U.S. moves forward with relaxing PTSD treatment regulations for veterans
President Obama said that the Department of Veterans Affairs will begin the process of making it easier for veterans suffering from post-traumatic stress disorder (PTSD) to get the treatment and benefits they need.
“Just as we have a solemn responsibility to train and equip our troops before we send them into harm’s way, we have a solemn responsibility to provide our veterans and wounded warriors with the care and benefits they’ve earned when they come home,” Obama said in a weekly radio address.
“We also know that for many of today’s troops and their families, the war doesn’t end when they come home,” Obama admitted. “Too many suffer from the signature injuries of today’s wars: post traumatic stress disorder and traumatic brain injury (TBI). And, too few receive the screening and treatment they need.”
For many returning war veterans they “have been stymied in receiving benefits” because they had to produce a plethora of paperwork and prove they suffered a traumatic event that caused PTSD. The President insisted that streamlining the process would “help both the veterans of the Afghanistan and Iraq Wars, along with generations (veterans from other eras), who have served and sacrificed for the country.”
However the Chairman of the House Veteran Affairs Committee, Rep. Bob Filner (D-CA) says soldiers shouldn’t prove they have PTSD, but they should have to prove they don’t. The Congressman has worked tirelessly on these issues and believes the military is letting down the soldiers by not decompressing these guys once they return from the battlefield.
The new PTSD regulations will relieve veterans from proving a single wartime moment that caused the hopelessness and fear. Now veterans only need to show evaluators they served in a region where there would be cause to fear the reprisal of terrorist attack.
“I don’t think our troops on the battlefield should have to take notes to keep for a claims application. And, I’ve met enough veterans to know that you don’t have to engage in a firefight to endure the trauma of war,” Obama said.
The American Legion’s Veterans Affairs and Rehabilitation Division Barry Searle concurs; “This requirement seems to be a step backward in an otherwise commendable move by the VA. Private healthcare providers should be given the opportunity to work with veterans and diagnose those who suffer from PTSD.”
Searle points out that if the VA has real concerns about the treatment methods of PTSD assessment standards, “it should create a certification process for private practitioners that would satisfy its requirements.”
If the government opened up returning veterans to the Tri-Care health program, which is similar to a PPO health care plan, the private sector doctors could alleviate the backlog for PTSD/TBI treatment.
“When the VA makes claims they have enough doctors on staff to take care of the PTSD cases they are wrong. I just went to the La Jolla, CA VA and they said there was a hiring freeze for psychiatrists,” Filner said. “It’s baloney; we don’t have enough psychiatrists to treat these guys and girls.”
One congressional analysis reportedly put the cost of the new changes at $5 billion
A senior department official said the price tag is “relatively small.” Under the older system bureaucrats claimed veterans eventually received the treatment they needed and hoped the new “stealthy process” would speed up the wait time. White House Senior staffers said the new process should also bring the cost of treating PTSD down.
The Veterans Affairs Department Secretary, Eric Shinseki complimented the new PTSD treatment process and said the new directive was another critical step forward in providing an easier process for combat veterans seeking health care treatment and disability compensation. The new VA regulation was published in the Federal Register last week.
“This nation has a solemn obligation to the men and women who have honorably served this country and suffer from the often devastating emotional wounds of war,” Secretary Shinseki said. “This final regulation goes a long way to ensure that veterans receive the benefits and services they need.”
By publishing a new regulation in the Federal Register it clears the way for the VA to simplify the process for a veteran to claim service connected PTSD immediately. In return the VA reduces the evidence needed if the trauma claimed by a veteran is related to fear of hostile military or terrorist activity and is consistent with the places, types, and circumstances of the veteran’s service.
Shinseki said the science-based regulation relies on evidence that concludes a veteran’s deployment into a war zone is link enough to increase the risk of developing PTSD.
Looking back at PTSD pitfalls
In the past, VA claims adjudicators were required to corroborate that a non-combat veteran actually experienced a stressor related to hostile military activity. The new rule simplifies the development that is required for these cases and will make it easier for those serving to receive the treatment they have been denied in the past.
