February 7, 2012

Army Review of PTSD May Reinforce Combat Veterans Not to Seek Help

This article seems to say they are passing out PTSD diagnosis to anyone who walks by and sneezes. It is not easy to get a PTSD diagnosis, that is the truth. When this same issue was brought up in the Veterans Administration, the government investigation showed that there was less then 1% actual fraud on PTSD diagnosis and service-connection compensation. When we do get that term put on our records as a service-connection, it is not a favor done for us. It means that we owe these men and women who have been destroyed in mind, body and spirit by the incredible sacrifices the average person would not think possible.
In a lecture to colleagues, a Madigan Army Medical Center psychiatrist said a soldier who retires with a post-traumatic-stress-disorder diagnosis could eventually receive $1.5 million in government payments, according to a memo by a Western Regional Medical Command ombudsman who attended the September presentation.
The psychiatrist went on to claim the rate of such diagnoses eventually could cause the Army and Department of Veterans Affairs to go broke (By Hal Bernton, Seattle Times staff reporter).
We did not hit the lottery because we get this diagnosis, this in not a windfall or something special in terms of winning. The diagnosis for PTSD is not permanent as it suggests, we are subject to reviews yearly and can be called to come before the Compensation and Pension Board. The 100% rating is a living wage paid monthly to us while we heal, and some of us may never heal completely. Most of us do not get the 100% rating, to suggest that this is the normal 'payout' for this detrimental psychiatric wound is dead wrong. Most veterans diagnosed with PTSD carry a 30% rating, not much to live on.

The system is overloaded not because of fraud which research shows is under 1% at the VA; the problem is not veterans or soldiers trying to work the system. The problem is not taking care of our soldiers and veterans when they become symptomatic, its not taking them seriously when they get home. This type of culture in the military and the VA effectively keeps soldiers and veterans from getting help in the beginning when it would do the most good.
As axiomatic to veterans as the oath they swore to defend the U.S. Constitution is the reality that a veteran filing a disability benefit claim encounters the VA’s ‘deny-delay-and-hope-you-die’ culture (Micheal Leon, Veterans Today).
It is sad that the we are being labeled as malingerer's again by another government organization trying to balance their budgets. I was called a malingerer to my face by nurses, doctors, psychiatrists and many people at the VA for the first 5 to 10 years due to a hostile culture towards veterans in the 90s in Louisville, KY (VA is better now in Kentucky). It was after the overwhelming evidence from the wreckage of my life I was finally diagnosed with PTSD in 2005 and received my 80% compensation in 2010.

I was actually service-connected in 2002 with hearing loss and tinnitus due to enemy artillery, but they had issues with reconciling my personal combat experience with the way Desert Storm was portrayed in the media; the myth that the First Gulf War was a bloodless conflict of buttons and smart-bombs. When I told them of the Highway of Death and driving seven (7) days without sleep, about what it looks like to see the world erupt in so much death in so little time; the 100 Hour Ground War was an enemy meat grinder. I was the Point Driver, an Mechanized Infantry Soldier leading our Main Battle Tanks to the enemy. My vehicle led 5,000 men into combat in the Biggest Tank Battle in the History of War. Driving in between explosions, mind screaming to go anywhere but here. I'm looking to move a brigade, not just myself. I am scanning the immediate ground and the terrain for the best movement for our unit, the landscape has a moon quality due to all the craters erupting from explosion after explosions. Their artillery was as good as ours, I hear it most days, boom, boom, boom in the distance, but when near you can feel the meat in your body shake like jelly and you try and control your movements to keep going, no time to die.

We operated at exponentially high stress rates everyday of our deployments, living on the edge of life and death to serve our country and freedom. Knowing you should have died a hundred times can leave us numb to everything; our loved ones included. This country owes those who cannot cope with life or make sense of what we did and saw in combat; this may take decades. That is what we should focus on, how do we reduce the amount of time it takes to reconcile war trauma so that we may live without the red vistas of war spraying all over our reality today.

Any therapist or psychiatrist worth their salt can discern malingering, lets test them on that and not the veteran. To blame the soldiers or veterans just alienates them further and reinforces "If you go forward with asking for help then you cannot be trusted." We loose 18 to 22 veterans a day to suicide, this culture of denial is killing more of our soldiers and veterans then the last 10 years of war, over 60,000 veterans to suicide in the last ten years. That's not counting the suicide in the military.

