PTSD Compensation and Military Service (2007) / Chapter Skim
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Pages 1-14
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From page 1... ...
While several factors have contributed to this development, three that have received particular notice are the increase in the number of veterans seeking and receiving benefits, the concomitant increase in benefits expenditures, and the prospect of a large number of veterans of Operation Iraqi Freedom and Operation Enduring Freedom entering the system. Compensation claims for posttraumatic stress disorder (PTSD)
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From page 2... ...
the basis for assigning a specific level of compensation to specific severity levels and how changes in the frequency and intensity of symptoms affect compensation practices for PTSD; 3. how VA's compensation practices and reevaluation requirements for PTSD compare with those of other chronic conditions that have periods of remission and return of symptoms; and 4.
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From page 3... ...
VA identified several issues related to the conduct of C&P exams that were of particular interest: the role of the Global Assessment of Functioning (GAF) score2 in evaluating PTSD, the division of symptoms among PTSD and comorbid disorders, the value of standardized testing in the conduct of examinations, and the scientific literature regarding the length of time between the occurrence of the stressor thought to be associated with an applicant's PTSD and the appearance of symptoms.
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From page 4... ...
This training program should emphasize diagnostic criteria for PTSD and comorbid conditions with overlapping symptoms as delineated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and include example cases that illustrate appropriate documentation of exam results for C&P purposes.
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From page 5... ...
There is no scientific guidance addressing the separation of symptoms of comorbid mental disorders for the purpose of identifying their rela tive contributions to a subject's condition. Standardized psychological testing of claimants may be a useful adjunct to the PTSD C&P examination but it is not a substitute for a thorough clinical evaluation.
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From page 6... ...
The Evaluation of PTSD Disability Claims Information developed in the C&P claims and examination process is used by VBA personnel informally referred to as raters to determine whether an identified disability is connected to a claimant's military service and, if it is, what level of impairment is associated with it. Raters use criteria and decision rules set out in the VA Schedule of Rating Disabilities (VASRD)
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From page 7... ...
To address these data gaps, the committee recommends that data fields recording the application and reevaluation of benefits should be preserved over time, rather than being overwritten when final determinations are made, and that they be gathered and coded at two points in the process where there is currently little information available: before claims are made, and after compensation decisions are rendered. Data such as these will facilitate more informed future analyses of PTSD disability compensation issues.
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From page 8... ...
In order to promote more accurate, consistent, and uniform PTSD disability ratings, the committee recommends that VA establish a specific certification program for raters who deal with PTSD claims, with the training to support it, as well as periodic recertification. PTSD certification requirements should be regularly reviewed and updated to include medical advances and to reflect lessons learned.
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From page 9... ...
These broader considerations include barriers or disincentives to recovery, the effect of disability compensation on recovery, the advisability of periodic reexamination of PTSD compensation beneficiaries, and gender and military assault. Research reviewed by the committee indicates that compensation does not in general serve as a disincentive to seeking treatment.
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From page 10... ...
It therefore recommends that VBA gather more detailed data on the determinants of service connection and ratings level for MSA-related PTSD claims, including the gender-specific coding of MSA-related traumas for analysis purposes, and develop and disseminate reference materials for raters that more thoroughly address the management of MSA-related claims. Training and testing on MSA-related claims should be a part of the certification program recommended above for raters who deal with PTSD claims.
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From page 11... ...
VA should conduct more detailed data gathering on determinants of service connection and rating levels for MSA-related PTSD claims and develop and disseminate reference materials for raters that more thor oughly address the management of such claims. More research is also needed on gender differences in vulnerability to PTSD.
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From page 12... ...
The report identifies a number of instances where there are gaps in the data and in the research literature regarding PTSD disability compensation issues and offers some specific recommendations to address them. Some data sought by the committee were not available because they were in various cases not collected, not coded, collected but not retained, annotated only in hardcopy files rather than placed in a da
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From page 13... ...
; and, most importantly, • evaluate what is working and what isn't and determine where resources should be focused. More widely and systematically collecting data for research, policy, and planning purposes and assembling these data in more user-friendly forms will allow VA to better conduct the kinds of analyses needed to make informed decisions about the scope and magnitude of the problems that exist within the PTSD disability compensation system and the best approaches to addressing them, as well as to better project the resources needed to serve future veteran populations.
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From page 14... ...
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.
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