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.

Combat Clips: A Selection of OEF/OIF Veteran Statistics, April 2010

Quick looks at the latest news containing statistics of interest to returning veterans, military families and their caregivers.

First up, Kristin M. Hall for AP:

Brig. Gen. Stephen Townsend addressed the 101st Airborne Division with military brusqueness: Suicides at the post had spiked after soldiers started returning home from war, and this was unacceptable.

"It's bad for soldiers, it's bad for families, bad for your units, bad for this division and our Army and our country and it's got to stop now," he insisted. "Suicides on Fort Campbell have to stop now."

It sounded like a typical, military response to a complicated and tragic situation. Authorities believe that 21 soldiers from Fort Campbell killed themselves in 2009, the same year that the Army reported 160 potential suicides, the most since 1980, when it started recording those deaths.

But Townsend's martial response is not the only one. Behind the scenes, there has been a concerted effort at Fort Campbell over the past year to change the hard-charging military mindset to show no weakness, complete the mission.

Chicago Tribune Reports on VA Claims Process Quandary

Headline splashed across the front page of today's Chicago Tribune: The Cost of War.

Analyzing more than 3 million VA disability claims (this figure equals the number of vets receiving such compensation in 2009 -- a jump of 24 percent over the 2003 total), it is the latest in a long line of government and private studies on problems at the VA. The Trib found:

The bulk of the increases didn't come from veterans of the current wars in Iraq and Afghanistan but from those who served years or even decades before. Veterans from the Vietnam and Persian Gulf eras accounted for roughly 84 percent of the rise in spending, which hit $34.3 billion last year.

The surge from past eras comes even as more soldiers than expected are returning home from Iraq and Afghanistan in need of care. With hundreds of thousands of troops still deployed, the VA already provides disability payments to nearly 200,000 veterans from the current conflicts, a number that is expected to balloon during the next 30 years.

The unanticipated crush of claims is exacerbated by the VA's antiquated compensation system, which hasn't been overhauled since 1945. Cumbersome and heavily bureaucratic, the system requires a mountain of paperwork, is based on diagnoses that lag far behind medical advances and runs on a computer system that is so outdated it can't accurately verify whether veterans were deployed.

Update on OEF/OIF Veterans' Mental Health, VA Benefit Issues

Building upon some of the data-rich news clips shared earlier this week, a few more grafs to consider.

Jia-Rui Chong, Los Angeles Times:

About 37% of veterans returning from Iraq and Afghanistan have mental health problems, a nearly 50% increase from the last time the prevalence was calculated, according to a new study published today analyzing national Department of Veterans Affairs data.

The study, which examined the records of about 289,000 veterans who sought care at the VA between 2002 and 2008, also found higher rates of post-traumatic stress disorder and depression. ... The previous study of national VA data, which examined Iraq and Afghanistan war veterans seeking care between 2001 and 2005, found that 25% of those veterans received mental health diagnoses. About 13% were diagnosed with the anxiety disorder PTSD and 5% with depression.

The new study by Seal and her colleagues, published in the American Journal of Public Health, found that 22% of the veterans in the study had PTSD and 17% had depression. When the researchers compared veterans of Afghanistan from early in the war to veterans of Iraq four years later, they found the rates of PTSD diagnosis more than tripled.

Congressman Hall's COMBAT PTSD Act Deserves Our Support

Last Monday, Rep. John Hall [D-NY], the chairman of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs, introduced important legislation that would give vets coping with PTSD easier access to their disability benefits and the treatment they need. Press release:

After visiting with veterans at the U.S. Veterans Hospitals at both Montrose and Castle Point, Congressman Hall announced legislation he has written called the COMBAT PTSD Act: Compensation Owed for Mental Health Based on Activities in Theater. The legislation will remove the onus from any veteran diagnosed with PTSD to have to prove that a specific incident during combat caused his or her PTSD. Hall's COMBAT PTSD Act will make it so that any veteran diagnosed with PTSD who served in combat will automatically have the ability to get treatment and benefits for the service injury of PTSD. ...