NOTE: I am so very grateful for the courage the Army investigators showed for blowing the lid off this repugnant practice based in an outdated culture within our military.

19 Comments:

Great blog!
I've been working with Combat PTSD Vets for 11 years. It brought up a couple things for me and I'd have to agree w/ the survey. There are out there what I call "Wanna bes", which is about one or two percent of those I've worked with. However what sux is those 1 to 2 % ruin it for those who do have it and do need the benef


Cant help but note you have a sidebar the Support our Incarcerated Veterans. I was giving a lecture on how to start a PTSD program in confinement. Question from Head of Army Clemency & Parole Board: "How do you know if someone was where they say they was or was really deployed , where they say the are?"

My answere after I showed some assessment tools and and other ways I work to sort out the wannabes: When I'm counseling someone one I can notice the differnce in the way a person reacts when they say i was sniper andI 10 confirmed kills and he's talking about it like, how aabout those Bears!" And The way a person describes what was like to be in the midst of a firefight have a buddy beed out in his arms and questioning himself, if i only would of ... he night be alive today!" His affect, emotion and how he can barely get the words out with tears streaming down his cheeks.

I guess my answere wasn't good emough because she went to the head man of military confinement and told him we could be misdiagnosing our guys and giving them clemeny & parole they might not desrve. So i walked into that shit storm after vi returned back to work after visiting my son who just returned from Afghanistan,

It also brought up a few more thought.

One) alot of GWI vets got the parades & then the period of thanks by America. You guys kicked thier ass, 100 days. Yee haa! How ever Non -military civilians don't realize there was the build up. The war and worse yet the aftermath plus all the other factors oil well fires, death, chemicals, depleted uranium, anthrax shots etc. Then after the hoopla America forgot.

2)Then there was were you in direct combat how do we know what you saw can cause pTSD, lets detemine that with out the person asking the questions with being in war an its environment. How do you know what they saw? I've seen many veterans suffer in poverty while some idiot trys to figure this out and then come back & say, "We need more information. Or we can't explain what you have because it hasn't been given a name."

3) Just like alcoholism not all cases of PTSD are not as severe as others, but does that mean a person does not have it. Who is qualified to say whose demons that haunt the soul of someone with PTSD, Combat Stress, Post Deployment Operational Stress Deployment what ever name one choses call it, is not as bad as his or hers.

Bottom line PTSD f's one up physically, emotionally, mentally and spiritually. Plus the loss of innoccence that the world is safe. These individuals gave ,so it is up to our country not to forget, be it in the honor or the compensation for those who gave while others sit on thier assess and decide if we should go to war or not.

Maybe the bean counters who send us to some wars we don't need to be in should count the post cost of war and its devestation after the war. Before jumping into a war.

Thanks for all of you have served may you get the honor & the compensation you ddserve!

In the first two years after I got home, the only times I would cry would be in packed grocery stores. I didn’t cry in therapy until recently, after 18 years. I was always jacked up, emotional and confrontational even. Had I had a therapist who could have gotten past their petty reactions, a social worker less depressed then me or an empathetic practitioner who could have opened a therapeutic window so they may intuitively guide me through the landmine field residing in my consciousness in the first two years I may not have had a lifetime of emotional and spiritual pain. If you were looking for me to cry in therapy you would have labeled me a malingerer.

Second, this post is not about a survey; it's a memo from a therapist who gave an opinion based in his beliefs, not in facts or recent events such as the Veterans Administrations investigation. The Army took a reactionary response to a burnt out therapist who cannot get past thinking about the LESS than 1% and concentrate on the other 99 Combat Veterans who walk in the door. Thirdly, the less than 1%, or "wanna be's" are not the issue that matters. Hold them responsible, yes. Tie their integrity to mine? I have issues with that. Their deception is not a good reason to jeopardize or threaten my benefits.

If we held financial institutions to the same standard we would have not banks or money. The research and investigations so far show a low fraud rate, to suspect every veteran who walks through the door is counterproductive to a healing environment and not grounded in evidence based science or facts.

