How does a returning veteran with long term physical, mental and, especially, financial issues manage to fit in the VA system?
by G. Duff
According to how some of our leaders look at it, our troops in Iraq do little but trying to figure out how to get a leg blown off, a closed head injury or a lifelong case of PTSD just so they can have something to talk about “down at the VFW” and get that compensation check in the mail each month.
Years after troops have been coming back from our current war, we have suddenly discovered that we have some major but mysterious failures in the way we handle our wounded and traumatized.
Commissions have been formed, fingers have been pointed, paint has been slapped on, but predictably, things will go back to normal, meaning mixed benign neglect, as soon as the stories die down and the new TV season heats up…
What will be left, and what is there now, is a huge new group of returnees joining the queue at the VA at the same time the surviving Vietnam vets are moving into the age group that will confront them with life’s newest challenges in the form of catastrophic illness. This should be an old story by now as Vietnam vets such as myself vied for post war care when tens of thousands of World War 2 veterans began needing more and more medical care as they grew older.
I’ve seen the VA system for decades now and have visited some of the rehabilitation facilities run by the military. As much as I enjoy pointing fingers, I see tremendous improvements in treatment and case management over what was available 20 or more years ago. Quality of care is equal to or even surpasses care available to insured civilians and non-vets and can be delivered faster and with much less stress in many cases. Veteran’s hospitals and clinics can be a marvel of government capability and efficiency.
However, the problem is, how does a returning veteran with long term physical, mental and, especially, financial issues manage to fit in?
To start with, every veteran returning from a hazardous duty assignment must ASSUME THAT YOU WERE IN A HUGE CAR WRECK AND ARE NOT ENTIRELY SURE YOU ACTUALLY SURVIVED.
With what we have seen from Agent Orange, Gulf War Syndrome and the current epidemic of closed head injuries, traumatic amputations and PTSD, assume that what is wrong with you now may only be what you KNOW about and not the whole story.
One of the great problems with vets is that anyone with less than two major limbs missing feels guilty about demanding attention and treatment. Survivor guilt and simply being “sick and tired” of regimentation or hearing about the war you hope you may have FINALLY left behind can stand between you and doing what is absolutely NECESSARY.
A returning vet, healthy or not, is faced with a number of issues. There are, not necessarily in rational order:
1. Putting life with family and friends back together without everyone looking on you as some kind of freak. Vets, welcome to a very, very hard job.
2. Figuring out what you want to do and what you really should do and how you are going to do both of those knowing you are capable of screwing up both.
a. Holding onto what money you have despite the absolute need to buy a very fast car, motorcycle or a truck that could terrify a semi.
b. Using your educational benefits knowing they are painfully difficult to work with since you have to pay for your education UPFRONT and get paid back after PASSING your classes if you have not already starved.
c. Assessing your mental and physical health, arranging TREATMENT programs and filing for DISABILITY COMPENSATION that everyone has told you will go from mailbox to circular file at record speed.
d. Genuinely TAKING CAR OF YOURSELF, staying in contact with your friends from home, fellow Vets and active duty buddies. These are the people who may end up keeping you alive.
Medical care and health issues, both physical and mental, related to military service, must be dealt with both because it makes sense and also because any problems must be documented immediately. Some things get better, some things stay the same and some things get worse. When these THINGS interfere with your ability to earn a living or live a decent life they MAY also be issues for DISABILITY COMPENSATION and related programs that MAY someday help you and your family in ways you have not THOUGHT about yet. Trust me on this.
Treatment is the first issue. Wounds, traumatic injuries, illnesses or psychological problems have to be addressed IMMEDIATELY.
Starting medical treatment at the VA is easy as making a phone call and showing up for an appointment. A SUCCESSFUL MEDICAL RELATIONSHIP WITH THE VA IS NOT ALWAYS EASY. The guidelines are simple:
1. Never miss an appointment.
2. Never miss an appointment.
3. During your first appointment with your Primary Care Physician, carefully review EVERYTHING you think is wrong and carefully ask your doctor what he or she thinks may also be a problem. Consider taking notes and writing it all down.
If you and your Primary Care Physician are not going to be able to get along please ask the Nurse Practitioner for a recommendation and explain how you feel. If there is help to give in this area, your VA Nurse Practitioner will do what is possible.
