by Matthew Bow
Service Background
I joined the Army in March 2004. I served in the 101st Airborne Division in both my deployments in Iraq, from 2004 to 2005, and from 2007 to 2009, I also worked desk-side Information Technology (IT) support and as a secure communications specialist. I was tasked with fixing computers. As an IT guy, I have had unique experiences, whether working Operations in Battalion, or working with the Lieutenant Colonel (LTC) and Sergeant Major (SGM).
Expectations vs. Reality
I am a Veteran who has been deployed to Iraq twice. I am currently receiving my primary health and mental health care via the VA – I was promised aftercare for my combat deployments via the VA. I was expecting healthcare due to the sacrifices I and my fellow veterans had performed. The system is opaque at best, which, in turn, drives the anxiety of the patient. I was looking for clear directives and medication management that will actually help. Instead, I received care with doctors not being forthright about why I can't receive certain care.
System, Structure and Complexity
President Herbert Hoover created the Veterans Administration through Executive Order S.398 in 1930 – it was re-established as the Department of Veterans Affairs on March 15, 1989.
What makes the VA so murky is that it's a state-ran, federally-funded program. The states can add regulations to the national VA guidelines. There's no way of knowing which type of treatment options are available for you, because that information is not made public. They don't tell us the process or the reasons and it feels like they keep it intentionally opaque. This all adds anxiety in the process of getting health care, which is not helpful if you already live with anxiety, as I do.
Mobility
Since individual states have rights over the VA, they can add regulations. So, they can change healthcare policies. If you move, you have to completely restart your healthcare. You have to wait for your initial primary care doctor visit – you can't receive healthcare until you've met with the primary care provider, and that can take a long time. Your health care suffers during this time because you can't get meds, physical therapy, prosthetics, or any health care. All your health care stops once you move until you have a primary care doctor. That causes a lot of strain, mentally and physically, for Veterans trying to advocate for themselves while trying to get healthcare in the VA.
Hidden Programs
The VA's processes are so murky that it oftentimes leads to people not receiving the care that they deserve. Say you're homeless and you don't know about the HUD VASH program, which is administered jointly with the Department of Housing and Urban Development – it gets you into a house within 4-6 months. The Veteran contribution in HUD VASH goes as low as $50, but most of the time, you have to pay your portion of the rent and electricity bill, and it's all based on your disability. The VA doesn't really advertise it, though – they have their website but you have to search for things and it's not easily accessible.
Medication Access
Because of how the organization is structured, the VA fails to meet certain levels of care. You can't really research the healthcare regulation for the VA, because of the national and state-level standards, so you can't see why certain meds can't be prescribed, even if you are diagnosed with ADHD.
As someone diagnosed with PTSD, and disabled, I know I need strong meds, but I have had trouble getting the meds I need. I am also diagnosed with ADHD in the VA system, but they won't give me Adderall, because that's one of their drug no-nos. The VA overprescribed pain pills for years in the 1990s and early 2000s, according to the Wall Street Journal. According to the Wall Street Journal, the VA was even targeted by drug companies in 2009 to boost opioid sales. Afterwards, the VA also grouped stimulants as well as opioids into a new class of medications where you would need a doctor's override in order to receive medication. Stimulants and opioids are grouped together as drugs of abuse in the VA, which makes it tough to get ADHD meds.
Trust and Respect
In order for the patient to be helped, the doctor has to trust the patient. When the doctor denies you medication, despite your diagnosis, it makes you feel infantile, like you're not a full adult. Overall, you feel like you're being treated like a child. If you question the doctors a lot, some will give you an attitude. I am an expert on my body and it's the doctor's job to fix me based on self-reporting.
In the Army, I was in charge of a million dollars worth of equipment, plus personal equipment, and put into a position of trust when it came to my job, which required a security clearance. At the VA, I feel a lack of trust – like the doctors don't trust me enough to prescribe me medication. They deny me medication based off of others' mistakes, unrelated to me. This leads Veterans into gaining medications through specialty clinics and outside agencies, as I did. This forces Veterans to advocate for themselves outside of the VA, since they are not listened to inside the VA.
Standard of Care
A lot of the doctors don't approach the patient with enough respect; more or less, you feel like you are in a bean counter type of doctor's office where the doctors rush through the appointment. On top of that, you have a lot of young doctors overseeing your primary care, which could lead to mistakes in care overall. I know you have to learn medicine by practicing it, but the preponderance of risk by young doctors is kind of outrageous.