The VA's current policy forces veterans to "prove" that a specific stressor during a war triggered their PTSD, even if they have already been diagnosed and been receiving treatment for the condition. Veterans must track down incident reports, buddy statements, present medals, and leap other hurdles to validate to the VA that their PTSD was a result from their war service.

"The current policy violates common sense," stated Hall. "A soldier who does not have PTSD before entering a war, who returns home from war with PTSD, should not have to prove that his PTSD is a result of a specific experience during war. Simply serving in combat can induce PTSD. The wars America is fighting right now have no front or rear lines. Danger can strike in any place, anywhere. It is clear that the current regulations are in need of change."

People are beginning to chime in on the issue.

New VA Report Stirs Up Long-Simmering Veterans Disability Claims Processing Controversy

Just when you think that our beleaguered veterans can relax, that health care improvements are on the way or already there, the latest VA report (yes, another one) confirms we're merely treading water.

While things are all a boil, again, this week, the veterans claims processing backlog (and everything that flows from it) has been a long-simmering problem.

Veterans for America Servicemembers Survival Guide a Must-Have for Every Military Family

Veterans for America delivers an early holiday present to our nation's military families: "The American Veterans’ and Servicemembers’ Survival Guide," a 599-page guidebook every veteran should own. And there's no need to worry about being naughty or nice, because the VFA Santa has made the ebook available to everyone as a free download.

Download the whole thing at once, or choose only those of its 28 chapters you most wish to read first. (Specific recommendations for PTSD issues are found as a subchapter in Chapter 3: Service-Connected Compensation [pdf]. I've excerpted a portion in extended to give you an idea of what you can expect to find in this vital survival guide.)

As Second Legal Attempt Fails to Force VA Hand on Claims Processing, Army Sued Over Discharged Vet PTSD Disability Ratings

From CNN:

The U.S. Army intentionally denied benefits to soldiers suffering from a widespread stress disorder after they returned from service in Iraq and Afghanistan, a veterans advocacy group charges in a suit filed Wednesday.

The lawsuit [pdf], filed by the National Veterans Legal Services Program, accuses the Army of illegally cutting off benefits to thousands of veterans and their families by refusing to assign a proper disability rating to those veterans after they had been discharged with a diagnosis of post-traumatic stress disorder (PTSD). As a result, the veterans have been denied benefits, including, among other things, lifetime monthly disability payments and free medical care for themselves and their families. ...

All disabled veterans are assigned a disability rating from zero to 100 percent. According to the Legal Services Program, a rating of at least 30 percent is required to qualify for benefits such as monthly disability payments and free health care. Soldiers receiving less than a 30 percent rating are entitled only to a one-time lump sum severance payment after being discharged.

On October 14, the Defense Department ordered the Army to assign at least a 50 percent rating to all soldiers discharged with PTSD in the future. The lawsuit seeks to provide full benefits to all veterans discharged with PTSD in the past six years.

Military Construction and VA Appropriations, Disability Claims Modernization, Veterans Compensation Cost of Living Adjustment

As Congress begins their annual August break, a look at some of their pre-recess veterans-related work:

• The U.S. House of Representatives passed [409-4] the 2009 Military Construction and Veterans Affairs Appropriations bill that would eclipse President Bush's budgetary request by $3.4 billion and gives the green light on construction of a new replacement VA hospital in Louisville, Ky. It still has to pass the Senate -- and the president's veto pen -- before the full $118 billion can be doled out.
  
  
• The House also rushed through another eight veterans' benefits bills, including the unanimous approval of the Disability Claims Modernization Act, which would speed up claims processing for those veterans recovering from disabilities clearly (i.e., serious physical combat wounds) connected to their military service. Senators Charles Schumer [D-NY] and Hillary Clinton [D-NY] have agreed to introduce Rep. John Hall's [D-NY] legislation it in the Senate in the "hopes of improving the delivery of compensation to veterans, their families and survivors."
  