Remember, every medical complaint you come up with can generate tests, diagnoses and treatments, including medications. Doctors are human also, so don’t talk yourself into getting your hangnail treated with a chainsaw.
HOWEVER, BE SURE THAT YOU AND YOUR DOCTOR PLAN A FOLLOWUP ON EVERY ITEM NEEDED. SHOW UP FOR THAT APPOINTMENT.
4. If it turns out you need treatment for, let’s say, chronic pain, PTSD, dental problems (if qualified or within time limits) or additional physical therapy, come to a VERY CLEAR UNDERSTANDING regarding EVERY TREATMENT OPTION AVAILABLE to you. Sometimes the VA has problems in this area.
If you are facing long term treatment for serious physical or psychological problems, you are going to need friends and family to support you. If you have neither, I suggest you locate veterans with similar issues through people you have served with or on the internet. There are vets from Vietnam and Desert Storm around who have learned to work within the system and who are realistic and helpful. There are also plenty of people out there if you look. These could and probably will be your friends for a very long time. Find people to help you and learn to help others. It is what vets do.
Service organizations are a mixed bag. Some service organizations simply don’t have the budget for qualified service officers to work with veterans. Some service organizations are simply a joke. If any group is going to help, it will always be the DAV. However, in many areas of the country, the American Legion, VFW and others have some great organizations and excellent people. Do not depend on service organizations to manage your claims or take care of you. You may be lucky, you may not. The really great people who have given their time and effort to help veterans through these organizations should and will tell you the same thing. Trust no one but yourself.
I am going to put my foot into it now and bring up PTSD. There is always lots of talk about PTSD but little “straight talk”. The government calls PTSD a “management problem” based on the potential of spending billions treating a disease without a clear cure that, through its nature, necessitates at least some DISABILITY COMPENSATION for EVERY victim.
We now have VA psychiatrists who are being trained, we hope, to identify PTSD sufferers and the military is refining programs designed to identify soldiers with Post Traumatic Stress. What those of us with a dark and slightly paranoid demeanor tend to ask, is whether our government is legitimately working to help PTSD victims or is simply trying to head off thousands of new Compensation claims that will cost billions in pensions and medical treatment.
I need not identify PTSD here. A useful website for reliable information on PTSD is www.drelainetripi.com.
Mostly I want to quickly note that it is not only people in daily combat who can suffer from PTSD. Some of the most severe cases I have seen have been from “peacetime” Cold War duty on submarines, guarding prisoners of war (do we call them “enemy combatants” or “detainees” now?) or what is often referred to as “rear echelon” assignments. In civilian life, PTSD is common for emergency response workers, police or crime victims. Narrowing those we look at may end up being very dangerous.
Worse yet, returning vets with PTSD can spiral out of control if some of the symptoms, such as depression, are untreated or if faced with school, marriage or job stresses. PTSD doesn’t stop when you hit CONUS.
Vets with illnesses such as Agent Orange, Gulf War Syndrome or other service related problems including and especially traumatic injuries can have significant increases in PTSD symptoms exacerbated by the continuing fear and stress brought on by illness itself.
A vet who seems OK when evaluated in the military or OK when returning home can deteriorate suddenly with a divorce, job loss or similar. I am not sure this is part of the current “straight talk” returning vets are getting but it should be.
Overtly, we think of PTSD as resulting from fear and stress from enemy contact over an extended period of time and, generally, one or more specific life threatening “stressors” that can overwhelm day to day reality, even years later.
Dr. Tripi’s site or others we can Google will outline symptoms and suggest treatments. This is a good place to start.
The issues confronting a vet with PTSD are treatment and disability compensation. For many years, VA doctors have not always helped veterans with a qualified diagnosis of PTSD sufficient to support a successful compensation claim, even though the veteran is being treated for PTSD at a level that would normally merit disability compensation.
This is not always the case, and is currently changing for the better, but I STRONGLY suggest that any veteran who has good reason to believe he has PTSD seek treatment at the VA but also seek a confirmed diagnosis from a qualified professional in the private sector, should the veteran seek to apply for benefits.
Compensation is important because PTSD is known to get worse as years go on. What may be “adjustment problems” or “anger issues” along with a few panic attacks and some social withdrawal, traditionally seen as “normal” for combat vets can turn into something too unpleasant to describe 10 or 20 years later for reasons that nobody has been able to explain to me or anyone else. However, generations of combat veterans can attest to this. Maybe early diagnosis and treatment can help and current programs will prove to be significantly beneficial. None of us really know because nobody with “old PTSD” has had an “early diagnosis.” I don’t suggest anyone wait for the vaccination!
