I'm hoping that someone with expertise in or familiarity with diagnosing and treating PTSD in military veterans can take a look at this op-ed in Wednesday's NY Times that tries to make the case that too many veterans are probably currently receiving financial compensation from the Department of Veterans Affairs for PTSD-related mental disabilities, especially Vietnam veterans whom the author claims were supposedly only recently diagnosed with PTSD and thus whose claims are of dubious merit.
Given that she works at the notoriously right-wing and pro-Bush American Enterprise Institute "think tank" (many in his administration used to work there as resident "scholars"), I sense that what's going on here is little more than an attempt to lay the groundwork for a case for reducing Veterans Affairs funding yet more than it already has been reduced under Bush, in order to "tame the budget deficit", on the backs of veterans who are allegedly defrauding the government. This sounds suspiciously like the old "welfare queen" canard that Reaganites loved to banter on about when they undertook to destroy the welfare system.
For Some, the War Won't End
By SALLY SATEL
Published: March 1, 2006
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.
...
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.
...
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.
Most important, more rigor in diagnosing will conserve resources for veterans who are truly deserving. With a new generation of soldiers returning from Iraq and Afghanistan, the Veterans Affairs Department needs to look at post-traumatic stress disorder in a new way: the department must regard it as an acute but treatable condition. Only in rare instances should veterans be eligible for lifetime disability; and perhaps there should be a deadline of years after service by which claims must be submitted.
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."
I'm sure that there are veterans who have tried to cheat the system by pretending to be mentally disabled, and the government certainly has the right to go after them. But to make the sort of blanket accusation that the author makes, that huge numbers of Vietnam veterans are undeservedly receiving compensation for PTSD, seems unfounded.
And while I suppose that making PTSD diagnoses up to 40 years after the fact is a challenge to mental health professionals, I'm guessing that there are ways of doing this that could meet reasonable federal requirements-and when in doubt, I'm strongly inclined to have the government decide in favor of veterans.
But "Decades after a war is too late to make sense of post-traumatic stress disorder" just seems really, really cold and calculating to me, and awfully convenient to right-wing "deficit hawks".
I'm also concerned with her apparent attempt to minimize both the seriousness and prevalence of PTSD among recent veterans--I understand that it's a HUGE problem with Iraq war veterans, even those who were lucky enough to avoid physical injuries--perhaps also to help create a case for reducing the financial burden on the federal government.
Something just doesn't feel right here. But I'm no expert in PTSD, the mental health field, or veterans affairs, and am hoping that people who are expert or at least knowledgable about them might chime in here with their thoughts and comments on this article, and these underlying issues.