Post Traumatic Stress Disorder and the Health Care Coverage of United States War Veterans
Post Traumatic Stress Disorder, once considered merely “shell shock” or “combat fatigue” is now gaining ground as a legitimate mental disorder, greatly increasing the chance that veterans suffering from this debilitating illness will receive the proper medical care required. Although there is no cure for PTSD, studies have shown that treating the illness as soon as possible greatly reduces its effect on the patient – in some cases, the symptoms are even reversed. It is important to treat veterans for PTSD, not just as a moral obligation for those protecting the American borders, but also for a financial reason. It has been shown that PTSD can trigger more expensive and complicated health issues and cost the health care system of the United States additional hundreds of thousands of dollars each fiscal year. By the 2005 fiscal year, the VA reported that PTSD was the fourth most common disability for veterans receiving benefits (VA.gov). It has been estimated that nearly 1 million veterans and current soldiers combined may be suffering from PTSD (ClinicalTrials, Suran, Melissa). 4,796 of them are currently enrolled in the PTSD studies conducted by the VA (NHF). Ergo, the VA is experimentally treating only 0.4796% of veterans suffering from PTSD with a budget of over 100 million. This paper aims to appropriately judge the impact a diagnosis of PTSD has on health care coverage from the perspective of a United States war veteran, by defining what PTSD is, how PTSD affects the health and overall lifestyle of an individual, what treatment, traditional or non-traditional, is available, how much this treatment costs, how much of this cost the VA covers, and what an individual has to do in order to receive that treatment. Finally, a proposed reform for the current system is included.
Until the Diagnostic and Statistical Manual of Mental Disorders (DSM) reached its fourth version in 1994, what is now known as Post Traumatic Stress Disorder was merely deemed “bad nerves” or “shell shock” at best, greatly withholding the chance that patients suffering from this anxiety disorder would receive requisite medicinal treatment.
Post Traumatic Stress Disorder (PTSD) can be difficult to diagnose, as both the DSM-IV and the Department of Veteran’s Affairs have specific decisive factors. The DSM-IV-TR describes PTSD as having six different criteria, with a patient having to satisfy several symptoms in a criterion to be diagnosed as such. The criterion are directly adapted from the National Center for PTSD as indicated by the DSM-IV-TR (APA, NCforPTSD) and as follows:
- The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
- The person’s response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
- Intrusive recollection:
(Must satisfy at least one of the following):
- Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
- Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
- Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
- Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(As indicted by any combination of three of the following):
- Efforts to avoid thoughts, feelings, or conversations associated with the trauma
- Efforts to avoid activities, places, or people that arouse recollections of the trauma
- Inability to recall an important aspect of the trauma
- Markedly diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restricted range of affect (e.g., unable to have loving feelings) Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
As indicted by at least two of any combination of the following:
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
- Criterion 6 and 7 encompass disturbances that persist for more than one month (6) and exhibit functional significance (7).
The Department of Veteran’s Affairs breaks this diagnosis down into an even more complicated and ambiguous manner; indicating that “in order to establish service connection for PTSD, the evidence must establish that during active duty a veteran was subjected to a stressor or stressors that would cause characteristic symptoms in almost anyone (va.gov).”
As can be seen, the diagnosis for PTSD is fairly complicated and severely specific. Some veterans who may be currently suffering from the milder symptoms may develop a “suck-it-up” mental, however, it is important to note that symptoms do not go away as time progresses – rather, they become worse. It is important and beneficial to the veteran to get help as soon as possible. This research paper will discuss what treatment is available, what is covered by the VA, and a proposed health care reform future for individuals suffering from this debilitating mental illness.
An important source of information for this research was adapted from the National Center for PTSD and the United States Department of Veterans Affairs websites. The VA’s Mission Statement – “To fulfill Lincoln’s promise… by serving and honoring the men and women who are America’s veterans” demonstrates their good intentions on satisfying the American citizen’s obligation to aide veterans in an act of gratitude for the sacrifices that they have made overseas when they come home. These websites provided a wealth of information regarding the diagnosis of PTSD, what the VA is doing now for veterans experiencing PTSD, as well as what they are not doing, and the current and future budget for the VA.
