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Rules Change for Vets’ PTSD Benefits

July 12, 2010 at 12:00 AM EST
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New government rules will make it easier for military veterans to claim disability benefits for those diagnosed with PTSD. Health correspondent Betty Ann Bowser reports.
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GWEN IFILL: Now: new rules for treating veterans suffering the psychological after-effects of war, post-traumatic stress disorder.

Health correspondent Betty Ann Bowser begins with this report. The Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER: Of the more than two million men and women who served in Afghanistan and Iraq, it’s estimated one in five will come home with post-traumatic stress disorder or PTSD.

But for thousands of those veterans and others from previous wars, getting the government to recognize their disorder and compensate them for their injuries has been difficult.

MAN: Good morning, ladies and gentlemen.

BETTY ANN BOWSER: Today, the Veterans Administration announced new regulations intended to make the process easier.

Michael Walcoff is the VA’s acting undersecretary for benefits.

MICHAEL WALCOFF, acting undersecretary for benefits, Department of Veterans Affairs: The VA is liberalizing the standard for veterans complaining PTSD by relaxing the evidence requirements for proving an in-service stressful event or stressor, streamlining the processing of PTSD claims which will result in veterans receiving more timely decisions.

BETTY ANN BOWSER: Under the new rule, the VA will pay disability benefits up to $2,700 a month and provide free health care to vets with PTSD, if they can show they served in a war zone and experienced fear or traumatic events believed to have caused their condition.

A VA psychiatrist or psychologist must also support the claim. The new rule applies to veterans of all wars. Under old regulations, a veteran had to prove verifiable names, locations and times when a traumatic event or stressor occurred, something many have found impossible to do many months after the fact.

President Obama said the change was long overdue on Saturday in his weekly radio address.

U.S. PRESIDENT BARACK OBAMA: I don’t think our troops on the battlefield should have to keep notes just in case they need to apply for a claim. And I have met enough veterans to know that you don’t have to engage in a firefight to endure the trauma of war.

BETTY ANN BOWSER: Nearly 400,000 veterans of all wars currently receive PTSD disability benefits. However, veterans advocate groups say only half of 153,000 diagnosed by the VA from Iraq and Afghanistan have been granted benefits.

Back in 2008, the “NewsHour” followed one such case that ended tragically, that of Specialist Scott Eiswert, who served in Iraq in 2004 as a driver for the Tennessee Army National Guard.

While there, Eiswert saw several of his friends blown up by roadside bombs. Yet, the VA repeatedly denied his claims for PTSD benefits, saying his condition wasn’t incurred or aggravated by military service.

TRACY EISWERT, widow of Specialist Scott Eiswert: No one told me what to prepare for, what to look for. No one said he would be different. No one said he would be angry. Nobody told me how different he would be when he got home.

BETTY ANN BOWSER: The “NewsHour” spoke with his wife, Tracy, just a few weeks after her husband committed suicide.

TRACY EISWERT: He said he just had faces, the faces of the dead, the blood and the body parts. He goes, that’s what’s in his head, not dates and names.

BETTY ANN BOWSER: After his death, the VA eventually agreed that Eiswert’s PTSD was in fact the result of his service in Iraq and granted his widow disability benefits.

Today, VA officials said they aren’t sure how many veterans will apply for benefits under the new rules, which go into effect tomorrow. But they believe they can handle any additional claims.

GWEN IFILL: Jeffrey Brown takes a closer look at the impact of the new rules.

JEFFREY BROWN: And, for that, I’m joined by Carolyn Schapper of Iraq and Afghanistan Veterans of America, a nonprofit organization that focuses on veterans’ issues. She served in a military intelligence unit in Iraq with the Georgia National Guard in 2005 and 2006. And Dr. Jeffrey Johns was an Air Force psychiatrist from 2001 to 2008 and treated many soldiers with PTSD. He’s now in private practice.

We invited the Veterans Affairs Department to join this panel, but they declined.

Carolyn Schapper, I will start with you just to talk about some of the important changes here.

One is relaxing the evidence requirements. We heard Betty Ann Bowser talk about it. Why is that so important?

CAROLYN SCHAPPER, spokesperson, Iraq and Afghanistan Veterans of America: That’s so important because a lot of people don’t keep paperwork, as you just addressed. The burden of proof has been very difficult for people that aren’t in combat arms units, such as women, that are being put on patrols, even though they may be finance, or even men who don’t have combat arms, like infantry and things of that sort.

So, if you don’t have the sworn statements that state that the activity happened or you weren’t writing it down or you don’t remember the dates, to this point, it was difficult for the VA to accept that.

(CROSSTALK)

JEFFREY BROWN: So, were people being kept out of benefits, or was it just — was it more a cumbersome process, or what, or both?

CAROLYN SCHAPPER: It was more time consuming.

First of all, you might have that burden of proof. Your line leader might have that burden of proof, but you would have to contact them, and that would take more time.

Or, if you didn’t have — or if it was just rockets flying over your head, there is no proof. It’s just a daily occurrence. And if you don’t have a combat action badge or a combat infantry badge, you also lack that proof.

JEFFREY BROWN: And, Dr. Johns, another thing they’re changing here is this reliance on a particular definition of combat service. Now, what would that mean in terms of expanding the definition of benefits and how that would work?

DR. JEFFREY JOHNS, former Air Force psychiatrist: Well, historically, the VA had taken a very strict definition of trauma.

And the president mentioned in his radio address the word firefight. And, for too long, the word firefight had been sort of a magic word that would open up the diagnosis and, therefore, the benefits of PTSD, within the VA system.