Why are we talking about the ONE puke out of a hundred and attributing his behavior to asking for help to the rest of us? That maintains the culture of disbelief in the military and the VA and blocks the fostering of rapport building, a crucial first step in therapy. I have gone through dozens of therapist for many of these kinds of reasons. Right out of the gate I have always told the doctors and therapist what was going on with as explicit details as I could about the flashbacks and what I was experiencing. Mostly I saw disbelief in their eyes, and many told me directly to my face that I was lying. Decades stacked up this way, I would not get help because a therapist had a idea of what to expect from a combat veteran.

I am usually very agitated and stressed in therapy sessions because I know I am going all in. I would probably seem excited to the person looking for it, but my anxiety level gets me all jazzed up talking about my combat experiences. There are many reasons why a combat veteran would seem excited or want to talk about their combat experiences to an empathetic therapist. For me, every time I went into therapy I was at my wits end, it is always kill myself or go and try and get help. So I spill my beans, all of them, I regurgitate the undigested contents of my emotional stomach. We assume therapists are empathetic, but from my experience most are not.

I went through so many hack therapists at the VA it is a joke, but let’s not talk about that real issue. They have their checklists and surveys to go by and cannot connect in a meaningful way to facilitate healing. A therapeutic window is the term used, whereby an empathetic connection between the therapist and client enables a safe place for exploration of traumatic events. I finally wound up with the department head as my psychiatrist and I will only see a therapist he recommends.

We are killing our veterans by treating everyone of them who walk in the door as faking PTSD! We already know we will be treated as malingerers if we ask for help. One of the tasks for us sadly is finding a therapist who will not let their personal beliefs and issues leak into the therapy sessions.

Scott it is sad at the way that the government is handling the PTSD epidemic. I get frustrated just walking into the VA, then to deal with them talking to me like I am full of shit. It is a fucking shame that some vets just give up because they dont want to deal with it anymore. Patience is a virtue but I lost my virtue in 2004 living in the dirt. Keep up your great work.
Take Care Scott.

Mr. Lee,

Sounds like you got it. From your writing, you move from this was to this is now, I am doing.

I was in from 84 to 93. Got out from post Gulf force drawdown. I had PTSD, and other stuff, didn't know it. I was just really pissed off all the time, walking hallways sideways, hated crowds, hated loud noises, sleeping with every light in the house on, all the doors and drawers open, 4 hours of sleep a night, 9mm with laser kwik-spot zeroed to 100 feet locked and cocked with a round in the chamber under the pillow, and a .380 same deal in the drawer 1 foot to my right. hated sleeping in the dark, or at night. Woke up screaming.

I went 7 more years like that as a civilian and it took it's toll went through about 10 jobs, and it all fell apart.
I got into the VA system as a homeless civilian living in an abandoned building in Pittsburgh in August, 2001.
I had been "Missing time" Blanking out for a few hours, not knowing where I was, how I got there. Might be 3 or 4 miles away. Some kind soul saw me walking the middle of the street in my chocolate chips, and said hey, man, you a vet?
I was a wreck. He walked me to a place called the vets drop-in center. From there I went to the VA, and I was in the system since. That dude saved my life.

For me, it's not about crying. I just avoid trigger stuff, don't watch TV, don't read about the 'stan. Don't talk about politics, or war,no one can understand or relate. "Tell me a story..." I do the one about little 2 year old kid crushed under rubble, brains leaking onto the dirt, flies.. What a person that is flat looks like is roadkill, only.. wider. yeah that makes em walk off... I do my hobbies, which are me, alone, painting and doing crafts. I go once a week to my doc, (with the wife I met in late 2001) three or four times a year to my psych doc. Every 6 months to a personal care provider doc. My doc has been urging me to mentor younger vets. Check it out, they figure I am too old at a greying 46 to have anything they can relate to... "Pops, you just don't understand." Those 23 year old guys are me, at 23, confused as hell, like I was. The VA System in Pittsburgh is one of the best in the country. I do not get jacked with. I say meds are too much, or need more they are on it like rounds on target. Dental is pretty good. I have zero complaints about Physical, Dental, or MH treatment.

Thanks for your service. No lie. Welcome back to the World for what it is worth.
Drive on.

- A NAVY E-5 from PGH

You didn't give up your virtues, they were just rewritten in the box and now it's like a bright light shinning when people try and toss us their bullshit. This phenomenon will trigger us as we see through most facades; it can and will alienate us from everyone.