  
• Meanwhile, the Senate passed the Veterans Compensation Cost of Living Adjustment Act, which would provide the nation's 3 million veterans drawing service-connected disability benefits the same cost-of-living increases Social Security recipients receive today. The legislation will have to pass the Senate and be signed into law before it can go into effect on December 1, 2008.
  
  
• The new GI Bill, dubbed "a GI Bill for the 21st century," officially went into effect on Friday, more than doubling the educational benefit each Afghanistan and Iraq veteran earns to $90,000 from $40,000. "The Post-9/11 GI Bill will cover full tuition at the most expensive public college in a veteran's home state, grant up to $1,000 for books and supplies, and provide a monthly living stipend."

Controversial VA Email Accepted into Evidence in Veterans' Rights Class Action Lawsuit Case

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

A federal judge presiding over an important veterans' health care rights case against the VA has accepted into evidence a controversial email suggesting fewer PTSD diagnoses be given to veterans coming in for care. This is the same case that first had the government attempt to dismiss it in its entirety, arguing that vets have no legal right to expect specific types of medical care. The case moved forward nonetheless, with testimony and closing arguments taking place in April.

Read more on this in the Fog City Journal, or more on April's trial (which I was too swamped to cover here at the time) in extended.

Editorial: Veterans funding or permanent tax cuts?

From the Mankato [MN] Free Press editorial board:

The U.S. House of Representatives and the U.S. Senate recently passed budgets that boost funding for veterans’ health care and other veterans’ needs at amounts higher than the Bush Administration’s proposal. The Bush budget boosts total VA funding by about 1.6 percent, or $1.7 billion.

The House bill adds about $600 million to the Bush proposal, which would bolster overall spending to about 2.6 percent. The Senate adds $3 billion, making the overall spending increase about 5 percent.

Many veterans groups have favored the congressional proposals saying the number of veterans entering the VA health system from wars in Iraq and Afghanistan warrants the extra funding. In fact, Congress and the president in the most recent fiscal year boosted VA funding by an “emergency” $3.7 billion appropriation midway through the budget year after seeing tremendous increases in health care costs for veterans returning from Iraq and Afghanistan. That figure is close to the increase being proposed by Bush.

Full Trial Moves Ahead in Lawsuit Against VA, OEF/OIF Veterans with PTSD Sought

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

If you're a long-time reader, you're probably aware of the class action lawsuit filed last July against the Veterans Administration by two veterans groups. One of them, Veterans for Common Sense, is helmed by tireless former VA employee and veterans advocate Paul Sullivan. His important update and call for help in extended.

Senate Amendment Aims to Decrease Veterans Disability Claims Backlog

From Rick Maze via Navy Times:

The Senate moved Thursday to add $50 million to the fiscal 2009 Department of Veterans Affairs budget specifically to speed the processing of disability claims. By voice vote and with no opposition, the Senate revised the 2009 federal budget to include an amendment sponsored by Sen. Blanche Lincoln, D-Ark., adding the money for VA claims processing.

The Senate’s budget resolution, S. Con. Res. 70, which lays out guidelines for federal spending for the fiscal year that begins Oct. 1, already included a $3.2 billion increase in veterans’ funding over the Bush administration request.

In total, the budget resolution would give the VA $93.6 billion in budget authority for 2009, $5.2 billion more than this year’s VA budget. Lincoln, who sponsored similar legislation last year, said the money is needed “to help veterans receive the benefits they have earned. Veterans are not getting the benefits they need and are not getting them in a timely way.”

The $50 million increase would apply to the general administration account for the Veterans Benefits Administration, which processes benefits claims. The money is earmarked for pilot programs to find ways to cut the average waiting time for a ruling on a claim, currently six months for initial claims. Lincoln thinks working the problem from that direction could have a bigger long-term effect than continuing to hire more people to try to whittle down the huge backlog of claims.

Returning Vets and Hearing Loss

In addition to the expected physical drawbacks of suffering combat-zone hearing injuries (now being called the "the silent epidemic"), I wonder what, if any, psychological effects these persistent wounds have on our soldiers.

