Tammy Duckworth reflects on her new role as director of the Illinois Department of Veterans Affairs and what needs to be done to fix the federal system.

July 28, 2007 - Last November, Army National Guard Maj. Tammy Duckworth, who lost both her legs in 2004 when the helicopter she was co-piloting in Iraq was hit by a rocket-propelled grenade, was appointed director of the Illinois Department of Veterans Affairs by Gov. Rod Blagojevich. But if anyone thought her new job would turn Duckworth from an impassioned veteran activist into a stoic government bureaucrat or quell her criticisms of the federal VA, they were wrong.

Since her appointment, Duckworth, who ran unsuccessfully for Congress last year in Illinois's Sixth District, has continued to speak out on the problems with the federal VA system and has worked to improve the situation for veterans in her home state. She's responsible for a new, first-of-its-kind program that will mandate screening of all Illinois National Guard members returning from Iraq and Afghanistan for traumatic brain injury (TBI) and 24-hour toll-free psychological counseling for service members who may suffer from posttraumatic stress disorder (PTSD). No such program has been mandated in any other state, or at the federal level.

In an interview with NEWSWEEK's Jamie Reno, Duckworth, who received a Purple Heart and whose husband, Maj. Bryan Bowlsbey, is currently deployed in Iraq, spoke about what needs to be done to fix the system, and reflected on what her life has been like since her injury, run for Congress, and appointment to the state VA. Excerpts:

NEWSWEEK: How did this new traumatic brain injury and post-traumatic stress disorder program come about? 

Tammy Duckworth: Reflecting on my experience recovering at Walter Reed, it seemed so illogical that only those of us with obvious physical injuries were being screened for TBI. You know, if we were at a high-school football game and the quarterback gets a couple of hard hits in a game or over the course of a season, we'd certainly check him out for a concussion or an injury. Yet we don't do this for a soldier who walks away from an IED seemingly OK. As for the PTSD part of the program, there's a real issue with access to USDVA care. Most of our vets live well over an hour's drive from the nearest USDVA facility. When you wake up at 3 in the morning, you need a way to reach out for help. This 24-hour PTSD hotline staffed by clinicians does just that.

The program is expected to cost more than $10 million a year. Where will the money come from?

Governor Blagojevich is backing the program fully. We will use existing available funds to get the TBI and PTSD program started and will work with the state legislators to get the additional funding that is necessary. The program increases health-care benefits and we hope that it will later become part of the governor's Illinois Covered health-care plan.

No one knows the actual number of troops returning from Iraq and Afghanistan who have TBI because the injury can go undetected. What is your best estimate?

The reason this program is so important is that no one truly knows. The numbers that I've seen range from below 10 percent to 25 percent. What this program will do is help identify those mild and moderate cases that are easily missed. I think the fact that no systematic comprehensive screening of all [Iraq war] vets exists is a real disservice to our troops and their families.

After you were wounded, did you personally receive any psychological evaluation or PTSD screening?

Yes, I was screened for PTSD and TBI. I never attended the formal counseling sessions for PTSD but the staff psychiatrist at Walter Reed certainly visited me like he did all the wounded.

How closely will you be working with this new program, what will your role be?

I will be working very closely on the PTSD/TBI program. The program will be the responsibility of my department even though the actually delivery of service will be under the Illinois Department of Healthcare and Family Services. I see myself as an advocate for my buddies who may or may not know that they need help. I didn't talk about my dreams of Iraq for a long time. I mentioned it to a fellow vet once and he was so happy to know that someone else had dreams, too, that I felt I needed to be open about my experiences.

How quickly will this program be implemented and working?

We plan on having it operational September of this year.

Why isn't the federal government addressing TBI and PTSD satisfactorily?

I think that generally speaking the federal government was not prepared for the number of PTSD and TBI cases coming out of these conflicts. I have no idea why the federal government didn't immediately begin to screen all of its returning troops for TBI once it became apparent that this was a significant injury of the war. To be fair, it is easier for states to screen just their vets than it is for the federal government to implement a national program. Regardless, it is something that must be done. Both TBI and PTSD have a higher success rate if the treatment begins as early as possible.

Nationwide, most agree that there is a shortage of treatment programs for PTSD for returning veterans. How can and should this be addressed?

There are many ways we could address the problem and one solution may be a partnership between states and the federal government. For example, Illinois's PTSD/TBI program is meant as a supplement to help identify the cases that are missed by DOD and USDVA and to help those slipping through the cracks. It is relatively easy to train clinicians to conduct the initial screenings and for the USDVA to take over once the cases are identified. I also think that the fifth year of the war is a woefully late point in time to start thinking about training PTSD clinicians. However, if the resources were truly put into it, we could train civilian mental-health providers to provide the needed care. Unfortunately, I don't see the federal government putting in this kind of effort right now.

What do you say to veterans who are on long waiting lists and have other complaints about their treatment? Is this frustrating for you when you hear these complaints?

It is incredibly frustrating to me to hear of the federal VA's backlogs. Right now they range from 400,000 to 600,000 cases. All those cases represent real men and women who have served. For the new claims, the vets can't get access to VA care until they are deemed eligible. This means that someone suffering from a brain injury may have to wait as long as 18 months to two years before getting help!

As someone who spent a substantial amount of time recovering at Walter Reed Army Medical Center, what was your reaction to all the negative publicity surrounding the hospital earlier this year?

I owe my life to the incredibly dedicated men and women at Walter Reed. The problems there were a result of lack of planning by the leadership. I saw some of the structural strains on Walter Reed when I was there. For example, my social worker was working 60-70 hour weeks to take care of his patients during my time [there]. Three years later, the number of patients had grown significantly but the number of social workers stayed the same. I still go back to Walter Reed and would trust the staff there with my life again. I just wish they had been supported by the leadership.

What was your reaction to the news last week that a coalition of Iraq veterans has sued the VA for allegedly denying or delaying claims for disability pay and mental health treatment, among other things?

I was surprised it took so long.

Looking back now on your foray into politics, how would you describe the experience and what did you take away from running for political office?

It was an exhausting, enriching experience. I can best compare it to trying to complete a 12-mile road march in full combat load. At the end of it you're dead on your burning feet, bruised, hurting in places you didn't know existed, but damn proud of having done it. 

How are you adjusting to postwar life with your disability? 

Life really does go on. It just takes me longer to do the same things that I used to do before. It can be frustrating, but then I remember that I made it home and over 3,000 of my comrades didn't.

What has been your biggest challenge since your return?

Trying to find some time to take a vacation!