Senate Committee review on Veteran's Disability Compensation

At the United States Senate Committee on Veterans' Affairs review of Veteran's Disability Compensation: Expert Work on PTSD and Other Issues, the purpose of the hearing was to hear recommendations on how the VA Disability system can be improved, since the current system is outdated, burdensome, and fails to address many issues.

Ranking Member Senator Richard Burr (R-NC) said that under his bill, the Veterans Mental Health Treatment First Act, there would be a wellness stipend while the veterans were waiting for treatment, and all the veteran would have to do is hold off on the rating claims. This emphasizes wellness as opposed to claiming disability. The current system, he said, does not keep pace with society and understanding disabilities. The rating schedules have not been updated in six decades, and promoting rehabilitation is a main goal, since there are young men and women returning from war that cannot return to work. Returning to the workforce, Burr said, should be the main goal of the VA, and this may require a large upfront cost.

Dr. Joyce McMahon, PhD, Managing Director, Center for Health Research and Policy, said survey results suggest that the relationship between compensation and medical treatment for PTSD (Post Traumatic Stress Disorder) showed through a series of indirect questions virtually no evidence for veterans to avoid treatment from fear of losing their benefits. In respect to evaluating the quality of life for veterans, they also did surveys of veterans and found that the degree of disability was in decline. With primary mental disabilities, they found there to be low physical quality of life as well.

Dr. Dean G. Kilpatrick, PhD, Director, National Crime Victims Research and Treatment Center, Medical University of South Carolina, said testimony showed that doctors were limited in their ability to take a lengthy exam of persons diagnosed with PTSD, and therefore were not able to have a thorough evaluation. Currently, Kilpatrick said, the same sets of criteria are used to evaluate all sorts of mental disorders, and that means that the criteria are crude and outdated. The DSM (Diagnostic and Statistical Manual of Mental Disorders) used by mental health professionals needs to be utilized.

The research team concluded that it is not appropriate to have an "across the board" evaluation of veterans with PTSD but should be done on a case by case basis. The evaluations should be timely, and there is no justification to single out and stigmatize veterans with PTSD by reevaluating them every two to three years. One of the disadvantages to reevaluation is cost, and if it was decided to do regular reevaluations, it should not be done until the resources are available to do a more thorough evaluation.

In response to a question, Kilpatrick said there is lore out there that veterans that get compensation have no incentive to seek treatment because there is no reason to get better. Research showed, he said, that some veterans may seek treatment because at a higher level of disability, they get better options for treatment.

House Armed Services Committee hearing on AMAP

At the House Armed Services Committee hearing on the Army’s Medical Action Plan and Other Services’ Support for Wounded Service Members, Subcommittee Chairwoman Susan Davis (D-CA) said "our challenge and our responsibility" is to make sure that the military as a whole, not just the health care system, remains focused on the recovery and rehabilitation of wounded soldiers and their families.

Congressman John M. McHugh (R-NY), ranking Republican on the Military Personnel Subcommittee, said he is concerned about reports from Fort Drum highlighting an apparent disconnect between the Army and the Department of Veterans Affairs personnel as to the type of support to be provided disabled soldiers.

In a joint prepared statement by Army Surgeon General Lieutenant General Eric B. Schoomaker and Assistant Army Surgeon General Brigadier General Mike Tucker, they said that because of the extraordinary success of modern battlefield medicine, there are many more wounded soldiers with injuries that are now struggling to recover. Walter Reed Army Medical Center is trying to support a population of outpatients that is six times greater than it was designed to support. Wounded, ill, and injured Soldiers are under the command and control of the medical treatment facility commander, in medical facilities called Warrior Transition Units. There are 35 Warrior Transition Units, and they are at full operational capability but staffed at 90%. One of the issues, they said, is of "sustainability."

Navy surgeon General Vice Admiral Adam Robinson said "our focus is to get the family back to ‘normal’ as soon as possible." Families, he said, are part of the care team and their needs are integrated into the planning process. Beginning in 2006, he said, Navy Medicine established Deployment Health Centers (DHCs) to provide care for Marines and Sailors who self-identify mental health concerns on the Post Deployment Health Assessment and Reassessment. From 2006 through January 2008, 28% of visits were for mental health issues.

Air Force Surgeon General Lt. Gen. James Roudebush said to be assured that the Air Force’s Medical Services is ready for today’s challenges. To execute their broad missions, he said, all military sections must work together, and also independently, as we are in the trust of today’s All-Volunteer Military.