More calls to investigate V.A.'s PTSD policy after CREW and VoteVets released email
Last week, CREW and Vote Vets "released an e-mail obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD):
On March 20, 2008 a VA hospital’s PTSD program coordinator sent the e-mail below to a number of VA employees, including psychologists, social workers, and a psychiatrist stating that due to an increased number of “compensation seeking veterans,” the staff should “refrain from giving a diagnosis of PTSD straight out” and they should “R/O [rule out] PTSD” and consider a diagnosis of “Adjustment Disorder” instead.
The fallout continues. Today, NPR is reporting that more members of Congress are asking for an investigation into this matter:
In an e-mail, a psychologist at the Olin E. Teague Veterans' Center in Temple, Texas, advised her staff to stop diagnosing veterans with PTSD to save money. The e-mail became public last week.
The head of the Department of Veterans Affairs insists that's not VA policy.
Psychologist Norma Perez was hired last summer to help coordinate a PTSD program at the center, which draws a lot of veterans. Not long afterward, Perez announced she would disband a dozen or so PTSD therapy groups, in which about 140 veterans met monthly with a clinical counselor. Perez wanted to replace the long-term groups with short-term plans — lasting no longer than three months — that focus on coping skills and cognitive processing therapy. The VA uses a broad range of therapies for PTSD, including group therapy.
Some veterans in the program said Perez told them that long-term group therapy doesn't work. Some vets accused Perez of personally trying to destroy their groups.
But Kim Larsen, a former Army medic and Vietnam vet with PTSD, who attended two VA forums about the plan to disband the groups, had a different impression. He thought Perez was simply the messenger. Then he saw an e-mail from Perez to her staff, advising them to "refrain from giving a diagnosis of PTSD straight out...." It was dated March 20.
Incensed, Larsen shared the e-mail and it wound up with Citizens for Responsibility and Ethics, a watchdog group, and VoteVets.org, a veterans advocacy group. Last week, the groups posted the e-mail on the Internet, setting off a tempest.
Congressional leaders and Democratic presidential candidate Sen. Barack Obama called for an investigation, and the inspector general of the VA has begun one.
Rep. Bob Filner, a California Democrat who heads the House Veterans Affairs Committee, said of Perez: "I can't believe that someone at that level position is doing this on her own. Somewhere in the hierarchy people are saying, 'It's costing us too much with these PTSD diagnoses. Cool it.'"
My brother who is a vet Without proper Meds
To whom this concerns My brother who is a vet. Diagnosed as a parinoid scitsor phrenic. Is becoming a real threat to me and my imeadet familly. He has threatend to ikll me and others as well. In the past few months about his medication and instead of re-evaluating him he complains about his sex life while he was on the medication that worked best for him, in reality it dosent work at all. He knows how to work the system to get what he wants and think he needs but I want to go on record that he is a real threat to me and my family I is extremely hard on me I am aa patient on Endstage Reinal Disease as if I don't have enough to worry about. I have to deal with un stable,confrintational and threating behavior I really need someone at the V.A. to help with this situation. Concerned Albert L. Collins
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Overhaul of the VA PTSD diagnosis and treatment
Finally realizing that the VA is not able to deal with a growing flood of new ptsd patients, the Veteran’s Disability Benefits Commission, primarily made up of retired military officers, made the following recommendations to the Senate Veterans Affairs Committee in January, 2008:
The Commission believes that a new, holistic approach to PTSD should be considered. This approach should couple PTSD treatment, compensation, and vocational assessment. The Commission believes that PTSD is treatable, that it frequently recurs and remits, and that veterans with PTSD would be better served by a new approach to their care. There is little interaction between the Veterans Health Administration, which examines veterans for evaluation of severity of symptoms and treats veterans with PTSD, and the Veterans Benefits Administration, which assigns disability ratings and may or may not require periodic reexamination. It is evident that PTSD reexaminations have been scheduled with less frequency in recent years due to the backlog of disability claims. It is also evident that case management of PTSD patients could be improved through greater interaction between the therapy received in Vet Centers and treatment in VA medical centers. IOM (Institute Of Medicine) concluded that the use of standardized testing and the frequency of reexaminations should be recommended by clinicians on a case by case basis, but did not suggest how that would be achieved. The Commission suggests that treatment should be required and its effectiveness assessed to promote wellness of the veteran. Reexaminations should be scheduled and conducted every two to three years.
Before the Veteran’s Disability Benefits Commission issued its final report in October, 2007, the Commission had asked the IOM or Institute Of Medicine to recommend changes in dealing with ptsd at the VA because of the IOM’s thorough knowledge of ptsd diagnosis and treatment. Ironically, key elements of the IOM’s recommendations were ignored by the Veteran’s Disability Benefits Commission in their final report and their recommendations to congress this year. This is part of the IOM’s recommendations taken from Appendix K of the Veteran’s Disability Benefits Commissions final report:
Neither federal regulation nor published VA materials offers advice to raters on how often or under what circumstances reevaluations of PTSD disability should take place. The committee recommends that this determination be made on a case-by-case basis using information developed in a clinical setting, such as a C&P examination. It recommends that specific guidance on the criteria for setting case-specific VA-initiated reevaluations be established so that the reevaluations can be administered in a fair and consistent manner; furthermore, VBA should collect and analyze data on VA and veteran-initiated reevaluations so that the system can be improved in the future. The committee does not believe it is appropriate to mandate across-the board periodic reexaminations for beneficiaries already being compensated for PTSD. Such a strategy would not take the diversity of the beneficiary population into account and would unduly single out veterans with PTSD for scrutiny. Within the context of VA’s limited resources, the committee believes that it would be best to invest in thorough C&P evaluations for new applicants—including the clinician’s determination noted above—rather than in the blanket review of past decisions.
Summary Findings and Conclusions
Research reviewed by the committee indicates that PTSD compensation does not, in general, serve as a disincentive to seeking treatment.
It is not appropriate to require across-the-board periodic reexaminations for veterans with PTSD service-connected disability.
Summary Recommendations
VA should consider instituting a fixed long-term minimum level of benefits that would be available to any veteran with service-connected PTSD at or above some specified rating level without regard to that person’s state of health at a particular point in time after the C&P examination.
The determination of whether and when reevaluations of PTSD beneficiaries are carried out should be made on a case-by-case basis using information developed in a clinical setting. Specific guidance on the criteria for such decisions should be established so that these can be administered in a fair and consistent manner.
VBA should collect and analyze data on reevaluations so that the system can be improved in the future.
Personally, I believe that the Veteran’s Disability Benefits Commission’s recommendations will be accepted by congress, and the VA will use the cover of these recommendations to do a complete review of existing PTSD ratings in order to reduce benefits to veterans, particularly Vietnam veterans with PTSD. This will create a hostile relationship between veterans and the VA and put an already stressed group of veterans at risk of worsening symptoms and possible suicide. Even though the majority of the Commission's recommendations are positive, the devil is in the details.
I am rated at 70% service-connected for PTSD and unemployable. If they reduce my disability rating, neither my wife or I will be able to work or to pay our bills. Mandatory reviews of only PTSD disabilities every 2 or 3 years is unfair and will create a poor atmosphere for PTSD therapy at the VA.
Sincerely,
PTSD patient