Aug 12, 2003 - BLUFFTON, IN-Jason Stiffler, a high-school dropout, hoped the U.S. Army could help him make something of himself. But two years after enlisting, the 20-year-old veteran of the Afghanistan war struggles just to care for the tiny garden outside his rented trailer home.

On a recent afternoon, Mr. Stiffler eased himself from his crutches to weed the flowers, dragging himself on his bottom. Half an hour is usually all he can take. "I still can't feel parts of my legs," says Mr. Stiffler, a gaunt man with dark, buzz-cut hair.

Mr. Stiffler was injured while manning an Army watchtower near Kandahar in April 2002: He plunged to the ground, leaving him in a coma for days and without memory of the incident. The Army says it was an accident, although it has never provided the veteran with details.

He continues to suffer from partial paralysis, memory loss and episodes of post-traumatic stress disorder. He and his wife have struggled to make ends meet. After missing payments on their car, they lost it in January. Trying to save on heat, they dragged mattresses into the living room of their trailer and slept around a space heater.

Since his discharge last October, Mr. Stiffler has relied on payments from the Department of Veterans Affairs, or VA, to provide for his wife and toddler son. When he argued that he deserved more than the $731 a month he was receiving -- because his disabilities were more serious than doctors originally thought -- he ran up against a vast medical bureaucracy. The wait for final disposition of his disability claim and appeal took seven months, a timetable that the VA concedes would have been even longer if it wasn't prompted to act by inquiries from The Wall Street Journal for this article.

Mr. Stiffler's story shows the human toll when critical benefits judgments are delayed, and the confusion veterans and their families often feel when they're forced to confront bureaucracy. It also illustrates some of the flaws in the $60.4 billion veterans agency, and how those problems could prove overwhelming as veterans of the conflicts in Afghanistan and Iraq start to enter the VA's rolls.

The roughly 175,000 military personnel who have served in the war against terror have not begun to apply for VA services in big numbers. But about 50,000 of them will file disability claims in coming years, if the 30% rate of VA utilization after the Gulf War is any guide.

That will place added burdens on a system that has been swamped for years. The average wait to get a medical appointment with the VA is seven months, according to a recent survey by the American Legion. There's a backlog of 280,000 veterans awaiting a disability rating, which determines how much they should receive in benefits; 108,000 veterans are waiting to hear back on appeals of rating decisions.

One reason for the backlog: a 1996 Congressional decision that expanded benefit eligibility to all veterans. Previously, the VA had been open only to indigent veterans and those wounded or injured during service. Since the change, the number of veterans seeking VA medical services has doubled to 6.8 million, while VA spending has risen 56%.

VA Secretary Anthony Principi says he "decided something was terribly wrong" last summer. He ordered the agency to stop enrolling higher-income veterans without disabilities, and to place its priority on those with service-related injuries. The freeze is expected to lock out about 525,000 veterans by the end of 2005. The Bush administration's 2004 proposed budget also calls for new premiums and higher fees. For certain categories of higher-income veterans, for example, the budget calls for increasing drug-prescription co-payments to $15, from $7. The move is expected to dissuade about 1.3 million veterans from enrolling for VA services next year.

Under Mr. Principi, who has been in office since January 2001, the agency has made progress in reducing its backlogs and speeding up claims processing, which is down to 5oe months from nearly eight a year ago. But the General Accounting Office, in May testimony to a Congressional committee, said too many veterans continue to wait too long for care and disability decisions.

Cheyne Worley, a former Army supply sergeant, filed a claim for VA disability benefits in 1991, soon after returning from the Gulf War, where he suffered injuries in a fall. The VA denied the claim, saying it couldn't locate his Army medical records. After 12 years of appeals, "I still haven't seen them," says Mr. Worley, who says he endured bouts of drug addiction and homelessness before becoming an aide to U.S. Rep. Dennis Moore, a Kansas Democrat.

A VA spokeswoman says that, while the VA didn't realize it at the time, the military medical records obtained from the Army after Mr. Worley filed his initial claim in 1991 didn't cover his last eight months or so in the service. Those medical records, which do contain information about his fall, were not located until last November. The spokeswoman said the VA cannot explain the error.

The VA system is particularly slow when it comes to assessing veterans with permanent disabilities. The agency is divided into separate medical-care and disability bureaucracies, which have a history of not communicating effectively with each other on disability cases. So, when a veteran is treated at a VA hospital, changes in his or her condition aren't automatically reported to officials who consider disability claims. As a result, those changes can't immediately be factored into claims decisions.

