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Monday, May 03, 2010

AP: Raising Traumatic Stress Malingering, VA Disability Claim Fraud Fears

Here we go again. Fears of PTSD malingering and VA claim fraud bobbed to the surface this weekend in a piece by Allen G. Breed, AP:

Moved by a huge tide of troops returning from Iraq and Afghanistan with post-traumatic stress, Congress has pressured the Department of Veterans Affairs to settle their disability claims — quickly, humanely, and mostly in the vets' favor.

The problem: The system is dysfunctional, an open invitation to fraud. And the VA has proposed changes that could make deception even easier.

PTSD's real but invisible scars can mark clerks and cooks just as easily as they can infantrymen fighting a faceless enemy in these wars without front lines. The VA is seeking to ease the burden of proof to ensure that their claims are processed swiftly.

But at the same time, some undeserving vets have learned how to game the system, profitably working the levers of sympathy for the wounded and obligation to the troops, and exploiting the sheer difficulty of nailing a surefire diagnosis of a condition that is notoriously hard to define.

"The threshold has been lowered. The question is how many people will take advantage of that," said Dr. Dan G. Blazer, a Duke University psychiatrist who has worked with the military on PTSD issues. PTSD, he adds, is "among the easiest (psychiatric) conditions to feign."

Mark Rogers, a longtime claims specialist with the Veterans Benefits Administration, agrees. "I could get 100 percent disability compensation for PTSD for any (honorably discharged) veteran who's willing to lie," said Rogers, a Vietnam-era vet who is now retired. "I just tell him what to say and where to go."

The only problem with this, of course, are the reams of past years' studies showing quite the opposite. Two that come immediately to mind:

  • In 2007, Navy Times reported: "In 2001, 10 percent of soldiers going through the medical retirement process received permanent disability benefits. In 2005, with two wars raging, that percentage dropped to 3 percent, according to the Government Accountability Office. Reservists dropped from 16 percent to 5 percent."

  • Also in 2007, US News & World Report found the military to be downgrading disability ratings, reporting: "Since 2000, 92.7 percent of the disability ratings handed out by PEBs have been 20 percent or lower... Moreover, fewer veterans have received ratings of 30 percent or more since America went to war in Afghanistan and Iraq... As of 2006, for example, 87,000 disabled retirees were on the list of those exceeding the 30 percent threshold; in 2000, there were 102,000 recipients."
Then again, maybe PTSD diagnoses shouldn't be taken seriously.

Breed, in a companion AP piece getting a bit less buzz but championing the same cause, reports "the fact that, as a constellation of self-reported symptoms, PTSD is very subjective."

Apparently, biological changes in the brain aren't objective, either.

Everyone agrees that each case of malingering or fraud should be penalized and stopped, no matter if that claim is being filed with the VA or a civilian's private insurance company. Unfortunately, this AP piece appears to do more to spread distrust and blame the veteran than anything else. Not surprisingly, the push-back has begun.

In educational interest, article(s) quoted from extensively.

The AP article offers up a handful of fraudsters, trailing all the way back to the Vietnam War era, who were caught cheating the system. Dr. John Grohol, CEO and founder of Psych Central, responds:

[W]hen I come across an article like this Associated Press one — talking about how some soldiers may be faking post-traumatic stress syndrome (PTSD) in order to gain benefits — it makes me cringe a little.

Are there people who try and game the system? Sure, there will always be such people. But they exist in any population. The real questions to be asked by such an article should be: Are more doing it now than before? If so, why? And what can be done to stop it?

No one knows the full extent of PTSD fraud. But there have been some hints.

A 1990 law allows the Veterans Benefits Administration to crosscheck its rosters with federal tax and Social Security databases to find “unemployable” veterans reporting work-related income. In 2004, this program identified 8,846 such veterans who reported at least $6,000 in earnings, including 289 with income of $50,000 or more.