FactCheck.org was used to verify certain statistics, such as the total projected cost of the Iraqi and Afghanistan war.
The website PBS.org offered a video, as well as facts and figures, concerning men and women suffering from PTSD and what they were experiencing in regards to working with the VA on their mental illness.
In order to acquire data for this research, first a specific problem within the current health care system was targeted. It was decided that war veterans, specifically those suffering from PTSD after they returned home, were one of the more severely marginalized group of individuals in line to receive appropriate care from the United States health care system. After this concern was established, many websites were pooled for their statistics and information regarding what PTSD is, how PTSD affects the health and overall lifestyle of an individual, what treatment, traditional or non-traditional, is available, how much this treatment costs, how much of this cost the VA covers, and what an individual has to do in order to receive that treatment. Search engines used included Serph (www.serph.com), Yahoo! Mindset (http://mindset.research.yahoo.com), and Dogpile (www.dogpile.com). The data and information were then compiled and analyzed in order to appropriately judge the impact a diagnosis of PTSD has on health care coverage from the perspective of a United States war veteran. Finally, a proposed reform of the U.S. healthcare system from this perspective was suggested.
The 2010 budget of $112.8 billion was expected to be divided between different divisions of the Veteran’s Administration. Out of the total, 43% was spent on medical programs. This requested budget was15 percent more than was asked for in 2009. (http://www4.va.gov/budget/products.htm)
|Total occupational and social impairment||Occupational and social impairment with reduced reliability and productivity||A mental condition was diagnosed.|
|Persistent delusions or hallucinations||Panic attacks more than once a week||Symptoms not severe enough to interfere with daily activities|
|Grossly inappropriate behavior||Difficulty in understanding complex commands||This condition does not require continuous medication|
|Persistent danger to oneself or others||Impairment of short- and long-term memory|
|Intermittent inability to perform daily activities of daily living||Disturbances of motivation and mood|
|Memory loss||Difficulty in establishing and maintaining healthy relationships|
|Disorientation to time or place|
Table 1.1 These criteria are directly adapted from the 38 C.F.R. § 4.130, DC 9411, DSM-IV, and Global Assessment of Functioning Scale (GAF) according to the Veteran’s Administration (http://www.vva.org/ptsd_levels.html). A 0% rating is completely non-compensable and a rating of 100% is usually given to the highest of the priority groups – Purple heart recipients and veteran with service related injuries in addition to PTSD.
The effect of treatment of mental disorders is difficult to gage. Little is known about the rate of treatment of mental disorders even though there have been significant changes to the health care system since the 1990s (Kessler et. al). There is no verifiable data on the average cost of treating PTSD because the variables that go into deciding cost, such as severity of the illness, type of medication and/or therapy, and duration of use, vary from veteran to veteran (Rose, V). Also, it must be noted that as of 2008, “an insured person cannot face a greater financial burden for mental health coverage than for any surgical, medical, or physical condition (Rose, V).”
Although PTSD has not been extensively studied, more and more veterans are being discharged and finding themselves struggling with newfound bouts of anger, depression, anxiety, and neurosis. PBS.org, in their documentary on PTSD, iterates that “between 1999 and 2004, the number of veterans seeking benefits for PTSD increased 79% (pbs.org).” This documentary also estimates that one in six American soldiers coming home from the Iraqi war has experienced PTSD (pbs.org). Although there is no cure for PTSD, catching the illness early can significantly lessen the degree of severity of the illness and cut down hundreds of dollars in costs for each veteran’s private insurance each year, as PTSD can trigger or create other health problems – “growing evidence suggests that PTSD is related to poorer health status and to increased use of health care services (ClinicalTrials).” It has also been cited that major mental disorders, of which PTSD falls under, costs the nation $193 billion annually (Bazelon Center).
