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PTSD/Substance Abuse COMMITTEE REPORT
BY TOM BERGER, CHAIR
Back in the fall of 2005, the office of Sen. Larry Craig
(R-Idaho) announced that the VHA had contracted with the
National Academies’ Institute of Medicine (IOM) to
conduct a review of PTSD diagnoses, treatment, and compensation.
The press release stated that the IOM would form two committees
to conduct its review—one committee was “to
review the literature of various treatment modalities (including
pharmacotherapy and psychotherapy),” while the other
committee was to review “the objective measures used
in the diagnosis of PTSD and known risk factors for the
development of PTSD,” and “the utility and
objectiveness of the criteria in the DSM-IV and will comment
on the validity of current screening instruments and their
productive capacity for accurate diagnoses.” Upon
completion, the PTSD reviews are to be forwarded to the
Veterans’ Disability Benefits Commission, which is
charged with the overall review of the VA’s compensation
system.
After the IOM committees were constituted, this
committee chair and members of the VVA national staff presented
testimony for the record at every IOM committee meeting.
Subsequently on May 8, the IOM review of PTSD and compensation
(entitled “PTSD
and Compensation for Military Service”) was released
(Note: The separate National Academies’ IOM committee
report addressing PTSD treatment issues will be released
later in 2007), and I am pleased to note that most, if not
all, of VVA’s recommendations and suggestions were
incorporated into this first IOM report. Among the many findings
were the following:
Standardized psychological testing of claimants
may be a useful adjunct to the PTSD C&P examination, but
not a substitute for a thorough clinical evaluation.
PTSD can develop at any time after exposure to a
traumatic stressor.
A standardized training program should be
developed for clinicians conducting C&P evaluations for
PTSD.
VA should establish a specific certification program
for raters who deal with PTSD claims, with the training to
support it and periodic re-certification.
Research reviewed by the committee indicates that
PTSD compensation does not, in general, serve as a disincentive
to seeking treatment.
It is not appropriate to require across-the-board
periodic re-examinations for veterans with PTSD service-connected
disability.
The determination of whether and when re-evaluations
of PTSD beneficiaries are carried out should be made on a
case-by-case basis using information developed in a clinical
setting. Specific guidance on the criteria for such decisions
should be established so that these can be administered fairly
and consistently.
VA should conduct more detailed data gathering on
determinants of service connection and rating levels for
military sexual assault-related PTSD claims and develop and
disseminate reference materials for raters that more thoroughly
address the management of such claims. More research is also
needed on gender differences in vulnerability to PTSD.
Does
this mean an end to the entire hullabaloo over PTSD disability
claims? We don’t think so. Stay tuned for
the next IOM report. The National Academies’ May 8
news release and report are accessible at http://national-academies.org
DOD
MENTAL HEALTH ADVISORY TEAM SURVEY
On May 7, DoD’s MHAT-IV survey was released; it was
the fourth in a series of studies since 2003 to assess the
mental health and well-being of the deployed forces serving
in Iraq. Although scheduled for release last November, reasons
for the delay were not announced. The MHAT-IV, conducted
in August and October of last year, assessed more than 1,300
soldiers and, for the first time, nearly 450 Marines. The
commanding general of Multinational Force, Iraq, also requested
a first-ever study of battlefield ethics with the participation
of soldiers and Marines currently involved in combat operations.
Significant
findings include:
Soldiers who deployed longer (greater than
six months) or had deployed multiple times were more likely
to screen positive for a mental-health issue.
Approximately 10 percent of soldiers reported mistreating
noncombatants or damaging their property when it was not
necessary.
Less than half of soldiers and Marines would report
a team member for unethical behavior.
More than one-third of all soldiers and Marines
reported that torture should be allowed to save the life
of a fellow soldier or Marine.
The 2006 adjusted rate of suicides
per 100,000 soldiers was 17.3, lower than the 19.9 rate reported
in 2005, but higher than the Army average of 11.6 per 100,000.
However, there are important demographic differences between
these two populations that make direct comparisons problematic:
Soldiers
experienced mental health-problems at a higher rate than
Marines.
Deployment length was directly linked to morale problems
in the Army.
Leadership is key to maintaining soldier
and Marine mental health.
Both soldiers and Marines reported
at relatively high rates—62
and 66 percent, respectively—that they knew someone
seriously injured or killed, or that a member of their team
had become a casualty.
PTSD AND REDEPLOYMENT
According to a November 2006 memo issued by the assistant
secretary of defense, psychotic and bipolar disorders automatically
disqualify someone from being redeployed to combat by the
military—but PTSD does not. The memo calls the disorder
treatable, although it says the potential for effective treatment
is considered on a case-by-case basis that takes into account
a soldier’s vulnerabilities and demands of the job.
If
soldiers are diagnosed outside the military health system,
such as at a VA hospital or a family doctor’s office,
it’s up to them to raise the issue—although officials
say they are working to share medical records more easily
between the military and Veterans Affairs. Army officials
have not responded to repeated requests for the number of
soldiers with PTSD who are now deployed.
COALITION TROOPS
AND PTSD
According to a soon-to-be-published article in The British
Journal of Psychology, the number of British military reservists
suffering mental-health problems after tours of duty in Iraq
has doubled in the past four years. The report suggests that
reservists may need more official support after returning
from operations. It also suggests that part-timers experience
increased stress because of family and civilian employment
pressures caused by their absence from home and job.
Almost
13,000 reservists have served in Iraq and Afghanistan to
plug gaps in the regular forces and perform a range of specialist
roles in short supply among their full-time counterparts.
Most part-timers are also deployed as individual replacements
or in small groups, while regulars are sent as 500-strong
battalions or 100-man “bolt-on” reinforcement
rifle companies or armored squadrons used to living and working
together.
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