Veterans Day: part three

Note: this was originally written on June 9, 2002. I recently decided to revise it somewhat for this blog. Revisions, additions, comments, and updates are indicated by italics.

part one
part two

THE SYSTEM FAILS

1. The VA mental health system fails the veteran by, in many cases, giving a veteran multiple mental health diagnoses. When the symptoms are added up, they equal PTSD. But the PTSD diagnosis is not made.

The VA are the PTSD experts of the world. They deal with PTSD continuously. They wrote most of the research on PTSD. In most cases I do not believe ignorance of PTSD can be an adequate excuse for this error. By diagnosing the veteran with personality disorders, depression, anxiety, panic attacks, etc. the correct diagnosis and treatment are not made. The precipitating event is not recognized. Proper treatment and support are not given and the patient suffers excessively.

2. The VA mental health system fails us by exploring childhoods of veterans excessively, in order to give them pre-service traumas. Everyone has childhood experiences that are maladaptive. Everyone has multiple issues in their lives. PTSD involves a traumatic precipitating event. Anyone in therapy would rather talk about something, anything, other than their major trauma.

Since cognitive dysfunction and memory problems are a major symptom of PTSD, it is extremely easy to victimize a PTSD patient in this way. Trust me, we do not want to get anywhere near that traumatic event again. But if we don't, we can't heal, and interact better in the world. Dealing with the trauma doesn't make our PTSD go away but we're able to recognize and deal with our symptoms easier.

By dealing with us therapeutically in this deceptive way, our healing is delayed, and our pain grows. The client/patient needs help. We come to the VA for that help. And in many cases we are betrayed and hurt again.

3. The Regional Offices and Board of Appeals fail us by ignoring the diagnoses and findings of their own psychiatrists, social workers, and compensation examiners, in order to find against the veterans compensation claim. Many people in the VA system courageously (and probably to their own personal career detriment) do diagnose veterans with PTSD. The psychiatrists carefully and thoroughly interview the veteran, considering their current level of functioning, their service record, and their medical history. In many cases they find that the veteran has PTSD, and based on their professional opinion psychiatrically as well as considering the medical symptoms and treatments at the time of the precipitating traumatic event state that:

• The veteran has PTSD
  
• Based on their interpretation of medical files and events, a traumatic event did occur to the veteran while they were in the service
  
• There is a medical nexus, or link, between the veteran's current chronic disease of PTSD and that traumatic event.

That professional opinion establishes that according to the Department of VA rules, the veteran is entitled to continued free mental health treatment and financial compensation to help them survive financially. PTSD has severe financial repercussions in a veteran's file.

The VA chooses to disregard their own professionals. In my own case, two treating psychiatrists, a compensation examination psychiatrist, and several social workers all agree that I have PTSD due to a rape trauma while I was in the service. The VA chooses to ignore their professionals by saying that they can't prove that what happened really did happen.

But that's not a real requirement for establishing a medical nexus. A medical nexus is a trained professional's most careful interpretation of the entire situation. Either that is a consideration in compensation determination, or it is not. If it isn't a consideration, please be honest and stop saying that it is. If the intention is to never compensate a veteran for service-connected systemic mental disorders, please make that the law. Otherwise, treat us honorably and fairly.

I worry about the honest professionals who tell the truth. I wandered for 24 years without knowing what my problems were. Eventually I found help at a VA treatment center. I was diagnosed with PTSD and helped to understand my symptoms. I went through trauma processing and am in group and private therapy.

I am currently only being seen once a month by a VA counsellor, privately, as I couldn't handle group therapy, and broke down further.

I am grateful to the caring professionals who are helping me. I worry that their being honest to the VA system about my disease will negatively impact their careers. That would break my heart again. These are the people who deserve the best from the VA employment system, the recognition, the raises, the promotions. Because they care enough to put their patients first. They see the damage of PTSD. They tell the truth. I hope that truth is a good enough shield for them, but I fear that it will not be.

Telling the truth hasn't exactly helped me out much.

4. The VA Regional Offices and claims systems fail us because records at the time of the traumatic events are missing or incomplete.

Or said to be missing or incomplete.

The VA denies that a traumatic event took place. If no traumatic event took place, the PTSD can't be from an in-service event, and there is no need to order a comprehensive exam to get the professional medical opinion. Nor is there a need for the medical nexus opinion.

Why are records at the time of the traumatic event missing or incomplete? This can be attributed to several reasons. First, the military and the VA control the records, not the veteran. Sometimes records are lost or destroyed in all or in part. Often a veteran will remember seeking medical treatment, but the records are never officially found or produced by the VA.

Moreover, a person who has suffered a traumatic event is psychologically damaged (as well as physically damaged) at the time of the trauma. In many cases they are dissociative and amnesic. Their cognitive functioning is impaired. They are depressed, anxious, and sleep-deprived. This is called acute stress disorder.

People with acute stress disorder make different decisions and behave differently than people who function normally. Because we have acute stress disorder at the time of the trauma, the VA uses our trauma-induced decisions and reports to discredit the reality of our trauma, and denies its existence. Our very mental disorder becomes the basis upon which they deny our claims.

