This bill seeks to end the inequity "non-combat" veterans deployed to war zones must deal with when it comes to a disability claim for PTSD. The COMBAT PTSD Act, introduced by Rep. John Hall, would clarify the phrase "combat with the enemy," for purposes of proof of service-connection for veterans' disability compensation, by including in this definition, deployment "in a theater of combat operations during a period of war; or in combat against a hostile force during a period of hostilities."
Ian C. De Planque, Assistant Director of the American Legion's Veterans Affairs and Rehabilitation Commission, explains:
Combat veterans have a huge advantage when attempting to establish service-connection for PTSD or other medical conditions incurred or aggravated in combat. Claims for service-connection of a combat-related condition receive special treatment under law and regulation administered by Department of Veterans Affairs (VA). They receive favorable treatment because war is, and has always been, a chaotic endeavor. It can be difficult to record every detail of operations in the heat of battle. There are so many unrecorded nuances to the activity of military forces that Congress has specifically directed that the special circumstance of combat merit special circumstances in the establishment of incidents during military service in the conditions of war. Therefore, if a combat veteran states that he or she suffered a disease, injury, or stressor event during combat, VA must generally accept that statement as fact. This is true even if there are no service records that support the statement.
Servicemembers, who received a combat-related badge or award for valor, trigger the combat-related presumptions of Section 1154(b), but a clerk riding in a Humvee, who witnessed the carnage of an IED attack on a convoy, and later develops PTSD, does not automatically trigger such a presumption. Proving that the incident happened or that clerk was involved in the incident, in order to benefit from the presumption afforded under Section 1154(b), can be extremely time consuming and difficult. In some instances, it may even be impossible to submit official documentation or records of the incident because such records do not exist. A good example of this is a soldier stationed in the Green Zone in Iraq who falls and injures his or her knee while running for cover during a mortar attack and later develops a chronic knee condition, but never received treatment after the initial injury. Since the soldier didn’t think he or she was hurt that bad and never sought treatment for the knee, the only proof the soldier has to offer that he or she injured his or her knee during an enemy attack on his or her base is his or her word. Since the soldier was stationed in a "safe" area and did not receive a combat decoration or award or participate in any combat operations, establishing that he or she "engaged in combat with the enemy" in order to satisfy the current narrow interpretation of the phrase just to trigger the provisions of Section 1154(b) will be extremely difficult, if not impossible. Adding to this already difficult burden is the VA General Counsel decision ruling that "the absence from a veteran’s service records of any ordinary indicators of combat service may, in appropriate cases, support a reasonable inference that the veteran did not engage in combat." This means that, according to the General Counsel, records supporting such an inference may be considered as negative evidence even though they do not affirmatively show that the veteran did not engage in combat. Read On...
Opening Statement of Hon. John J. Hall, Chairman, House Committee on Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs
The current Rating Schedule for PTSD has been described as vague and subjective. Furthermore, the adjudication process does not solely accept, as the law prescribes, lay evidence as sufficient proof as long as it is consistent with the circumstances, conditions, or hardships of such service, notwithstanding that there is no official record. This law should seem self-evident as to the intent of Congress! So why isn’t it? The controversy seems to exist because of numerous interpretations of Congressional intent. Leading decision makers at VA General Counsel have issued opinions and Court decisions concluded that if it were the intent of Congress to specify a combat zone or a theater of combat operations, Congress would have done so as it has in other provisions of the law under title 38, but omitted in Section 1154.
My intention today is to re-open this dialogue. The nature of wartime service has changed as many can agree. Warfare encompasses acts of terrorism, insurgency, and guerilla tactics. No place is safe and the enemy may not be readily identifiable.
Psychiatry has changed too. PTSD is a relatively new diagnosis; first having appeared in the Diagnostic and Statistical Manual in 1980 – five years after the end of the Vietnam War. An array of mental health research has been conducted and assessment techniques have been developed. Since the world is not the same place it was in 1941, I have introduced HR 952, the Combat PTSD Act to redefine section 1154 to include a theater of combat operations during a period of war or in combat against a hostile force.
