Veteran's Disability Benefits Commission Recommendations for Overhauling the VA

Finally realizing that the VA is not able to deal with a growing flood of new ptsd patients, the Veteran’s Disability Benefits Commission, primarily made up of retired military officers, made the following recommendations to the Senate Veterans Affairs Committee in January, 2008:

The Commission believes that a new, holistic approach to PTSD should be considered. This approach should couple PTSD treatment, compensation, and vocational assessment. The Commission believes that PTSD is treatable, that it frequently recurs and remits, and that veterans with PTSD would be better served by a new approach to their care. There is little interaction between the Veterans Health Administration, which examines veterans for evaluation of severity of symptoms and treats veterans with PTSD, and the Veterans Benefits Administration, which assigns disability ratings and may or may not require periodic reexamination. It is evident that PTSD reexaminations have been scheduled with less frequency in recent years due to the backlog of disability claims. It is also evident that case management of PTSD patients could be improved through greater interaction between the therapy received in Vet Centers and treatment in VA medical centers. IOM (Institute Of Medicine) concluded that the use of standardized testing and the frequency of reexaminations should be recommended by clinicians on a case by case basis, but did not suggest how that would be achieved. The Commission suggests that treatment should be required and its effectiveness assessed to promote wellness of the veteran. Reexaminations should be scheduled and conducted every two to three years.

Before the Veteran’s Disability Benefits Commission issued its final report in October, 2007, the Commission had asked the IOM or Institute Of Medicine to recommend changes in dealing with ptsd at the VA because of the IOM’s thorough knowledge of ptsd diagnosis and treatment. Ironically, key elements of the IOM’s recommendations were ignored by the Veteran’s Disability Benefits Commission in their final report and their recommendations to congress this year. This is part of the IOM’s recommendations taken from Appendix K of the Veteran’s Disability Benefits Commissions final report:

Neither federal regulation nor published VA materials offers advice to raters on how often or under what circumstances reevaluations of PTSD disability should take place. The committee recommends that this determination be made on a case-by-case basis using information developed in a clinical setting, such as a C&P examination. It recommends that specific guidance on the criteria for setting case-specific VA-initiated reevaluations be established so that the reevaluations can be administered in a fair and consistent manner; furthermore, VBA should collect and analyze data on VA and veteran-initiated reevaluations so that the system can be improved in the future. The committee does not believe it is appropriate to mandate across-the board periodic reexaminations for beneficiaries already being compensated for PTSD. Such a strategy would not take the diversity of the beneficiary population into account and would unduly single out veterans with PTSD for scrutiny. Within the context of VA’s limited resources, the committee believes that it would be best to invest in thorough C&P evaluations for new applicants—including the clinician’s determination noted above—rather than in the blanket review of past decisions.

Summary Findings and Conclusions

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 reexaminations for veterans with PTSD service-connected disability.

Summary Recommendations

VA should consider instituting a fixed long-term minimum level of benefits that would be available to any veteran with service-connected PTSD at or above some specified rating level without regard to that person’s state of health at a particular point in time after the C&P examination.

The determination of whether and when reevaluations 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 in a fair and consistent manner.

VBA should collect and analyze data on reevaluations so that the system can be improved in the future.