More on PTSD
Study Finds Gaps Meeting PTSD Claims
Military.com | By Christian Lowe | May 08, 2007
Veterans suffering from the effects of post traumatic stress disorder face a wide variance in diagnosis from government doctors and are likely to encounter shortfalls in disability benefits based on existing rules.
According to a report released today from the Institute of Medicine and National Research Council, a recent surge in PTSD disability claims revealed inconsistencies in how doctors working for the Veterans Administration evaluate troops who claimed the disorder, with some being examined for only 20 minutes and others sitting through evaluations for as long as four hours.
The report also showed that some veterans with PTSD could be denied disability compensation based in current rules governing when a patient qualifies for funds. Former service members diagnosed with the disorder receive compensation if they are not working, and current rules do not cover a veteran who returns to work but suffers a relapse of symptoms.
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“PTSD has become a very significant public health problem for the veterans of current conflicts and past conflicts,” said the study’s chairwoman, Dr. Nancy Andreasen, in a May 8 interview. “Our review finds shortcomings and indicates that a comprehensive revision of the disability determination criteria is needed.”
The study, titled “PTSD Compensation and Military Service,” was initiated by the Veterans Administration last year.
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Researchers outlined a “substantial increase” in PTSD claims and a spike in compensation to veterans diagnosed with the disorder, centered primarily on veterans of the Vietnam war - many of whom have reached retirement age and lack the mental health infrastructure to keep symptoms at bay.
The report indicates an 80 percent increase in PTSD cases from 1999 to 2004, with nearly 216,000 claimants that year. Disability payments for PTSD also skyrocketed during that period, growing 150 percent to more than $4 billion in fiscal 2004.
The researchers called on the VA to establish a revamped criteria for evaluating PTSD claims, instituting more focused guidelines to diagnose the disorder and increasing training for doctors who meet with patients claiming PTSD -- a condition that could manifest itself from experiences in combat or a physical assault, researchers said.
“The assessment of disability in general is a challenge in our nation across all of our healthcare systems,” said Dr. Robert Ursano, one of the study’s authors. A “complex but also integrated approach to assessing disability could provide a better assessment of an individual’s ability to function and also of their needs.”
In general, patients are given an examination for PTSD by a VA doctor who rates the condition on a scale called the Global Assessment of Functioning, or GAF. The patient is given a score which is then handed over to government officials who determine disability compensation based on criteria in the VA Schedule of Rating Disabilities.
The study’s researchers found both rating systems too rigid, calling current benchmarks for determining disability payments “crude and overly general,” and said they did not account for “remitting [or] relapsing conditions.”
“Determining ratings for mental disabilities in general, and for PTSD specifically, is more difficult than for many other disorders because of the inherently subjective nature of symptom reporting,” the study found. The VA “should establish a specific certification program for raters who deal with PTSD claims … [with] specialized training on the psychological and medical issues that characterize the claimant population, and guidance on how to appropriately manage commonly-encountered ratings problems.”
It is unclear how costly implementing the study’s recommendations would be, researchers admitted, but the VA already has some programs in place that officials could use as a starting point for needed reforms.
“The committee is acutely aware that resource constraints -- both funds and staff -- limit the ability of VA to deliver services and force difficult decisions on allocations among vital efforts,” the study concludes. “The increases in the number of veterans seeking and receiving disability benefits for PTSD, the prospect of a large number of veterans of Operations Iraqi Freedom and Operation Enduring Freedom entering the system and the profound impact of the disorder on the nation’s veterans, make changes in PTSD [policy] a priority deserving of special attention and action.”
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