Obama's VA eases rules for PTSD

[SirNitram]

Link

The government is preparing to issue new rules that will make it substantially easier for veterans who have been found to have post-traumatic stress disorder to receive disability benefits, a change that could affect hundreds of thousands of veterans from the wars in Iraq, Afghanistan and Vietnam.

The regulations from the Department of Veterans Affairs, which will take effect as early as Monday and cost as much as $5 billion over several years according to Congressional analysts, will essentially eliminate a requirement that veterans document specific events like bomb blasts, firefights or mortar attacks that might have caused P.T.S.D., an illness characterized by emotional numbness, irritability and flashbacks.

For decades, veterans have complained that finding such records was extremely time consuming and sometimes impossible. And in the wars in Afghanistan and Iraq, veterans groups assert that the current rules discriminate against tens of thousands of service members — many of them women — who did not serve in combat roles but nevertheless suffered traumatic experiences.

Under the new rule, which applies to veterans of all wars, the department will grant compensation to those with P.T.S.D. if they can simply show that they served in a war zone and in a job consistent with the events that they say caused their conditions. They would not have to prove, for instance, that they came under fire, served in a front-line unit or saw a friend killed.

The new rule would also allow compensation for service members who had good reason to fear traumatic events, known as stressors, even if they did not actually experience them.

There are concerns that the change will open the door to a flood of fraudulent claims. But supporters of the rule say the veterans department will still review all claims and thus be able to weed out the baseless ones.

“This nation has a solemn obligation to the men and women who have honorably served this country and suffer from the emotional and often devastating hidden wounds of war,” the secretary of veterans affairs, Eric K. Shinseki, said in a statement to The New York Times. “This final regulation goes a long way to ensure that veterans receive the benefits and services they need.”

Though widely applauded by veterans’ groups, the new rule is generating criticism from some quarters because of its cost. Some mental health experts also believe it will lead to economic dependency among younger veterans whose conditions might be treatable.

Disability benefits include free physical and mental health care and monthly checks ranging from a few hundred dollars to more than $2,000, depending on the severity of the condition.

“I can’t imagine anyone more worthy of public largess than a veteran,” said Dr. Sally Satel, a psychiatrist and fellow at the American Enterprise Institute, a conservative policy group, who has written on P.T.S.D. “But as a clinician, it is destructive to give someone total and permanent disability when they are in fact capable of working, even if it is not at full capacity. A job is the most therapeutic thing there is.”

But Rick Weidman, executive director for policy and government affairs at Vietnam Veterans of America, said most veterans applied for disability not for the monthly checks but because they wanted access to free health care.

“I know guys who are rated 100 percent disabled who keep coming back for treatment not because they are worried about losing their compensation, but because they want their life back,” Mr. Weidman said.

Mr. Weidman and other veterans’ advocates said they were disappointed by one provision of the new rule: It will require a final determination on a veteran’s case to be made by a psychiatrist or psychologist who works for the veterans department.

The advocates assert that the rule will allow the department to sharply limit approvals. They argue that private physicians should be allowed to make those determinations as well.

But Tom Pamperin, associate deputy under secretary for policy and programs at the veterans department, said the agency wanted to ensure that standards were consistent for the assessments.

“V.A. and V.A.-contract clinicians go through a certification process,” Mr. Pamperin said. “They are well familiar with military life and can make an assessment of whether the stressor is consistent with the veterans’ duties and place of service.”

The new rule comes at a time when members of Congress and the veterans department itself are moving to expand health benefits and disability compensation for a variety of disorders linked to deployment. The projected costs of those actions are generating some opposition, though probably not enough to block any of the proposals.

The largest proposal would make it easier for Vietnam veterans with ischemic heart disease, Parkinson’s disease and hairy-cell leukemia to receive benefits.

The rule, proposed last fall by the veterans department, would presume those diseases were caused by exposure to Agent Orange, the chemical defoliant, if a veteran could simply demonstrate that he had set foot in Vietnam during the war.

The rule, still under review, is projected to cost more than $42 billion over a decade.

Senator Jim Webb, Democrat of Virginia and a Vietnam veteran, has asked that Congress review the proposal before it takes effect. “I take a back seat to no one in my concern for our veterans,” Mr. Webb said in a floor statement in May. “But I do think we need to have practical, proper procedures.”

More than two million service members have deployed to Iraq or Afghanistan since 2001, and by some estimates 20 percent or more of them will develop P.T.S.D.

