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Congress Asks: In Wake of Court Ruling, Should VA Do More to Push Troubled Veterans Into Treatment? Cont.
- Categorized in: Addiction, Department of Defense (DoD), Department of Veterans Affairs (VA), Depression, July 2011, News, PTSD, Psychiatry, Rehabilitation, TBI
Linking Disability and Treatment
Hanson’s story, while extreme, is not uncommon for veterans suffering from PTSD who either never find their way to VA treatment or for whom VA treatment is ineffective. Similar stories have been told during VA committee hearings over the last several years, prompting legislators to demand that VA incorporate community programs such as MNTC into VA treatment.
It was when legislators asked Hanson about the relationship between his disability benefits and his treatment that the issue became politically complex. Hanson freely admitted that his disability check from VA was supporting his addiction at a time when he was depressed and making very poor decisions.
He also was taking advantage of educational benefits through the GI Bill. Asked what would have happened if those benefits had been held back until he got treatment, Hanson responded, “If you said, ‘You can’t go to school until you get help,’ that would have worked for me.’”
The idea of withholding benefits, either educational or monetary, from veterans until they received mental health care, is ethically questionable and likely politically impossible. But there is a push to better integrate the disability ratings process with the treatment process.
In preparation for last month’s hearing, the VA’s Advisory Committee on Disability Compensation (VDBC) analyzed the current methods of diagnosing, evaluating, and adjudicating the claims of veterans suffering from mental illness, paying particular attention to veterans with PTSD. The VDBC’s recommendations included that VA consider any baseline level of benefits to include health care, especially for PTSD patients.
The VDBC also recommended that VA establish a “holistic approach that couples PTSD treatment, compensation and vocational assessment, and that reevaluation should occur every two to three years to gauge treatment effectiveness and encourage wellness.”
“The benefits of linking these factors is that it may reduce homelessness and suicide as well as evaluate the effectiveness of treatment programs,” explained VDBC Chairman James Terry Scott, LTG USA (Ret.) “Most importantly, it greatly improves the opportunity for a veteran suffering from mental disability to maximize his or her future contributions to society.”
Scott admitted this was a controversial recommendation and that opponents will argue it could be used as a mechanism to covertly reduce disability payments and that it differs from how VA addresses physical disabilities. The VDBC believes, Scott said, that such problems can be addressed with carefully written and explained regulations and policy directives.
Some legislators noted that, however the regulations are written, such a change in VA policy was a slippery slope.
Labeling as Barrier to Treatment
There could be a clinical argument for restructuring VA’s disability ratings process, argued Sally Satel, MD, a noted psychiatrist, advisor to the Substance Abuse and Mental Health Administration, and author of several papers on substance abuse treatment and coercion.
According to Satel, being labeled as disabled before receiving any kind of treatment can be psychologically damaging to a veteran. “Despite the best interests of this system, awarding disability levels prematurely, especially at levels that suggest unemployability, may complicate a veteran’s recovery.”
Veterans suffering from PTSD or depression are already at a very vulnerable point in their lives, and may be reluctant to enter treatment, especially since one of the symptoms of PTSD is avoidance. For VA to label those veterans as 100% disabled before they engage in therapy of any kind could encourage them to see themselves as disabled, further preventing them from seeking treatment.
Satel urged legislators to consider a disability ratings system that held off on a final rating until after attempting to treat the veteran. Without the rating, the veteran would not receive disability benefits.
While Satel admitted that such a system would never work without a stipend for the veteran and their family to live on during treatment, she said her concern is not saving money but the labeling of the veteran as disabled.
“Call it a wellness stipend, call it a treatment scholarship, call it something,” Satel said. She said she would not object to the stipend being greater than the amount of a 100% disabled benefits check, as long as it was not called a “disability check.”
Responding to Satel's suggestion, Scott said that such an idea is not out of line with the VDBC recommendations and that such a stipend would almost certainly be required. “This is a complicated solution,” Scott said. “There is no one-size-fits-all [with PTSD treatment], but I do believe in a relationship between treatment and compensation.”
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