Moreover, in making disability decisions, the VA relies heavily on military records. But these largely consist of paper files that must be located and shipped when a request is made, slowing response times. Often files are misplaced or incomplete. "Stuff just goes into a big black hole sometimes," says Mr. Principi.

Under Mr. Principi, the VA has made a priority of fostering better cooperation and communication between its Veterans Health Administration, which operates VA hospitals, and the Veterans Benefits Administration, which makes disability and pension decisions. Last year, the VA centralized management of the two entities' information-technology operations. And, to streamline the transfer of files, the Department of Defense has begun sending certain military medical records into an electronic database that VHA doctors can tap into. But most Defense medical records are still kept only on paper and must be transferred by hand.

Jason Stiffler had no memory of his fall when he awoke from a coma at a military hospital in Germany, a few days later. From there, he was transferred to Walter Reed Army Medical Center in Washington. Mr. Stiffler and his wife made available copies of his medical records for this story, and signed waivers requested by Walter Reed, giving it permission to discuss his case. But Walter Reed spokeswoman Beverly Chidel declined to answer questions about him, citing privacy concerns.

After just over a month of daily therapy at Walter Reed, Mr. Stiffler was using a walker by the end of May 2002. But he continued to complain about insomnia, irritability and depression, hospital records show, adding that he frequently lost his train of thought and forgot things. Walter Reed doctors said in the records that his mental capacity had been damaged and warned that psychological factors could hamper his physical recovery. But they also projected that such problems would ease as Mr. Stiffler continued regaining use of his legs.

Toward the end of his stay at Walter Reed, Mr. Stiffler began his trip into the military's health-care bureaucracy. On Aug. 2, 2002, an Army review board determined that Mr. Stiffler was too injured to return to active duty. He was placed on the "temporary disabled retirement list," meaning he could go back to civilian life but would have to be periodically re-evaluated for up to five years to see if he was fit to return to duty.

The Army reviews the case of every soldier who has been injured badly enough to possibly be discharged, and assigns the soldier a disability rating, in 10% increments up to 100%. Because of the loss of strength and sensation in Mr. Stiffler's legs, the board deemed him 40% disabled, but boosted the rating to 50%, the minimum rating required to be placed on the temporary disabled retirement list. In related records, the board indicated, without explanation, that Mr. Stiffler's psychological condition wasn't severe enough to boost his rating.

The soldier's mother, Arvilla Stiffler, was shocked at his score. "Are you telling me a pair of legs is only worth 40% to the military?" she recalls telling an Army social worker.

A social worker explained that Mr. Stiffler had a choice: He could either use the Army's rating as the basis for Army disability payments, or he could register with the VA and get a new rating from their doctors and payments from the VA. Since the Army's final benefits formula heavily relies on rank and length of service, many officers and longtime soldiers prefer it to the VA.

Mr. Stiffler initialed a paper waiving his right to appear before the Army board and argue for a higher rating. He says he just wanted to get out of the hospital and was in a fog brought on by painkillers and his injuries. Back then, "if I tried to read something, like maybe a paragraph, I couldn't comprehend it."

His mother, director of trauma programs for the University of North Carolina Healthcare System and an Army reserve captain, says she was assured by Walter Reed caseworkers that they would arrange for VA officials in Indiana to contact her son after he returned there to continue his treatment and therapy. That never happened, the Stifflers say. Ms. Chidel of Walter Reed says hospital-discharge planners make such arrangements, but normally only for personnel transferred to a VA hospital for in-patient treatment.

VA officials say they try to make military personnel aware of their services through mass mailings and visits to military outposts, but it is ultimately up to the veteran to seek them out after discharge. VA records indicate that Mr. Stiffler signed up for the agency's services before leaving Walter Reed.

Mr. Stiffler returned to Bluffton, where he, his wife, Jacki, and toddler son, Jason, moved into a rented mobile home. Mr. Stiffler persuaded a contractor friend to let him clean up at a construction site, but his crutches made bending all but impossible. One relative set him and his wife up in business selling shoes beside a highway, but manning the stand proved too draining for the veteran, who sometimes collapsed without warning, relatives say.

With her husband unable to work, Ms. Stiffler found a job at a food-distribution warehouse but often had to miss work to take care of her husband -- who needed help bathing and using the toilet -- and Baby Jay, who is now 17 months old.

