FairWarining Investigates

Some Peace Corps Volunteers Face Injury Overseas, Indifference at Home

Former Peace Corps volunteer Christie-Anne Edie in Colorado Springs, Colo., in September.

In June 2011, nine months into her assignment as a Peace Corps paramedic in the Central Asian republic of Turkmenistan, Caitlyn Hogan was run over by a car while crossing a gravel road near her apartment.

Her ankle was crushed but, as she tells it, her ordeal had just begun. Instead of receiving help from federal agencies because of being hurt while on duty overseas, Hogan said she got caught in a bureaucratic maze that has haunted her life ever since. Her requests for disability payments were ignored. On top of that, she is fearful that she will be stuck with many of her unpaid medical expenses, which so far total $17,000. Meanwhile, the collection agency calls keep coming.

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“It’s kind of devastating really. Peace Corps was something I wanted to do forever, and I get this chance to go,” Hogan, 27, said in a recent interview with FairWarning. “I can’t even feel positive about the stuff I got accomplished because it’s so overshadowed just by the lack of care by Peace Corps and their disinterest in helping.”

Hogan’s feelings of abandonment by the Peace Corps are hardly unique. Volunteers who serve in impoverished, dangerous countries all too often endure sexual and other assaults, psychological trauma and physical injuries, as well as exotic diseases. Yet former volunteers-turned-activists say the government workers’ compensation program that is supposed to provide medical care and disability payments for the injured is rife with troubles. Even Peace Corps officials, while declining to comment on any specific cases, acknowledge some of the problems.

The program’s flawed management was underscored by a Government Accountability Office report issued in November. The assessment was required by the Kate Puzey Peace Corps Volunteer Protection Act of 2011, named after a volunteer who was murdered while working in the West African nation of Benin.

Caitlyn Hogan, who served in Turkmenistan.

The narrowly focused report faulted both the Peace Corps and the U.S. Labor Department, which administers the workers’ compensation program known as FECA, after the Federal Employees’ Compensation Act. “The agencies generally do not work together to use available information to monitor the accessibility and quality of FECA benefits for volunteers,” according to the assessment.

The report, which noted that FECA serves about 1,400 Peace Corps volunteers a year and spent $36 million in benefits on them from 2009 through 2011, did not examine actual examples of the hardships resulting from the program’s flaws. Nor did the Government Accountability Office note that it found similar problems when it examined FECA 21 years ago.

No Mental Health Specialists

But the report gave a clue of how difficult it may be for returning volunteers to get proper treatment. Using the government’s online search tool to look for doctors registered with the program, the report’s authors did not find any mental health specialists in California, New York, Texas or any of the other 10 states with the most Peace Corps veterans.

As the cautious language of the report put it, “volunteers may face some challenges accessing registered providers.” Beyond that, the report noted the possibility that there may be volunteers who are assaulted but are too ashamed or fearful to report the incidents while overseas and, as a result, may lack the documentation to file FECA claims later on.

Interviews by FairWarning with more than a dozen former Peace Corps personnel – about half of them members of Health Justice for Peace Corps Volunteers, an advocacy group – highlighted the struggles of harmed volunteers. Many failed to gain government-paid medical care when they returned to the U.S. because they couldn’t find doctors registered with FECA. What’s more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.

Volunteer Jessica Gregg, for example, said she was drugged and sexually assaulted in October, 2007 by a young man she met at a restaurant in Mozambique, where she had served for 13 months as an English teacher. Afterward, Gregg returned home to Tucson, Ariz., to recover. But after Gregg had several psychological counseling sessions, the labor department denied her health care claim, and she went without further therapy or medication for six months, until she obtained private insurance through a new job.

“There was never a person I could talk to specifically about workers’ compensation that seemed competent,” Gregg said. She explained that her claim was denied because she found out too late that the labor department required a doctor, not a psychologist, to perform her initial medical examination.

“My PTSD symptoms and depression were crippling,” Gregg testified in an affidavit submitted in February, 2011 to the House Committee on Foreign Affairs, which looked into cases of volunteers who were raped or otherwise assaulted after ABC News reported on the issue. “I went without psychological care for an extended amount of time simply because I could not afford treatment or even navigate the system on my own.”

