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Saturday, June 17, 2006

Update: VA-Mandated Institute of Medicine PTSD Review

For a look at the current progress and controversy surrounding the updating of the PTSD definition for DSM-V, see "Defining PTSD: Update on Our Way to DSM-V." -- Ilona Meagher, 12/07/08

It's been a while since we've seen an update on the politically charged VA-mandated review of 'PTSD as a diagnosis' taking place at the Institute of Medicine (IOM) of the National Academies. Steve Robinson, Government Relations Director for Veterans for America (formerly Veterans for Common Sense), gives us an update on an important meeting held yesterday. Haven't found anything in Google News pop up yet; but, from the looks of the email, there's some (cautious) good news that's come out of the review so far.

Click on 'Article Link' below tags for more...

In the interest of public education, and spreading the news, I'm going to share the entire postfound on the Veterans for America website:

Steve Robinson
Government Relations Director
Veterans for America

Today (Fri 16 Jun 06) I attended the meeting of the Institute of Medicine (IOM) Post-Traumatic Stress Disorder (PTSD) review.
At the request of the Department of Veterans Affairs, the Institute of Medicine (IOM) conducted a study to validate Post-Traumatic Stress Disorder (PTSD) as a diagnosis and to ensure the DSM-IV and other objective measures used in the diagnosis of PTSD were evidence based and scientifically sound.

The committee found that PTSD is a well characterized medical disorder and that the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for diagnosing PTSD are evidence-based, widely accepted, and widely used. This is an important finding which should end once and for all any claims that veterans were filing fraudulent claims. In fact I asked the Chairman of the committee if he believed a veteran could game the system by memorizing the DSM-IV to present false answers to a mental health care provider. He stated emphatically that it would be almost impossible because the DSM-IV has built in tools to detect deception and only a minute fraction of society had the ability to pull it off. Soldiers who serve in our wars are honorable men and women who only expect that their voices are heard and their needs are met when they come home. This study should be sent to your elected Representatives.

Additionally the committee found that only health professional with experience in diagnosing psychiatric disorders (e.g., primary care physicians, nurses, social workers) using the DSM-IV criteria are trained to make the diagnosis. The committee also stated that the diagnosis should take place in a private setting with a face-to-face interview that can last an hour or more. We all know that DoD clinicians are not spending an hour with returning veterans and they are not using the Clinical Practice Guidelines for PTSD published by the Department of Veterans Affairs. By the way, if used, the Clinical Practice Guidelines takes at least three hours to complete for one soldier.

The committee also commented on screening tools and diagnostic instruments for the assessment of PTSD. The committee commented that, “these tools cannot substitute for an evaluation by an experienced professional.” This statement is important because the way DoD screens for PTSD is the DDForm 2796 or Post Deployment Health Assessment. This form is administered by clerks, admin staff and persons who do not possess the skill to interpret the results because they are non-mental health personnel. How many soldiers are falling through the cracks because of the cost saving DDForm 2796?

Clearly this committee believes there is only one validated way to screen and diagnose PTSD. Why is the DoD allowed to make up itÂ’s own rules and screening tools?

The committee wrote that because ALL veterans deployed to a war zone are at risk for the development of PTSD, it would be prudent for health professionals to query veterans about their wartime experiences and their symptoms, when presenting at primary care and other health facilities (inpatient or outpatient) and this task must be done by trained professionals using validated screening tools.

This committee said the only validated screening tools were:

CAPS - Clinician Administered PTSD Scale
SCID - Structured Clinical Interview for DSM-IV
DIS-IV - Diagnostic Interview Schedule for DSM-IV
PSS-I - PTSD Symptom Scale - Interview Version
SIP -– Structured Interview for PTSD

Based on this report DoD is in willful violation of established and validated screening and diagnostic recommendations.

I wonder who will suffer because they donÂ’t follow the rules.

For further information on the report email:

Link to the study -

This is the link to the NCPTSD, this is a must read -

Veterans for America is all over this issue and is working diligently to inform Congress, the media and the veterans about these and other returning veterans issues.

VFA Legislative Priorities

Veterans for America (VFA) has nine immediate policy goals focusing on service members and veterans from the Global War on Terror (GWOT), Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). These policy goals represent the essential responsibilities of the Federal government to meet the needs of a new generation of war veterans.

1. Extend VA Medical Care from Two Years to Five Years: VA should extend free healthcare treatment to veterans who deployed to a war zone to five years (VHA Directive 2005-020). On May 5, 2006, Frances Murphy, M.D., Deputy Under Secretary for Health at VA, told Psychiatric News that existing lengthy waiting lists render [mental health] care virtually inaccessible.

2. Face-to-Face Medical Exams: DoD should conduct in-person physical and mental health exams with every service member 30 days before and again 30 days after deployment to war zone (PL 105-85, Sections 762 - 767). A recent GAO report (GAO-03-1041) identified serious and significant shortcomings with implementing the law.

3. Equal Outreach: VA should provide identical briefings and transition services (such as VAÂ’s Benefits Delivery at Discharge) for all deployed service members regarding VA healthcare, disability compensation, and other benefits, regardless if they are regular Active Duty, activated Reserves, or activated National Guard.

4. Electronic Records: DoD should provide each separating service member a full electronic copy of all military and medical records at the time of discharge.

5. Equal Education Benefits: VA should provide equal education benefits to veterans who are deployed to a war zone, regardless if they are regular Active Duty, activated Reserves, or activated National Guard.

6. Veteran Access to Attorneys: VA should allow veterans to hire an attorney to obtain VA healthcare, disability compensation, and other benefits (S. 2694 and H.R. 4914). This choice may be critical for some veterans (and some times families or guardians) dealing with serious traumatic brain injuries or psychological conditions.

7. GWOT Definition: VA should define GWOT in order to quickly and accurately determine healthcare and other benefit eligibility for returning war veterans.

8. GWOT Data: DoD and VA should begin collecting data on GWOT service members and veterans to monitor their health and their VA healthcare and benefit use.

9. GWOT Reports: DoD and VA should prepare reports describing the GWOT service member population so their healthcare and benefit use may be analyzed.

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