PTSD WOUND OF LESSER VALUE?

Experts: VA disability system can be fixed

By Kelly Kennedy - Staff writer
Posted : Wednesday Feb 27, 2008 12:47:24 EST

Medical experts, advocacy groups and Veterans Affairs Department officials say VA’s disability rating schedule needs to be updated — continually — but they denied the system is so bad that it needs to be dumped completely.

A Tuesday hearing of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs also focused on studies conducted over the past year that point toward needed improvements not only in the ratings schedule, but in VA’s disability retirement system itself.

Rep. John Hall, D-N.Y., chairman of the subcommittee, said VA needs to remove “archaic” criteria from the rating schedule; update psychiatric criteria to better reflect symptoms of troops diagnosed with post-traumatic stress disorder; find out why so many veterans with PTSD have been rated fully disabled; and update neurological criteria to include new research on traumatic brain injuries.

“The VA needs the right tools to do the right thing,” Hall said.

VA argued that it is already doing the right thing and has been updating the rating schedule, though officials acknowledged they could do better. From 1990 through 2007, VA had updated 47 percent of the ratings schedule, but 35 percent of the codes had not been touched since 1945. However, VA said it updated the codes for TBI in January and is working on an update for PTSD.

The Veterans’ Disability Benefits Commission began looking at how service members’ and veterans’ disability cases were being handled long before February 2007, when Military Times and the Washington Post featured stories highlighting problems in the system. Retired Vice Adm. Dennis McGinn, a member of the commission, said VA has made “very limited progress” since the group’s report came out in October.

“I believe the ratings schedule needs to be clarified so it has logic from the point of view of medicine and science,” McGinn said. “It has not progressed in the last five decades.”

The group found that VA compensates veterans according to the schedule in a way that is “generally adequate to offset average impairment” and that the schedule does “reasonably well.”

But there are specific areas where VA’s system does not serve troops and veterans well, McGinn said, including those with PTSD, those severely disabled at a young age and those granted maximum benefits because a disability makes them unemployable.

Veterans with PTSD, he noted, have “much greater loss of employment and earnings” than those with physical disabilities.

McGinn recommended separate criteria on the rating schedule for PTSD, as well as a way to compensate unemployable veterans for lost quality of life, not just their inability to work.

So-called “individual unemployability” veterans may have formal VA disability ratings of less than 100 percent, but are still rated fully disabled because of their inability to work. The commission found that almost half of the 223,000 IU veterans have primary diagnoses of PTSD or other mental disorders.
The problem is that if a veteran has physical disabilities that lead to a 100 percent disability rating, he can still work and keep his full compensation. But a veteran who has a 100 percent disability for a mental disorder tries to work, he loses his compensation.

go here for the rest
http://www.navytimes.com/news/2008/02/military_disabilityratings_022708w/

This last part is very important. My husband is 70% disabled for PTSD and 30% unemployable. Yet it is 100% of his life that has been touched. He can't work but he fought very hard to keep his job under Family and Medical Leave Act for as long as he could. His doctor told him that he was just making his PTSD worse with the stress. Every aspect of his life and mine are adapted to deal with his wound. There are conversations we cannot have.

There are times when we cannot communicate at all except to have a brief conversation about what to have for dinner. His decision making skills are virtually gone, paranoia consumes him to the point where I get so fed up I tell him "You get worried if you don't have something to worry about." The body wounded is terrible and the scars can be seen for a lifetime. When they mind is wounded the scars on the life are forever. Depending on when they get treated and begin to heal, their wound can be mild all the way to fully consuming every aspect of their life.

A while ago a reader wanted to know why I thought PTSD was worse than losing a limb. He wanted to know how I could compare the loss of a leg to PTSD. I told him it was easy. Had my husband lost a limb, I would still have a husband with the rest of his body, his mind and his heart. I have a husband who has had his mind wounded and his soul torn.

If we go to one of the parks on our Friday play day and his face begins to twitch or he begins to make involuntary mouth movements as if he is talking to himself, he gets stared at as if people are afraid of him. What most people do not fully understand is that many who have lost limbs also have PTSD and they are dealing with double the wounding but they get a Purple Heart for a body wound while their other wound, the one that inflicts the most pain on their lives as well as their family's lives, is something considered of lesser value.

With a physical wound that is not a back injury or a brain injury, they can be retrained to do something else for work. With a back injury, they cannot. With a brain injury, depending on how serious it is, they cannot work either. With PTSD they cannot work if they have high levels of test results. PTSD and TBI wounded need to be taken seriously enough to have their wounds categorized as enveloping not just their lives but the lives of their families as well. If we do not fully appreciate the role of the families in taking care of these veterans, then we will see a lot more homeless veterans because of PTSD.

Aside from providing support groups to help hold families together and proactive outreach to them, they also need to be provided for when it comes to the quality of their own lives being involved. My husband is one of the biggest reasons why I cannot work full time any longer. Doing this work at home on a volunteer basis, I can be here when he needs me and I don't have to answer to anyone as to why I have to take him to the doctors when he's having a bad day and cannot go alone. That's why working part time was perfect for me. He can be alone a few hours a day with no problem at all. This gets forgotten about when wives and husbands are unable to do the jobs they used to do in order to take care of their wounded warrior.

This hearing today was a step in the right direction.

This could inspire a veteran to avoid seeking out vocational rehabilitation or employment, and also implies something “suspect” about claiming PTSD — which only adds to the considerable stigma behind the disease, said Dean Kilpatrick, a member of the Committee on Veterans’ Compensation for Posttraumatic Stress Disorder at the Institute of Medicine.

Avoiding employment is not the problem. Being unable to be employed is. You cannot retrain a mind to work normally.

McGinn also requested couples therapy as part of treatment for PTSD. That is important because responding to a veteran’s anger with more anger can exacerbate the problem, while learning how to work with a spouse suffering PTSD can be part of a cure, he said. Also, many family members deal with their own mental health issues while living with someone with PTSD.

Again it needs to be noticed that there has to be other factors put in when considering steps to take in improving the treatment the veterans have by including their families.

McGinn’s group and Kilpatrick had different recommendations as far as follow-up evaluations for people with PTSD. Again, other disabilities are not re-examined, so an exam puts those with mental disabilities in a separate class. But McGinn’s group sees follow-ups as a way to encourage vets to seek further treatment.

The only thing that has kept my husband in treatment with the VA is the thought of getting as bad as he was without it. The idea of retesting what is already known to be a lifetime wound only causes more stress for the veteran. If they are in treatment, then there is no need to "retest" to make sure they are still wounded.

TBI and PTSD are not wounds of lesser value and they need to be treated differently than other wounds. If a soldier has TBI from a bullet wound, that is a wound from the bullet, the TBI and in most cases PTSD as well.