that a complete evaluation of the strategies for reducing disincentives and maximizing incentives for achieving optimal mental functioning would include the examination of the role of all of these services as well as of the coordination among them. Currently, coordination between VBA- and VHA-administered services is limited, and there is no process in place for individual case planning and management, for integration of services, or for evaluation of opportunities for providing incentives for improvements in health and function. VA has the opportunity to adopt this broader vision of benefits provision, and the committee believes that PTSD may be a good test case for an integrated benefits approach. As one component of this approach, VA should evaluate the feasibility of decoupling the seeking of PTSD disability through the C&P system from some form of priority access to VHA-provided mental-health services.

The committee is acutely aware that resource constraints—on both funds and staff—limit the ability of VA to deliver services and force difficult decisions on allocations among vital efforts. It believes that increases in the number of veterans seeking and receiving disability benefits for PTSD, the prospect of a large number of veterans of Operation Iraqi Freedom and Operation Enduring Freedom entering the system, and the profound impact of the disorder on the nation’s veterans make changes in PTSD C&P policy a priority deserving of special attention and action by VA and the Congress.


DVA (Department of Veterans Affairs). 2005. Review of State Variances in VA Disability Compensation Payments. Report No. 05-00765-137. Washington, DC: VA Office of the Inspector General. [Online]. Available: [accessed November 9, 2006].

IOM (Institute of Medicine). 2006. Posttraumatic Stress Disorder: Diagnosis and Assessment. Washington, DC: National Academies Press. [Online]. Available: [accessed November 9, 2006].

IOM. 2007. A 21st Century System for Evaluating Veterans for Disability Benefits. Washington, DC: The National Academies Press.

Szybala RL. 2006. Statement of Renée L. Szybala, Director, Compensation and Pension Service, to the National Academy of Sciences’ Institute of Medicine Committee on VA Compensation for Posttraumatic Stress Disorder, May 2, 2006. [Online]. Available: [accessed October 12, 2006].

VBA (Veterans Benefits Administration). 2002. C&P Service Clinician’s Guide—March 2002. [Online]. Available: [accessed November 28, 2006].

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