The federal government's decision to cut some of the red tape for veterans with posttraumatic stress disorder will make it easier for them to seek benefits and treatment, mental health experts say.
The rule, which went into effect immediately after it was announced, should help veterans with PTSD to get needed treatment, said Dr. Lisa Routh, a Houston-area neuropsychiatrist.
Over the years, seeking mental health services within the VA system has been cumbersome, she said. Eliminating some of the hurdles veterans must clear should not only make services more readily available, she said, but give PTSD a higher profile within the VA.
“Many people are touched by post-traumatic stress disorder, not only the people who are victimized by war but their families as well. The relaxing of restrictions on who can seek services will improve immediate functioning of the person and their family, and their long-term performance,” Dr. Routh said.
The Department of Veterans Affairs issued a final regulation on July 13 that reduced the level of evidence that veterans must provide in order for their PTSD to be recognized as connected to their military service.
Previously, noncombat veterans had to provide extensive records proving that they experienced traumatic events during their service.
To receive benefits for non–combat service related PTSD under the newly isssued rules, a veteran now must meet the following criteria:
▸ Be diagnosed with PTSD.
▸ Provide a personal account of a stressful event or set of circumstances.
▸ Claim that the diagnosis is based on a “fear of hostile military or terrorist activity.”
▸ Show that the stressor is consistent with the place and circumstance of his or her military service.
▸ Have that stressor confirmed as adequate support of a PTSD diagnosis by a VA psychiatrist, psychologist, or contract provider.
While this is a huge step forward, Dr. Routh said it would be even more beneficial if veterans also were allowed to have their PTSD assessments conducted by physicians outside the VA system. There are many skilled physicians outside the VA community who have experience working with veterans and military personnel with PTSD. And some veterans are simply more comfortable seeking their care outside of the VA, she said. “What you ultimately want is you want people to get care,” Dr. Routh said.
Reducing the burden of proof on the veteran is especially important given the current military conflicts in Iraq and Afghanistan, where there isn't a clear front, said Dr. Felise S. Zollman, medical director of the brain injury medicine and rehabilitation program at Rehabilitation Institute of Chicago.
“There are a lot of people who have felt in fear for their life in the course of service who couldn't claim they were combat veterans,” she said.
Dr. Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute in Washington, said the “anticipatory fear of being in harm's way” can be crippling for some noncombat veterans. However, it's unclear just how often these symptoms persist and become a lasting disability.
If veterans get appropriate treatment early on, only in rare cases will the symptoms fail to resolve over time, Dr. Satel said.
My Take
Focused Treatments Are Essential
This development is positive, and the long view of PTSD is that it does not necessarily lead to lifetime disability. However, it is essential that mental health professionals use clear, focused treatments that work–such as guided imagery, reciprocal inhibition, and systematic desensitization. Codification of treatment strategies is needed.
ROBERT T. LONDON, M.D., is a psychiatrist with the NYU Langone Medical Center.
