"Make the VA Great Again": Medical-Legal Partnerships for Veterans

February 27, 2017

Veterans have long suffered from the invisible wounds of war, such as PTSD. These injuries have become painfully apparent in the 20 veteran suicides committed every day. Some blame the Department of Veterans Affairs (VA) for failing to address this crisis. President Trump, for one, views the VA as “the most corrupt agency in the United States.” He is considering getting rid of it altogether by privatizing veterans’ healthcare.

President Trump’s harsh words and taste for privatization miss the mark. There is certainly room for improvement at the VA, such as with wait times. Yet much would be lost by dismantling it. Research has shown that on average, the VA delivers higher quality care than other providers. And the available data suggests that the VA administers this care more cheaply than the private sector. The VA is also better equipped to provide culturally competent mental healthcare to veterans. In other words, the VA may well be our best bet at combating the epidemic of veteran suicide.

But if President Trump’s vision for the VA is so wrong, what is right? The status quo is not acceptable either. As things stand now, thousands of veterans are trapped in an inhumane web of mental illness, substance abuse, and homelessness.

To tackle this tragedy, we should build on the VA’s strengths. The VA already excels at providing comprehensive, integrated care. However, these services do not include a resource veterans desperately need—legal assistance. According to a recent VA study, five out of the top ten problems leading to veteran homelessness, and the associated health risks, require legal help. That is to say, veterans’ health and legal needs are often intertwined.

To address veterans’ interconnected problems, the VA should broaden its existing integrated service model. Specifically, the VA should foster collaboration between the professions at the frontline of veteran care—medicine and law. Medical-legal partnerships (MLP) are a promising approach because they arrange these crucial professional marriages. MLPs are an interdisciplinary model of care that recognizes that many health problems cannot be solved without legal aid. Thus, doctors and lawyers in MLPs work as members of the same team. Typically, lawyers offer aid onsite at medical facilities. And doctors refer patients directly to these lawyers for help with the legal issues underlying patients’ ill health.

The dire need for MLPs for veterans is evident in the military’s unjust practice of issuing other-than-honorable discharges based on mental illness. Many veterans experience traumas in service, such as violent combat or military-sexual trauma, and develop PTSD as a result. Sometimes, their symptoms manifest during service, and the military misinterprets their behavior as misconduct. The military is increasingly responding by kicking these veterans out of service with other-than-honorable discharges. Tragically, this discharge status bars veterans from receiving the VA services they need to heal.

Veterans can restore their right to resources for recovery by getting a discharge upgrade. But this is no easy task. Indeed, it is often a bureaucratic nightmare that can take years to resolve. And legal representation is essential. Moving the military to recognize that “misconduct” was symptomatic of undiagnosed mental illness requires a lawyer’s understanding of complex regulations and powers of persuasion. VA MLPs enlist these indispensable legal skills in service of vulnerable veterans.

Though veterans with other-than-honorable discharges are not in a position to receive referrals for legal help from traditional VA doctors, since they are not eligible for their services, other VA referral networks are available. Many of these veterans have access to one basic VA resource: community-based behavioral therapy. The therapists at these community centers can make the legal referrals necessary to put the VA’s wraparound services, including medications, within reach.

Moreover, many veterans who already have full access to VA healthcare need legal help too. Those with impairing health conditions that stem from their service are entitled to VA disability benefits. Without this compensation, and unable to work because of their disabilities, veterans are exposed to the health-harming effects of poverty. These important benefits are not automatic, though. Veterans must navigate a byzantine regulatory framework. Without lawyers, many get lost. The presence of MLP lawyers at VA medical centers facilitates direct legal referrals from doctors, so that veterans do not lose their way.

The MLP model also recognizes that doctors can play a critical role in legal battles beyond initial referrals. After all, a veteran lawyer’s case is often only so strong as her medical evidence. To prove that an other-than-honorable discharge based on mental illness is unwarranted, for instance, lawyers need robust evidence of the condition that led to the perceived misconduct. Only a doctor can provide a medical opinion on the illness and the role it played in the veteran’s behavior. The collaborative MLP framework encourages doctors to share this vital information. Just as MLP doctors refer patients for legal services, so can MLP lawyers refer clients for medical evaluations and treatments. So, ultimately, the benefits of MLPs flow in both directions. They improve veterans’ chances at legal success and wellbeing.

In the words of President Trump, “You know, when you hear the 22 suicides a day—big part of your question—but when you hear the 22 suicides a day, that should never be. That should never be.” But the fact is that veterans are facing increasing barriers to rebuilding their lives. We need a new approach that capitalizes on the VA’s talent for integration: the lawyers and VA doctors who have long been the first responders to this crisis must build bridges across professional divides. By working together through VA MLPs, they can treat the tangled medical and legal wounds that drive so many veterans to become casualties at home. Under any profession’s ethical code, this should never be.

Rose Carmen Goldberg is a Skadden Fellow at Swords to Plowshares. She holds a JD from Yale Law School, an MPA from Columbia University, and a BA from St. John’s College in New Mexico.

Republished with permission from Harvard Law and Policy Review, article dated February 13, 2017.