Richard Nystrom was in the Air Force serving in the Korean War when an Army dentist put temporary fillings in two teeth. The work was faulty, and the teeth eventually rotted under the fillings...

Forty years later, Nystrom needed the dental work redone. But it's taken him a decade of appeals just to get an exam. Today, he's missing 17 teeth and is too self-conscious to smile. He chews with two molars. And living on $1,200 a month, the 76-year-old Tigard resident cannot afford to pay a private dentist $5,000 to fix his teeth...

There is no shortage of complaints such as Nystrom's about the difficulty in establishing eligibility for VA health care. His story and those of other older veterans offer a warning to an agency bracing for the return of tens of thousands of military men and women fighting in Iraq and Afghanistan...

Once deemed eligible, veterans face an eight-tier system of prioritization when they seek health care that takes into account issues such as service-connected disabilities, combat wounds, whether they were a prisoner of war and net worth...

The pool of veterans being treated by the VA is increasing -- from 4.1 million in 2001 to 5.5 million in 2006. But the influx is nothing like the numbers the VA was built to handle, said Phillip Longman, author of "Best Care Anywhere: Why VA Health Care Is Better Than Yours..."

Unlike private hospitals, the VA has controlled per-patient costs during a time when health care costs across the nation have skyrocketed, Longman said...

Longman, a senior fellow at the New America Foundation, writes that it's "truly remarkable" that the VA has been able to contain costs while treating generally older, sicker and poorer clients. But in an e-mail exchange with The Oregonian, he acknowledged weaknesses.

Paperwork problems are at the top of his list. Another big problem is that the military is mostly using paper records and its computers can't talk to the VA's computers. Easing the transition between military hospitals and the VA is at the top of Secretary Nicholson's to-do list.

Solving that problem will be a key to preventing more frustrations because thousands of current soldiers will be accessing VA care in the years to come...

A radical solution that Longman, the author, has proposed would eliminate the complex system of prioritization in favor of treating every vet who needs health care. In the next decade, nearly all World War II and Korean War veterans will be dead, he said. He argues that the system must expand eligibility if it's to maintain safe patient volumes.

If a surgeon only picks up a knife once a year, he's going to be out of practice," Longman said...

For the complete article, please visit The Oregonian website.