SAN DIEGOÂ — New, relaxed regulations for veterans seeking health benefits and disability compensation for post-traumatic stress disorder could have major implications for San Diego, a hub for military health care and home to more than half a million veterans.
At the heart of this change, which became effective in July, is a shift in the burden of proof required for veterans seeking help with PTSD. Prior to this ruling, veterans seeking benefits and compensation were required by the Department of Veterans Affairs to furnish corroborating evidence that the trauma they experienced was directly related to military activity.
“If you said you were in a fire fight on [a particular] day and people were killed, they may have required you to provide evidence, like someone else’s testimony saying it occurred and the vet did what he said he did,” said Phil Landis –Â president and CEO of Veterans’ Village of San Diego –Â a not-for-profit organization serving homeless military veterans.
That requirement often stalled claims from being processed for years as VA searched for records that often didn’t exist or were difficult to obtain.
The New Process
According to the new VA regulations, individuals stillÂ areÂ required toÂ prove that their trauma occurred as a result of a war-related incident. Veterans’ accounts of PTSD will be assessed against their service record, including the places where they served and under what circumstances. This, along with a diagnosis of PTSD from a VA psychiatrist or psychologist, is enough to establish disability under this new regulation. The changeÂ is expected to streamline the claims process and reduce the amount of time veterans must wait for benefits to kick in.
“Instead of proving that the veteran was involved in or witness to a specific trauma and providing documentation of such trauma, the veteran had to be diagnosed with PTSD regardless of the stressor,” said Kathleen Kim, acting chief of psychiatry with the VA San Diego Healthcare System.
According to Kim, approximately 24,000 San Diego-based veterans from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom are enrolled through VA for health care.
Nationally, more than 400,000 veterans are receiving benefits for PTSD-related symptoms.
An Onerous Process Corrected
The change in the PTSD benefits process has been hailed by advocates as a positive step toward creating greater and much needed access to services for people with a condition that has been historically difficult to prove. PTSD determination, according to the VA, is science-based and relies on evidence that deployment to a war zone is linked to an increased risk of the disorder.
According to Landis, veterans often seek treatment for PTSD many years after the event causing the disorder took place, which makes it particularly difficult to offer corroborating evidence. It also leaves room for details about the traumatic event to be lost. “The traumatic memory plays tricks on itself over time,” Landis said.
The demanding and lengthy process of filing for PTSD-related benefits has, itself, been stressful for many veterans. “As a clinician, I suspect that this [ruling] was a response to complaints about the existing process,” said Kim.
“If there are roadblocks to filing, the process causes stress on an individual already overloaded,” said Bill Rider –Â CEO of American Combat Veterans of War –Â a San Diego-based not-for-profit organization that works with veterans suffering from combat stress.
A Gain for San Diego Vets
The move away from proving PTSD also is likely to make a difference in the lives of San Diego veterans who haven’t served in roles of direct combat. Historically, it’s been difficult for these people to prove war-related trauma. Women, in particular, may gain greater access to benefits as a result of this ruling.
“We have female service members who drive trucks in convoys and combat theaters,” Landis said. “That’s a very dangerous job. Many of the convoys, especially in Iraq, were targets.”
In addition, Rider points out that female service members are more likely than their male counterparts to become traumatized during war. Isolation and increased risk of sexual assault while in the service are just some of the reasons, according to Rider.
“It’s worse for women because they have to be stronger and can’t show fear,” Rider said. In addition, Rider said, women tend to have fewer opportunities to bond with their primarily male colleagues while at war, often leaving them without someone with whom they can discuss their fears.
“If you can’t talk about your fear, it gets worse,” Rider said.
The impact of this change on VA’s health care delivery system could be big, but theÂ effect is yet to be determined.
The new rules will apply to recently discharged veterans from Iraq and Afghanistan, as well as to veterans of all previous American wars.
“I would think there is the potential for an enormous number of claims to flood the VA,” Landis said. San Diego VA is making the effort to meet the demand, he said.
“I believe that the regional office is hiring claims adjusters at a rate they have never hired before. The VA is doing an enormous amount of back-fill with staff to accommodate the vets making claims,” according to Landis.
Whether the change in the way PTSD disability is determined increases the workload for the San Diego VA remains to be seen. The Veterans Equitable Resource Allocation Model, which was established to accommodate changes in the practice of medicine and in the delivery of health care services, will respond with increased funding if the need presents itself, Kim said.
“This doesn’t mean that there won’t be problems, but we believe that we are prepared and will address issues as they arise,” she said.
Problems on the Ground
Since the new ruling took effect in July, Rider said he’s still had to fight for veterans in need of benefits. He said he has recently assisted some veterans who are clearly injured, yet have had their benefits.
“We’re afraid they will drop the requirements of OEF and OIF warriors coming home. They are bringing them back up for review after 18 months,” Rider said.
But Landis believes that while there are weaknesses,”the vast majority of claimants are compensated fairly over time.”
He’s also not overly worried about the possibility of fraud, which has been a cause for concern as a result of the relaxed regulations.
“The VA is very good at winnowing out [fraudulent claims],” Landis said.
A Greater Need To Come Â
Unfortunately, the nature of our modern wars leads some experts to predict growth for the occurrence of PTSD.
According to Landis, soldiers are increasingly engaged in urban combat, which is intensely stressful, and are also being redeployed multiple times.
“The very tempo of these wars puts enormous stress on vets and their families,” Landis said.