Barriers to care lie strewn about the VA like candy being given out on Halloween. It takes an average of 2 to 3 months to get an appointment with a therapist or psychiatrist unless you go into inpatient emergency care (suicidal or homicidal). Legally once you invoke these words they have to keep you for at least 3 days or it is determined that you are no longer a harm to yourself or others. So, you see the dilemma we face in making that decision.

It takes finding the right therapist and psychiatrist to heal from the complex nature of Combat PTSD. Keep gathering useful VA information, keep your mind on winning over the bureaucrat and not spiting them. This only hurts you and keeps the iron curtain of benefit denial alive. The VA culture is changing and in some regions you wouldn't know it, where others regions are better. So, the friendly and empathetic practitioner is at the VA waiting for you to find them. But, you may have to wade through the bullshit first.

Remember, our experiences tell us that we can get through this too.

Welcome home brother. Maybe being a mentor is the next step in your recovery. When the same message divines from three or more sources I feel it's resonance. Whether I resist or conform to God's plan depends on me.

The system we have learned to use can be intimidating to those of us newly in need of its services.

Peace be with you

I was astounded with the results of the recent investigations and applaud the findings and recommendations. I am a bit jaded, so this all came as a surprise, yep. More on it later in a post I'm sure. If I don't remind me.

Lol. There are many honorable veterans that have PTSD and deserve compensation and treatment. However, if you actually believe the rate of fraud is less than 1% I have a bridge to Nowhere in Alaska to sell you. It is commonplace for many veterans to overreport their symptoms in the attempt to gain a PTSD diagnosis. Or to get some other problem such as substance abuse or personality disorder diagnosed as PTSD. Happens every day in the US of A.

You must be quoting your beliefs and not actual facts, which I was doing. Let me guess. VA employee?

The recent VA investigations show this as fact and the recent Army investigations are in FACT overturning 1 in 3 cases back a diagnosis of PTSD. Further fact, the investigation is being opened to ALL military branches as of UNDER diagnosing. Same results as the VA investigation and you want to give some lame ass reasoning de facto manisfesto - Substance abuse, check. Personality disorder, check. PTSD r/o. Which in VA speak means 'rule out' or never give this diagnosis no matter what.

You must be of the Madigan Mental Health school of fuck em, they are broken throw them away. You are using the same reasons that were given to not diagnose PTSD, you really should do some reading and research. Your mode of thinking is being blasted all over the news as harmful to soldiers and veterans and part of the reason we are killing ourselves in droves. Probably making that up to, huh?

Thank you Scott Lee,

Its an untold nightmare what veterans with PTSD, constantly deal with. Not only the lumps in the dirt, to the pieces of plastic/metal on the side of the road, load noises, crowds of people, blood, guts, the children...

You were in an unimaginable situation doing the unthinkable in the name of the soldiers next to you and survived. Could be that you came home to return to your past life, or maybe war changed you and now wonder who you are. I was able to find purpose through writing and networking with others.

It's ok to be where you are and feel the way you do. Keep reading. I hope you are getting some help from the VA, you deserve to heal from your trauma.

Nice blog. I deployed to Iraq in 2004 with 2/2 Marines. I didn't realize I had PTSD until a couple of years ago. My life is a wreck as well. I've already been hung up on by the VA, and treated poorly. I just don't understand how they can advertise that they are there for us and then treat us like shit. I'm almost afraid to file a claim.

This is the first time I have visited a forum and am impressed with the conversation. I am not a veteran, my husband is. 1968 thru 1970. He volunteered to serve his country at the tender age of 17. I met him after his completion of boot camp. Therefore, I have been a part of his life since 1968.
I have personally experienced my husband's PTSD (which was not defined as such at the time). In the middle of a nightmare; he put me in headlock and was about to snap my neck. Luckily, I was about to wake him. I have experience the rage, the anger, the extreme hyper vigilance, and so much more. It has been a very hard life not only for him but his children and me.
The VA claims that if you are able to maintain a relationship then you can't have PTSD. What does that have to do with anything? Because I loved my husband and stuck with him. Why does he have to be punished because I chose to stay?
Work. He could not hold a job for more than 3 months. Some only lasted hours.
I have personally sat in on some of my husband’s sessions with his VA psychiatrics, and then acquired his progress notes a few weeks later. It is amazing how the VA doctors dismiss the most pertinent details.
You also have to be careful what kind of information you give these doctors. They have the tendency of taking your words and making them fit a predetermined diagnoses.
On the advice of another, we went outside the VA to get a diagnosis of PTSD. Not one doctor but two; both with a PTSD diag. The VA had no choice at this point but to recognize his condition. This only took 33 years.
Here is a kicker for you. One of my husband trigger is the VA. He walks into the clinic and the anxiety immediately kicks in. I am there with him. I see it happen.
My husband’s psychiatrics once told us that the VA "Discourages" them from getting involved in VA claims. What does that mean? He as once told that VA counselors would not help him because he smoked pot. What?
He has been diagnosed by VA doctors for everything from depression to schizophrenia but never PTSD until the outside doctors diagnosed him. He has been made to feel like a complete degenerate. My husband had dreams, these dreams were destroyed. He is now dying of cancer and is still fighting the VA for justice.
I could go on and on, after all, I have 43 years of history with the VA alongside my husband.
I wonder what ANONYMOUS has to say about that.