Massive amounts of money have been poured into the war machine without much regard for those who operate it. It is an obligation that American citizens work to thank these men and women for the sacrifices that they have made in defending American values and soul when they come home, i.e., proper medical and psychological care. Of the one trillion dollars being spent on the current war, only a little over 100 million is partitioned to the VA. By the 2005 fiscal year, the VA reported that PTSD was the fourth most common disability for veterans receiving benefits (VA.gov). In 2007, Harvard University reported that over 1 million American veterans are without health insurance and 3.8 million members of veteran households are also without health insurance (Suran, Melissa). Oftentimes, veterans cannot afford the expense of their PTSD on their own and need the VA’s help, which is all too often more of a burden than a relief.
In working with the VA, it was found that those veterans who apply for VA PTSD disability benefits increase their use of the mental health facilities offered by the VA (Sayer et. al). This indicates that if benefits are awarded, the facilities are indeed repeatedly used, and it can then be assumed that the treatment that is being offered is effective. It has been estimated that nearly 1 million veterans and current soldiers combined may be suffering from PTSD (ClinicalTrials, Suran, Melissa). 4,796 of them are currently enrolled in the PTSD studies conducted by the VA (NHF). There was no exact number to be found on exactly how many veterans the VA is actually treating for PTSD, however, it can be assumed that the number is higher than 4,796 and lower than 830,000 veterans, which is the amount in the war zones as of 2008 (NHF). Ergo, the VA is experimentally treating only 0.4796% of veterans suffering from PTSD with a budget of over 100 million. Kate Chard, director of the PTSD Division at Cincinnati VA Medical Center, iterates that about 70% of veterans who receive care for their PTSD end up getting better (Suran, Melissa).
The most recent governmental policy is a mental health evaluation for every soldier in the army (Attrition). By conducting these evaluations, it is hoped that PTSD can be mainstreamed (Attrition). Another hope in this is that it can judged whether or not combatant training increases the likelihood of PTSD, so that this mental illness can be caught at its earliest (Attrition). The main point here is that PTSD can be reversed and become less a crippling mental illness and shift over to a work related hazard.
It can be concluded from the data collected that the Veterans Administration is offering sub-standard care to its veterans with the budget that they have – and in addition, the eligibility requirements to be awarded benefits for a veterans by the VA for PTSD is complicated and strict. Major hurdles experienced by the VA are similar to those experienced by single-payer systems – these include rationing of care, restrictions on improved prescription drugs, and misallocation of funding (NYTimes). The VA is also grossly understaffed and mostly uneducated – their training does not include how to deal with patients with PTSD. It is proposed, then, that the VA adopts a reformed method for assisting their patients with PTSD.
In order to reform the current system as offered by the VA, the government needs to take more control over the administration. The eligibility requirements to be considered for benefits concerning PTSD need to also be lessened.
In 2008, the House passed a bill that aimed to improve the treatment of PTSD and hire more people to process claims quicker (NYTimes). In 2008, as well, the House also passed the Wounded Warriors Assistance Act, which seeks to reform medical information services, provide additional staff members, transition support, and overall improve the quality of current programs (NYTimes).
Although there is limited information available concerning exact statistics regarding veterans suffering PTSD that are working with the VA, PTSD is a serious mental illness. Treatment should begin as soon as possible, particularly within 3 months after a soldier has completed his or her tour. Starting treatment, however, is made difficult because the VA is understaffed and under-budgeted. Wait times are long and frustrating – in many cases some veterans may not even be eligible. Although the VA receives nearly $100 million, the money is not allocated in areas that so desperately need its attention – such as the National Center for PTSD. In order to reform the health care system for veterans suffering from PTSD, more VA Medical Centers with less severe eligibility requirements should be put in place. Also, it should be made that all veterans be mandatorily required to receive an early preliminary screening of PTSD shortly after combat training. If symptoms are caught early on, then perhaps it can be held that PTSD would shift from a severe case of mental illness to simply a work hazard that can be reversed. Finally, although the Wounded Warriors Assistance Act of 2008 passed by the House is an excellent jumping point, the government needs to better monitor the Veterans Administration and ensure that all veterans, at any level of PTSD, are receiving the appropriate treatment so as to not increase the chances that they will develop serious negative health issues.
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