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The late Sen. Daniel K. Inouye, who lost an arm fighting in World War II, once observed that advances in transportation and medicine were allowing soldiers to survive battlefield wounds that would have been a death sentence during his time in combat.
“In my case, it took nine hours to evacuate me. Nine hours? That is a long time. But in Italy, they have hills. We had no helicopters in those days. You had to be carried by hand. As a result, no brain injuries survived and no double amputees survived,” the Hawaii Democrat said in a 2010 floor speech.
Now, advanced treatment on battlefields followed by quick transport to more sophisticated medical care has shifted the odds of survival in war zones. The military has treated some 40,000 survivors with severe to moderate brain injuries suffered in connection with the wars, according to the Congressional Research Service.
The near-miraculous interventions that have spared many lives have also strained the resources of veterans health services and the ability of service providers to manage both the rehabilitation and the years of continual support that have grown out of wars in Iraq and Afghanistan. Added to this is the widespread post-traumatic stress disorder reported by veterans — the grim echoes of a decade of war.
“As we engage in wars, it is a two-part cost. One is the action of the war and the actions after,” said Sen. Mark Begich, an Alaska Democrat, at a 2011 Senate Veterans’ Affairs hearing. “When we engaged in the wars of Iraq and Afghanistan, not a lot of people thought about the next cost.”
By late 2012, about half of returning veterans from these conflicts — 783,623 of 1.66 million — had applied for disability benefits, according to a Department of Veterans Affairs document cited by Linda J. Bilmes, a budget expert at Harvard University’s Kennedy School of Government who wrote a book examining the costs of the Iraq War — “The Three Trillion Dollar War” — with Nobel Prize-winning economist Joseph E. Stiglitz in 2008.
The impact will reverberate on U.S. spending for many years, according to Bilmes.
“The legacy of decisions taken during the Iraq and Afghanistan wars will dominate future federal budgets for decades to come,” Bilmes said in a March 2013 paper on the costs of the two conflicts.