E. S. Hamilton
VFW Post 9876

Pattaya City, Thailand
 

 
Surgeon's Corner

The PTSD Debate #1
 

  
  The following article is one of the better ones I have read on this subject. I do, however, feel compelled to comment on some of its content. Remember now, I am a Public Health Officer, not a psychiatrist/psychologist but have considerable experience with Workman’s Comp issues.

The article touches on one of the deepest dichotomies that embroil this topic. The first mandate of the Veteran’s Admin is to treat and cure. Failing that, another section of the VA provides compensation for those who are disabled. Herein lies the problem. It seems that on one hand the "experts" can’t completely agree of what the "problem" is or how to define its many ways of presentation. This makes it extremely difficult, then, to determine the best means of treatment, much less when and how to declare someone "cured". At the same time, it is almost as hard to determine how "disabling" the individual’s symptoms are. There do not seem to be very clear criteria as to what a veteran is "unable to do" that warrants being labeled as "disabled" and to what extend (percentage).

As the article points out there are- "perverse incentives to stay ill." Once an individual is declared to be "disabled" is it possible for him to become "enabled?" For a given individual, the financial penalty of a "cure" could be quite severe. Unfortunately, there is also the incentive to cheat. It would seem quite reasonable for the VA to have "concerns about fraudulent claims." What better condition to cheat on than one which has a somewhat uncertain set of symptoms and an unlikely cure?

I would personally take exception to some of the statements in the latter part of the article like those attributed to – http://www.vawatchdog.org/ . This group seems particularly adversarial to the VA, but at times not without cause. Certainly, the admission that "VA centers in some states are more likely to grant veterans 100 percent disability" does not bode well. It is quite understandable that "an underground network advises veterans where to go for the best chance of being declared disabled" would have developed. While it smacks of fraud, it is seemingly encouraged by a lack of oversight by the VA in policing itself! It is not fraud if you are simply "shopping" for the best deal!

So, let’s review. We have "condition" that is thought to be fairly common. But is not well defined. Has a large variety of ways that it manifests itself. Is not easily treated or cured. Is heavily compensated for as "disabling". Small wonder that there is controversy and even a bit of fraud.
I, for one, would be willing to give the VA a bit more leeway in this controversy than some of those quoted below. While the VA dollars paid in compensation are not in direct competition with those used to provide VA medical services, in a larger sense all budget matters are a zero-sum game. From the perspective of the VA and the medical profession in general, it is far better to spend the money on treatment towards cure than to simply throw up one’s hands, declare defeat, and compensate the veteran as disabled.

The Institute of Medicine (IOM) has a storied reputation for providing in-depth analysis of complicated subjects. This one has got to be one of the most convoluted that they have been asked to look at. Some of you might want to check out their website: -www.iom.edu . You should also be able to follow developments on this topic there.

There seems to be no question that the (IOM & VA) jury is still out on this one. Nor is there a guarantee that the VA will agree and implement the recommendations that the IOM will make. The VA is paying for the study. It is theirs to do with as they please!

Will some veterans likely be "hurt" by the outcome? That is entirely possible. But it would seem that in the long run a clearer set of criteria for diagnosis, treatment, cure and disability would be beneficial to all concerned parties – both the payers and the payees!  2006 should prove interesting as the IOM and VA move toward a solution.

 (Next see PTSD2)