review the U.S. Department of Veterans Affairs (V.A.) response to those needs.
“From changing residences and finding jobs to securing educational and vocational training and settling back in with family, veterans face post-war difficulties that are costs of war not easily captured in health care spending totals or in the epidemiology of combat-related health problems,” Zogas said.
She found that the V.A., the nation’s largest integrated health care system, changed its policies to better assist veterans and more than doubled spending between 2002 and 2015 on programs related to employment and education, two top areas of need according to veterans.
Zogas emphasized that the non-medical services the V.A. provides in tandem with health care are key to helping veterans leave the “disciplined, rigid, high-stakes environment” of the military and reintegrate with family, find work, pursue education and navigate a daily routine that is no longer predictable, orderly and mission-focused.
“Distinguishing strained social relations from specific medical problems is important because how we define problems shapes our efforts to solve them,” Zogas wrote in the study.
Enlisted service members who fought in post-9/11 wars have been leaving the military at a rate of roughly 250,000 each year, the study reports, and the Department of Defense estimates that this rate will remain at 230,000 to 245,000 per year through 2019.
The difficulties veterans have in easing back into civilian life correlate with age, education level and work experience — and many of these veterans are young and lack a college degree. The study reports that in 2008, the year in which the highest concentration of U.S. troops deployed overseas, 41 percent of service members were 25 years old or younger, and only 18 percent had a bachelor’s degree.
This means that hundreds of thousands of young post-combat veterans leave the military each year, many of them without established careers to which they can return. Those who enter a college or vocational program may be older than traditional students and may have families to support.
Zogas found that between 65 percent and 80 percent of veterans surveyed between 2014 and 2016 left the military without a job lined up. The study cited interviews with case managers of a career services program who suggested veterans have unrealistic expectations of employment options and salaries in the civilian job market. Although they are highly motivated to work hard and move up corporate hierarchies, Zogas wrote, veterans were frustrated by having to start in low-paying, entry-level positions and many reported feeling like they were starting over completely.
Young veterans also report social difficulties with greater frequency than the rate at which they are diagnosed with specific mental health concerns, Zogas said. In 2008, 96 percent of a group of post-9/11 combat veterans surveyed reported that they were interested in receiving services to ease “community reintegration problems,” even though they were already using V.A. primary care or mental health services.
More recently, Zogas wrote, in studies published between 2014 and 2016, veterans of the post-9/11 wars reported adjustment difficulties at rates between 61 percent and 68 percent. Even without the most troubling health issues, such as traumatic brain injuries or PTSD, many post-combat veterans contend with physical and mental health concerns — from musculoskeletal ailments to mental disorders, insomnia and headache — that can make reintegrating with family and succeeding in school and work difficult, the report found.
The V.A.’s response to a new generation of veterans
Before 2008, veterans were required to secure official recognition of combat-related disabilities before they could receive free medical treatment, Zogas reported. That year, the V.A. streamlined this process, allowing all veterans the ability to start receiving free care immediately.
That change cut down on red tape, Zogas said, making it possible for veterans transitioning into civilian life to receive supportive services — from group to individual counseling and educational support — without a prior medical diagnosis. It also accounts for the possibility that some combat-related symptoms take months to fully manifest, which Zogas said signals a new responsiveness to the need for services that aid veterans in adjusting to civilian life.
In addition to ensuring that veterans are more easily able to access medical care, the V.A. increased spending on programs related to employment and education from 3.6 percent of total spending in 2002 to 8 percent by 2015, according to the study.
V.A. services for recent veterans include training in study skills, strategies for improved sleep, financial management, parenting and services that help reduce veterans’ feelings of social isolation, such as outdoor activities organized by recreational therapists.
“In some cases, this support takes shape through formal programming, such as parenting classes run by psychologists inside V.A. clinics,” Zogas wrote, or classes that help veterans prepare to participate in college classes. Zogas cited “an eight-week course, wholly designed and taught by V.A. therapists in a V.A. clinic, in which a ‘class’ of post-9/11 veterans sat together in a conference room for two hours a week, learning about cognition and memory in a way that mimics a college classroom.”
These kinds of programs can help veterans prepare to acclimate to college classrooms that will likely be populated by 18- to 22-year-olds, the study noted.
“In a college or university, the concerns of traditionally aged students can seem trivial to people with combat experience, making it difficult for veterans to relate to their peers,” Zogas wrote. “Less than 0.5 percent of the country’s population is serving in the military at any time, and post-9/11 veterans are a minority among their peers and families.”
The V.A. also provides vocational rehabilitation, including support for apprenticeships and on-the-job training, post-secondary training at a college, technical or business school, and supportive case management, Zogas wrote.
She said that V.A. spending on rehabilitation and investment in veterans’ education and job training is not a cost of war in the strictly financial sense but that it represents an effort to address the day-to-day difficulties veterans returning to civilian life face.
In addition to formal vocational rehabilitation programs and the G.I. Bill, V.A. clinicians provide services tailored to young veterans’ non-medical needs within the relative isolation of their own clinics, Zogas said. This makes it almost impossible to gain a top-down perspective on how the institution and its operations help veterans transition back to civilian life.
“The V.A. has moved toward institutionalizing meaningful support for ‘transitions,’” Zogas said. “If recent projects under V.A. Secretary Robert A. McDonald’s strategy for improving the organization materialize into formally organized, meaningful, sufficiently funded and sufficiently researched programs to assist veterans in their transitions, it would be a step toward taking veterans’ own stated post-military social, educational and employment needs as seriously as the military takes their training.”
Anthony Hardie, Director of Veterans for Common Sense, agreed with this assessment. “While today's VA provides key medical, educational, and other services to help our returning veterans, adapting to and overcoming these interconnected challenges is more complicated,” he said. “More modernization of the VA is needed to more fully meet the interwoven medical, economic and other challenges faced by our transitioning war veterans.”