In the midst of this, Mr. Stiffler received his first word from the VA. In the letter, dated Oct. 18, 2002, the agency said that it had given him a preliminary disability rating of 50% based on a review of his Army medical records. He got 40% for his legs, 10% for his mental impairment. His compensation came to $731 a month. (Given his short time in the service, the Army's disability pay would likely have been less.) The VA's letter said the agency would contact him to schedule a full exam to assess his mental state, among other things.

Meanwhile, Mr. Stiffler's mental and physical state deteriorated, say family members. One night, Ms. Stiffler came home to find her husband on the kitchen floor. Frenzied and wide-eyed, he was aiming one of his crutches like a rifle.

The Stiffler family kept waiting for the VA to intervene, based on what they had heard at Walter Reed. Mr. Stiffler's mother lost patience and urged her son to take action. On Oct. 30, 2002, after the Bluffton police found Mr. Stiffler wandering by the roadside, he and his wife went to the regional VA hospital in Fort Wayne for the first time and asked for help.

Mr. Stiffler was scheduled to see doctors, psychologists and social workers. He got prescriptions for medications to fight pain, nightmares and depression. A psychologist wrote that, during a Nov. 5 session, Mr. Stiffler exhibited "a significantly depressed" demeanor and was probably suffering from post-traumatic stress disorder. That day, after Mr. Stiffler told a VA social worker that he faced eviction, he was given $250 to cover part of his overdue rent.

The VA also put him in touch with John Hickey, an Indianapolis-based veteran's advocate for the American Legion. On Dec. 9, Mr. Hickey filed a formal "notice of disagreement" with the regional VA office in Indiana, the first step in challenging the VA's disability rating.

The VA made no official response to his notice of disagreement for more than two months. Mr. Hickey says the VA's normal response time to notices is "almost immediate," usually a week or so.

The VA says its disability specialists didn't have Mr. Stiffler's medical and Army records. They normally would have been on file at the claims-processing office in Indianapolis, the VA says, but they had been borrowed by the medical staff treating Mr. Stiffler in Fort Wayne. The VA says it seldom makes copies of records to keep at the regional office because the files are often so large. That meant work on Mr. Stiffler's notice of disagreement stopped until the file was returned to Indianapolis on Jan. 29.

In the intervening period, Mr. Stiffler began the VA exams that would be used to determine his final disability rating. And he continued to exhibit troubling symptoms. Some nights, his wife reported in VA hospital records, police found him hobbling down the street, lost and confused. Other times, he woke his wife and son, screaming for his sergeant and warning comrades to take cover. Just before Christmas, Mr. Stiffler suffered a seizure in his front yard and fought off responding paramedics with a crutch, calling them "Afghanis."

On Feb. 20, more than two months after he had filed his notice of disagreement, the VA responded to Mr. Stiffler's notice by offering him the choice it gives all veterans who disagree with their disability assessments. He could file a formal appeal, or he could request a special review of his case by senior VA examiners who had not previously worked on it.

In a formal appeal, a veteran must wait for his regional office to produce a "statement of the case," which outlines the legal and regulatory reasons for his disability rating. Last year, the average wait was more than three months. Then the veteran must submit forms detailing what mistakes he thinks the VA made. This paperwork must be certified at regional headquarters and shipped to the Board of Veteran Appeals in Washington, all of which takes nearly 26 months on average, according to figures compiled by the VA last year. The board then usually takes another three months to make a decision.

By contrast, a review is a relatively informal inquiry conducted at a veteran's regional VA headquarters. In Indianapolis, for example, it takes four to five months to get a review decision. This decision, in turn, can be appealed.

On March 4, Mr. Stiffler requested a review. And began to wait. By spring, VA hospital files in Fort Wayne were replete with accounts of the veteran's medical, psychological and economic troubles that might have sped up the consideration of his disability claim. But Jim Whitson, VA director of benefits for the region that includes Indiana, says VA information systems are not set up to automatically alert disability-claims processors of the agency's medical work.

Unless a veteran is hospitalized for more than 21 days or judged to be incompetent, "it's not the kind of information that flows to us," says Mr. Whitson.

The enormous backlog of cases also hampered Mr. Stiffler's review. "Because there was an existing inventory of work, we were unable to get to it for a couple of months," Mr. Whitson says.

In mid-May, soon after a Journal reporter began making inquiries, VA case reviewers in Indianapolis worked overtime one Saturday on Mr. Stiffler's case. They determined that he is unemployable, totally disabled and in need of a personal assistant to help him with daily tasks. His case will be reviewed again in October to see if his condition has changed. For now he and his wife receive about $2,900 a month, along with more than $15,000 in retroactive payments.