Although the Peace Corps covers medical costs for volunteers while they are on duty, once they return home, volunteers are expected to turn to the agency’s “Post-Service Unit” to receive medical examinations. After that, the Post-Service Unit largely steps aside, and its only continuing involvement is providing assistance in filing a FECA claim with the labor department.

Like federal employees, Peace Corps volunteers with job-related injuries can file claims to cover medical bills and, if they can’t return to work, to secure disability payments. Since volunteers are considered to be on the job around the clock when they are on foreign soil, any injury they suffer while on assignment is eligible for coverage.

But Peace Corps officials admit the system is flawed. “Unfortunately, this system has failed” returned volunteers, “and that is truly disheartening,” Peace Corps acting director Carrie Hessler-Radelet wrote in a recent blog post.

An Incentive to Deny Claims

To improve the situation, Peace Corps officials told the Government Accountability Office that they are adding staff and giving case managers authority to provide “care coordination for some catastrophic illnesses or injuries.”

Jessica Gregg (center) with other former Peace Corps volunteers in Mozambique in 2006.

But the agency says it has limited authority to make reforms, and points the finger at the labor department for the way it runs the workers’ compensation program.

Still, labor department figures show that the Peace Corps sometimes falls down in handling its part of the job. For instance, the Peace Corps delivered its paperwork for wage-loss claims on time in only 42 percent of the cases in the 2012 fiscal year.

And critics doubt that the Peace Corps pushes the labor department very hard to approve more claims because the Peace Corps, like any other federal agency, would wind up having to foot the bill. “Peace Corps has a financial incentive to get the Department of Labor to deny claims,” said Kevin Clark, a former volunteer from Canaan, N.H. who was one of the founding members of Health Justice for Peace Corps Volunteers.

Another former volunteer, Chuck Ludlam of Washington, D.C., said, “the transition between the Peace Corps medical system and the Department of Labor medical system is of no interest to the Peace Corps. As long as you get the volunteers off the books, they’re happy.”

Geoffrey Shapiro, a workers’ compensation lawyer in Warrensville Heights, Ohio, who has represented injured Peace Corps volunteers, said the labor department – which declined to comment for this story — also is to blame. He said it wants to protect federal agencies by holding down workers’ compensation costs, “so they blame the injured workers” and deny many of their claims for benefits.

Calls Ignored

In September 2008, Peace Corps volunteer Christie-Anne Edie started teaching women and adolescents about family planning, sexually transmitted diseases and sanitation. But by spring of the following year, while she was in the West African nation of Burkina Faso, Edie says she contracted a mysterious gastrointestinal infection. It was so severe that by December 2009 the Peace Corps sent her back home to Fort Collins, Colo.

When the Post-Service Unit turned her case over to the labor department, she said it felt as though the Peace Corps was saying, “We wash our hands of you. There is nothing we can do.”

Since then, according to records Edie provided FairWarning, the labor department has rejected her more than $25,000 in medical bills. “They always come up with some sort of excuse not to pay,” Edie said.

Getting help from either the Peace Corps or the labor department, she said, has proved futile. In addition to sending several letters, Edie said she has left 16 voicemail messages with the labor department that have never been returned.

Christie-Anne Edie in Burkina Faso in June 2009.

The shortcomings of the Peace Corps’ Post-Service Unit have been a concern for more than two decades. In 1991, the Government Accountability Office (then known as the General Accounting Office) said the unit’s officers often were unable to answer volunteers’ questions about FECA. Many returned volunteers weren’t even told they were entitled to health care benefits.

Former volunteers for years pressed, unsuccessfully, for Congress and the Peace Corps to set up an ombudsman office where the injured could turn to for help.

By 2008, Christopher Dodd, then a U.S. senator from Connecticut and chairman of the Subcommittee on Western Hemisphere, Peace Corps and Narcotics Affairs, was spurred to write to the Peace Corps director at the time, Ronald A. Tschetter. Dodd said he had been contacted by a “significant number of Returned Peace Corps volunteers who have expressed deep concerns with the performance of Office of Workers’ Compensation Program.”