More than 150,000 cases of P.T.S.D. have been diagnosed by the veterans health system among veterans of the two wars, while thousands more have received diagnoses from private doctors, said Paul Sullivan, executive director of Veterans for Common Sense, an advocacy group.

But Mr. Sullivan said records showed that the veterans department had approved P.T.S.D. disability claims for only 78,000 veterans. That suggests, he said, that many veterans with the disorder are having their compensation claims rejected by claims processors. “Those statistics show a very serious problem in how V.A. handles P.T.S.D. claims,” Mr. Sullivan said.

Representative John Hall, Democrat of New York and sponsor of legislation similar to the new rule, said his office had handled dozens of cases involving veterans who had trouble receiving disability compensation for P.T.S.D., including a Navy veteran from World War II who twice served on ships that sank in the Pacific.

“It doesn’t matter whether you are an infantryman or a cook or a truck driver,” Mr. Hall said. “Anyone is potentially at risk for post-traumatic stress.”

About time. PAST about time. But like the EPA's moves against coal-fired plants, nice and quiet. And evading the GOP-generated gridlock.

[Kanastrous]

Under the new rule, which applies to veterans of all wars, the department will grant compensation to those with P.T.S.D. if they can simply show that they served in a war zone and in a job consistent with the events that they say caused their conditions. They would not have to prove, for instance, that they came under fire, served in a front-line unit or saw a friend killed.

The new rule would also allow compensation for service members who had good reason to fear traumatic events, known as stressors, even if they did not actually experience them.

There are concerns that the change will open the door to a flood of fraudulent claims. But supporters of the rule say the veterans department will still review all claims and thus be able to weed out the baseless ones.

This jumped out at me because it appears that the burden of proof is set so low (just show that one was present somewhere in a war zone, and claim PTSD) that I have to wonder what criteria the VA will use to "weed out baseless" claims.

Still, I'd rather that some number of frauds (however many people that would be anyway) get benefits, than turn away people who really do need the help.

[Aaron]

The US VA has been poking around VAC and various federal agencies for a few years up here, gathering ideas. I know that the US Marines for example where looking to adopt a similar assessment process as VAC uses (something I fully expect VA to use), which basically consists of a series of interviews with a psychiatrist, a really long questionnaire, some testing with blocks, etc.

The requirement to have served in a war zone to get PTSD is simply bunk. It should simply be related to military service, I've got it and I never deployed outside of Canada, yet I'm rated at 30% (just for PTSD) disabled.

[Kanastrous]

Since it's personal I fully understand if you prefer not to get into it, but what sort of situations does one encounter in the military short of being in a combat zone that lead to developing PTSD? My contact with the military was limited to some time in ROTC, so I'm not really equipped to answer that for myself.

[Aaron]

Assisting with natural disasters (I deployed to the ice storm in 98 that hit Ontario and Quebec and parts of the US), search and rescue (we were called out to find a 3 year old girl that went missing), accidents during training, I'm sure I'm forgetting others.

All three of those (though the final was the tipping point) lead to me getting it.

Folks can get it from a car accident or rape (also encountered in the military). As far as I'm concerned if it happened on company time it's the company's dime.

[FSTargetDrone]

Since it's personal I fully understand if you prefer not to get into it, but what sort of situations does one encounter in the military short of being in a combat zone that lead to developing PTSD? My contact with the military was limited to some time in ROTC, so I'm not really equipped to answer that for myself.

I would imagine medical personnel who are stateside or elsewhere outside of a combat zone would certainly be subject to PTSD. Seeing grievous injury after grievous injury, multiple amputations (especially concerning the same individual), catastrophic burns, brain injuries and the like would take its toll on caregivers after awhile.

[Aaron]

I would imagine medical personnel who are stateside or elsewhere outside of a combat zone would certainly be subject to PTSD. Seeing grievous injury after grievous injury, multiple amputations (especially concerning the same individual), catastrophic burns, brain injuries and the like would take its toll on caregivers after awhile.

Yup. When the Swiss Air flight went down off the coast of Canada, a number of folks in the military; medics and divers got it.

Edit: I knew a woman, deployed to Germany in the 80's who was in all likelihood gang-raped by her co-workers. She got a pension for PTSD as a result, it was a long and drawn out battle with VAC but she did. Never saw combat, never deployed to a combat zone.

[Coyote]

Rescue workers who responded to the Air New Zealand Mt. Erebus crash in 1979, too, IIRC. Picking through bodies for days, chasing off gulls consuming the dead in front of them... the damn birds wouldn't stop.

This is a good thing, though, and the requirements can tighten up eventually. About time mental reactions to combat were given as much attention as physical ones.

