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Message Stuart Steinberg
I wanted to follow up on Larry Scott's editorial about the recent Washington Post article about combat and post traumatic stress disorder. The story clearly points out the endemic problems that pervade the VA mental health system. No one denies that individual and group therapy, when they're available, can help those suffering with this affliction learn to cope with some of the more troubling symptoms. That and a lot of psychotropic medication. But there lies the rub: there are scant resources within the VA to provide the mental health services that many veterans need. Moreover, the VA claim that those suffering from long-term, persistent symptoms can "get better" in some conventional sense is simply not borne out by current research or by the reality of the disease. The idea that you can wake up some day, assuming you were actually able to sleep the night before, and not have the memories, not have the nightmares, not have the flashbacks, not have the startle response or the hypervigilance, not abuse substances to help you forget, not think about that damn war all the time, not have trouble with relationships, not have anger management problems"well, it's just not going to happen for some combat veterans. Ever.

First, there is virtually no individual therapy offered at all, anywhere within the VA system, for PTSD patients. Secondly, while there are some PTSD group therapy programs, and several inpatient programs, there aren't enough. All such programs have waiting lists and patently absurd disqualifying factors that deny treatment to those veterans who are, no doubt, most in need. Thus, before someone suffering from this disorder can receive diagnosis and treatment, they must additionally suffer while their symptoms intensify due to a lack of adequate mental health services.

Here's one perfectly absurd VA disqualifier. Two programs I am familiar with require at least thirty days of sobriety from drugs and alcohol prior to admission to their PTSD programs. Given that substance use or abuse is a prevalent symptom for many veterans with PTSD, it is simply wrong to deny program access to a veteran who makes a commitment to remain sober while in the program. I would agree that someone who shows up for admission, who is high or drunk, should be denied admission to the program. However, a veteran who shows up sober, or who has no symptoms of being on drugs at admission, should be admitted. I see no difference in requiring thirty days of sobriety and requiring thirty days of not being angry, or not having startle response. Neither should the VA.

At the VA primary care clinics I am familiar with, there is essentially no individual therapy. If a veteran is lucky, he might be seen individually once a month; most of the veterans I know are seen less than that. The PTSD groups have waiting lists. This is the result of two factors: first, there are not enough mental health staffers to offer such treatment; second, the staff that is there is overwhelmed by the sheer numbers of veterans suffering from the long-term effects of PTSD, not to mention veterans being treated for other mental health problems. As a result of budgetary restrictions and an abject failure to keep up with the need for treatment, the VA is woefully understaffed. Given their overall failure to provide adequate care for all veterans in need, it is, therefore, not at all surprising that the Bush administration would attempt to pare the federal budget on the backs of combat veterans by reducing the number receiving compensation for PTSD and by attempting to make it more difficult to receive compensation in the first place. Their claims about how much they have increased the VA budget are misleading at best, and just plain dishonest at worst. It doesn't matter how much the VA gets if it's not enough, or it's taken away later because it was discretionary money, or it is simply misused for things like studies to examine the outsourcing of VA jobs.

In 2004, according to the Post article, 215,871 veterans were being compensated at some level for PSTD. Most of these veterans are not rated at 100% disabled, with the vast majority being rated between 10% - 70%. Even the veteran whose symptoms are mild, should have access to treatment if he or she needs it and wants it. He or she should be able to receive that treatment when they want it, not only when the VA's financial and staff situation allows for it. If the VA is right, and PTSD can be "cured", or symptoms lessened, then you would think they would be offering every veteran with PTSD immediate access to treatment, for as long as necessary, and for so long as the veteran wants it.

Thanks to Larry Scott at, we recently learned that scarce VA health care dollars are being spent on outsourcing studies, despite the fact that such use of these funds for that purpose is illegal. Larry also reported on the VA deal with the Institute of Medicine to study the possibility of changing the diagnostic criteria for PTSD. This is another example of wasting scarce federal dollars to design a system of exclusion, rather than spending these funds to include more combat veterans with PTSD in long-term treatment programs, or to provide more individual therapy.

What this is really about is the problem faced by the government of some men and women returning from heavy combat who will suffer the effects for the rest of their lives. Every day, sometimes all day, forever. For the government to have to admit that war can have this effect on some people is somehow, to them, the same as saying that war is not ever justified. Whether this is true or not, in a philosophical sense, is beside the point. The truth is that war will have long-lasting, debilitating mental health effects on some people, just as some victims of rape or other violent crimes never really recover from their experience. The VA's National PTSD Center web site is replete with research articles""done by or for the VA""that fully back up this contention.

The truth is that the number of PTSD cases is a very small minority of the total number of patients seen by the VA and represents an even smaller percentage of the tens of millions of American men and women who served from World War II until the present. In that regard, the VA says that in Fiscal Year 2004, there were approximately 24.8 million veterans, nearly three-quarters of which served in war time or during an official conflict. Thus, the 215,871 veterans from all wars currently receiving disability compensation benefits for PTSD represent 8/10 of 1% of all veterans who are eligible for VA benefits, and 1.1% of veterans who served during a time of war or official conflict. Those being treated and compensated for PTSD include veterans from World War II, Korea, Vietnam, the Dominican Republic, the Panama Conflict, Lebanon, Somalia, Grenada, the first Gulf War, Kosovo and Bosnia, and now Iraq and Afghanistan. Moreover, according to the VA web site, there were 2.9 million veterans receiving disability compensation or pensions in Fiscal Year 2004. Thus, only 7.4% of those veterans were receiving benefits for PTSD. If we include the additional millions of soldiers who served in peacetime, the numbers receiving disability compensation for PTSD are so small that we should all be asking why the government has turned on its veterans with such vehemence.

