Veterans’ caregivers lose VA stipends, struggle to understand why

For three years, a monthly stipend of $1,275 from the federal Department of Veterans Affairs gave Sarah Jenkins the freedom to care for her husband without having to worry about resuming her career.

That let her keep a calm home and respond instantly if her veteran husband experienced one of the mood swings that have characterized his behavior since a group of mortars landed close to him on an Iraqi air field.

The checks abruptly stopped in August when the VA declared her family no longer needed them. Jenkins is still trying to figure out why.

“How am I going to keep him still feeling safe? That’s what the caregiver program has enabled me to do — to keep him feeling safe,” said Jenkins, 39, whose family recently moved to their hometown in North Idaho after spending the previous 17 years in Roy and Yelm.

Her family is one of a growing number around the country who are raising questions about why the VA has been removing them from a caregiver program it launched in 2010.

The program delivers extra compensation to caregivers of badly wounded Iraq and Afghanistan veterans in the interest of keeping them out of expensive, long-term treatment facilities. Most of the caregivers are spouses or close family members of veterans.

That program still is growing at a rate of 400 patients a month, but the VA has been taking a closer look at the veterans it initially enrolled to see whether they still meet standards to continue receiving checks.

So far, about 7,000 veterans who once were enrolled in the program no longer are getting stipends. About a third were cut because VA staff members determined they did not meet medical criteria for the support.

From the beginning, the money was not intended to be a permanent benefit and the program’s creation stipulated that the VA occasionally would reassess patients.

The trouble was, the VA badly underfunded the program and fell behind in oversight, according to a September 2014 study from the Government Accountability Office.

What’s different now is that the VA only last year published an official rule laying out how the program should be administered and it might finally have enough employees to manage it as it was designed.

The idea is to provide stipends to families as long as the veteran’s health meets criteria laid out by the law, VA officials said. If the veteran’s health improves, the VA might remove a patient from the financial part of the program.

“What you’re seeing today is based on our (GAO) findings nationwide that have helped us refocus the program and make sure we’re following the guideline set by the law,” said Rocco Bagala, the assistant chief for social work at VA Puget Sound.

Veteran support organizations around the country have been hearing scattered reports of caregiver families raising concerns about losing their stipends.

They don’t have enough information yet to decide whether they want to press the VA for reforms or to know for certain that the VA is removing patients from the program who genuinely no longer need the stipends.

“The spirit of the law is that you go with the veteran, you go with the caregiver,” said Adrian Atizado, the deputy national legislative director for Disabled American Veterans.

“The purpose of this program is to provide support and services to the caregivers because they are taking part in personally discharging this nation’s responsibilities to this nation’s veterans,” he said.

Congress in 2010 called for the creation of a robust caregiver program for Iraq and Afghanistan veterans, pointing to studies that showed families missing work to care for wounded loved ones.

A Rand Corp. study in 2014 estimated the work of those families was worth about $3 billion a year, money that otherwise might be spent by the government on veteran support services.

Staff for U.S. Sen. Patty Murray, D-Wash., have received several complaints from families cut from the program in recent weeks. She’s been one of the program’s main supporters, promoting it at events with the Wounded Warrior Project and the Elizabeth Dole Foundation.

She has been advocating for its expansion to include veterans of all conflicts instead of just the most recent wars.

“We know that our military caregivers sacrifice their careers, their time, even their own health to take care of our veterans, and they absolutely deserve our support,” Murray said. “I want to make sure VA is a good partner in that effort.”

The GAO showed the VA initially estimated about 4,000 veterans would qualify for the stipend. Instead, more than 15,600 had enrolled by 2014.

Last year, more than 24,700 people received caregiver stipends, according to the VA. Spending on the program has swelled to the $555 million budgeted for 2016 from $350 million in 2014, according to VA documents.

Staffing has increased, too.

At the time of the GAO report, VA Puget Sound had two caregiver case managers overseeing 331 patients. It was one of the highest workloads in the VA. Now, VA Puget Sound has four case managers working with 287 veterans.

The program is bigger than just the financial stipends. It also provides coaching and networking to help caregiver families learn from each other. Those benefits are provided to all veterans, not just people who served in Iraq and Afghanistan.

“We take a lot of pride in making sure that we are providing services for veterans and family members,” Bagala said. “We want to make sure the hard work the caregivers are doing to support the veterans is recognized.”

Some veterans who recently lost caregiver stipends took the decision as a sign the VA did not value them. They’re also unaware of the non-financial services the program provides.

“The recognition of all my hard work, that was important,” said Alisha McNulty, 32, of Olympia. “Now it’s like they’ve said, ‘Never mind.’”

She and her husband have received caregiver stipends since 2012. They were abruptly cut from the stipends in December after a short meeting with a psychologist at the Seattle VA hospital in November.

It was a conspicuously quick decision to the McNultys.

“The VA doesn’t do anything that fast,” said Jared McNulty, 33, a former infantry staff sergeant who has struggled with post-traumatic stress since his deployment to Iraq with a Joint Base Lewis-McChord Stryker brigade in 2004-05

He works part-time for the Timberland Regional Library system and Alisha spends much of her life making a home that feels safe for him. They rarely have friends over, don’t go out often and have cut down trees so Jared McNulty can have a clear view of approaches to their house.

“I told the VA over and over. I don’t know if they’re not writing it down, if they don’t think it’s issue or what the deal is, but (Jared’s post-traumatic stress) has never been addressed,” Alisha McNulty said.

The McNultys are appealing the VA’s decision to cut their stipends.

Sarah Jenkins in Bonners Ferry, Idaho, is out of appeals.

Her family lost its stipend in August when a VA psychologist determined her husband, who has held a job has an X-ray technician despite his head injuries, did not need additional support at home.

The psychologist’s summary of his condition describes her husband — who did not want to be identified in this story — as needing “minimal assistance” to overcome a hyper-alert state and incidents in which he becomes startled.

Otherwise, it characterized him as generally able to care for himself while Sarah performs typical “household duties.”

That’s not how Sarah Jenkins describes her life.

She had been struggling with her husband’s mood swings since he deployed to Iraq as a medical technician with a JBLM Stryker brigade in 2004. She didn’t know he’d been exposed to close mortar blasts until she stumbled on medical records almost three years later.

He goes to the doctor less than he used to, but she worries that will change when she has less time to give him if she returns to work.

She wrote a six-page appeal to the VA’s Northwest regional headquarters asking to retain the stipend. In it, she wrote that her husband still experiences nightmares, insomnia, memory loss and a quick temper. They were the same conditions that led her enroll in the program four years ago.

“They don’t see what I see in front of me,” she said.

This story was originally published January 29, 2016 at 10:15 AM with the headline "Veterans’ caregivers lose VA stipends, struggle to understand why."