Friday, July 11, 2014

Remove D from PTSD; put V back in VA

President George W. Bush is the latest voice to join a chorus calling for mental health professionals to remove D from PTSD.

Tifton, GA Veterans Memorial Park
Tifton, GA Veterans Memorial Park | PHOTO CREDIT Wiki Commons

The wars in Iraq and Afghanistan have resulted in a nearly incalculable number of military veterans returning with Post-Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI). Even those exposed to mild, indirect concussive pressures from exploding improvised explosive devises (IEDs) and enemy artillery (mortars or rockets) may have mild damage to gray matter known as mild TBI (MTBI). The number of veterans diagnosed with TBI is over 260,000. The number of reported PTSD diagnoses from Iraq and Afghanistan has topped 325,000.

The latest extrapolations of the statistics indicate at least 20 percent (and as many as 30 percent) of Iraq and Afghanistan war veterans have PTSD, TBI or both with at least 50 percent of those veterans not being diagnosed.

Among the reasons many of those undiagnosed veterans remain unidentified or untreated is the stigma surrounding PTSD. Once labeled with the injury, veterans fear facing prejudice in the workplace and in society. Other implication include the increasing number of reports alleging veterans affairs personnel at state and federal levels restricting the Second Amendment rights of veterans diagnosed with PTSD without due process, a legal hearing, or court order.

Remove the D from PTSD

Though he is often maligned for initiating the war in Iraq, President Bush is also known for working on behalf of injured and disabled veterans. His latest cause is a campaign to help remove the D from PTSD. The cause is to have the word “disorder” removed from PTSD, especially when referring to combat veterans.

Web Extra: George W. Bush on PTSD

Many PTSD researchers and experts from various related fields such as neurology, neuro-psychology, and clinical psychology seek to remove the D from PTSD, claiming that “disorder” is a misnomer. In the case of a combat veteran, PTSD is an injury the brain suffers due to long-term overexposure to epistemic violence and near-continuous threats to life and limb. Research indicates this causes changes in brain chemistry and the amount of gray matter in affected areas. Magnetic Resonance Images (MRIs) comparing pre- and post- combat brains offer supporting evidence. The same affects have been discovered on people who suffered long-term abuse and neglect as children.  Thus, this growing population suggests, PTSD is not a “disorder” but an actual brain injury.

Some civilians diagnosed with PTSD favor this change. One such lady, on condition of anonymity, stated there should be a separate label to distinguish the PTSD afflicting combat veterans from those diagnosed due to non-combat events. When she reveals she was diagnosed with PTSD,  people tend to question her about her military experiences.

Though many symptoms are similar, the condition resulting from a single traumatic event such as a rape, train wreck, or other near-death traumatic experience is significantly different from the injuries suffered due to hyper-vigilance and continuous exposure to a violent, life-threatening environment such as long-term abuse or combat.

The American Psychiatric Association’s (APA) latest Diagnostic and Statistical Manual of Mental Disorders (DSM) is the fifth (V) edition and was published in May 2013. The DSM-V took a step towards redefining PTSD, moving it from the broader classification of an “anxiety disorder” to a new category of “trauma or stress-related disorders”. So why won’t the APA remove the D from PTSD. The APA released a statement summarizing why it will retain the label of “disorder” despite the growing population requesting the name change. The APA’s own PTSD fact sheet states:
But others believe it is the military environment that needs to change, not the name of the disorder, so that mental health care is more accessible and soldiers are encouraged to seek it in a timely fashion. Some attendees at the 2012 APA Annual Meeting, where this was discussed in a session, also questioned whether injury is too imprecise a word for a medical diagnosis.
In DSM-5, PTSD will continue to be identified as a disorder.

Put the V back in VA

Matt James at Disabled Veterans wrote a commentary about an article he read at Daily Caller. Daily Caller acquired an audio file of Veterans Administration (VA) employees discussing, among other things, shredding portions of  veterans official files. Allegedly, they did so as a means of reducing the increasing backlog of unprocessed veterans’ disability claims. Matt warns fellow disabled veterans to clear the room of any baseball bats before listening.

System Redesign | Oliver Mitchell

This is the latest in what many veterans are perceiving as a steady stream of mismanagement, corruption, or incompetence in Gen. Shinseki’s VA.

Obama appointed the retired Army Chief of Staff to head the Veterans Administration in Jan. 2009. Shinseki retired from the Army in 2003 amid what many see as conflicting reasons. Shinseki had served 38 years. He was appointed as Army Chief of Staff by Bill Clinton in 1999. Shinseki was the head cheerleader for changing the Army headgear to the black beret with a United Nations “flash” or patch. The change was met with mixed responses from Soldiers. Shinseki retired not long after he disagreed with the operational plan for the Iraq invasion. Shinseki disagreed with the forces and organizational structure necessary to defeat Saddam Hussein’s forces. Shinseki was proven incorrect when Baghdad fell in the spring of 2003.

Over the past few years, the VA has come under fire for disability claim processing times. Policies enacted during the Bush (43) administration allowed veterans preparing to leave service to file as early as 90 days before separation or retirement. The idea was to have disability payments begin within 30 days of separation or concurrent with the first or second pension check.

However, a reported backlog has prevented the timely processing. In 2011, one veteran filed his VA claim exactly 90 days prior to his retirement date. He had his VA assessment physical 75 days prior. At 60 days prior, he had additional tests and assessments to determine if the extent of his injuries were greater than initially assessed. He didn’t receive his benefits letter with disability rating until 13 months after his retirement date. The whole process took 16 months, not the three months the early submission policy promised. In addition, several items the veteran requested to be assessed were ignored. The issues in question are obvious to any who bother to read his Army medical records. Veterans are required to submit a complete copy of those records to the VA. The VA is supposed to screen them in order to help identify service connected and combat connected (a higher classification from just service connected) injuries and disabilities. In this case, according to the veteran,  it was obvious they had not done so.

Yet, The VA was able to afford to send administrative workers to “training conferences”. In one such conference, attendees learned dance moves so they would not embarrass themselves when they had to perform the same dance at a future conference. Taxpayer dollars that were intended to care for our veterans on behalf “of a grateful nation” were wasted on dance lessons for bureaucrats.

VA Dance Lesson Conference Aug. 2011

Perhaps the backlog would not be as overwhelming if VA allocated funds were better managed. If the funding wasted on these conferences were spent on hiring more health care professionals or contracting the work to the same medical professionals TRICARE uses, there wouldn’t be as much of a backlog.  Instead, the allocations seem to be used as an employment program for unemployed social workers.
Perhaps Shinseki needs to enact a VA policy that makes veterans the priority.
(H/T to the Free Range Texan for providing research materials.)