At a later evaluation at the Veterans Administration's Tampa Polytrauma Rehabilitation Center in Florida, he was diagnosed with a "traumatic brain injury with a blow-out fracture to the right orbital wall; he had vision, hearing, and cognition deficits with short-term memory loss and chronic migraines. He also sustained a right shoulder injury and has an otolith disorder." On top of all of that, Marcum was told he had post-traumatic stress disorder.
Today is the first National Rural Health Day, and VA Office of Rural Health (ORH) Director Mary Beth Skupien said she's proud of how far the office has come since it began three years ago. The office is most focused on getting veterans better access to care close to home and specialty care in their communities, she said.
Forty-one percent of veterans in the VA system live in rural areas, according to ORH. There are 22 million veterans, and 6.1 million live in rural areas, of which 3.3 million are enrolled in the VA system. A study from ORH found that distance was identified as the most important barrier for rural veterans seeking care.
Plus, soldiers from more recent wars are increasingly coming from rural areas, and rural VA users also are growing, according to the office. Young people living in rural zip codes are 22 percent more likely to join the Army.
April Marcum described the process of seeking medical care as "a lot of unknowns" for her husband and family members. They have two boys -- Jared, 14, and Gabe, 11, who was diagnosed with secondary post-traumatic stress disorder even before Marcum got his proper diagnosis. After finally navigating the system, April Marcum said they have found doctors who are making a real difference in their lives. "We have some truly amazing medical people that are on our side who want to help Tom as much as I do," she said.
But, like many other rural veterans, the problem is that the VA hospital they go to for this care is two hours away from their home in Ray City, Georgia, and the closest Vet Center is over an hour and a half away. There is a community-based outpatient clinic about 20 miles from their home, but April Marcum said the clinic is very limited in what can be treated there.
The Marcums are not the only ones for whom distance is a problem when seeking care. While psychiatric disorders are lower among rural veterans seen by the VA compared to those in urban areas, rural veterans often have lower health-related quality of life, according to ORH. Rural veterans are also less likely to access their care, despite greater health care needs, the office stated, and, particularly, veterans have lower access to care for PTSD.
In May 2010, Marcum was placed on a temporary duty retirement list. A year later, the couple went to San Antonio, Texas, for a re-evaluation by the medical board. In September, April Marcum said they were told her husband would be officially retired on November 6. She said she was upset that he did not receive a letter thanking him for his nearly 15 years of service. Now Marcum no longer reports to work, and April Marcum has had to quit her job look after him.