E. S. Hamilton
VFW Post 9876
Pattaya City, Thailand
Surgeon's Corner
The PTSD Debate #2
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E. S. Hamilton Pattaya City, Thailand |
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| The Institute of Medicine has published its report on the questions posed by the VA concerning the diagnosis of PTSD. This study was limited to an evaluation of the criteria used to diagnose PTSD. The IOM determined that the diagnostic criteria and methods as defined by the American Psychiatric Association as published in its manual, Diagnostic and Statistical Manual of Mental Disorders (DSM), are perfectly valid. End of report. In short, the IOM upheld the validity of the diagnosis and the means to determine if an individual indeed suffers from PTSD. However, it is important to recognize that that was the extent of the questions posed by the VA and the limit of the report. There was no attempt to evaluate any VA PTSD cases either individually or in the aggregate. There was no attempt to determine if these criteria – deemed valid when used properly - were applied to any or all VA cases now receiving compensation. I would guess that this is a first step on part of the VA to assess and re-evaluate the claims made for PTSD. As long as a claimant has a well-grounded claim based on a full and valid evaluation using the appropriate APA tools, there is no issue. Validating the tools was necessary to allow the VA to review which (if any) of these tools was used to make the diagnosis and file the claim. As I noted in the first article in this series, paying compensation for any condition is akin to surrendering that a cure cannot be affected. This current study stops at diagnosis. It does not deal with treatment much less cure. Let's follow this trail to its logical end. Now that the VA has validated that a set of objective surveys and tests are completely valid in making the diagnosis of PTSD, the next logical step would be for them to call for periodic re-evaluation of cases. If the results of the follow-up evaluations are different from the earlier ones, it might be determined that that Vet is no longer suffering from PTSD. After all, if the tests were valid in order to make the case for compensation for this condition, then the same tests should be valid to determine if the said condition no longer exists. This IOM study did not evaluate anything concerning methods of treatment or the chronicity of this diagnosis. Is it, for example, curable with time after the traumatic event? What treatments should the sufferers of this condition undergo? What precisely is the sufferer of PTSD unable to do that constitutes a disability requiring compensation? Can a sufferer be declared cured and therefore no longer entitled to compensation as a disabled member of society? These are all questions for the future. I venture to guess that the VA and the IOM have just begun a long journey down this path. This report can be found at http://www.nap.edu/catalog/11674.html |