Vets have the right to choose their VA doctors, especially when they try to stick you with residents. The VA does allow choice of doctor; if, for some reason, you feel your doctor isn't listening to you, there's a process to change your primary care manager, which is your doctor. The VA has contact lines and an ombudsman – one for each VA – who can switch your doctor to another doctor.
Misinformation
The doctors seem scared to give me what I need because of policies unknown to me. The VA doctors literally told me they could not prescribe me Adderall because of the policies – they said Adderall was listed under prescriptions of abuse, or something like that.
Doctors also do not listen to me and do not take the time to explain side effects. Around 2018, a young doctor lied to me about a med and it cost me a semester of school. They told me that it did not have the side effect of brain fog, and then when I called her saying I had diarrhea, she said it was not a known side effect, either, so I kept taking it. I learned that diarrhea was, in fact, a side effect of the antidepressant Topamax when I talked to a nurse. Topamax was an antidepressant but also linked to weight loss. I had to get an appendectomy because of gastrointestinal issues, so I did not do well in university. The surgery's anesthesia gave me memory loss that made it impossible for me to catch up with work after I got my appendix out.
Profiling & Stigma
I'm a big man with PTSD who is scared of what happens to big men when others are scared. I also found out that Wellbutrin causes me to be angrier. I can't be angry – I'm built like an offensive lineman. If I'm angry in public, bad things happen to me due to my sheer size because people are scared of me. They are scared of someone big like me being angry.
Involuntary Hospitalization
I think it is because of a VA social worker's fear of me that the VA institutionalized me when I was seeking anti-anxiety meds during an anxiety attack that was caused by a close friend's personal situation. It happened so long ago, perhaps 2022, that these days, I could not even place a name with a face, but as I recall, the social worker recommended me for five days of an involuntary inpatient stay for mental health care. The social worker – not even someone with a psychology degree – accused me of being manic and a bunch of other stuff. I said, "no, I'm just very upset, and I talk very fast when I am upset, and when I talk fast, people think I am crazy."
Institutionalization
In inpatient care for mental health, the care team analyzes you, and they start you on meds the first day. That's also when you meet your care team, which is overall in charge of your care and discharge. There's a lot of homeless Veterans who voluntarily commit themselves and do nothing but sleep. Sometimes, homeless Veterans also try to get committed to detox themselves from drugs.
Over five days in inpatient, you participate in groups, even if you think the groups are stupid. The groups are usually psychotherapy groups or recreational therapy groups or other types – these are meant to give you more tools in your toolbox to tackle and improve mental health. It's a multi-functional team with physical therapy, covering mental and social and other aspects to get you back to being functional. You play the game, so to speak, or they keep you there longer.
Program Access
The VA is weird because they may have a thousand different programs, but they never advertise them – you almost have to have a social worker who is looking for programs for clients in order for you to find out things. You have to really seek out the information. A lot of the programs are hard to access, even if you know about them. The average time for caregiver support is five to 10 years, and that is just one example.
Regional Care Variants
VA healthcare should be a federal program that is the same across states. Different states have different levels of health care.
The best VA health care I ever received was in Phoenix in 2020. I had a med doctor and I could get my meds sent to me within three days and I could talk to my doctor every two weeks so I could dial in the medication right and do it fast. When I had bad side effects, one of the meds I was taking was causing me to sweat too much, and so she took me off of it. At the Phoenix VA, they actually put me on an actual anti-anxiety med, Klonopin, a really long-acting benzodiazepine sometimes prescribed for anxiety. The current VA policy is to avoid prescribing benzodiazepines except for high-risk patients.
The VA lacks continuity of care among the different VAs. You have to start over and get your primary care assigned each time you go to a new VA, and that could take months. The other thing is that your care might not be the same – you might have been going to a chiropractor in AZ, but in OK they put you in physical therapy. In essence, every time you move, you start your care over.
Oklahoma ranks among the worst VA health care I have ever received – that's where I was involuntarily admitted because I was asking for an anti-anxiety med since I got triggered.
The Paradox of VA Care
There are some bright sides to the VA. There are doctors and nurses who seem to really care, but the intentional opaqueness of the system drives the anxiety of the patient they are trying to help. A lot of volunteers work at the VA and they help patients navigate the buildings. The building is set up weirdly, so you end up having to ask for people. Another shoutout goes to the nurses, who will at least listen to you and give you solid advice, because you do not spend a lot of time with the doctors.
Bio: Matthew Bow is a veteran of the United States Army as part of the 101st Airborne Division. He served two tours in Iraq from 2004-2005 and 2007-2009 for a total of 27 months in Operation Iraqi Freedom.
