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Costs of care for veterans: high and rising

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"The bottom line is there is a surge in demand in VA services across the board," Veterans Affairs Secretary James Nicholson told a House panel this week.

Earlier this year, Mr. Nicholson told lawmakers the VA had used 2002 estimates when assuming that 23,553 veterans of Iraq and Afghanistan would need medical care in 2005. Since then that number has been revised upward more than fourfold to 103,000. Part of the reason is the changing nature of war and the casualties it produces.

As helicopters did so prominently in Vietnam, new means of transporting and treating the wounded in Iraq are saving lives. But this also means a higher portion of overall casualties will need extended government benefits. During the wars of the 20th century, the ratio of wounded to killed in action was about 3 to 1. In Iraq that ratio is more than 9 to 1.

Another new factor is the relatively large number of women who've been in combat, who now face what some experts think are different kinds of post-traumatic stress disorder - called "soldier's heart" during the Civil War.

"I'm no psychologist, but my understanding of the perceptual and psychological differences between men and women suggests the likelihood that PTSD reactions will be different, requiring nuanced treatment for a devastating condition when extensive clinical experience doesn't exist for women," says Colonel Smith, now a military analyst with the Friends Committee on National Legislation in Washington. "This in itself will add to costs."

PTSD for all returning vets - men and women - may be of particular concern because of the nature of a counterinsurgency fought among, and in some cases against, civilians. Another unknown is the long-term effects of exposure to depleted uranium, suspected of causing the "Gulf War Syndrome" ailments experienced by veterans of the 1991 war in Iraq. Thousands of rounds of armor-piercing shells made of depleted uranium were used by US and British forces in the 2003 invasion of Iraq.

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