Shhh...afting Veterans

Time quoted this etching of an unknown soldier on Gibraltar on a recent veterans article:

God and the soldier, all men adore In time of danger and not before. When the danger is passed and all things righted, God is forgotten, and the soldier slighted.

It's a view that the US has long attempted to contrast itself to, that we can and will do better for those that served in its name. Unfortunately our system is far from perfect, and a recent revelation from an internal VA e-mail has caused an uproar among veterans groups. From CBS News:

On March 20, Norma J. Perez, a PTSD program coordinator and psychologist at the Olin E. Teague Veterans’ Center in Temple, Texas sent an e-mail with the subject line “Suggestion” to several staffers including psychologists, social workers, and a psychiatrist.

In the e-mail, Perez wrote, “given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out.” She then went on to say, “consider a diagnosis of Adjustment Disorder…”

"This means the veterans will not get disability benefits and health care for PTSD,” Paul Sullivan, the executive director of the advocate group Veterans for Common Sense, told CBS News.

Hearings and investigations are already being called for by many veterans groups as well as in congress to settle whether this is truly an isolated incident that was merely inappropriate, as the VA insists, or if this type of nonsense is being propagated from higher up the chain, how many veterans may have actually been affected, etc.

Obama gets the credit for being the first Presidential candidate to address this incident:

According to today's Washington Post, Norma Perez, a psychologist at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Texas, sent an email to other staffers saying: "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out." She then suggested the alternative diagnosis of "Adjustment Disorder," adding that VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD."

Simply put, Ms. Perez's email is outrageous. As you well know, PTSD is the most prevalent mental disorder afflicting our returning Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans. In order to receive their deserved benefits, these brave men and women must endure a long and arduous process. To hear that a VA official is promoting misdiagnoses of soldiers to save money is unacceptable and is tantamount to fraud.

My own personal twist on this problem goes a bit further. The VA system is government health care, a sort of "universal health care system" for veterans. Just like private coverage there is always endless haggling over budgets and fine tuning things to save a buck at the expense of those who depend on it. The big difference is when the government screws you, they don't have to let you sue them to fulfill their obligation. They have "sovereign immunity" from such lawsuits.

While both the DoD and the VA have various systems in place to appeal decisions and rulings on coverage and benefits, they're more on par with mediation... but the mediator is working for them. While they describe these hearings and systems as "non-adversarial" they tend to run more like an inquisition where the prosecutor and judge are one and the same.

What's different in this case than most of the times such systems tend to screw people out of their benefits, is that normally the providers of health services are kept independent of the claims/coverage process. Those hearing the claims/coverage arguments are typically not allowed to ignore, dismiss, or challenge the medical evidence without some conflicting medical evidence to justify doing so. If the doctor says you have condition X, the judge isn't allowed to claim greater medical knowledge than the doctor to say he's wrong.

With the VA system, the doctors are also in the employ of the same organization as the judges on these matters, the VA rating officers who decide claims. It's hard enough to get a claim through with all of the technicalities and loopholes in the laws/regulations that allow a denial of a claim, even with an accurate diagnosis.

If the VA is in any way influencing the VA medical service providers to taint the diagnosis as well... veterans, who normally can at least depend on their doctors to put them ahead of the bottom dollar, will have nobody to trust in the VA.

We've already seen this happen with the DoD health system with doctors diagnosing "personality disorders" and other "pre-existing conditions" to force out service members with previous service-connected diagnoses, both physical and mental, without the benefits the DoD would normally have to pay for with them. If they can rule the service member's problems as "pre-existing" they aren't responsible. And when the veteran, now out of the service without DoD benefits for their medical problems, attempts to file a claim with the VA they find they have years and years of fighting on their hands in denials, hearings, appeals, etc to prove their conditions are service connected and not pre-existing as the DoD claimed.

The VA was apparently paying attention. A less severe diagnosis, or a diagnosis that can be seen as not service connected, means fewer if any benefits for the veteran. For an agency that is obviously facing budget challenges in spite of the political appointee being in lock step with his appointer on championing the budget, the motive is obvious.

Getting the truth behind the actual back door policies and "suggestions" is a bit more difficult given the VA's propensity towards saying one thing publicly, and saying quite another out of the public eye (from the TIME article above):

At a May 6 hearing, lawmakers lit into officials from Veterans Affairs after an e-mail surfaced from Ira Katz, its chief of mental health, on suicide rates of soldiers in its care. The subject line: "Shhh." The VA had been insisting there were fewer than 800 suicide attempts a year by vets in its care; the real number was closer to 12,000. "Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" Katz asked. Bob Filner, chair of the House Committee on Veterans' Affairs, saw criminal negligence. "The pattern is deny, deny, deny," he told Veterans Affairs Secretary Jim Peake. "Then when facts seemingly come to disagree with the denial, you cover up, cover up, cover up."

Shhh... don't tell anyone, but I don't buy the VA's "isolated incident" rhetoric one god damn bit.