General Shinseki referenced an internal — an Institute of Medicine report in his op-ed day today in the USA Today that shows that simply being in a war zone does increase the risk of PTSD substantially. And they list several different types of trauma that can cause PTSD.

It could be being mortared, driving a truck, fearing that an IED would be around the corner, patrolling the neighborhoods, harassment from others, handling dead or wounded. And many of those events can be just as traumatic as a firefight or a bomb explosion.

JEFFREY BROWN: And, Carolyn Schapper, you mentioned this would have this — this broadening of the definition would have a particular impact on women.

CAROLYN SCHAPPER: Definitely, because women aren’t in combat arms.

Even though some women sign up for jobs in the military, such as military intelligence, medics, pilots truck drivers — and it goes on — that know they are going to be outside the wire every day, a claims processors at the VA may not assume — or may assume that that is not combat and deny their claim.

The same goes for the women that are being pulled out to screen women or to fill a spot in the convoy that traditionally aren’t in jobs that even leave the base.

JEFFREY BROWN: Now, Dr. Johns, would you expect a big increase in the numbers of those who qualify for benefits because of this?

DR. JEFFREY JOHNS: Yes, and as well there should be.

However, that will in the long term hopefully shorten the waiting time that individuals need to get their disability. However, in the short run, that could increase the waiting time, because you have more people applying.

So, these rules need to be matched by an increase in the providers who are capable of doing the evaluations, as well as the treatment that these individuals deserve.

JEFFREY BROWN: Well, explain that a little bit more because I think — I gather today the VA was suggesting that they don’t think they will need more providers to implement all this. You think that is probably underestimating the problem?

DR. JEFFREY JOHNS: Definitely far underestimating problem. The wait times are far too long for individuals to get the benefits they need. Between the time that someone applies for a benefits and they actually get them can be six months, eight months — or 18 months — excuse me — which is far too long.

The VA, even it sees its own patients, has far too long between appointment in order to provide the adequate level of care.

JEFFREY BROWN: How do you see this, Carolyn Schapper?

CAROLYN SCHAPPER: I see this very similar, that the claims will shorten in time, which the benefits are earlier.

But we want to make sure the people that are diagnosing — diagnosing PTSD are qualified to do that. And, right now, I don’t know if the VA has enough people, because right now the veterans are too far away from the hospitals in a lot of instances.

And I go to the VA in Washington, D.C. And there you kind of feel like you’re being processed through, that there are so many veterans there, that you only get 15 to 30 minutes. And you wait months for that appointment.

JEFFREY BROWN: Is there — what about the potential for fraud or abuse? It’s always been a question in this. As you expand the definition, is that a concern?

CAROLYN SCHAPPER: It’s definitely a concern. There’s always malingerers. There’s people in uniform that are trying to bilk the system.

So, once they get out, they’re still going to do the same thing. If people are so determined to get benefits for something that hasn’t occurred to them, they will find a way. So, yes, of course this is the way that they can do it. But the process of going through it, the number of interviews you have to go through is a lengthy process.

And you really have to be committed to fraud.

JEFFREY BROWN: Dr. Johns, what do you think about that potential for fraud, or malingerers, as she put it?

DR. JEFFREY JOHNS: The potential is there, but I think the — the larger picture is that so many individuals have been denied the (AUDIO GAP) and that it is our duty, as the president said, our sacred trust to provide them the care.

It has been an onerous process for individuals to prove the date, the location of a traumatic event and all the details there. The military is a tremendous bureaucracy that has not done a very good job and can’t do a job — great job of documenting all the horrors of a messy war.

JEFFREY BROWN: Now, let me stay with you on the question of cost, or the potential cost of this.

I have seen a wide range here. I have seen up to $42 billion over the next 10 years. But the VA today seemed to feel that it might not cost anything extra, because it would be saving time.

What — what do we know about that?

DR. JEFFREY JOHNS: I can’t imagine that to be the case.

I mean, war is expensive. And taking care of our troops is terribly expensive. If we are going to live up to the slogan, support our troops, we need to fund them, the VA, much more than we are doing right now.

JEFFREY BROWN: What do you think about the cost question, especially because we’re in a very tight budgetary environment, right?

CAROLYN SCHAPPER: It’s understandable that cost should not be a question, because our veterans need to be taken care of. And the sooner you take care of people with PTSD, the better their care is, the more likely they are going to get the education they need, start working again, and the costs eventually will decrease, because you’re not taking care of them for such a long term.

JEFFREY BROWN: But they will be there in the beginning.

CAROLYN SCHAPPER: They are going to be there, but they’re worth it. And the veterans deserve it.

JEFFREY BROWN: Let me ask you one last thing. Every time we look at this, inevitably, the notion of stigma comes up, the stigma of a soldier or a Marine going to say, I have — I have a psychological problem.

To what extent is that problem still there? And do you see any change — these new measures having any impact on that?

CAROLYN SCHAPPER: It’s certainly still there. I think, slowly, it’s changing. As Secretary Shinseki said today, it takes courage and determination to apply for these benefits, to say that you might have a problem.

And I agree with that. It’s the first step. And it shows the strength of a warrior to admit you have a problem and get the help you need. It’s going to take time. It’s still…

JEFFREY BROWN: The problem is not going away right away.

CAROLYN SCHAPPER: It’s not going away right away, but slowly, but surely, this is one of the ways to get towards it.

JEFFREY BROWN: All right.

Carolyn Schapper and Jeffrey Johns, thank you both very much.

CAROLYN SCHAPPER: Thank you.

DR. JEFFREY JOHNS: Thank you.