Dodd suggested that the Peace Corps establish an “information center” that could track the handling of workers’ compensation claims. But that request, too, failed.

“Billing Process Is a Nightmare”

When it comes to getting medical care back in the U.S., injured volunteers often have few options. Dr. John Ellis, an Oklahoma City, Okla., physician who specializes in treating injured workers, said federal employees from all over the country travel to see him because they can’t find anyone else who will treat them. “It just blows my mind that no one will see these people,” Ellis said.

Toby Rubenstein, who for more than 20 years was a claims handler and supervisor for the labor department’s workers’ compensation program, said physicians lack a financial incentive to treat Peace Corp volunteers or federal workers.

The program is “not paying very much and yet the billing process is a nightmare, so that’s why the doctors don’t want to see them,” Rubenstein said.

Jack Saul, a psychologist based in New York City and an assistant professor at Columbia University’s Mailman School of Public Health, said he has treated two or three volunteers for free. “My experience has been that the process was so complicated that I eventually just gave up in trying to be compensated for work that I had done with some people who had been in the Peace Corps,” he said.

When it comes to getting paid, “It’s literally a word game,” said Howard L. Graham, an attorney in Tacoma, Wash., and author of the “Federal Employees’ Compensation Act Practice Guide.” “They require the perfect medical report.”

No one has struggled more, however, than injured volunteers like Hogan, whose ankle was crushed while on duty in Turkmenistan. After being treated at a hospital in the capital city of Ashgabat, Hogan said she spent six weeks sleeping on the floor of the local Peace Corps office trying to recuperate. Then, suddenly, she was shipped home to the Pittsburgh, Pa., area, when a doctor back in the U.S. saw an MRI of her injury and realized she wasn’t recovering properly.

Hogan continues to suffer from traumatic arthritis. Because her leg gives out on her at least once a day, she often uses a cane. Her bad ankle has led to other injuries, like a recent fall that hurt her back and neck. She also is being treated with electroshock therapy for anxiety issues. And she carries on the battle to get her medical bills paid by the labor department.

“I guess I’m kinda stuck with being 27 and being crippled for life,” she said.

Myron Levin contributed to this story.

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About the author

Lilly Fowler is assistant editor at FairWarning.

9 comments to “Some Peace Corps Volunteers Face Injury Overseas, Indifference at Home”

  1. DYS

    PC just wants payments moved to DoL. Rest is just lobbying.

  2. Claudia Jayne

    I too am going through this medical nightmare…six months home and still no treatment. I was wanting to be a Peace Corps Recruiter when I returned…now I am so frustrated with the PC for not taking care of us stateside! I am giving many presentations to groups about my PC experience…and not sure what to say about PC lack of medical care upon completion…

  3. Nancy Tongue

    I founded Health Justice for Peace Corps Volunteers in March 2012 after struggling wtih my Peace Corps-related illnesses for decades. White it is tragic that it has taken multiple efforts on the part of hundreds of returned volunteers and the creation of a formal group to bring about improvements, I am pleased that since the creation of this group, Peace Corps’ Acting Director (Carrie Hessler-Radelet) has mobilized to create new positions for staff within the agency to offer support for those who have become sick or injured as a result of service. She promptly hired a consultant, Carol Chappell to intervene. And Carrie came to my home to learn about the magnitude of the health issues many of us have suffered, poring through and even photographing my many filing cabinets filled with documents pertaining to the Peace Corps Post Service Unit. the USDOL and my personal claim. Carol personally worked for months to obtain coverage for a necessary medical procedure for me that had been denied by the USDOL — and succeeded.

    My issues are not fully resolved and may never be but I hope that the battles to get procedures approved and covered lessen and consume less of my time allowing more time for my life’s goals. And I know that many out there are suffering gravely.

    While the recent GAO investigation and resulting report are a welcome beginning to examining long-standing problems within both the USDOL and Peace Corps’ handling of healthcare for volunteers, it fails to provide significant insight into the issues or make many recommendations beyond what was already known.”