Claims by some mental health professionals that some vets exaggerate, and that an underground network "advises veterans where to go for the best chance of being declared disabled"""are"well"a giant load. There may be some veterans who have exaggerated their symptoms to get a higher rating, just as there are other people exaggerating about other things every day. Like weapons of mass destruction in Iraq and African uranium. Fraud is committed in all of life's venues, especially in the Bush administration and the Republican-controlled Congress. However, the number of exaggerated or false PTSD claims is miniscule and bringing this to public light serves no purpose other than to raise a phony issue the VA will use to the detriment of the vast majority of veterans who do not lie or exaggerate. It was interesting to me that the Washington Post would write a rather lengthy article on this particular issue, but apparently""according to Google""not have written a single story about the plight of homeless veterans or the long-term effects of PTSD on the lives of veterans and their families.

These right-wing attacks on the veterans disability compensation system are particularly troubling for those veterans now returning from Iraq and Afghanistan who are making claims for PTSD. These are the same combat veterans that President Bush makes such a big, and apparently phony, deal out of honoring. Insofar as this alleged "network" is concerned, I have been doing veterans disability claims for more than thirty years and have never heard or read about this so-called "network." So, whoever they are, I guess they need a good publicist so that they can get the word out that they exist.

The web site I was referred to by a psychiatrist who made this claim does nothing more than explain in detail every aspect of filing a claim for disability benefits from the VA. This is a service which every congressionally chartered national veterans service organization provides in their own materials. After reviewing the online manual, I could find nothing that "advises veterans where to go for the best chance of being declared disabled." I was not surprised at discovering yet another urban legend perpetrated by individuals who believe that PTSD is easily faked by many veterans, even those with extensive, well documented histories of extreme combat exposure.

The Post article led me to a recent paper presented at a conference sponsored by the American Enterprise Institute, "Soldiers, Psyche and the Department of Veterans Affairs." If this wasn't such a serious matter, I'd be laughing my ass off at the idea of the AEI involving itself in this issue. The paper was as shocking in its conclusions as it was in its claim that the information reviewed by their so-called experts on military personnel records was conclusive proof as to the extent of a particular soldier's combat experiences. Based only upon a review of summarized information from a veteran's military personnel records, the authors of the article and the alleged experts concluded that claims made by certain Vietnam veterans to have been in combat, or who witnessed other combat-related traumatic events, were exaggerated or false. The truth is, these researchers are as ignorant of the reality of military records, as they are in their belief that their research proves the result they intended to prove in the first place.

I was truly shocked to read that one of the so-called experts was "an Army veteran with Vietnam war-zone service and extensive professional experience in analyzing military personnel records-- If this "expert" researcher believes that summarized information from a veteran's military personnel file is the end-all and be-all of establishing combat exposure, then he is sadly misinformed and has no business involving himself in any aspect of veterans affairs. The fact that there are a few people who claim to be something they are not, should not be the basis for attempting to belittle those Vietnam veterans who do have PTSD, which is precisely what this kind of tripe does.

There is, indeed, a paucity of information contained in some soldiers' individual files. However, this means absolutely nothing in many cases and the proof often lies in other official military records that pertain to a veteran's unit, or units the veteran's unit was attached to. In this regard, although the VA is mandated to gather unit records when needed in certain PTSD cases from the Center for Unit Records Research (CURR), they virtually never do this. The research article I read proves this point because neither the mental health people who wrote the article, nor their records experts, sought records from either CURR or the National Archives and Records Administration (NARA), or any of the dozens of other sites that store various military records. Thus, without utilizing these resources, all of their conclusions about the veterans they claim were not exposed to combat, or who exaggerated their combat experiences, are highly questionable. In fact, at least one member of the research team that published this article is a VA employee and knows that unit records exist.

I offer these people this challenge: send me just the dates these men were in Vietnam, their military occupational specialties, what they say happened to them and what unit they were with, and we'll see how many of them were actually committing fraud or lying. In my experience, even a finance clerk serving in a forward base near the DMZ, or in War Zone C, saw and was exposed to as much enemy action as some soldiers who were actually in the bush. The Coffelt Data Base is a sortable data compilation of every person killed during the Vietnam War. One of the sortable categories is the military occupational specialty. The Army MOS that begins with "71" includes clerks of all types, journalists, administrative assistants and post office workers. According to the Coffelt Data Base, 337 men with these specialties were killed. Thus, the fact that those clerks who were killed died as a result of enemy action could not be proven simply by their MOS and where they were stationed. The same is true for the thousands of other men and women who served in the same specialties who were not killed, but who were, no doubt, exposed to combat. Clerks pulled regular perimeter guard, and even went on patrols, at every fire base I was ever on. They were subject to the same incoming rockets, mortars and sniper fire that infantrymen were exposed to. And on many bases, this was happening a lot.

Recently, the VA announced that they were going to review some 72,000 PTSD cases decided since 1998 to determine if some of the claims were fraudulent. These were cases in which the veteran was found to be totally and permanently disabled by PTSD, or PTSD in combination with other disabilities. In the 2,100 cases the VA reviewed, the Associated Press reported this past Veteran's Day that "in looking more closely at the sample of 2,100 claims reviewed by the Inspector General, the problem appeared to be missing documents-- This was according to Veterans Secretary R. James Nicholson. Several days after the report was released, the VA stopped their review of these cases. The operative phrase in the preceding quote is "the problem appeared to be missing documents." This simply proves the point, by the VA's own admission, that you cannot determine a soldier's exposure to combat trauma without the appropriate documents.

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Stu Steinberg is a retired public defender, law school educator and capital defense investigator. He served for eighteen months in Vietnam as an explosive ordnance disposal specialist and was decorated for heroism, meritorious achievement in combat, (more...)
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