RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

PTSD UPDATE 15 June 2008

Posted by Service Officer on June 15th, 2008

Two veterans’ advocacy groups have asked for copies of all documents relating to the Veterans Affairs Department’s post-traumatic stress disorder policies after an e-mail surfaced asking VA doctors to keep costs down by giving diagnoses of adjustment disorder instead. Veterans diagnosed with PTSD are eligible for health benefits and, in some cases, disability retirement pay. Adjustment disorder, on the other hand, is considered a short-term diagnosis, and does not qualify veterans for benefits, said Brandon Friedman, vice chair of VoteVets.org, one of the advocacy groups. “They can say, ‘Ah, you’ve got something temporary, it’ll go away, so we don’t need to pay you for the rest of your life,’ ” Friedman said. He said several veterans have told him they were diagnosed with adjustment disorder rather than PTSD, and that they felt they had received the wrong diagnosis. “We hear anecdotal evidence all the time that VA is trying to cut costs by not diagnosing PTSD,” said Friedman, a former infantry officer who served in Iraq and Afghanistan. “But we’ve never actually seen proof that it was being done in an organized way.”

 

The e-mail, which Friedman said came from a VA hospital’s PTSD program coordinator, was apparently sent to several VA employees at that hospital. A psychologist from the hospital in turn sent it to VoteVets.org, Friedman said. “Given that we are having more and more compensation-seeking veterans, I’d like to suggest you refrain from giving a diagnosis of PTSD straight out,” the e-mail states. “Consider a diagnosis of adjustment disorder, r/o [rule out] PTSD. Additionally, we really don’t … have time to do the extensive testing that should be done to determine PTSD.” The e-mail also states veterans are appealing their compensation and pension ratings based on diagnosis from his staff. VA Secretary James Peake acknowledged in a statement that the e-mail did come from a VA facility, but said it’s not official policy. “A single staff member, out of VA’s 230,000 employees, in a single medical facility sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health-care organization,” he said. “The employee has been counseled and is extremely apologetic.”

VoteVets.org and Citizens for Responsibility and Ethics in Washington (CREW) filed a Freedom of Information Act request 14 MAY asking VA for all documents relating to PTSD. On 28 MAY they requested that the Inspector General for the DVA open an investigation into the process and manner by which the VA makes a diagnosis of post traumatic stress disorder (PTSD) in veterans. Their basis for making this request was additional information they became aware of indicating:

• The VA has adopted incentive programs that, by rewarding those employees and hospitals that distribute lower levels of compensation to veterans, encourage adjustment disorder diagnoses rather than the most appropriate but also more costly diagnosis of PTSD.

• VA’s internal computer system permits medical files to be changed by health professionals who did not conduct the initial examinations, a practice that appears to have resulted in changed diagnoses from PTSD to adjustment disorder, even where there is no additional medical evidence to support the downgraded diagnoses.

• Assertions from VA employees that they suffered retaliation for their failure to support these practices.

“We’re not head-hunting,” Friedman said. “There are a lot of great people who work at VA who have helped me and my friends. We had to file the FOIA to get to the bottom of this. Is it from the head of the VA? The presidential administration? Or individual hospitals? I would like to know where this directive is coming from.” Peake said his staffs “works hard” to make sure mental health issues are accurately diagnosed. “VA’s leadership will strongly remind all medical staff that trust, accuracy and transparency is paramount to maintaining our relationships with our veteran patients,” he said. “We are committed to absolute accuracy in a diagnosis and unwavering in providing any and all earned benefits. PTSD and the mental health arena is no exception.” [Source: Air Force Times Kelly Kennedy article posted 16 May & CREW press release 28 May 08 ++]

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