However, it’s Rep. Filner’s view that the military “has a much deeper problem.” Filner also alludes to the stigma attached to PTSD. “The military doesn’t want to know the full extent of the problem; they just don’t want to know.”
Nevertheless the VA expects this new rule will decrease the time it takes the VA to decide access to care.
Shinseki claims there are more than 400,000 veterans currently receiving compensation benefits that are service connected for PTSD. Congressman Filner challenges this number and believes the number is much greater than anyone is willing to admit and the VA could not handle an influx in veterans coming forward.
In the private sector, PTSD has been a medically recognized anxiety disorder that can develop from seeing or experiencing an event that involves actual threatened death or serious injury to which a person responds with intense fear, helplessness or horror, and is not uncommon among war veterans.
Filner says he has been trying to encourage the military to add an eight week decompression course for all soldiers to attend. “Right now the veterans coming home are asked two questions to self assess a PTSD problem. On top of that many of the Commanding Officers tell them to mark no on the questionnaire so they can get home faster,” Filner explained.
The program Filner describes could take place at their home base with brothers in arms, family members and trained clinicians. “This would be a good dovetail with job training classes as well,” he said.
The costs led to the new VA regulation
The process of change within the giant bureaucracy that is Washington D.C. came about in part by testimony of Barton F. Stichman, Joint Executive Director of the National Veterans Legal Services Program.
“Under current law, VA has to expend more time and resources to decide PTSD claims than almost every other type of claim. A major reason that these claims are so labor intensive is that in most cases, VA believes that the law requires it to conduct an extensive search for evidence that may corroborate the veteran’s testimony that he experienced a stressful event during military service,” Stichman testified to at the House Veterans Committee.
“According to the VA, an extensive search for corroborating evidence is necessary even when the medical evidence shows that the veteran currently suffers from PTSD, and mental health professionals attribute the PTSD to stressful events that occurred during military service.”
“Often there is no corroborative evidence that can be found – not because the in-service stressful event did not occur – but because the military did not and does not keep detailed records of every event that occurred during periods of war in combat zones,” he concluded.
Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs conducted the hearing to discuss the compensation owed for mental health. The hearing addressed the difficulties veterans encounter when they are required to prove stressors in order to receive service-connected compensation for PTSD that occurred as a result of their military service.
A different outcome for British soldiers with PTSD
When looking into PTSD issues in other countries, a report shows the British soldiers are far less likely to demonstrate symptoms of PTSD. Why?
While the numbers of U.S. soldiers suffering PTSD land somewhere in the 20-30 percent range, depending who you talk to, only four percent of British soldiers who served in Iraq or Afghanistan exhibit symptoms of PTSD even though both countries’ warzone veterans have seen comparable levels of violent combat, according to an English study.
“This is truly a landmark study, in its size and rigor, and the findings are surprisingly positive,” said Richard J. McNally, a psychologist at Harvard, told the New York Times. “The big mystery is why we find these cross-national differences.”
Researchers for the British study analyzed answers to mental health questionnaires given to Royal Army, Navy and Air Force members. The results showed that approximately 20 percent suffered some form of mental health issues, including moderate anxiety and depression. Another 13 percent admitted to drinking heavily. However, few were diagnosed with PTSD.
Once researchers began to dissect reasons for the PTSD discrepancies, possible reasons included the use of reservist soldiers and differences in ‘dwell time.’
The mental health study found British reservists were more likely to cope with post-traumatic stress disorder symptoms. Another factor that could determine the successful processing of PTSD may be the fact that British troops serve six-month tours and do not spend more than 12 months in combat in every 36 months.
As far as their American soldier counterparts, U.S. military personnel, depending on their service, can serve more than 12 months at a time with only a single year in between combat deployments.
Living with the aftermath of TBI and PTSD
A common thread soldiers share is their fear of losing loved ones; “Will they still want me.”
It’s a legitimate fear as many end up losing their significant others once the hard work of rehab, reality sets in and they learn their lives will never return to pre-deployment fitness.