    We feel changes in legislation are also needed in the following areas to:

    1. Place an expert with knowledge of Peace Corps job service and health issues within the USDOL to broker our claims, since the paperwork doesn’t reflect our unique types of health issues or job responsibilities
    2. Create a health insurance plan, as other Federal employees have when they become sick/injured on a job. When volunteers return home sick/injured some become uninsurable due to their “pre-existing illness” from their Peace Corps service.” Because we are deemed “volunteers” and not “employees,” we are not grated the same privileges that other federal employees get.
    · 3. Increase the “value” of Peace Corps Volunteers to a level greater than a GS-7, step 1 so that when they are unable to work, due to illness/injury, their disability is not fixed at a level that keeps them in poverty in America.

    Health Justice for Peace Corps Volunteers remains hopeful that the concerns of the Acting Director and newly hired staff at Peace Corps will continue to advocate for our needs and that legislation can be enacted to make positive changes permanent, especially within the USDOL. The general public knows little of the suffering many have endured because of service-related health issues since the founding of the Peace Corps fifty one years ago. Fortunately, we now have some advocates at Peace Corps who truly seem to understand the magnitude of the issues.

  4. Jennifer Jansen

    Once again, another sad example of how the US government takes care of its injured servicemen and women upon return. Since FECA and US Labor ignore its citizens who have returned home from serving abroad, there needs to be a safety net in place for PCVs injured overseas, whether through private insurance or something similar. In any case, this information needs to be included in Peace Corps recruiting presentations so prospective volunteers are aware of their potential circumstances when becoming ill or injured. Maybe this will help Peace Corps and its affiliated health organizations to clean up their act.

  5. Bridget DeCourcey

    Another issue worth noting is AfterCorps, Peace Corps’ version of insurance. AfterCorps mixed up two of my claims, and insisted that before they would cover the 90% portion of a $2,990 emergency room bill for a condition unrelated to a chronic stomach problem that forced me to leave my service, they told me I needed a FECA denial. FECA claims are needed only for injuries/illnesses sustained in your country of service. It took months and many phonecalls (during which I was talked down to like a child) to get the matter cleared up.

    AfterCorps also raised its monthly premiums without notice in September of this year, by over 30%. Federal law requires that insurance companies provide notice to clients of a rate increase, so that they have time to seek out insurance from other companies if the new rate is too high. When I called to complain, the representative I spoke to said, “In our agreements, we do reserve the right to change rates at any time.”

    It doesn’t make sense to me. We leave the comfort of our lives because we feel that we are called to serve. How Peace Corps and the Department of Labor can make the process of getting help with illnesses we experience on the job so difficult is something that bothers me tremendously. If this continues, Peace Corps will not be able to find amazing men and women to serve, which is a shame. It is a wonderful agency that puts America’s best foot forward. But as long as people hear about the horrors of FECA and AfterCorps, they’ll stay away.

  6. Wendy

    I am an RPCV, served Samoa 1997-2000, and I am so sorry to hear of PCVs/RPCVs challenges in accessing, receiving, and getting reimbursed for appropriate health and mental health care. I had an overall very positive experience as a PCV. I needed surgery, was medivac’ed, and stayed there until I was healthy enough to return to my country of service (I was cleared for return on day 43; if I had not been cleared by day 45, I would have been medically separated). Upon COS and return home, I had exploratory surgery to make sure everything was healing properly; I also needed to see a gasteroenterologist for treatment, and did so. All my medical done both in country and upon return went really well, and I had no problems with reimbursement (yes, it was a lengthy process, but all was achieved in the end). I had an amazing PCMO team (PC Medical Officer), and my return was to the Washington DC area – which meant I had much greater access to medical professionals in the system; I am sure both these issues played a large part of how well my process went.

    Again, it is so sad to hear of PCVs/RPCVs who leave with such negative experiences, and I’m sorry their PC time was tarnished like it was. It baffles me that PC and FECA are not doing more to support these volunteers. It also amazes me that there are so few medical professionals who participate in the system. I thought the medical field was “do no harm”, and when doctors refuse to see patients because they are under FECA, it is doing harm. Every medical professional should be obligated to see a small % of patients receiving medical benefits (FECA, workers’ comp, Medicaid, Medicare, etc) so that the responsibility is spread thin but wide, and access to medical care is increased to all.