My husband was a Vietnam era vet. When he was discharged in 1970, he threw his uniform in the trash as he was ashamed to be seen in his uniform. Vietnam vets were mistreated and spat upon by the general public. This was on top of the trauma he endured while serving his country.
To top that off, our town was under martial law when he returned home due the racial riots of the 70's. For him, it was like not leaving the military at all.

The VA's responsibility should be: recognize the problem. The VA's goal should be: Help the Veteran get better. SIMPLE!
Denial is never the answer.

I would say there is a great organization that can help you with all of your issues concerning the VA and filing a claim. Family of a Vet is an awesome resource, they can help with the filing process and can answer your questions concerning the VA.

File a claim with the Veterans Administration Regional Office (VARO), they are run by the state and can help you file a claim. At the top of this blog is a navigation bar with "VA and Legel" In there you will find tips I suggest for filing a claim.

i entered MCRD san diego dreaming of proving myself to my uncles and father. they were all wwII vets. two uncles retired navy. i went to nam in 67. extended my tour. came "home" in 69 an E-1. i never made it all the way home. i been in I-corps, leatherneck square, happy valley, and danang ever since. too much of me is still stuck in the nam. i've been struggling with ptsd from combat and graves registration - body parts - lots of 'em. for 40 some years in and out of marriages, probably over a hundred jobs - don't do well with authority figures and bosses in general, and several attempts at VA outreach counseling. i hear the demands of the current crop of iraq and af/pak vets for help - NOW - and all the "support our troops" and "war fighters" hoopla and began to think - hey, wait a minute i been dying for 40 years. you been back one, two, or three years and you're already screaming for help. you got decades of dying and pain and tormented days and nights before you even come close to "needing" help. i was fired again (from a bus driving job) and ended up without work for over a year, and all that time on my hands led me to too much reading, thinking, and wondering if "today" was the day i was gunna' just do "it" - end it all - get it over with. a couple of other white haired old men in VFP (vets for peace)at an anti-war rally in DC said, time to surrender clyde. go back and ask again for help. i walked in to the VA hospital in austin, thought i was gunna' puke, pass out, and wake up screaming. a young vet came over to me and said, you look like shit man. come on over here and sit down. by the time he got done telling me part of his story i knew it was because of the recently returning vet's activism and the increased awareness of tbi and ptsd that maybe i was gunna' get help too. i aked him if he knew what to do and he said follow me. he signed me in and sat me down outside roon 107. they called my name. i went in and they got me started. when i went out to the waiting area he was gone. i went to the desk to hand in my completed papers and began my "work" at the local readjustment counseling service. i have been treated with respect and dignity and i am making my way back home. i was wrong - way wrong about the current returnees. it is their right and their duty to ask for and expect help and to get help for each other and maybe the rest of us who have been trying to make it on our own. that young vet saw a fallen grunt (0311) that needed to be "out of the field". he brought me to the "doc". he didn't leave me behind. he got me help. i'm going to do the same when it's my turn. i'm retired now and getting social security. i'm gunna' retire from vietnam too. i'm getting good help and making forward progress. thank you austin VA and thank you young vets. please don't leave us behind. we got enough MIA !

Welcome home brother, it took me 15 years after war to finally begin the journey of recovery and more recently to see the growth in myself. We do owe our younger veterans a debt of gratitude for the recent progress made in awareness and advocacy work.

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Please share your comments, stories and information. Thank you. ~ Scott Lee

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