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Comments by YACCS
Monday, March 06, 2006

We need to save money on PTSD cases

So, you're lying to me, right?

For Some, the War Won't End


ACCORDING to a report from its inspector general, the Department of Veterans Affairs is now paying compensation for post-traumatic stress disorder to nearly twice as many veterans as it did just six years ago, at an annual cost of $4.3 billion. What's more surprising is that the flood of recent applicants does not, for the most part, consist of young soldiers just returned from Iraq and Afghanistan. Rather they are Vietnam veterans in their 50's and 60's who claim to be psychologically crippled now by their service of decades ago.

This leads to an obvious question: Can it really take up to 40 years after a trauma before someone realizes he can no longer cope with the demands of civilian life? The answer: possibly, but it is often hard to know which applicants can be helped with short-term psychiatric care, which are seeking a free ride and which are truly deserving of the diagnosis of post-traumatic stress disorder and thus long-term care and payments of up to $2,300 a month for life. The task before the Veterans Affairs Department is to come up with criteria.

Medically speaking, there is some evidence to support what psychiatrists call "reactivated" post-traumatic stress disorder. The literature is dotted with cases of veterans of World War I, World War II and the Korean War who, after briefly showing signs of stress disorders in the immediate aftermath of their ordeals, led productive lives for decades before breaking down in their 60's and 70's. Little is known about the treatment of reactivated symptoms, but there is reason to be optimistic that patients will recover nicely in view of their having functioned well for so long.

But it's also very likely that some of the veteran baby boomers who have filed claims in recent years did so not out of medical need but out of a desire for financial security in their retirement years. Indeed, 40 percent of last year's claimants had been out of the military for 35 to 49 years.

In any case, the rush of applications for long-term disability entitlements reflects the extent to which the culture of the Department of Veterans Affairs since Vietnam has become fixated on post-traumatic stress disorder. While claims for all other forms of mental illness, like schizophrenia and bipolar illness, have declined by about 12 percent of patients at veterans' hospitals over the last decade, the number of veterans receiving compensation for post-traumatic shock has nearly tripled.

Having worked as a psychiatrist at a Veterans Affairs hospital, I can attest to the good intentions with which the department created its post-traumatic stress disorder programs. But as the bureaucracy has become entrenched — and politicians and veterans' groups have applied pressure — a culture of trauma has blossomed. If a veteran can demonstrate service in Vietnam and simply list a few symptoms of the disorder (terrifying nightmares, bad memories, anxiety, survivor guilt and so on), there is a good chance he will be granted the diagnosis and a tax-free monthly stipend.

The problem in giving a diagnosis so long after a patient saw combat is that it can be very difficult to know whether traumatic exposure was the true cause.

Third are the veterans who managed to get diagnoses of post-traumatic stress disorder decades after their military service. They have made use of a system that has coalesced around the idea that combat is the root of all anguish. They deserve treatment to the extent that it can help, but rarely long-term disability payments.

As the department tries to distinguish among these groups, verification of exposure to trauma is vital. The inspector general's office found that for one-quarter of Vietnam veterans claiming post-traumatic stress, the department could not confirm any incidents of traumatic stress. A study in a leading psychiatric journal last year could not verify such history in 59 percent. True, military personnel records are not perfect — a cook who endured a terrifying rocket attack on an airbase at which he was stationed may be unable to produce documentation of it. However, such records could indeed disprove the fabrications of a cook who claimed he was traumatized by a firefight on infantry patrol.


Someday, the diagnostic techniques may be sophisticated enough to help us parse the varieties of claimants; but for now we must be skeptical of veterans who file claims as retirement approaches. The Veterans Affairs Department should be spending its time and money helping our newest veterans now, when the psychological consequences of war have fresh meaning and patients have an excellent chance at recovery. Decades after a war is too late to make sense of post-traumatic stress disorder.

Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute, is a co-author of "One Nation Under Therapy."
You know, to a rational person, this might make sense.

If they know nothing about the ways of the VA.

But to me, I think she should be locked in a room with vets and explain this penny pinching bullshit.

People aren't running to admit to PTSD, they often refuse to deal with it.

Someone asked a WWI vet, who was in his 90's, how often he thought about the war, and he said every night. When asked, John Kerry admitted to nightmares every night for decades.

This is the same bullshit which came when vets were complaining of Gulf War Syndrome and were told it was psychosomatic. But the reasoning here is vile.

Sure, there are some fraudsters, but they are few and far between. As a person who worked in the VA system, and couldn't hack it, she doesn't suggest more funding, but shoving the old vets out the door.

Why? Because dealing with the VA is a fucking nightmare. And $2300 a month is no bounty. You try to get full disability and you're gonna be wondering why. Forget actual treatment.

If WWII vets could wait 50 years to admit to PTSD after seeing Saving Private Ryan, why can't Vietnam and Korean War vets not have PTSD triggered years later?

What this really is a guise for is cutting funding for the VA, despite her claim to help. PTSD can occur years later.

I mean, the VA is easier to grant disability pay than the Army, but it's no walk in the park, nor is getting treatment.

Oh yeah, the people the VA tends to deal with tend to be really fucking crazy. When my father was a psych orderly, the men he dealt with on a locked ward was nuts, for lack of a better term. They had to pumped full of Thorazine and Lithum to control them during the day.

People who can cope usually get help with their health insurance. Part of the reason other mental health illneses aren't being treated by the VA is that they aren't service realted. As the VA's funding has been cut and facilities closed, treatment has increasingly limited to service related injuries.

I'd like to see if she had real proof of this fraud or if she dreamed it out of her ass.

posted by Steve @ 7:52:00 AM

7:52:00 AM

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