U.S. Reconfigures the
Way Casualty Totals Are Given

DENISE GRADY / New York Times 2feb2007

Statistics on a Pentagon Web site have been reorganized in a way that lowers the published totals of American nonfatal casualties in Iraq and Afghanistan.

Dr. Michael Kilpatrick, deputy director of force health protection and readiness at the Defense Department, said the previous method of tallying casualties was misleading and might have made injuries and combat wounds seem worse and more numerous than they really were.

The old method lumped many problems under the label “casualties,” including illnesses, minor injuries and injuries from accidents, as well as wounds sustained in combat. But the public may assume that every casualty is a war wound, Dr. Kilpatrick said, so the site was changed to avoid misunderstandings.

On Monday, the bottom line of the Defense Department’s Web page on casualties in Iraq listed a total of 47,657 “nonmortal casualties.”

By Tuesday, the same page no longer showed a total for nonmortal casualties. The bottom line is now “total — medical air transported,” and the figure is 31,493.

The new total excludes 16,164 troops who were wounded but did not require medical air transport because their injuries were minor. The total does include combat wounds, nonhostile injuries and diseases serious enough for medical transport.

Half the nonhostile injuries are from vehicle accidents, and a third are sports injuries from activities like basketball, Dr. Kilpatrick said. About 50 disease categories — including mental problems and gastrointestinal illnesses — have led to medical evacuations. Dr. Kilpatrick said that 85 percent of those who were flown out for medical reasons eventually returned to duty.

“It may be a few weeks, or it may be a year or more,” he said.

Concern at the Pentagon about public perceptions of the wounded increased last month after Linda Bilmes, a Harvard professor, published an opinion article in The Los Angeles Times mentioning 50,508 “nonmortal woundings” in Iraq and Afghanistan. That number came from a Web page posted by public affairs employees at the Department of Veterans Affairs.

But officials from both agencies said that figure had been posted by mistake, lumping combat and noncombat injuries as well as illnesses and labeling them all “woundings” instead of casualties.

“If public affairs people at the V.A. misunderstood, we thought the public would misunderstand it, too,” Dr. Kilpatrick said.

Both Web sites were changed.

Paul Sullivan, director of research and analysis of Veterans for America, said the changes actually meant the Pentagon was trying to conceal the rising toll of injuries and illness.

Mr. Sullivan, formerly a project manager at the Department of Veterans Affairs, also said that the department was not prepared to provide the health care that returning veterans would need for mental and physical disabilities.

source: 3mar2007

New Pentagon Numbers Raise Health Care Worries

JOSEPH SHAPIRO / All Things Considered / National Public Radio 4feb2007

Last month, Harvard professor Linda Bilmes presented a paper at a meeting of social scientists about the cost of treating injured soldiers. She reported that 50,000 American troops had been wounded in Afghanistan and Iraq.

A few days later she got a call from a senior Pentagon official.

"The assistant secretary for Health of the DOD phoned me up asked me where I had found the numbers, and I faxed him his own Web site and that was the last I heard from them," Bilmes says.

Now both the Pentagon and the Department of Veterans Affairs have changed the number of wounded on their Web sites.

The Pentagon says the more accurate number is 23,000, and that this lower number simply makes a distinction between injuries of combat and other health problems, like the stomach flu.

Bilmes says that using the bigger number gives a more realistic picture of the health care that's going to be needed.

"Regardless of the official number the Pentagon wants to put out — whether they want to count nonhostile injuries or they don't — either way, the VA is not going to be prepared," Bilmes says.

Bilmes is a professor of public finance at Harvard's Kennedy School of Government, and was an official in the Clinton administration. She's been looking at historical comparisons.

"The first Gulf War in 1991 was a short war — it only lasted four or five weeks — and there was a relatively low number of injuries and fatalities," she says. "However, we currently spend $4 billion a year for disability for soldiers who fought in that first Gulf War."

Bilmes says that when soldiers came back from that first Gulf War, 44 percent applied for VA disability benefits. And more than half now use the VA medical system as their main source of health care.

Based on that, and current injury numbers, she estimates that the lifetime health-care costs for veterans of Afghanistan and Iraq will be $250 billion to $650 billion.

Dr. Michael Kilpatrick runs the Pentagon office in charge of protecting the health of troops. He says the Pentagon and VA already have a pretty good sense of what returning soldiers need.

"What we're seeing is about a third of those people leaving active-duty service are going to the VA," Kilpatrick says. "And the big categories are for pain in the muscles, bones and joints, which is what we see most commonly in veterans. That's about a third. Another third is for mental health. And that, to us, again is not surprising."

Kilpatrick says the Pentagon learned a lot from the first Gulf War — especially about mental health problems of war. He says that this time around, there's more care being offered, from the battlefield to when soldiers return home.

Still, many soldiers who've returned from Iraq worry about their health.

Patrick Campbell served as a medic with a National Guard infantry brigade. He lost some of his hearing in Iraq, the result of being too close to too many IEDs. And he's had mental health issues that are common of returning war veterans.

Campbell is back in law school now and is working in Washington for a veteran's group called Iraq and Afghanistan Veterans of America.

He says it doesn't matter to him that his own injuries weren't counted on some Pentagon Web site. He just wants to make sure there will be health care for him and other veterans when they need it.

"These types of injuries might not be so bad now. But in 10, 20, 30 years — when people get older and those injuries start to aggravate and they turn into disability for the VA — those injuries become a big deal," Campbell says.

There are some signs that Washington is paying more attention to veterans' health care. The VA has struggled with underfunding, but this last week, the House of Representatives passed a new funding bill that would give the VA an extra $3.6 billion.

source: 3mar2007