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Fyi, Ptsd Reevaluation

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VA is apparently initiating a new review of PTSD diagnosis, treatment and compensation. The VA’s plans came to light on 16 NOV, six days after they had canceled a review of 72,000 PTSD claims awarded at 100% disability. Information about the new PTSD review was made public in a press release by Senator Larry Craig (R-ID), Chairman of the Senate Committee on Veterans’ Affairs. The release, in part, said, “The Department of Veterans Affairs announced today that it has contracted with the Institute of Medicine (IOM) on a two-pronged approach to the examination of PTSD.” The VA’s announcement was in the form of two documents they sent to Sen. Craig's office. One, a Fact Sheet prepared by the VA's Office of the Under Secretary for Health detailing the contract between the VA and the IOM. The other was a Question and Answer sheet prepared for members of Congress and the press. At www.vawatchdog.org/newsflash/newsflash11-23-2005-3.htm.both documents a!

re available for review.

The Fact sheet notes that The Secretary of the Department of Veterans Affairs has requested that the Institute of Medicine (IOM) conduct a review of PTSD. The IOM will provide the VA with current information that might reform VA policy as it relates to PTSD diagnosis, treatment and compensation. To accomplish this task, IOM will convene two separate committees. Specifically, the committees are to:

- Review the utility and objectiveness of the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM- IV).

- Redefine PTSD by altering diagnostic and treatment techniques.

- Review and comment on the objective measures used in the diagnosis of PTSD and known risk factors for the development of PTSD.

- Comment on the validity of current screening instruments and their predictive capacity for accurate diagnoses.

- Review literature on compensation practices for PTSD and how changes in the frequency and intensity of symptoms affect compensation under these practices.

- Assess how compensation practices and reevaluation requirements for PTSD compare with other chronic conditions which have periods of remission and return of symptoms.

- Review strategies used to support recovery and return to function in patients with PTSD.

The IOM reviews are to be completed in a year. They could become the basis for the VA to write an alternate definition of PTSD exclusive of the DSM-IV and institute new methods of treatment outside of normally accepted guidelines. They could also be the means to lower PTSD compensation based on “frequency and intensity of symptoms” & “remission and return of symptoms.”

The O&A sheet revealed that the VA is examining compensation for ALL health conditions and that they are coordinating their efforts with the Veterans’ Disability Benefits Commission (VDBC). The VDBC, by law, is independent of the Department of Veterans’ Affairs. The VDBC is made up of 13 members who are currently studying all areas of VA compensation. Nine members were appointed by Republicans. The VA Secretary Nicholson was appointed by President Bush. For additional information refer to previous Bulletin articles titled “VDBC”. [source: http://vawatchdog.blogspot.com Nov 05]

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  • HadIt.com Elder

weeding out the phonies is supposed to be the job of the VARO when they adjudicate the claims, if every claim is as thorough as mine was there are no phonies getting compensation for PTSD, anytime the IOM gets near reports for the government the veteran is usually on the short end of the stick. Why should a medical investigation team be deciding on issues like how much compensation a veteran deserves, at what point is he been "cured" we all know there is "no cure" for PTSD. Doctors don't set how much each veteran should get paid, so why should the IOM even have a committee to meet and discuss such issues. The VDBC is not a positive committee for veterans and neither is this "new" IOM PTSD review why have the National Center for PTSD that is paid for by the VA, why use the Mental health Manual IV for classifying PTSD cases, anytime the government says they are here to help you bring your own vaseline. This already has an independent panel of mental health professionals to help streamline the verification of PTSD for the VA, it's already paid for the National Center for PTSD has mental health professionals from across the nation involved. Why not utilize the expertise they already have, but then again the VARO describes their published documents and studies on PTSD and related physical ailments as internet garbage when they deny your claims citing their reports as published evidence. If they don't believe what the doctors post on the VA own website as legitimate research something is wrong, and I don;t think it's the doctors, I think it is the VARO's.

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Personally, I don't have a dog in the fight over this issue. The info I posted just came across my desk this morning and I put it up for informational purposes. Having said that and noting Michael's comment that it is the VARO's duty to validate the claims, I'd offer that they haven't done a very good job of it. As a taxpayer, if a government agency has noted they failed in their fiduciary duty to the public, I'd expect them to go back and fix it.

This issue comes up as a result of the Knight Ridder report indicating Illinois vets were being short changed. ISTM, Lane Evans got into the picture hoping to take political advantage of the situation and started whining to the VA about it. The VA's response was to sic their OIG on the problem to find out what happened and why certain areas appear to be getting the short end of the stick. It appears the OIG Report indicates that the problem isn't necessarily that certain areas got shortchanged but that other areas weren't validating claims properly and that the big money was in the PTSD/IU claims.

I suppose everyone expected the VA would roll over and just loosen up the purse in those areas that appeared to be shortchanged but in an era of ever increasing expenses for OIF/OEF, there's no fat in the budget. In any event, I doubt the taxpayer is sympathetic to continued overpayments. The VA was willing to go off and re-examine the last 5 years of PTSD/IU awards because that's where the biggest bang for the buck was but everyone pitched a bitch. Now, we have the IOM and the Veterans Commission getting in on the act. No telling where this will lead and I don't think we are going to like the result.

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  • HadIt.com Elder

If you are going to weed out phonies why not start at the VARO and the Service Organizations who are supposed to help Veterans? If I understand correctly someone is caliming that the VA is toeasy with some claims. From what I have observed the VA is inefficent, and moves slowly to determine if a Veteran qualifies for benefits. Why can't they do it in a few months like Social Security does?