  7. Joan McKniff

    “Volunteers who serve in impoverished, dangerous countries all too often endure sexual and other assaults, psychological trauma and physical injuries…” Do you have statistics that show sexual and other assault rates are higher in poor and “dangerous” countries than in NYC or USA as a whole? What do you mean by dangerous? Do you have statistics on % of Peace Corps volunteers who have been assaulted? Of course even 1 person is one too many but I suspect the rate is less than 2%.

    I fear what could have been a very good story, especially if had suggested solutions, on problems of FECA was sensationalized by headline and emphasis on supposed great risk of being a Peace Corps volunteer and then being ignored once home.

  8. Ms. Toby Rubenstein

    Are you aware that monetary compensation may be payable?

    I am willing to take cases under the FECA from Peace Corps volunteers. My affiliate consultant, Richard Kulick, may be able to help with medical bill processing.

    We are not attorneys, but together we have 33 years of experience at the Division of Federal Employees Compensation. The firm has been in existence for seven years. Fees are lower than attorneys would charge.

    We specialize in claims for emotional conditions but take other cases as well.

    You may reach me at (302) 559-7501.

  9. Matt

    I was lucky to get away without permanent injury, and only a couple thousand in debt. I had some dental fillings done in country that were improperly cleaned; decay continued under the fillings until it reached the roots of my teeth. I have been trying to get root canals for over a year.

    The problem is not with the Peace Corps medical unit, but with the FECA system, and the fact that volunteers are required to use it at all. Peace Corps, to be fair, was excellent for their piece. They got my condition to be accepted on the first attempt, with within weeks. I believe that to be nothing short of a miracle. After that, however, they wash their hands of you.

    In order to contact your FECA case worker, you leave a voicemail and they call you back sometime within the next two to three weeks. If you cannot talk or do not pick up when they call, then you leave another voicemail. Your caseworker is legally prohibited from assisting you in finding a medical provider who will accept workers compensation.

    After calling every endodontist within 200 miles, I found one in New Jersey who thought they were already enrolled with the FECA payment processor. They were not. If your medical provider needs any guidance for submitting your claim, or for enrolling in the payment system, they need to leave a voicemail with the case worker. If when the caseworker calls they are put on hold, for example because someone is with a patient or because your file needs to be retrieved, the case worker simply does not have the time to wait.

    Unfortunately they also do not try again later. The receptionist has no clue who that was, and the doctor who eventually picks up the phone to dead air definitely has no clue who that was. The office continues to believe that they requested assistance that is not coming.

    Every procedure needs to be pre-approved, so this has to happen at every step. Diagnosis, approval, and payment. Hopefully your doctor does not insist on being paid for the first procedure before moving on to the second, because that is not going to happen.

    At first I lived with the pain because I thought I was in the system now. Then I lived with it because I realized if I paid out of pocket, I would never be reimbursed. I couldn’t risk of not being able to repay the debt. At one time a volunteer’s readjustment allowance could buy them a decent car. Now it barely covers a security deposit and the first and last months’ rent. To some I am sure that the thought of not immediately paying is ridiculous, but to a freshly returned volunteer who nothing but a suitcase of used clothes purchased in an african market, a couple thousand dollars is an impossible sum.

    Twelve months after my close of service date, I had absolutely no hope of receiving approval. I am back in school, so I could take out student loans, but I continued to live with it out of sheer stubbornness. I felt betrayed. They call volunteering service, after all. “Ask not what your country can do for you, but what you can do for your country.” Right? Right.

    I am so angry, and every time I chew, drink, or swallow, I am reminded by agony of the injustice. I’ve finally realized that living with constant pain is twisting me into a person that I do not want to be. I will put it on a credit card. In the spring I will take extra student loans to pay for it, and put it behind me. I thank God that I can, and I am so, so sorry for those who cannot.

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