Support Our Troops with Dollars, not Magnets & Slogans

Wednesday, June 04, 2008 at 08:00 PM

The political world, especially at the right end of the spectrum, is full of "support our troops" mantras, supplemented by the millions of Americans whose cars & trucks sport magnets bearing the same slogans. Needless to say, slogans don't particularly help our troops, being incapable of restoring health, supplying food and shelter, or finding jobs for the vets. And it looks like, once again, those who scream "support our troops" the loudest have missed another opportunity to render support beyond words and magnets.

In the midst of the Clinton-Obama votefest, you might not have heard about the VA controversy involving a Doctor's e-mail suggesting that fewer vets be given the diagnosis of Post-Traumatic Stress Disorder (PTSD). This information was made public, and objections voiced, not by the Bill O'Reilly/Rush Limbaugh/Ann Coulter crowd, but by a vet working through groups like Citizens for Responsibility and Ethics in Washington (CREW), which posted the e-mail on its web site.

Here's the March 20, 2008 e-mail from VA Psychologist Norma Perez in full:

Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder R/O PTSD.

Additionally, we really don't or have the time to do the extensive testing that should be done to determine PTSD.

Also there have been some incidence [sic] where the veteran has a C&P, is not given the diagnosis of PTSD, then the veteran comes here and we give the diagnosis and the veteran appeals his case based on our assessment.

This is just a suggestion for the reasons listed above.

The "C&P" referenced in the e-mail is a "compensation and pension examination" at which a veteran's claim for compensation and/or a pension is assessed. Anyone interested in how this assessment process works for vets with possible PTSD can see this 3-part video from the VA.

Once the cat was out of the bag, there was a lot of reaction from vet groups and many angry citizens. NPR, that supposed collection of leftists sympathizers, did a story about the e-mail on May 23, shortly after it became public. From NPR's piece:

More and more military veterans returning from Iraq and Afghanistan are seeking help and compensation for post-traumatic stress disorder. That has created concern by veterans and others that the government could try to minimize the problem of PTSD to save money. An incident at a veterans' hospital near Fort Hood, the Army post in Texas that is one of the nation's largest military bases, has stoked that concern.

In an e-mail, a psychologist at the Olin E. Teague Veterans' Center in Temple, Texas, advised her staff to stop diagnosing veterans with PTSD to save money. The e-mail became public last week.

The head of the Department of Veterans Affairs insists that's not VA policy.

Psychologist Norma Perez was hired last summer to help coordinate a PTSD program at the center, which draws a lot of veterans. Not long afterward, Perez announced she would disband a dozen or so PTSD therapy groups, in which about 140 veterans met monthly with a clinical counselor. Perez wanted to replace the long-term groups with short-term plans — lasting no longer than three months — that focus on coping skills and cognitive processing therapy. The VA uses a broad range of therapies for PTSD, including group therapy.

Some veterans in the program said Perez told them that long-term group therapy doesn't work. Some vets accused Perez of personally trying to destroy their groups.

But Kim Larsen, a former Army medic and Vietnam vet with PTSD, who attended two VA forums about the plan to disband the groups, had a different impression. He thought Perez was simply the messenger. Then he saw an e-mail from Perez to her staff, advising them to "refrain from giving a diagnosis of PTSD straight out...." It was dated March 20.


Rep. Bob Filner, a California Democrat who heads the House Veterans Affairs Committee, said of Perez: "I can't believe that someone at that level position is doing this on her own. Somewhere in the hierarchy people are saying, 'It's costing us too much with these PTSD diagnoses. Cool it.'"

The VA has refused interview requests about the incident. In a statement, Secretary James Peake characterized the e-mail as an isolated example: "A single staff member, out of VA's 230,000 employees, in a single medical facility, sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health care organization."

The VA's inspector general's office is headed to Temple to find out if anyone higher up is telling the VA to "cool it."