If we were capable of reporting and responding to a "traumatic" event as a non-traumatized or normal person would respond, is that proof that we were not traumatized? Please do not use my mental disorder as a reason or basis to deny that I have a compensable mental disorder. Be fair or change the rules.

5. The VA Regional Office and BVA fail us by asking female veterans reporting rape trauma questions about our contraceptive use at the time of the trauma. They love to find "evidence" that we were on oral contraceptives at the time of the trauma.

What does the use of oral contraceptives mean? It doesn't mean that a given veteran is, is not, is nor plans to be sexually active. Reasons for taking these contraceptives vary with the individual. In any case, if we thought we might become sexually active at some point, are we bad people to want to avoid an unplanned pregnancy? Does that mean that we planned to be traumatized?

Let's consider a more likely scenario, using myself as an example. Many young women suffer from heavy painful periods. By taking oral contraceptives, a woman can reduce her menstrual flow and reliance on sanitary products, and the number of days she will bleed.

She can therefore know exactly when her period will begin, and when it will end. Doesn't it seem that this is a pretty handy thing for a female soldier to know? I even packed a good supply of birth control pills from home so I wouldn't have to worry about whether I could obtain them from the Army doctors or not.

My point is there are a lot of different reasons for women to use oral contraceptives. My personal reason seems the most logical. Apparently, the VA thinks other female soldiers and I took them because we had the time and inclination for numerous casual sexual encounters. Personally, I did not have the time or the inclination for that; I was busy training to be a solider. I was serving the people of my country. I think all of us soldiers were busy being soldiers.

The real issue is, was there a trauma, instead of coming up with a fictitious reason to dislike a person enough to justify denying their claim. Don't assume the worst about me, and I'll try not assume the worst about you. Which means I won’t assume that you, Mr. or Ms. rating/hearing officer, have never been in the military, and don't have a clue what military life really involved during the time of my service.

6. The VA, and sometimes the mental health systems itself, fail us by believing that veterans seek help at VA treatment centers only to pursue compensation claims. Veterans seek help for the same reasons anyone else does. They have medical and/or mental health problems and need treatment. Most of these veterans live in poverty and have no, or inadequate, health insurance.

When they seek medical or mental health care outside of the VA system, that is a reflection of their satisfaction with the care they have received there. If they feel they have been misdiagnosed and not helped, or that their concerns are minimized they seek help elsewhere, just like you would.

7. The VA fails veterans by assuming that all claims are fraudulent, and are processing all claims on that basis. There is a strategy by the VA to slow the claims process down at all levels throughout the process: the initial filing, acknowledging communications from the veteran, and providing the veteran with confusing, inaccurate, and false or misleading information about their claim.

This backlog of claim cases is then used to further justify additional delays in processing the veterans claim. So the VA controls the sluggish speed of the claims process, with no consequences for doing so. Only the veteran has consequences.

All claims deserve to be handled in a reasonable timely manner. I am not asking that all claims be granted. I am asking that they be evaluated fairly, in a timely manner, and that consequences be built into the system to VA employees and the system itself so that the veteran does not suffer from this system with no opportunity or ability to be compensated.

At this time there is discussion about legislation to allow attorneys to represent veterans at the initial stage of the claims process. The Republicans are favoring this as a solution to the slow claims process! As though allowing attorneys, who are paid by the hour to handle VA claims, will speed up the process! What is needed are consequences to the VA employees for delaying and making errors in cases.

For example, in my own case, which has been ongoing for four years now, action was delayed for an entire year at one point because the VA decided that they had issued a "statement of the case" to me.

The statement of the case is the VA's initial summary of the facts of the case and the VA’s decision. A veteran must have a statement of the case before they can appeal a decision against them.

In fact, they had not done so. I was asked to prove to them that I had not received a “statement of the case.” According to them I had received one, and had not responded in time therefore my case was closed.

It was beyond my ability to prove non-receipt of this document. How would you go about proving that you never got something? Congressmen Sherrod Brown corresponded with the VA regional office on my behalf. As a result, I was sent a letter along with a statement of the case which stated that I had not previously been sent a statement of the case" and that this was the first one.

That's very nice. No apology. No consequences to the VA, only to me. This insanity caused a year's delay in my case. The date on which my appeal will be heard is determined by when I officially appeal , which was directly delayed by errors caused the VA, not me. But my case is delayed again, because of their delay. I am the one who pays the price. I wait longer. No consequences to the VA.

Many veterans give up their claims because the process is so demeaning and tiring. Those of use with mental disorders are the least equipped to deal with the additional stress of pursuing these claims, and we need the help.

We have real problems. We live in poverty. We need good VA mental health and medical care. We need financial help. That help was promised to us. Do the American people want their veterans to be treated this way?

Please help to change this system so that it operates more fairly, or please be honest and just tell us mentally disabled veterans to seek help elsewhere. Either answer is fine. I would just like to be treated honestly and fairly. I do not want to be traumatized anymore.

Next: part four, with other real cases.