Veterans benefits for post-traumatic stress disorder in the United States
The Department of Veterans Affairs (VA) began to provide disability benefits for post-traumatic stress disorder (PTSD) in the 1980s after the diagnosis became part of official psychiatric nosology.
Veterans who file a disability claim due to PTSD almost always receive a compensation and pension examination (C&P exam) by VA-employed or VA-contracted psychologists or psychiatrists.
Recent efforts to change VA disability benefits for PTSD include urging the VA to place more emphasis on vocational rehabilitation and treatment versus cash payments; revising the General Rating Formula for Mental Disorders to better reflect problems experienced by veterans with PTSD, and considering a veteran's quality of life when determining the disability rating.
Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event.
It is characterized by several of the following signs or symptoms: unwanted re-experiencing of the traumatic event—such as vivid, intense, and emotion-laden intrusive memories—dissociative flashback episodes, or nightmares; active avoidance of thoughts, memories, or reminders of the event; hyperarousal symptoms such as always being on guard for danger, enhanced (exaggerated) startle response, insomnia, trouble concentrating, or chronic irritability; anhedonia, social detachment, excessively negative thoughts about oneself or the world, marked guilt or shame, or a persistent depressed or anxious mood.
[11][a] The United States provides a range of benefits for veterans with post-traumatic stress disorder (PTSD), which was incurred in, or aggravated by their military service.
[15] Since the founding of the country, the United States has compensated the men and women who have served in its armed forces and uniformed services.
[16][17][18] Near the end of World War I, the U.S. Congress passed legislation establishing an indemnity model for veterans' disability benefits.
[19] Since that year, compensation has been provided to veterans who have physical or mental disabilities that were incurred during, or aggravated by, military service, and which have adversely impacted their ability to work.
The amount of compensation provided—both cash payments and VA-sponsored services—is based on the veteran's "average impairment in earnings capacity".
The U.S. Government Accountability Office (GAO) analyzed this recommendation and suggested that it be considered as one of three major changes to modernize the VA disability benefits program.
[28] Some scholars argue that the VA disability benefits program is counter-therapeutic because it provides no incentives to overcome symptoms and problems caused by the disorder, and, in fact, rewards veterans for staying sick.
[29][30] In a similar vein, a military scholar suggests that current VA disability benefits policy inculcates in veterans a lack of self-efficacy and fosters dependency.
[37] There are exceptions to the general rule that injuries or diseases incurred in, or aggravated by, military service are eligible for VA disability compensation benefits.
[47] After the VBA obtains all relevant documentation (evidence), the "rating activity" renders a decision regarding the veteran's claim.
[66] In 2012 the General Accountability Office reported that "VA's modifications of the medical information in the disability criteria have been slow and have not fully incorporated advances in technology and medicine.
The Initial PTSD exam must be conducted by a VA psychologist or psychiatrist certified by the VHA Office of Disability and Medical Assessment (DMA)[77] to evaluate veterans for this purpose.
[88] However, VA medical examiners are presumed competent to provide expert witness testimony[89][90] without having to meet FRE 702 standards.
[91][92][93] Researchers, current and former VA psychologists, investigative journalists, and individual veterans have expressed concerns about the inter-rater reliability and validity of C&P exams for PTSD.
[94][95] For example: Mental health professionals document the results of Initial and Review PTSD C&P exams on a Disability Benefits Questionnaire (DBQ).
In addition, VBA indicated that in recent years "... a growing industry of individuals and companies marketing the service of completing DBQs for Veterans ... [were] engaged in questionable, even fraudulent, practices ...."[131] VBA's decision to remove publicly available DBQs came in the wake of a VA Office of Inspector General report that recommended the action.