[Kanastrous]

Yeah, I've read about the recovery work at the Erebus site. Just nightmarish.

[Aaron]

Rescue workers who responded to the Air New Zealand Mt. Erebus crash in 1979, too, IIRC. Picking through bodies for days, chasing off gulls consuming the dead in front of them... the damn birds wouldn't stop.

This is a good thing, though, and the requirements can tighten up eventually. About time mental reactions to combat were given as much attention as physical ones.

Yeah, it's still progress.

[Coyote]

I was only in a couple of direct-fire situations in Iraq, and I never actually saw the people shooting at us. But there were RPGs going off, stuff buzzing by overhead... the prospect of my own imminent death was a very real possibility, and the thought of my long and adventurous life coming to a close in a dusty street in Baghdad seemed, to me, an ignominious end. But then aren't they all?

And on a couple of occassions, I and the people with me had to get ready to shoot at people who were getting too close despite repeated warnings and displays to back off. Those were the situations where I fired my only shots of the war: warning shots. Each time I was gratefully relieved that the people always backed down.

But for a few moments there, the decision had been made in my mind that I was ready and about to shoot people if they did not follow my instructions. That is an interesting switch to flick in your head, and I starkly remember a look of raw, horrid fear in one man's eyes as I got ready to shoot.

Then there's the time we had the prisoners, the guy caught teaching his 14-year old son to use an RPG and we had to process him like everyone else even though we were pretty sure that one of his RPGs was the one that killed a guy we knew the week before...

One that I really hated was inventorying the personal belongings of guys who were, for various reasons, no longer there. Some were wounded and rotated home, some were killed. A bunch of us had to seperate personal from military gear, and further subdivide re-usable military gear from stuff that was damaged. I distinctly remember picking up a helmet which, on the surface, seemed okay, until I turned it over and saw the inside full of rust-brown, and saw the torn fibers which were traced to the little bullet hole on the back. I looked at the name tape on the front and recognized the guy's name, I passed him in the chow hall almost every day.

That constant feeling hanging over you... it eats at you. And I was insanely lucky: I never actually shot anyone, got shot, or knew personally anyone who got shot (I knew a few people peripherally who got shot, but they were never more than names & faces I recognized). I never even saw a dead body, and I only saw very little actual blood.

But my personality has changed after that, and I'd guess I have a mild sense of PTSD (very minor, not debilitating). On the one hand I'm more patient, but I'm also more gruff with people, and when I finally lose patience I tend to lose it with a bit more anger than with, say, a sense of just ignoring the situation. I'm a little more edgy sometimes (not often) with crowds or loud noises I can't see the source of. So, yeah, PTSD can reach out and touch you even without direct combat.

[Broomstick]

I'm not sure that really qualifies as PTSD - sure, it's had an effect, but can you still function day to day? Does the personality change impair you?

That, and what triggers PTSD in one person won't do so in another. Really, each person must be evaluated individually. No, one does not need to see combat or horrific injuries to have this disorder, some who see combat never suffer from it. Wow, people are individuals, who'd have thunk it?

[Coyote]

I'm not sure that really qualifies as PTSD - sure, it's had an effect, but can you still function day to day? Does the personality change impair you?

I don't know, maybe, maybe not. I don't think I'm imparied but I'm definitely of a different mindset than I was before. I just don't know what else to call it, though. By no means do I consider myself to be a "sufferer" of PTSD because I don't feel like I'm suffering. It's defintely stress, and after the fact, but I don't really feel the "disorder" part of it. And there are others that are in real stress compared to my minor sense of discomfit.

That, and what triggers PTSD in one person won't do so in another. Really, each person must be evaluated individually. No, one does not need to see combat or horrific injuries to have this disorder, some who see combat never suffer from it. Wow, people are individuals, who'd have thunk it?

Yeah, I kinda wonder if this ruling is going to have an affect on, say, counseling for child-abuse victims, or people who are police and EMTs who live in PTSD-producing situations frequently, almost daily in some cases. That's why I think the parameters for what constituted PTSD will be tightened and defined before too long.

[Broomstick]

I'm not sure that really qualifies as PTSD - sure, it's had an effect, but can you still function day to day? Does the personality change impair you?

I don't know, maybe, maybe not. I don't think I'm imparied but I'm definitely of a different mindset than I was before. I just don't know what else to call it, though. By no means do I consider myself to be a "sufferer" of PTSD because I don't feel like I'm suffering. It's defintely stress, and after the fact, but I don't really feel the "disorder" part of it. And there are others that are in real stress compared to my minor sense of discomfit.

