VA rules on PTSD criticized
WASHINGTON – The government’s methods for deciding compensation for emotionally disturbed veterans have little basis in science, are applied unevenly and may even create disincentives for veterans to get better, an influential scientific advisory group said Tuesday.
The critique by the Institute of Medicine, which provides advice to the federal government on medical science issues, comes at a time of sharp increases in cases of post-traumatic stress disorder, or PTSD, among veterans and skyrocketing costs for disability compensation. The study was undertaken at the request of the Department of Veterans Affairs amid fears that troops returning from the wars in Iraq and Afghanistan will produce a tidal wave of new PTSD cases.
VA officials said they welcomed the independent report. “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,” spokesman Matt Burns said in a statement.
The report suggested changes to VA policies, but the panel could not say whether those changes would result in more or fewer PTSD diagnoses, or in greater or lesser expense for taxpayers.
“PTSD has become a very serious public health problem for the veterans of current conflicts and past conflicts,” said psychiatrist Nancy Andreasen of the University of Iowa, who chaired the panel. Noting the shortcomings of the VA system, Andreasen added that “a comprehensive revision of the disability determination criteria are needed.”
She said the current VA system, in which PTSD compensation is limited to those who are unable to hold a job, places many veterans in a Catch-22.
“You can’t get a disability payment if you get a job – that’s not a logical way to proceed in terms of providing an incentive to become healthier and a more productive member of society,” she said.
The practice is especially wrong, she added, because it is at odds with VA policies for other kinds of injuries. To determine the compensation a wounded veteran should get, the government assigns one a disability score.
Veterans who are quadriplegic, for example, can be assigned a disability level of 100 percent even if they hold a job, whereas veterans with PTSD must show they are unable to work to get compensation.
One solution suggested by the panel was to set a minimum compensation level for veterans disabled by PTSD, which would allow those who can seek work to do so.
“This is the report the VA didn’t want,” said Larry Scott, founder of the group VAWatchdog.org, who applauded the conclusions.
If the IOM’s recommendations are implemented, he said, they will cost VA “billions of dollars – more staff, more staff training, more data collection, more clinical evaluations and higher awards.”
The Institute of Medicine panel said the scale used to evaluate veterans is outdated and largely designed for people who suffer from other mental disorders.