There should be a better way for VA to assist veterans suffering from PTSD adjudicate those claims without it being burdensome, stressful and adversarial. Veterans still face issues with stigma, gender and racial disparities in rating decisions, poorly conducted disability exams, and inadequate military histories. So, I am eager to hear from the witnesses today about their experiences with denials, inequities, and variances. In the last few years, the IOM comprehensively reviewed the research on PTSD diagnosis, assessment, and compensation. In 2008, the RAND Report on the Invisible Wounds of War gave us a new perspective on the costs of war when soldiers are left without treatment or support and I look forward to hearing more of its witness’ analysis. Finally, DoD and VA will share their insights into how they determine combat vs. noncombat and how they have chosen to evaluate PTSD disability. Read On...
For all testimonies and full video of the hearing follow this link.
Carolyn Schapper - Representative for Iraq and Afghanistan Veterans of America testified before the House Committee on Veterans Affairs.
The nature of modern warfare and the history of this conflict force us to constantly reassess the conventional wisdom surrounding what we perceive to be the "front lines". No longer is there a single line in the sand where the military operates according to a rigid force structure that defines the rolls of combat, combat support and combat service support soldiers. To determine whether one’s Post Traumatic Stress is combat related based on an outdated perception of combat operations hurts veterans and is an active impediment to the recovery and reintegration process...
H.R. 952, introduced by the chairman, corrects this hole in the evaluation process by changing title 38 to presume service connection for PTSD based solely on a soldier’s presence in a combat zone. This is a common sense solution to a complex problem that continues to change as the nature of warfare evolves. Read On...
Paul Sullivan, Executive Director of Veterans for Common Sense commented:
The scientific evidence is overwhelming: engaging in combat with the enemy can and does cause PTSD among some veterans. In addition, the scientific evidence concludes that deployment itself, without combat, is also linked to PTSD and suicide. Due to VA’s cumbersome, complex, and adversarial rules for veterans diagnosed with PTSD to prove the existence of a combat stressor incident, VA takes longer than six months to process PTSD claims. As a result, VA’s claim system becomes further mired in a growing backlog of benefit requests.
VCS believes a fair and reasonable way to resolve this situation, keeping with VA’s stated objective of putting veterans first, would be to define combat under the law (38 USC § 1154) as deployment to any nation or body of water declared a war zone by the Department of Defense. Deployment itself, not combat with the enemy, should be considered the stressor for PTSD claims, as the IOM study concluded.
In an effort to resolve VA’s claim crisis, VCS urges Congress to pass HR 952 as soon as possible because of VA’s continued adversarial policies against veterans and because VA has utterly failed to address the PTSD claim disaster. VA’s crisis is expected to worsen significantly as the two current wars continue and multiple deployments increase. Based on VA’s healthcare use reports indicating 10,000 new, first-time Iraq and Afghanistan war veterans flooding into VA each month, VCS estimates VA may diagnose and treat total of 450,000 mental health patients by the end of 2013, including as many as 250,000 diagnosed with PTSD.
Now is the time to fix the problem of unreasonable claim delays for veterans with PTSD so they can receive the disability benefits needed and earned in a timely manner. With a new law, VA should be able to quickly approve tens of thousands of PTSD claims filed by Iraq and Afghanistan war veterans that remain mired in VA red tape. Veterans of other conflicts may also find justice with the passage of HR 952.
VA should and could be putting disability benefits into the hands of deserving veterans during the current economic crisis when their need is most acute. A timely and proper adjudication of claims may make the difference between staying in a home or living on the streets for veterans, especially veterans deployed to a war zone with PTSD.
Although enactment of HR 952 may cost billions of dollars in the short-term, these are entitlement payments VA will eventually pay to veterans and survivors. This is true because VA confirms fraudulent claims are nearly non-existent. VA may actually realize a cost savings and improved efficiency when VA employees now working on complex and time-consuming PTSD claims are freed up to process other disability compensation claims of equally deserving veterans. Read On...
Just an additional note on how the numbers don't jive. As of Jan. 15, 2009 the Veterans Health Administration (VHA) had 105,465 GWOT PTSD Patients (26% of all GWOT Patients)
However, the Veterans Benefits Administration (VBA) has approved only 42,844 GWOT veterans PTSD Claims (41% of PTSD Patients).
This information is obtained by Veterans for Common Sense (VCS) using the Freedom of Information Act. Unfortunately it appears that the Jan. 15 VCS VA fact sheet is not posted online so here's a link to the Oct. 14 2008 VCS VA fact sheet.