Are returning vets with ringing or buzzing ears, also known as tinnitus, at a disadvantage when it comes to putting the war behind them? What effect does the constant reminder of the IED blast or RPG attack they survived have on them?

From AP:

Large numbers of soldiers and Marines caught in roadside bombings and firefights in Iraq and Afghanistan are coming home with permanent hearing loss and ringing in their ears, prompting the military to redouble its efforts to protect the troops from noise.

Hearing damage is the No. 1 disability in the war on terror, according to the Department of Veterans Affairs, and some experts say the true toll could take decades to become clear. Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said. ...

For former Staff Sgt. Ryan Kelly, 27, of Austin, Texas, the noise of war is still with him more than four years after the simultaneous explosion of three roadside bombs near Baghdad.

"It's funny, you know. When it happened, I didn't feel my leg gone. What I remember was my ears ringing," said Kelly, whose leg was blown off below the knee in 2003. Today, his leg has been replaced with a prosthetic, but his ears are still ringing.

"It is constantly there," he said. "It constantly reminds me of getting hit. I don't want to sit here and think about getting blown up all the time. But that's what it does."

Testimony Begins in Class Action Lawsuit Against Veterans Administration

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

From the San Francisco Chronicle:

The nation's foremost authority on post-traumatic stress disorder testified in federal court Monday that up to 30 percent of combat veterans of Iraq and Afghanistan are likely to be diagnosed with the ailment and that the Veteran's Health Administration is not doing enough to help them.

Dr. Arthur Blank, a psychiatrist who has worked with troops and veterans with PTSD since 1965, said the disorder is treatable, but it requires a "human connection" with a therapist, and that's something the VA is ill-prepared to support.

"With hope and with help, recovery is possible," he said.

Dr. Blank testified at a hearing in connection with a lawsuit brought by veterans advocacy groups against the VA, claiming that the federal government's health care system for troops returning from Iraq and Afghanistan illegally denies care and benefits.

The plaintiffs, Veterans for Common Sense and Veterans United for Truth, are seeking to make the case a class action on behalf of 320,000 to 800,000 veterans or their survivors. The hearing Monday concerned a request by the veterans groups that the judge issue a preliminary injunction ordering the VA to provide immediate mental health treatment for veterans who suffer from stress disorders and are at risk of suicide.

Experts, Advocacy Groups, Officials: VA Disability System Fixable

From Kelly Kennedy via Navy Times:

Medical experts, advocacy groups and Veterans Affairs Department officials say VA’s disability rating schedule needs to be updated — continually — but they denied the system is so bad that it needs to be dumped completely.

A Tuesday hearing of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs also focused on studies conducted over the past year that point toward needed improvements not only in the ratings schedule, but in VA’s disability retirement system itself.

Rep. John Hall, D-N.Y., chairman of the subcommittee, said VA needs to remove “archaic” criteria from the rating schedule; update psychiatric criteria to better reflect symptoms of troops diagnosed with post-traumatic stress disorder; find out why so many veterans with PTSD have been rated fully disabled; and update neurological criteria to include new research on traumatic brain injuries.

“The VA needs the right tools to do the right thing,” Hall said.

VA argued that it is already doing the right thing and has been updating the rating schedule, though officials acknowledged they could do better. From 1990 through 2007, VA had updated 47 percent of the ratings schedule, but 35 percent of the codes had not been touched since 1945. However, VA said it updated the codes for TBI in January and is working on an update for PTSD.

Military PTSD Diagnosis Now Proof Enough for VA -- For Some

Kelly Kennedy, Air Force Times:

The Department of Veterans Affairs has scrapped a policy requiring combat veterans to verify in writing that they have witnessed or experienced a traumatic event before they can file a claim for post-traumatic stress disorder — but only if the military has already diagnosed them with PTSD.

“This change provides a fairer process for veterans with service-connected PTSD,” Sen. Daniel Akaka, D-Hawaii, said in a written statement. “[It] leaves claim adjudicators more time to devote to reducing the staggering backlog of veterans’ claims.”

