It was an average-looking letter that landed in Paul Weaver's mailbox. But bearing news that his veteran's disability benefits had been stopped, it felt more like a ton of crashing bricks.
He felt shock, then resignation.
He thought "I can't do this anymore. I have to move on."
Mr. Weaver had sought treatment at US Department of Veterans Affairs (VA) facilities a few years earlier for what had been diagnosed as a serious illness as well as for post-traumatic stress disorder (PTSD) from his Marine Corps deployment to Iraq in 2003, where he was a machine-gunner with the original invasion force.
Now it was July 2007, and he wanted to leave the battle behind him – even if it meant giving up thousands of dollars a month in disability benefits. But his father, a retired senior chief petty officer with the Navy, wouldn't hear of it.
"You can't just have a civilian tell you 'no,' " Paul Weaver Sr. told his son. "They owe you a day in court."
He decided to fight – and unwittingly started a chain of events that would lead to improvements in the local San Diego VA system, benefiting thousands of others. They are the kinds of improvements called for by Congress, veterans groups, and the public as the VA system comes under increased scrutiny with the arrival of a new generation of veterans from the Iraq and Afghanistan wars.
Rep. Bob Filner (D) of California, chairman of the House Veterans Affairs Committee, says years of underfunding and poor leadership are to blame for the system's shortcomings, particularly a shortage of mental-health services for the new veterans.
"It's a long history of not being funded properly," says Representative Filner. "Morale goes down in a place when you get asked to do more and more with less and less."
Even with a 40 percent increase in VA funding over the past two fiscal years, says Filner, spread throughout the VA's vast bureaucracy, the money "takes a while to filter down." Some 250,000 VA employees are spread among about 1,500 facilities from medical centers to community clinics to nursing homes. In the last year, the VA started a suicide hot line, made plans to hire suicide prevention coordinators for each medical center, and convened panels of mental-health experts to advise the department on improving suicide prevention.
Veterans' mental health and suicides have become critical issues. One reason: More survive war thanks to better armor and battlefield treatment, but are also more likely to be left with serious mental injuries, according to experts who have studied US casualty causes and rates in Iraq and Afghanistan.
The VA came under particularly harsh criticism earlier this year when an e-mail surfaced showing that VA officials discussed keeping secret the figure of about 1,000 attempted suicides per month among veterans in VA facilities. The secretary of the VA later said the figure was unreliable, but he got a thorough tongue-lashing from Congress and veterans groups nevertheless.
"To me, we've committed murder," says Filner of reports of veterans who commit suicide while waiting for an appointment to see a VA mental-health specialist.
In such cases and in Weaver's, the problem usually isn't the quality of care, but gaining access to it, Filner says.
Weaver finally did get access to his benefits, but only after five months of intense campaigning.
With the help of his parents, he fired off scores of letters and made many phone calls to VA officials and lawmakers. He spent hours calling the Mission Valley community clinic to meet with key decisionmakers there regarding his benefits and calling the VA San Diego Healthcare System, a hospital where he needed to see doctors for his illness diagnosed as cancer now in remission.
In a last, desperate measure, he wrote out the details of his situation, then stuck hundreds of copies of the paper across windshields in the parking lot of the community clinic. "We shotgunned it," says Weaver's father. "Everyone shy of the president of the United States got a letter. A lot of people responded."
One of those was Filner's office. The congressman's staff met with Weaver and forwarded his list of complaints to the VA Office of the Inspector General (IG), which included Weaver's frustrations with the San Diego VA's scheduling call center and the Mission Valley community clinic.
"They never call you back. They hung up on me several times and once is too many times," says Weaver. "I can show you the phone bill, [waiting] 54 minutes, 47 minutes, just to ask a simple question. I wanted to know why they were taking my benefits away."
Filner's office forwarded Weaver's complaint about the call center to the VA Inspector General's office in February. In March, IG investigators visited the VA hospital in San Diego and interviewed call center officials and doctors. VA officials were already aware of the problems at the call center and were working on them, says Marvin Bailey, the call center supervisor, assigned to the post just a few months earlier in part to address the problems.
Mr. Bailey says the call center usually had about a 20 percent "call abandonment rate," the rate callers on hold simply hang up, each month. But in January and February it had spiked to 30 percent.
In its report, the inspector general's office said between October 2007 and February 2008 the call abandonment rate, was over 30 percent, far above the industry standard of about 10 percent.
But over the next few months, thanks to Weaver's persistence and the official interest it generated, the call center changed radically.
A line dedicated to automatically canceling appointments was installed, nearly half the 13 call center staffers were replaced, quotas for the number of calls each employee is expected to answer daily were established, and much of the responsibility for calling back veterans was shifted to clinicians so the call center staff could focus on taking incoming calls.
The changes happened over about a year, Bailey says. But just two months after the investigators' visit, the call abandonment rate was averaging below 5 percent. In June, just 3.4 percent of the 13,443 calls into the center were abandoned, says Bailey. They also cut the time veterans were kept on hold from 3 minutes during fiscal year 2007 to 36 seconds since April, near the industry standard of 30 seconds.
The VA inspector general's office is still investigating Weaver's other complaints regarding his benefits. Broader problems with the VA remain to be resolved, but Weaver's squeaky wheel campaign shows individuals can prompt changes, too.
"It wasn't just a case of helping myself," says Weaver, who recently finished college with a business degree. "I think you have a sense of civic duty to address something like this."