Hints are nice, but data are even better. Are these people “unemployable” because of physical disability, or mental disability? An important distinction, given this article is apparently about how “easy” it is to fake PTSD. The article doesn’t say.

This sounds more like an accounting oversight issue than anything else — How come the government isn’t asking these 8,846 veterans about this income and how it was earned when they were supposedly “unemployable”? That’s the real question and the only answer is “lack of resources and personnel to do so.” Right. We have resources to track down tax cheats, so why not these folks?

The article is surprisingly pretty thin on any actual research data, but full of those juicy anecdotes that make for good story-telling. We love a good story as much as the next person, but when it comes to implicating an entire population — U.S. soldiers who serve their country — we’d like to see a little more hard data and a little less of those juicy stories that make it sound like this is an out-of-control problem amongst veterans.

Norman Rogers, An American Lion:

This sort of nonsense is a media specialty--stoke outrage and make everyone feel like Veterans are no-good thieves. ...Congratulations--the media found evidence that at least three individuals are shitheads. Might we then conclude that everyone else is doing what they are supposed to do? Until you show me evidence, I have to conclude that everyone else is on the up and up. I'm a Republican, after all, but an Independent sort of a Republican now. I am conditioned to believe the worst in people. I'll believe the best in Veterans until the media can prove me wrong on that front.

I say, give them the benefits. Don't create a super-bureaucracy of wanna-be gumshoes who make it their solemn duty to deny benefits to people who need them. Certainly, a few unethical people would then be able to "game" the system and get something they are not supposed to get. That's life. But, that's no reason to deny deserving Veterans the benefits they need. We have people who regularly defraud the government with regards to taxes, Medicare, Social Security, home mortgages, education, and whatever else you want to throw in there. Do we then conclude that we should stop giving these things to people just because a few people are ripping off the system?

Paul Sullivan, a former veteran and VA employee, offers up the following facts at Veterans for Common Sense:

Here are two very important facts AP overlooked.

If AP had included these two facts, then readers would understand more about VA and veterans suffering with PTSD after deploying to the brutal Iraq and Afghanistan wars, sometimes two or three times.

Fact Number One
There is no widespread fraud problem at VA. Out of more than one million claims per year, less than a score are ever investigated for fraud.

Furthermore, in November 2005, VA auditors randomly selected 2,100 PTSD claims. After an exhaustive investigation, VA found zero cases of fraud. VA has extensive methods to prevent fraud, contrary to AP's baseless assertion. AP should have reported that fact.

VA’s investigation began when a reporter at the Chicago Sun Times observed that VA pays different average amounts in disability benefits based on a state-by-state comparison. The true culprit: poor leadership, staff shortages, and a lack of consistent training. VA Secretary Shinseki is taking bold steps to address these challenges, and he has broad support among veterans’ groups.

Fact Number Two
The standards for reviewing PTSD claims won’t be “loosened” as AP asserted without attribution. VA standards will be based on scientific evidence.

VA and independent scientists overwhelmingly agree the diagnosis of PTSD is very real. Our goal at VCS is for the scientific evidence to match VA’s rules for obtaining disability benefits and healthcare. That's responsible, and that's fair.

Here’s what independent scientists found. In 2007 the Institute of Medicine at the National Academy of Science reviewed scores of peer-reviewed and published scientific studies and validated PTSD. In “Gulf War and Health, Volume 6,” IOM concluded:

The epidemiologic literature on deployed vs nondeployed veterans yielded sufficient evidence of an association between deployment to a war zone and psychiatric disorders, including posttraumatic stress disorder (PTSD), other anxiety disorders, and depression; alcohol abuse; accidental death and suicide in the first few years after return from deployment; and marital and family conflict, including interpersonal violence (page 319).

In fact, the escalating suicide epidemic among active duty service members and veterans represents clear and convincing evidence of the psychological impact of war, especially repeated deployments into war zones where car bombs and roadside bombs are daily - and deadly - events killing and maiming our troops as well as innocent civilians.

