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    Thursday, August 11, 2005

    Second Guesses: The Veteran's Administration suspects suspects post traumatic stress disorder is being overdiagnosed:

    Last year, the VA spent $4.3 billion on PTSD disability payments, not including medical care.

    The number of vets receiving compensation benefits for the illness rose nearly 80 percent between 1999 and 2004 -- from 120,265 to 215,871. During the same period, benefits for all types of disabilities grew by just 12 percent, to about 2.5 million.

    So far, about 10 percent of the stress syndrome increase comes from veterans of the Iraq and Afghanistan wars, Budahn said.

    Where do the other 90% come from?

    UPDATE: A former West Los Angeles VA clinician says a good portion the other 90% comes from substance abusers looking for a free ride:

    A few years ago WLA leased out some buildings to community organizations and created partnerships for programs for Vets. These programs included residential long term substance abuse tx programs as well as temporary transitional housing for homeless vets. Of course this created a magnet for any vet with substance abuse or homeless issues and we were inudated with new vets who had deferred medical care while they did "recreational pharmacology" and /or were living on the streets due to psych and drug issues. Vets (especially those w/ substance abuse issues) are very good at networking among themselves and figuring out how to work the system. I had one patient obtain a 100% service connection for PTSD after learning that his buddy had obtained a PTSD rating. It is not that difficult to learn the DSM criteria and recite them to a psychologist or psychiatrist. There is no real effort to verify what the patient has reported - no interview of the spouse or family or S.O. to confirm that the pt has nightmares, flashbacks etc. Plus, when dealing with patients with dual diagnoses (e.g., schizoaffective d/o and substance abuse) whose to say that the sx are not due to other issues?

    I agree it is way overdiagnosed - there was even a recent inservice by the inspector general who stated that they identified a VA counselor who had feigned sx to obtain a SC rating. 

    On the other hand, I had a patient come in for care - he was seeking care for the first time ever at the VA because his PTSD sx were starting to interfere with his marriage - he was not seeking a service connection - doubt he was aware of his eligibility - he just wanted a referral to a psychologist or psychiatrist. I was the first person that he had ever told about his symptoms - and they stemmed from Vietnam. PTSD is kinda like the kid who cried wolf - those complaining the most probably do not have severe sx, but there are many living in the community who do not talk about it and truly have sx.

    What used to really make me mad was that I would have patients with 50 to 100% SC disabilities for PTSD, but they were receiving NO TREATMENT - no counseling, no meds, no f/u. And with those with substance abuse issues, there was no oversight of the funds - no fiduciary or payee. My own feeling is that for those with recent substance abuse, that in order to continue to receive the money they either need to complete random drug screening, or a payee who makes sure that the basic necessities are paid for; but that will never happen.

    It was this influx of substance abusers and homeless that made me want to leave the WLA VA. Not a pleasant population to deal with - very much a "gimme" mentality and focused on using the system to their advantage.

    posted by Sydney on 8/11/2005 09:10:00 PM 0 comments


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