The key is to get early treatment, stay in contact with other vets with PTSD and make sure you receive compensation based on your real disability level. The government has a very, very bad reputation for helping veterans with compensation and will have to go a very long ways before even beginning to be remotely trustworthy. Current changes in VA policy require the VA to help disability compensation applicants get needed information and to help them with their claims but this policy has yet to have proven itself effective.
Please carefully note that use of alcohol and drugs, even if it may plausibly attested that their use is tied to stress related problems, will not, in itself support a claim or diagnosis. It also won’t help you get better. Getting clean and staying clean is an important part of the treatment. Diagnosing and treating someone with PTSD who is high or drunk is not possible.
A real problem has been that veterans with PTSD are the worst people in the world at navigating almost impossible administrative processes created by the VA. In some areas, helpful VA employees work with veterans to supply records, get both treatment and diagnosis and work through the claims process. In other areas, application forms are repeatedly lost, processing times work themselves into months and years and applicants with well documented severe cases of PTSD receive little or no compensation. The VA has promised that this has been fixed. It has not!
I hope this is clear. If it looks like you have PTSD, seek treatment and also get a qualified diagnosis from the VA or a qualified private professional. File for compensation quickly and support your claim as asked. A service representative from the DAV or other organization can help you with the forms but I suggest you mail them yourself CERTIFIED and keep the receipt very carefully available. Think about a bank in Switzerland.
It is very likely that you will be asked for documentation of military service and other medical records after submitting your application. Please work very hard to supply everything you are asked for. Consider getting letters from members of your unit who can verify situations and conditions. Statements from friends and family members regarding changes since returning from service can also be helpful. If you are having difficulty getting documents you need, please contact the VA and request help. Remember to document these calls and note who you talk to. If possible, try to work with the same person every time.
The VA will schedule a Comp and Pension hearing to judge your disability rating. Whatever diagnosis or support you have submitted, the findings of this doctor based on this hearing will matter most. Everything about you will be observed and your answers to questions will be the only direct input you will be able to give. Too often, veterans are ashamed to admit minor things like the fact that they might think about killing themselves a bit too often or seem to have the same dream every night. These are good things to keep to yourself at a cocktail party or golf outing. Keeping them to yourself at a session with your VA psychiatrist or especially at a Comp and Pension hearing is idiocy.
Do note that if you are awarded a disability, you will be reviewed and the award will be lowered if and when you get better. This is fair and reasonable. Also note, however, that if you get worse, your compensation will not be increased. You will have to file claim and support your worsened symptoms with a new diagnosis. Welcome to reality!
Should you disagree with the findings of the Comp and Pension hearing, please file a timely appeal. However, an appeal requires some basis other than simply saying that the doctor is a “fathead.” You must be specific as to which part of their finding you disagree with and support that with documentation from your VA psychiatrist or a private physician. Without doing so, you are not going to be successful.
If all of this sounds difficult and stressful and far too demanding for anyone who is fighting PTSD and trying to keep working, holding together a family and/or getting an education, you are absolutely right. This really isn’t a plot although it seems, at times, as though it may be. Believe me, the government is smart but not that smart. One thing they won’t do at the VA is shoot you.
A PTSD claim is, perhaps, the most common type and, thus, the one I have spent the most time discussing. Most of what we have gone into here can and will apply for other physical difficulties.
Keeping a broad and healthy outlook while working with an excellent but somewhat flawed healthcare delivery system such as that at the VA or working your way thru the long broken compensation process is going to put you in contact with, not only other vets, but VA employees in a variety of specialties.
Whatever you may or may not have heard, I believe the best people in the world work at the VA. I also know that a “good patient” is one who asks questions, shows up for appointments, is understanding and polite with VA employees but also insistent that everything that can be done is done. Expect to be periodically uninformed and misinformed. It has happened and it will continue to happen. If you don’t like the answer you have gotten, be patient, be polite but ask someone else. Never give up. Never walk away.
A perfect world is coming soon. I see it right around the corner. Between then and now it will take many of the skills that kept you alive “over there” to keep you alive and healthy over here.
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