When I've suffered a trauma of some sort in the past (and I've had a couple) I've jokingly referred to my "post traumatic stress annoyance" - which is not to make light of the genuine disorder, which really can be tremendously disabling, but rather to emphasize that one or two nights of troubled sleep, or the occasional unpleasant memory, do NOT make for a genuine psychological disorder or call for treatment. It's an annoyance, it's not a disaster.

That said, some people who experience the exact same sort of events actually ARE traumatized and really do suffer and really do need help to get past it. Why? I don't know. Neither does anyone else.

It's certainly a spectrum from my viewpoint - it ranges from "wow, I had a nightmare last night but turned over and went back to sleep" through "I can still get up and go to work and function, but I'm really unhappy and preoccupied" to "complete basket case".

I view it like falling off something - 10 people could fall 5 meters. 2 might get up and walk away more or less unhurt, most will be injured somewhat, 1 might break a leg and another lands on his head and dies from it. There's an element of chance, there's the matter of physical health/age/resilience, and sometimes you just have a bad landing. No one would say anyone who falls 5 meters should be stuck in a body cast for three months regardless of injury or lack of it, we evaluate everyone who takes such a fall and treat according to their actual condition - PTSD screening should be the same - evaluate not based on the specific trigger but how they are actually affected, the mental injury, and try to find a treatment that will either correct their problem or at least enable them to cope with a chronic condition.

[Knife]

I'm not sure that really qualifies as PTSD - sure, it's had an effect, but can you still function day to day? Does the personality change impair you?

That, and what triggers PTSD in one person won't do so in another. Really, each person must be evaluated individually. No, one does not need to see combat or horrific injuries to have this disorder, some who see combat never suffer from it. Wow, people are individuals, who'd have thunk it?

Well technically, a disorder by definition means it is seriously interfering with your daily life, so no. However, all the underlying factors can be there and the patient can lead a normal life but at some point digress to the point where his/her life is abnormal due to PTSD factors.

[Coyote]

Maybe that works: PTSI, Post-Traumatic Stress Irritability. Again, not to make light of the real disorder, whch causes real problems, but more accurately reflects my circumstances-- while seperating myself from people who have legitimate concerns.

[Aaron]

It's possibly combat stress reaction (or acute stress reaction if you want the civvie term) which could in the long term become PTSD if untreated. One of the requirements for PTSD is that it be severe and chronic.

[loomer]

My little sister(maybe sisters, we fostered the most difficult kids who weren't put into straight up mental hospitals or juvenile detention, but only one has a definite diagnosis confirmed by psychologists and psychiatrists. Firestarters, teenage girls with kids, constant kleptomaniacs and serious fighters all ended up with us.) has PTSD, and more government recognition of it is - whatever the cause - is great, because it can be treated with relative success and the more work is done on it with government funding, the more progress will be made towards understanding and controlling it.

For reference, I myself have some very mild touches similar to elements of it (not debilitating, fortunately, so not full blown PTSD) thanks to living with the most out of control teens in the foster system from the age of seven. It has secondary effects on family - you adopt mannerisms as a commonality with them, you hear the stories, deal with the initial chaos they bring before they realize you're simply not going to give up and settle down, all sorts of things. Around my place we basically learnt to walk on egg shells constantly - including my friends - because if you said the wrong thing you could be in for a week long shitstorm of constantly changing responses.

That doesn't even bring in the sheer amount of work it is fighting bureaucracies and incompetent doctors to try and help them, which is something we still do today for a lot of them. It's worth it, beyond a doubt, but the more recognition of the condition itself is only part of what needs to be done. Support for their entire family and friends needs to be there as well.

[JCady]

Since it's personal I fully understand if you prefer not to get into it, but what sort of situations does one encounter in the military short of being in a combat zone that lead to developing PTSD? My contact with the military was limited to some time in ROTC, so I'm not really equipped to answer that for myself.

I would imagine medical personnel who are stateside or elsewhere outside of a combat zone would certainly be subject to PTSD. Seeing grievous injury after grievous injury, multiple amputations (especially concerning the same individual), catastrophic burns, brain injuries and the like would take its toll on caregivers after awhile.

The PTSD rate among civilian EMTs is incredibly high; as a corollary, alcohol abuse is rampant.

[Aaron]

Yeah, the two usually go hand in hand. Well substance abuse in general.

[FSTargetDrone]

Seems trauma ward docs would suffer as well, especially in rough areas.

[Aaron]

Probably, though a big part of it is how much support you get, or don't get.