A federal study
released yesterday urges the most sweeping changes since
World War II on how veterans are diagnosed with and
compensated for post traumatic stress disorder.
NELVIN CEPEDA / Union-Tribune
Bill Rider Jr., president of the American Combat
Veterans of War in San Diego County, seeks a uniform
disability rate schedule.
The Department of Veterans Affairs needs to replace its
narrowly defined and unevenly applied criteria for PTSD
screening with broader standards based on the latest
knowledge about psychiatry, the Institute of Medicine and
the National Research Council said in their joint report.
The agencies also called on the VA to jettison its current
rating scale for disability payments and establish a
system of fixed, long-term benefits.
“As the increasing number of claims to the VA shows,
PTSD has become a very significant public-health problem,”
said Nancy Andreasen, who led the committee of
mental-health experts that conducted the yearlong study.
“Comprehensive revision is needed.”
Rep. Bob Filner, D-San Diego, said the report had “some
really good ideas for what we should be doing” and hoped
VA officials were paying attention.
Filner, chairman of the House Veterans' Affairs
Committee, agreed with the report's recommendations for
improving PTSD screening practices. But he did not promise
to seek additional money for the overhaul, which includes
hiring more mental-health professionals to diagnose and
“I think we've given them the resources,” Filner said,
referring to Congressional proposals to boost VA funding
by more than $6 billion in the next fiscal year. “The
question is, are they being used properly?”
A Veterans Affairs statement confirmed that the agency
requested the study and paid $840,000 for it.
“VA is studying the findings, conclusions and
recommendations of the report to determine actions that
can be taken to further enhance the services we provide,”
the statement said.
But there was no getting around the fact that VA
leaders also hoped to control skyrocketing compensation
for PTSD. Three of their four goals for the federal study
committee dealt with compensation – and for good reason.
PTSD claims to
Department of Veterans Affairs rose from 120,265
in 1999 to about 233,000 last year.
VA disability payments
for PTSD increased nearly 250 percent between 1999
and 2004 – from $1.72 billion to $4.28 billion.
Compensation for all other disability categories
went up by 42 percent during that time.
PTSD payments make up 8.7 percent of all VA
disability beneficiaries, but get 20.5 percent of
the total compensation.
An estimated 17
percent to 33 percent of veterans will file a
claim for PTSD or other mental-health problem
during their lives.
Sources: Institute of Medicine; Department
of Veterans Affairs; Department of Defense
Online: The new reporton PTSD treatment
and compensation is available at
From 1999 to last year, the national VA system's number
of PTSD claims rose from 120,265 to about 233,000. Its
disability payments for PTSD more than doubled between
1999 and 2004 – from $1.72 billion to $4.28 billion.
Comparable numbers for the San Diego VA system weren't
In the past year, VA leaders have acknowledged that
they were unprepared for the flood of new PTSD claims.
While their overall budget has increased dramatically, the
amount designated for mental-health care remains
The result is a shortage of psychologists,
psychiatrists and nurses trained to deal with PTSD and
other mental-health conditions. Several VA and independent
review panels have concluded that burnout is high among VA
mental-health specialists because of their overwhelming
The situation won't likely improve for them.
The new report shows that Vietnam War veterans made up
most of the recent spike in applications for PTSD
benefits. The study's authors expect hundreds of thousands
of troops from the Persian Gulf, Iraq and Afghanistan wars
to seek similar payments in the decades to come.
“There likely will be many more claims .
. . so how this issue (of
diagnosis and compensation) is resolved now will
eventually affect many active-duty personnel,” the
researchers wrote in their conclusions.
In a report released last month, the VA said 39,243
veterans out of 686,000 who have served in Iraq or
Afghanistan since 2002 have been diagnosed with PTSD as
their primary health problem.
Studies by the agency, the Pentagon and several
universities have estimated that 17 percent to 33 percent
of Iraq and Afghanistan veterans will file a claim for
PTSD or other psychological problems during their
lifetimes. If these veterans resemble their Vietnam War
predecessors, many of their mental-health disability
claims will come in their latter years – when their
overall health fails or when another war reminds them of
the ones they fought.
The report released yesterday also found that:
The VA must do a better job of
gathering, analyzing and publishing information about PTSD.
To operate an effective PTSD
program, the VA must use only experienced mental-health
professionals to diagnose patients claiming to have the
disorder. Currently, some of the evaluations last only 20
minutes while others run for three hours.
VA officials must update the
criteria they use to determine the severity of PTSD and
thus the level of compensation. The study's authors
described the present standards as crude and too general.
VA leaders need to model their
PTSD program after guidelines set by the American
Psychiatric Association. They also should establish
certification programs for workers who deal with PTSD
The VA should base PTSD
disability payments on how much the disorder affects all
aspects of a veteran's life, not just his or her ability
to be gainfully employed.
PTSD can be triggered by
trauma other than combat, such as sexual assault. Female
veterans are less likely to receive compensation for PTSD,
which may partly be due to the difficulty of
substantiating exposure to traumatic events unrelated to
combat, including sexual harassment or assaults that
occurred during military service.
The study's authors did not address how much it would
cost to carry out their recommendations or how long the
overhaul might take.
Nevertheless, leaders of several veterans groups
praised the report.
“It's a step forward. It insists on training and
accountability and more thorough examinations – a lot of
the things we've been seeking for a long time,” said Dave
Gorman, executive director for Disabled American Veterans,
a national organization with 1.2 million members.
He and other advocates for veterans said the VA system
needs standardized disability rates, better training for
its compensation evaluators and more thorough screenings
“The VA should uniformly apply the disability rate
schedule for everyone,” said Bill Rider Jr., president of
the American Combat Veterans of War in San Diego County.
“In some places in the country, you get higher ratings
of disability compensation versus other regions,” he said.
“Some military services also get a higher rate than
The veterans' representatives are wary of VA leaders'
intentions for commissioning the new study. They're
concerned that the report will serve as a Trojan horse for
military and VA officials who want to reduce PTSD benefits
because they believe the disorder doesn't affect many
veterans or because they foresee a shortage of funds to
deal with the swelling caseload.
“There are some people in Congress, the Bush
administration and the VA who keep saying that all these
entitlement programs are out of control and that something
has to be done in the name of saving taxpayer money,” said
Dave Autry, a spokesman for Disabled American Veterans.
“What they forget is that this is an earned
entitlement,” Autry said.
Copley News Service writer Paul Krawzak contributed
to this report.
Rick Rogers: (760)