“I was in a coma for 12 days and now I’m like a six-year-old in a man’s body,” says S. Sgt., Jay Wilkerson, U.S. Army barracks, Iraq. He suffers from a closed-wound head trauma commonly known as TBI one of the signature wounds of the Iraq/Afghanistan wars.
“Sometimes I can’t remember my own kid’s names… I feel stupid, but my brother helps me. My son’s name is Manny and my daughter is Precious,” Wilkerson tearfully repeats.
His grueling treatment schedule includes memory groups, cognitive-skills training, physical therapy as well as psychology appointments; “All these appointments are meant to build me up and get me where I used to be.”
The Army soldier acknowledges that war is war and no medals will bring him a normal life again, but at least he is making the effort and hopes to regain a sense “normalcy.”
That life of “normalcy” often includes using nonprofit groups like Help Wounded Troops or Wounded Warrior Foundations. They step in when the Veteran Affairs and Department of Defense fall short.
It’s not unusual for wounded veterans to seek financial help while waiting for benefits to kick in. Many soldiers don’t know there are advocacy organizations out there that can assist them with the mountain of paperwork the VA requires. During the sometimes lengthy paperwork process military families can lose their homes, cars and jobs.
These nonprofit organizations provide soldiers with money to pay for rent, electricity, food or even car payments. Without the support from a generous American population these wounded warriors may otherwise fall through the cracks and disappear into homelessness.
The bottom line for the VA to consider is the need to speed up an effective TBI/PTSD treatment program. The process must ensure that there are no military service members left behind or undertreated.
Just as there have been technological breakthroughs in medical treatments, there have been significant advancements in treating TBI and PTSD. The all-volunteer troops serving in a long Middle East war deserve to be treated with the best PTSD/TBI protocol available and then the treatment plan needs to be individually tailored to meet each soldiers needs, according to Dr. Mark Wiederhold who has developed a new virtual-reality based PTSD program.
This often proves the private-sector lays claim to the most up-to-date treatment methods.
However, the VA bureaucracy doesn’t act quickly enough or at all when providing the best care for returning war veterans. One program with a stellar record is Mt. Sinai hospital in New York City. Their TBI treatment employs a rigorous-daily cognitive therapy without the use of drugs.
Another highly-successful, private sector PTSD treatment facility is located in San Diego, California. The Virtual Reality Medical Center uses virtual reality computer generated programs with physiological readings to monitor soldier’s reactions to incidents that cause them severe anxiety. The success for the $4-6 thousand program is 85 percent. However, the doctors running the virtual reality retraining sessions are working overtime to find ways to improve their success rate to more than 90 percent.
Side affect of war – suicide among soldiers on the rise
Army suicide statistics just released leave military officials trying to reverse a grim trend in the Iraq and Afghanistan wars.
A recent report showed that 32 soldiers killed themselves in June; it is the highest number of suicides in a single month since the Vietnam era. At least 21 took their lives while on active duty and the other 11 were inactive National Guard or Army Reserve.
The Army admits seven of the soldiers killed themselves while serving in Iraq and Afghanistan. “There were no trends to any one unit, camp, post or station,” Col. Chris Philbrick said, of the Army’s suicide prevention task force. “I have no silver bullet to answer the question why.”
With no solutions on the horizon Philbrick said his department will: “look for opportunities we have been facing in terms of the challenges in the Army and continue to prevent these events from taking place.”
There is no doubt that streamlining the TBI/PTSD screening process is a step in the right direction, but what returning war zone soldiers really need is their quality of life.
Oftentimes when soldiers are separated from military service they lose extra-combat pay, housing allotments and their Tri-Care health insurance. The loss of income can split families apart, especially if there is a serious injury to contend with.
A country at war must live up to all the promises they offer military personnel. These brave soldiers should not have to lose their quality of life along with any means to earn an honorable income for their families.
America has done better, but as the “War on Terror” enters its ninth year, it must do better- the all volunteer forces are not expendable on any level.