VA denies money a factor in PTSD diagnoses
Posted : Wednesday Jun 4, 2008 8:36:11 EDT
WASHINGTON — A Veterans Affairs Department psychologist denies that she was trying to save money when she suggested that counselors make fewer diagnoses of post-traumatic stress disorder in injured soldiers.
Norma Perez, who helps coordinate a post-traumatic stress disorder clinical team in central Texas, indicated she might have been out of line to cite growing disability claims in her March 20 e-mail titled “Suggestion.” She said her intent was simply to remind staffers that stress symptoms could also be adjustment disorder. The less severe diagnosis could save VA millions of dollars in disability payouts.
“In retrospect, I realize I did not adequately convey my message appropriately, but my intent was unequivocally to improve the quality of care our veterans received,” Perez said in testimony prepared for delivery Wednesday before a Senate panel.
The Senate Veterans’ Affairs Committee and the VA inspector general are investigating whether there were broader VA policy motives behind the e-mail, which was obtained and disclosed last month by two watchdog groups. VA has strenuously denied that cost-cutting is a factor in its treatment decisions.
“One question that was raised repeatedly about this latest e-mail was, ‘Why would a clinician be so concerned about the compensation rolls?”’ said Sen. Daniel Akaka, D-Hawaii, who chairs the Senate panel. “As an oversight body, we must know whether the actions of these VA employees point to a systemic indifference to invisible wounds.”
VA Secretary James Peake has called Perez’s e-mail suggestion “inappropriate.” VA officials this week said her e-mail was taken out of context.
“The e-mail, as characterized by others, does not reflect the policies or conduct of our health care system,” said Michael Kussman, VA’s undersecretary for health, in testimony prepared for the Senate hearing. “We certainly agree that it could have been more artfully drafted.”
In her e-mail to staffers at the VA medical center in Temple, Texas, Perez wrote, “Given that we are having more and more compensation-seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out. ... We really don’t or have time to do the extensive testing that should be done to determine PTSD.”
Many veterans and injured troops have long charged that the government might seek to reduce disability costs by assigning a lower benefits rating. Last year, retired Lt. Gen. James Terry Scott, chairman of the Veterans’ Disability Benefits Commission, said he believed the Army might at least subconsciously consider cost. A lawsuit filed in San Francisco accuses VA of misclassifying PTSD claims.
In her testimony, Perez said symptoms for PTSD and adjustment disorder are often similar, as are the treatments for them. She said by making an initial diagnosis of a lesser disorder, VA staff can begin treatment right away without going through the arduous process of diagnosing PTSD.
Perez also noted that awarding disability benefits is not part of her staff’s work, but she did not say why she chose to cite that as a factor in urging fewer PTSD diagnoses. Veterans diagnosed with PTSD are eligible to receive up to $2,527 a month in government benefits.
A recent Rand Corp. study found about 300,000 U.S. military personnel who served in Iraq or Afghanistan are suffering from PTSD or major depression, potentially saving the government millions of dollars if lesser diagnoses are used in disability benefits decisions.
“Although our clinic is a treatment clinic, we all fully support the compensation process and the department’s policy of erring in the best interest of the veteran whenever there is any doubt,” Perez wrote.
Perez’s testimony comes after Peake was called to Capitol Hill last month to answer questions about internal e-mails suggesting that VA officials were hiding the number of veterans trying to kill themselves.
One of the e-mails, disclosed during a San Francisco trial, started with “Shh!” Some lawmakers have said the VA’s top mental health official who wrote it, Dr. Ira Katz, should be fired, but Peake has said he has no plans to do so.
Money is a factor, in Alaska last week while campaigning with Senator Ted Stevens, Sec Peake made remarks to the effect that TBI injuries are similar to injuries high school football players get, excuse me, I know he didn't mean that. He also made comments to the effect that PTSD is being diagnosed to quickly and it is a shame to label someone for a lifetime when after a few months of treatment they may get better.
ReplyDeleteYes, but the DSM4 says if the symptoms have lasted longer than 6 months it is chronic PTSD, not "battle mind" or "adjustment disorder" I went thru the PTSD board at Augusta VAMC, it took three months of tests, interviews with 3 different mental health workers and they had to agree to the diagnosis, so it is not like one doctor can say yup you have PTSDand they start sending you a check, they low ball the award, despite several years of statements stating that my PTSD symptoms alone made me unemployable and given the fact that I had been badly coping with it since Feb 1975, they did not feel that I would ever improve enough to return to work, so the VA awarded me 50% I appealed it in May 2005, after getting Senator Larry Craig then Chairman of the senate VA committee, the VA sent a letter full of lies to Senator Craig and myself, adter he showed them in DC the evidence that the local VARO was ignoring they awarded me 100% P&T, and attempted to drop all the other medical issues related to the chemical weapons and drug experiments I was used in at Edgewood Arsenal in 1974, the program lasted from 1955 thru 1975 and 7120 men were used in it, in FY2000 they did a health study on the men and they could only find 4022 survivors, which indicates 3098 men had already died, these were men aged 45-65 in FY2000, that is a very high rate, of the 4022 men they did find, 54% of them or approximately 2200 reported being disabled, which combines for a 74.43% death and disability rate. On June 12 the House VA committee will have hearing on HR 5954 which will attempt to cover the SHAD/112 veterans that were used from 1963-1973 but the bill ignores the other "test vets" of Fort detricks biological weapons program, Edgewood Arsenals chemical weapons and drug experiments. The bill should be changed to include all veterans used in any of the Cold War era human experiments, that used chemical, biological or pharmacuticals on American soldiers, Air Force personnel and Naval personnel.