Now Fix the VA Disability System

From AEI:

Now Fix the Disability System By Sally Satel

New York Times Room for Debate

Thursday, July 8, 2010

The New York Times Room for Debate blog posed the following question: "The Department of Veterans Affairs is preparing to issue new rules to make it easier for veterans who have been diagnosed with post-traumatic stress disorder to receive disability benefits. The new regulations, which apply to veterans of all wars and will cost as much as $5 billion over several years, essentially eliminate a requirement that veterans document specific events that might have caused their P.T.S.D. and simply require those with the illness to show that they served in a war zone. Given the research that exists about P.T.S.D., is this a step forward?" AEI's Sally Satel, M.D., offered the following response.











The Department of Veterans Affairs has a moral obligation to veterans. The pending change in regulations is an effort to meet that duty. But as the number of veterans who will now apply to enter the disability system increases, the V.A. must turn its attention to that troubled system itself. Two overarching problems need urgent remedy.



The first is that diagnostic screening for post-traumatic stress disorder is often inadequate. It is a real and potentially devastating disorder, but not every veteran with post-war distress has a mental illness--there is a continuum ranging from normal, if painful, readjustment difficulties to chronic, debilitating pathology.



This distinction matters when the veteran is seeking total and permanent disability status.



Full disability naturally leads a veteran and his or her family to assume--often incorrectly--that their loved one is no longer able to work. Then the downward spiral beginsThat said, Veterans Affairs should make it very easy for any suffering veteran to obtain social support and therapy aimed at easing the transition back to civilian life. Whether the treatment offered at V.A. centers is of uniformly high quality is doubtful, however, and yet another issue that demands attention.



As for disability benefits, the key point is that there are often deleterious effects of ongoing compensation. Granted, in the short term, a monthly check of about $2,500 for full disability, tax-free, is a great relief to the struggling veteran and his family. But serious consequences can accompany a rush to judgment about a veteran's rehabilitative potential. Before exposing patients to those, the V.A. should adopt a high threshold for designating someone as totally and permanently disabled.



This brings us to the second major system weakness: a veteran can be declared disabled with post-traumatic stress disorder without sufficient evidence of his or her capacity for recovery. Judging an individual unlikely to improve before he has even had a course of therapy and rehabilitation is drastically premature.



Full disability naturally leads a veteran and his or her family to assume--often incorrectly--that their loved one is no longer able to work. Then the downward spiral begins: the longer a patient is sidelined from the workplace, the more his--anyone's--confidence in his ability to work erodes and the more his skills atrophy. Understandably, he becomes increasingly afraid of losing the monthly check. This deprives the veteran of work, a potent therapy in and of itself. Lost are the sense of purpose and competence work gives (or at least the distraction from depressive rumination it provides), the daily structure it affords and the opportunity for socializing and connection to society it creates.



The V.A. disability system can be a blessing for those suffering permanent and severe psychological injuries of war. But for the majority who is able to recover, misapplied largess, however well-meaning, can undermine those prospects.



Sally Satel, M.D., is a resident scholar at AEI.