It's About The Money

Judging by the number of e-mails I’ve received in recent weeks, many of you have heard the news that the VA will be reviewing some 72,000 PTSD claims that have been granted. “Why?” is the No. 1 question that’s being asked of me in those e-mails. The answer: Because earlier this year, the Inspector General’s Office (the IG) looked at about 2,100 claims and found that in some 600 cases, “the presence of a stressor was not clearly defined.” So, according to the VA, they “will be looking to ascertain the presence of a stressor” (a specific traumatic event or experience occurring during the period of military service. For a more comprehensive look at the review issue, see the Government Relations report)

Keep in mind that this is all about money. Rep. Steve Buyer (R-Ind.), chair of the House Committee on Veterans’ Affairs, recently stated: “Many veterans stop going to therapy/treatment once they have received their 100 percent PTSD disability claim.” The fact of the matter is that PTSD and other related mental health issues represent long-term VA health care costs, not short-term costs such as those associated with a broken arm. We also know that the longer PTSD goes untreated, the worse it can become over time, and subsequent treatment costs will rise. Add to this mix the fact that many—if not most—VA facilities have neither the appropriate number of professional mental health staff or resources (programs, beds, or funds) to provide adequate mental health services, despite VA claims to the contrary.

For example, at VISN 15 at the Kansas City VA Hospital, in 1996 there were 41/2 F.T.E.s (full-time equivalencies of staff time) dedicated to 55 clients diagnosed with PTSD. In 2005, there are 21/2 F.T.E.s assigned to more than 1,000 clients. Weekly group therapy sessions consist of hundreds of clients packed into standing-room-only rooms. If you’re lucky, you can schedule a one-on-one, 30-minute therapy session once every three months. Given these facts, why do you think veterans would stop seeking long-term VA mental health services?

In other news: In July 2004, a report in The New England Journal of Medicine estimated that 17 percent of service personnel returning from Operation Iraqi Freedom had PTSD-related symptoms. But Dr. Al Batres, who heads the VA’s Readjustment Counseling Service (Vet Centers), believes the rate is now higher—and growing. So far this year some 14,000 veterans have sought counseling at the 207 community Vet Centers he oversees. About 27 percent of them, he explains, report such symptoms. “The numbers coming in are escalating,” says Batres, who stresses that his data are anecdotal.

PTSD continues to be an acronym the military doesn’t like. Rather, it prefers “temporary adjustment disorder,” with an emphasis on “temporary.” If Batres’s numbers prove correct, the overall rates of PTSD could equal those of the Vietnam War.