First Shots Fired In The Claims War

On February 13, VVA presented testimony before the National Academy of Sciences’ Institute of Medicine Gulf War and Health Subcommittee. This is the subcommittee that is looking at the PTSD clinical and diagnostic procedures used in the VA disability claims process.

The subcommittee consists of a group of mental-health professionals not in the employ of the VA, and none of whom are veterans. It also includes the American Enterprise Institute’s Sally Satel—the so-called expert who claims that there’s a “secret underground network which advises veterans where to go for the best chance of being declared disabled.” She could not answer any questions about the science behind PTSD diagnoses, and when questioned in detail about her allegations, kept making outrageous statements that had nothing to do with the day’s proceedings. She left the room after her presentation and did not return.

Seven speakers addressed the subcommittee during the public comment period at the end of the day: VVA’s PTSD/SA Chair and the Director of Government Relations; one of Rep. Lane Evans’s (D-Ill.) staff; a former Veterans Benefits Administration official; and three people from the Vietnam Veterans of America Foundation, two Iraq vets and Bobby Muller. VVA’s written testimony was accepted for the official record.

One of the main points in VVA’s testimony was that by 2002 the Department of Veterans Affairs had prepared a “Best Practices Manual for Post-traumatic Stress Disorder (PTSD) Compensation and Pension Examinations,” containing scientifically validated assessment instruments for the diagnostic evaluation of PTSD and guidelines for the determination of a service-connected disability for PTSD using criteria from the DSM-IV. Several of the VA scientists who wrote this “Best Practices Manual” were present at the subcommittee meeting.

You might be amazed to discover that as of February 2006, the VA had issued no directives to its clinicians and adjudicators to use the Manual, nor had it provided any training on this guide. Copies are not available to staff throughout the VA, nor to anyone else. VVA has good reason to believe there are thousands of copies of the “Best Practices Manual” sitting in a warehouse somewhere—printed with tax dollars— that the VA refuses to make available.

Is there any wonder that there is so much variation among states’ veterans disability compensation payments?

The message that we must continue to press on this issue is: The VA must distribute and train its mental health clinicians and staff in the use of its “Best Practices Manual” for the clinical assessment and diagnoses of PTSD in the disability claims process. We can accept nothing less.

FAMILY MATTERS

For almost 2,300 American families who have lost loved ones since the invasion of Iraq, the visit announcing that death has become a reality. More than 16,000 troops also have been seriously wounded, warranting similar visits or phone calls. According to the Institute for Policy Studies, since 2001 more than one million families have had to learn to adjust to a life without a loved one near—and the constant worry and fear. How do they cope?

Some try to outrun their fears by becoming workaholics. But according to the National Mental Health Association, finding support is imperative in handling stress, although the organization also suggests trying to maintain control over what you can. This can mean sticking to a daily routine, such as having the phone nearby, and having calls forwarded to your cell phone each morning before work.

“It’s support that seems essential to the well-being of families,” says Mark Smaller, director of the Neuro-Psychoanalysis Foundation in Chicago. “The first step in managing these stressful feelings is to acknowledge them and talk of them when they emerge. Just talking to another about these feelings can diffuse intensity, but certainly not make them go away.” Many spouses and parents should acknowledge the importance of connecting, especially with those in similar situations.

Clearly, spouses and parents of those deployed suffer terrible mental anguish. But they are not alone. Children suffer as well. “Children need to feel not alone or isolated with their feelings,” Smaller says. “The more available parents or caretakers are to the child’s fears, anxiety, sadness, and anger, the better the child can integrate these feelings and not feel alone. Kids should be encouraged to talk about their feelings, ideas, thoughts, and fears about a parent leaving or one who is gone. Anything less can leave children feeling as if they have done something wrong to make the parent leave. Any way to maintain some contact through telephone, e-mails, or letters is encouraged.”

When family members go off to war, it is important to remember that they are not the only ones suffering. That is why mental health experts say it is important to be on the lookout for signals that might indicate a military family member is experiencing too much stress: persistent fatigue; inability to concentrate; flashes of anger, lashing out at family and friends; changes in eating or sleeping habits; increased use of alcohol, tobacco, or drugs; repeated tension headaches, lower backaches, stomach problems or other physical ailments; and prolonged feelings of depression, anxiety, or helplessness. If these occur, individuals should seek a support group, or in more serious instances, professional medical attention.