Meanwhile, the VA has reassigned Perez from the PTSD clinic, but it won't say where.

Faced with the backlash, Dr. Perez "clarified" the purpose of her memo in a written statement submitted to the Senate Committee on Veterans' Affairs for a hearing held by that Committee today:
Norma Perez, who helps coordinate a post-traumatic stress disorder clinical team in central Texas, indicated she might have been out of line to cite growing disability claims in her March 20 e-mail titled "Suggestion." She said her intent was simply to remind staffers that stress symptoms could also be adjustment disorder. The less severe diagnosis could save the VA millions of dollars in disability payouts.

"In retrospect, I realize I did not adequately convey my message appropriately, but my intent was unequivocally to improve the quality of care our veterans received," Perez said in testimony prepared for delivery Wednesday before a Senate panel.

The Senate Veterans' Affairs Committee and the VA inspector general are investigating whether there were broader VA policy motives behind the e-mail, which was obtained and disclosed last month by two watchdog groups. The VA has strenuously denied that cost-cutting is a factor in its treatment decisions.


"The e-mail, as characterized by others, does not reflect the policies or conduct of our health care system," said Michael Kussman, VA's undersecretary for health, in testimony prepared for the Senate hearing. "We certainly agree that it could have been more artfully drafted."

The same newspaper report, however, goes on to note that (emphasis added):
Perez also noted that awarding disability benefits is not part of her staff's work, but she did not say why she chose to cite that as a factor in urging fewer PTSD diagnoses. Veterans diagnosed with PTSD are eligible to receive up to $2,527 a month in government benefits.

A recent Rand Corp. study found about 300,000 U.S. military personnel who served in Iraq or Afghanistan are suffering from PTSD or major depression, potentially saving the government millions of dollars if lesser diagnoses are used —rightly or wrongly — in disability benefits decisions.

Keep in mind that this comes close on the heels of charges that the VA is deliberately underestimating/underreporting suicides among vets. So, not surprisingly, today's Senate Committee hearing was heavy on criticism of the VA in general and Perez in particular (the hearing at which Dr. Perez testified is available on video here).

How much money is at stake in the classification war that appears to be going on at the VA? An AFP report today states:

According to a study released in April by the RAND Corporation about 300,000 of the 1.6 million US troops who have deployed to Iraq and Afghanistan since 2002 suffer from PTSD or depression, but only around half have sought medical care for the conditions.

The study estimated the cost of treating soldiers diagnosed with PTSD or depression in the first two years following their return from Iraq or Afghanistan at up to 6.2 billion dollars.

The Pentagon last month issued data showing diagnoses of PTSD among troops who served in Iraq and Afghanistan had climbed from 9,549 in 2006 to 13,951 in 2007.

On Wednesday, the Pentagon said it is recruiting government public health workers to offset a shortage in mental health care providers for troops returning from war with mental problems.

Could the rise in PTSD diagnoses be part of the price of "the surge" in Iraq? That depends on the dates of service to which the study's 2007 data correspond, but the connection is a real possibility.

The sad fact is that until recently, the long term consequences of military injuries were underestimated and undercompensated. In past wars, it cost a whole lot less to really "support the troops" simply because the mortality rate was so much higher among injured soldiers, and the survivors were simply expected to bear their psychological injuries in stoic (and unpaid) silence. The idea of measuring and compensating the so-called "invisible" psychological injuries had not yet really born.

In a country like America, which takes its capitalism seriously enough to equate capitalism and freedom, it's going to be a tough sell to get the money required to really support the troops. The system is, after all, capitalism, not humanism. No matter what they say in public, too many on the right, and certainly too many in the business and finance sphere, view human soldiers as a renewable resource, and money as the highest good.

Maybe if we collect all the vehicle magnets and sell them we can use the proceeds to contribute to the actual well being of the troops.

And I can't help wondering where Senator McCain stands on this issue, given his recent statements in opposition to newly proposed version of the GI bill.