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I don't have a rating or a claim for PTSD. However, the writing is on the wall.

The VA has has just spent millions and millions studing PTSD and deployment stress factors as a cause for Gulf War 1 veterans complaints of illness. This was the prime focus of attention for the VA, to discount veterans as having "psychological problems" rather than physical health problems. Yet, PTSD is being investigated and diagnostic criteria altered outside of the normaly excepted by the medical community.

Spending research money makes the masses happy that the VA is doing something to help. It makes the medical community happy that new information may be learned. It makes researchers VERY happy. And it makes the VA happy that they are saving many millions more by putting off the veterans for another ten or twenty years untill the mistake is 'found'.

It is obvious that there will be thousands of Vets from this latest War filing claims for PTSD. I am brain damaged and can see that comming. The Republicans are in the process of damage control. PTSD will be one of the biggest financial draws on the VA in the next 10 to 60 years. They want to stop it now.


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  • HadIt.com Elder

I think to much happened to quick at the same time and some people are getting bad reps for the wat things fell, if we go back to the 100 vet PTSD study group that the shrink from Wisconsin? and JG Burkett used from Charleston SC that inspired the VA OIG to want the study of 72,000 veterans, which happened to become public about the same time Senator Durbin and Obama wrote the VA wanting to know why vets in Illinois were among the lowest paid vets in the nation and took the longest to get claims decided and the files tossed in the trash can, all came together to make a big confusing mess. After reviewing the first 2100 claims the VA OIG discovered it wasn;t fraud involved in the claims as the Shrink from Wisconsin and Burkett thought it was, it turned out to be sloppy records not getting the right copies from the Army, Marines or Air Force etc to put in the claim files to validate the stressors, the vets had the stressor verifications, it just turns out the vets are getting approved for TDIU at to high of a rate, now no one wants to look at the fact that to get to 100% for PTSD you basically have to be drooling, siucidal or in lockdown so most vets who can not work are awarded 70% TDIU because that is how the rating system works, but lo and behold PTSD is a devastating diease that many vets were able to cope with but then 20-40 years down the road the life they were barelty dealing with falls apart, leave them alone in the woods, or on a farm or in there basements and with meds yes they are alive but not capable of leading the "productive" life that Senator Craig thinks they are capapble of leading. yes, PTSD at the TDIU rate is expensive and with them diagnosing it faster for 19-21 year old OIF/OEF vets it is going to get real expensive real fast, this is just another result of war, not people trying to cheat a system, are there some frauds yes but not the 25% they expected to find it turns out less than 1% of the claims are fraudulent. PTSD is just a very expensive and long lasting disease. I have a solution quit getting involved wars, then the price will go down, disabled veterans cost money plain and simple.

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This new review needs to be stopped before it's started. Essentially, what the VA is saying is that they don't like the current accepted medical opinion of the world's psychiatric professionals and that they want to find a way around the current standards to justify less payments. Honestly, can anyone remember the VA ever starting a study because they felt they weren't paying enough? For those that claim this isn't a veiled attempt at compensation reductions just look at the VA's history of "studies"...they always error on the side of less compensation.

PTSD is a brain disorder and it is not curable. Just as with a missing hand, you can use devices, pills, prosthetics, etc to compensate for the injury, but the injury will never improve. This is the generally accepted view of the psychiatric community and one that the VA wants to change. If they can find even a hint that PTSD can improve they will start a man-hunt for every PTSD vet on the planet and if a lot vets kill themselves then they will save even more money (I guess you can call that win-win for the VA).

As for fraud - I have been over this before....I have no doubt that fraud exists in the VA system, but I highly doubt that there is a lot, if any, fraud in the 70%-100% range. One can fool a psychiatrist by claiming nightmares, sleeplessness, anxiety, depression, etc (general signs of PTSD below 50%), but one would be HARD pressed to prove psychosis, severe anxiety, severe depression, suicidal/homicidal ideation, OCD, severe panic attacks, etc. Severe symptoms have easily observable, physical side-effects.....for instance - A person with severe anxiety tends to act very agitated and said agitation increases when they are put in more stressful situations. One also exhibits shakes, rapid eye movement and is generally easily startled. One with severe depression tends to make NO eye contact, slopes in his or her seat, is easily emotional (typically crying or anger) and has a general lack of interest in the world that can be heard through the person's voice (inflection) and their behavior during an evaluation. All of the symptoms of severe PTSD are easy for a trained doctor to PHYSICALLY see; whereas, a doctor evaluating a less severe person has to make a lot more judgment calls and get a lot more information surrounding the claims (IE - if someone claims to be terrified of loud noises, due to gun fire, yet slips and says they have no problem at a fireworks show, then perhaps that person is being less then honest).

As you can see, any potential fraud in the VA would be in the 50% and less level, but the VA is going after the top end, not because there is fraud or misdiagnosis, but because they can save more money and, hopefully, some vets will commit suicide and not be on their payroll any longer (harsh but true).

There are lots of ways to trim the VA budget, but the VA has chosen to prey on the weakest amongst us.....but, unfortunately, there are many vets who support the VA no matter what they do and I have no doubt that a large number of vets believe that PTSD is a joke and no PTSD vet should receive a penny. It's this mixed support that the VA uses to prey on PTSD vets...they know that if they were to start going after phsycailly unjured vets they would be plastered by the media and the SOs. Who was it that said "the path of least resistance"?

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