Micheal Leon also chimes in at Veterans Today:

Reviewing Allen Breed’s national AP hit job on U. S. veterans and reformist elements at the U.S. Dept of Veterans Affairs (DVA), there is a danger in writing a follow-up piece asking for comment from veterans.

Namely, Breed’s assertions that disability claims are being handled too “quickly, humanely, and mostly in the vets’ favor” present a risk that veterans may just stroke out in righteous anger when asked their opinion of these statements. I don’t want cause an activist veteran his or her life. Not kidding.

As axiomatic to veterans as the oath they swore to defend the U.S. Constitution is the reality that a veteran filing a disability benefit claim encounters the VA’s ‘deny-delay-and-hope-you-die’ culture.

The fallout continues as Patience Mason, author and wife of a Vietnam veteran who has PTSD, writes:

In one of the stupider articles I have ever read, Alan G Breed makes it clear how little he understands about the VA Claims process. He tracked down three assholes who suckered the system. Did he track down three guys who had had legitimate claims denied, or thirty, or three thousand, or any of the 391,257 claims that are now waiting adjudication? Apparently not, although he does mention one guy whose legitimate VA claim has been repeatedly denied.

I guess denied legitimate claims are just not that interesting.

My experience of the VA claims process is that the compensation system is not on the veterans side. It is slow. It is ponderous. It is full of psychiatrists running veterans through compensation exams in a few minutes, when it should take hours. They get paid the same no matter how long or short the exam is. ...

I went with Bob [Mason's husband] to his last compensation exam, with a tape recorder. The woman psychiatrist pointed out to Bob his original diagnosis was for "nervousness." I said "Look at the date!" 1968. "What difference does that make?" she said. She was totally ignorant that in 1968, the American Psychiatric Association came out with the Diagnostic and Statistical Manual II in which PTSD did not appear in any form. ...

Then there was the veteran of Hamburger Hill who called me. He was very upset because the VA compensation psychiatrist (this is not the treating psychiatrist but someone hired by the compensation system to do compensation exams) said to him, "Oh, I saw the movie. It couldn't have been as bad as that," thereby ending the exam. (It's worse when it's real," Bob said to me when I was upset about the wounded in Platoon.) This kind of total lack of information and understanding causes people who actually have PTSD to lose their ability to pursue the claim. It triggers them into painful scary reactions as well as makes them feel disrespected, devalued and hopeless, which is what the VA compensation system wants. ...

I'd love to see Mr. Breed do a story on some of our 300.000 plus veterans who are not getting what they fought for (and in many cases nearly died for) instead of one o[r] three crooks.

Another Vietnam vet wife, Chaplain Kathie Costos, also gets right to the heart of the matter at Wounded Times:

I'll admit it that after reading the AP piece, I popped my cork. Not so much online but in the privacy of my office. Anyway, another sleepless night thinking about how much harm this can do to the veterans we've been trying to reach since Vietnam. Between this blog and my older one, Screaming In An Empty Room, there are over 20,000 post[s]. On this one alone there are over 9,000. I would be shocked to discover more than 2 percent of the posts were about frauds. I do not bury those stories. I spotlight them because they are causing more problems for real veterans with real claims waiting for their claims to be processed.

There is one thing I beg you to keep in mind and that is the simple fact that it is harder to get them to go for help in the first place, yet we watch them suffer as their lives fall apart when we know they could be healing instead. Don't give up on fighting for them just because someone decided to blame the veterans yet again instead of the system that let them down.

Right on, Kathie.

While the production quality is low, the following series of videos explores the physiology of PTSD. Details: "Psychologist Michael Ryan, Psychotherapist Carolyn Carino, Vietnam War veteran Jim Hodges, and Hauenstein Center Director Gleaves Whitney talk about returning veterans and post-traumatic stress disorder."

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