Report: VA must revise criteria for evaluating stress disorder

WASHINGTON—The Department of Veterans Affairs must change the way it evaluates former soldiers for post-traumatic stress disorder if it hopes to eliminate the wide disparities across the country in how much it compensates those who have the disability, a new report has concluded.

Released Tuesday by the highly regarded Institute of Medicine, the report says that the recent surge in cases of PTSD, coupled with ineffective VA rules, suggests that veterans could be getting disability payments that are too high or too low.

Saying that PTSD has become a "very significant public-health problem," one of the report's authors, Nancy Andreasen of the University of Iowa, concluded that a "comprehensive revision is needed" of the government's PTSD-compensation system.

Among other things, the report calls for new testing procedures and new training regimens to ensure that government "raters," who decide on veterans' cases, do a better—and more uniform—job.

Knight Ridder, which McClatchy Newspapers bought last summer, reported in 2005 on the VA's unequal levels of disability compensation, particularly among more subjective conditions such as PTSD. The investigative report found that the size of the benefit varied widely by geography and mental problems had larger variations than physical ailments.

The VA, which requested and paid for the Institute of Medicine study, said in a statement that the report was welcome. The institute is part of the National Academies, a nongovernmental, independent research organization that often advises government bodies on scientific issues.

The VA said it would "continue to take steps to ensure veterans have timely and seamless access to compensation" and that it was "studying the findings, conclusions and recommendations of the report."

Post-traumatic stress disorder is one of the most prevalent conditions—mental or physical—to emerge from the wars in Afghanistan and Iraq.

Often tied to intense warfare, the mental condition can manifest itself in hair-trigger nerves, flashbacks and nightmares, which often lead to intense feelings of fear, helplessness and horror. Some former soldiers isolate themselves or try to numb their memories with drugs or alcohol. Some, unable to cope, have killed themselves.

Although some soldiers always have had anxiety or shell shock in the wake of warfare, the acceptance of the diagnosis PTSD became common after the Vietnam War. The report released today shows that the number of veterans who receive disability compensation for PTSD has skyrocketed in recent years, although part of that growth might reflect a new tendency to diagnosis PTSD instead of similar anxiety diagnoses. Veterans diagnosed with PTSD linked to their military service are eligible for monthly compensation checks.

The VA has come under fire in recent years for the way it handles disability compensation cases, including its inability to bring down a huge backlog of cases and reduce its high number of errors. Wide variations among the 57 regional offices that handle cases compound the delays and mistakes.

Among the more vexing problems are the wide swings in the amount of disability payments depending on a veteran's regional office. Veterans in some states get more money per month than those in other states. Currently, a veteran who's considered 100 percent disabled is eligible for a monthly payment of $2,471.

In its 2005 investigation, McClatchy found that the more subjective ailments had the largest disparities. For example, veterans with PTSD who were assigned to the Wilmington, Del., office were more likely to have the highest disability rating than their counterparts in Lincoln, Neb. In Delaware, 34 percent of those with PTSD had the highest rating; in Lincoln it was 10 percent, the investigation showed. The report was based on 2004 data.

The Institute of Medicine report recommends that the VA revise its criteria for evaluating PTSD and establish a new training and certification program for its employees to ensure "more accurate, consistent and uniform" disability ratings for PTSD. The institute concluded that the common assessment test the VA uses to judge veterans is only "marginally applicable to PTSD."

Because of gaps in data—information that's stored on paper but not on computer; information that's never collected or is erased—the institute wasn't able to perform the complete analysis it wanted.

Its report says that a lot more work needs to be done to fully evaluate the job that the VA is doing with PTSD cases. It also said that the VA's disability and health-care divisions need to do a better job communicating the information they have about veterans.

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