DEBBIE ELLIOTT, host:

When senators began debating the new Iraq security plan tomorrow, they'll be thinking not just of the sectarian violence killing Iraqis but also of the mounting toll on U.S. lives. Last week, the Pentagon's Web site changed its count of the number of U.S. troops injured in Afghanistan and Iraq. And the new number is lower. Veterans groups charged it was an attempt to hide the true cost of war. The dispute reflects a bigger issue. As soldiers come home with long term and even lifelong injuries, will they get the healthcare they need?

NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: Last month, Harvard professor Linda Bilmes presented a paper at a meeting of social scientists. Her topic was the cost of treating injured soldiers. She used the number, 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.

Professor LINDA BILMES (Harvard University): The assistant secretary for health at 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.

SHAPIRO: Now both the Pentagon and the Department of Veterans Affairs have changed the number of wounded counted on their Web sites. The Pentagon says the more accurate number is 23,000, and that this lower number simply makes the distinction between the often more serious injuries of combat and other health problems like getting stomach flu. Linda Bilmes says using the bigger number gives a more realistic picture of the healthcare that's going to be needed.

Prof. BILMES: I know there's a kind of sexy issue around changing the numbers, but I think that it's important that we keep the focus on the main finding of my research, which is that the V.A. is not prepared to handle the influx of soldiers coming back. Regardless of the official number that the Pentagon wants to put out, whether they include non-hostile injuries or they don't, either way the V.A. is not going to be prepared.

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

Prof. BILMES: The first Gulf War in 1991 was a short war and only last four or five weeks, and there was a relatively low number of injuries and fatalities. However, we currently spend $4 billion per year on paying disability benefits for soldiers who fought in that first Gulf War, and that is a very large number, $4 billion a year.

SHAPIRO: Bilmes says when soldiers came back from that first Gulf War, 44 percent applied for V.A. disability benefits, and more than half now use the V.A. medical system at their main source of health care. Based on that and current injury numbers, she estimated the lifetime healthcare costs for veterans of Afghanistan and Iraq from $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 V.A. already has a pretty good sense of what returning soldiers need.

Dr. MICHAEL KILPATRICK (Office for Force Health Protection): And what we're seeing is about a third of these people leaving active duty service are going to the V.A., and the big categories are for pain in the muscle, 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.

SHAPIRO: Kilpatrick says the Pentagon learned a lot from the first Gulf War, especially about the mental health problems of war. This time around, there's a lot more care being offered, from the battlefield to once soldier's return home. Still, many soldiers back 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 dealt with some of those common mental health issues.

Mr. PATRICK CAMPBELL (Medic): I am using the V.A. I attend counseling at the Vet Center for post-traumatic stress disorder. I've been having nightmares. It's a little hard to talk about, but I did have a couple of bouts of what he called uncontrollable crying. For me the Vet Center is just about finding a place where I can talk about some of the issues that I'm going through. I'm just trying to find someone who I can chat with.

SHAPIRO: Campbell's back in law school now and he's working in Washington for a veterans group, Iraq and Afghanistan Veterans of America. He says it doesn't matter to him so much that his own injuries weren't counted on some Pentagon Web site, but he wants to make sure there will be healthcare for him and other veterans when they need it.

Mr. CAMPBELL: And 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 V.A., those injuries become a big deal.

SHAPIRO: There are some signs that Washington is paying more attention to veterans healthcare. The V.A. has struggled with being under-funded. But last week, the House of Representatives passed a new funding bill that would give the V.A. an extra $3.6 billion.

Joseph Shapiro, NPR News, Washington.

ELLIOTT: For a detailed look at casualties suffered by U.S. forces, as well as Iraqi troops and civilians, go to our Web site, npr.org. Click on the link called Toll of War.

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