In the past, a veteran has needed written verification — a statement from a commander or doctor, or testimony from co-workers — that he or she was involved in a traumatic situation to receive disability compensation from VA if they had not already been diagnosed by the military during a disability retirement process. But PTSD is the only condition that a veteran must “reprove” to receive disability benefits from VA.

“They don’t have to reprove their diabetes,” said Mary Ellen McCarthy, special projects counsel for the Senate Veterans’ Affairs Committee. “They don’t have to reprove a leg injury. I have never seen any other condition diagnosed in service [for which] people had to reprove their injury.”

Action: Full Faith in Veterans Act

Editorial from the Bangor Daily News:

The phrase "War is hell," attributed to Union Gen. William Tecumseh Sherman during the Civil War, is perhaps the most succinct and eloquent description of armed conflict. Yet it falls far short of bridging the gulf between those who have experienced war and those who have not, and it fails to impart the indelible impression this particular hell leaves on young hearts and minds.

Almost no one survives war unscathed; whether the scars are physical or psychological, they are there, and remain for decades. The terms used to describe troops who struggle to heal from those wounds have changed, from "shell shocked" in the World War II era, to "flashbacks" from the Vietnam years, to the clinical Post Traumatic Stress Disorder now in vogue. But the condition is the same. After witnessing unspeakable horrors, or having to kill, or simply from the crushing weight of constant fear, our young men and women succumb. It is a reaction that is more normal than not.

Some rebound with rest and connection with family and friends back home. Others need help. Just as the federal government is obligated to treat the physical wounds, so must it treat the psychological wounds. A bill proposed by Reps. Tom Allen and Mike Michaud, the Full Faith in Veterans Act [pdf], goes a long way toward ensuring that PTSD victims get help and compensation.

The bill would change the standard of proof for veterans who don’t have full military records to verify the cause of their PTSD. Under current law, veterans must have a diagnosis of the condition and military documentation or two "buddy statements" to show the stressor event occurred during duty.

Vets' Legal Challenge to VA Health Care System Shortfalls Proceeds Forward

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

Good to see our veterans will get their day in court. From Time:

When veterans of America's two current wars — Iraq and Afghanistan — tried to sue the Department of Veterans Affairs for failing to process thousands of claims for post traumatic stress disorder (PTSD), the Department waved them off saying they had no right to do so. The VA said that Congress had set up an administrative — not judicial — process for evaluating individual disability claims. The veterans, it declared, just had to wait for bureaucracy to take its course — no matter that it has a backlog of 600,000 unresolved claims, each of which can take up to six months or more to process.

Now, however, a federal judge in San Francisco has cleared the way for a dramatic challenge to the constitutionality of the VA's claims system. Judge Samuel Conti of the Northern District of California ruled that the administrative system is not "adequate" for reviewing claims of organizations suing on behalf of a broad class of veterans (the class-action lawsuit was filed in July by two veterans organizations). Nor is that bureaucratic process empowered to grant the kind of relief sought by the veterans groups: systemic changes in the VA's processing of disability claims, strengthened rights of individual veterans to press their claims and immediate medical and psychological help for returning troops complaining of PTSD symptoms.

Arguments Heard in Govt's Motion to Dismiss VA Class Action Lawsuit Case

Latest updates on this and related VA/Army lawsuits posted in "As Second Legal Attempt Fails to Force VA Hand on Disability Claims Processing, Army Sued Over Discharged Veteran PTSD Disability Ratings." -- Ilona Meagher, 12/17/08

From San Francisco's KGO Channel 7 [ABC]:

A legal battle affecting some 600,000 veterans, many with post traumatic stress disorder came to a San Francisco courtroom today. The federal government is trying to dismiss a lawsuit filed over a tremendous backlog for treatment.

The lawsuit filed by veterans groups in July asks the federal court to intervene to require the Veterans Administration to change its procedures so it can handle disability claims in a fair and timely manner.

Today, a judge heard arguments on the government's motion to dismiss the lawsuit, claiming that the federal courts have no jurisdiction in this case -- that only Congress does.