Pure Crap: Veterans' Mental Health Treatment First Act

Updated with additional links 2/27/08

My friend Maggie pointed me to this Opinion Piece (thanks Maggie!)

Sally Satel, a resident scholar at the American Enterprise Institute (just what is a resident scholar?? Do they LIVE there?) wrote this opinion piece for the Wall Street Journal in which she (once again) posits that veterans who receive disability compensation for the VA have no incentive to receive treatment... that, in effect, if you compensate an individual for his mental health disability, you are paying him to be ill.

And don't be fooled by this statement in the OpEd: "Last year the Government Accountability Office, the President's Commission on Care for America's Returning Wounded Warriors, and the Veterans' Disability Benefits Commission all urged that the disability, compensation and rehabilitation benefits systems be reformed and updated." While it's true that the GAO and these two commissions recommended many reforms, THIS legislation is not in response to those recommendations to come out of the reports and studies. This is just one of Dr. Satel's little pet theories she's willing to try out on Veterans. I watched her testimony before the House Veterans' Affairs Committee last May and pointed out Dr. Satel's (and others') clueless testimony then.

This scholar (how do you get to be designated a "scholar" and I'm not clear exactly what subject she is actually a "scholar"... Does a 5-year medical residency -- where PTSD may have been one of any number of neuropsychiatric disorders afflicting her patients make you a scholar on the many manifestations of combat-induced PTSD?? I digress.) Dr. Satel -- whose admirers love to cast her as the maverick challenging the establishment (how terribly '60's!) -- has been carping ("that posttraumatic stress disorder is a straightforward diagnosis... She questions... and speculates on why they are perpetuated. The case of combat veterans will be discussed with emphasis on the implications for failing to consider alternative explanations (and treatments) for post event phenomena." Yah.) and whining about PTSD in veterans for many years. This latest pronouncement in the WSJ is nothing more than a position she (and the Senator) have been promoting for a number of years (see the VA Watchdog site; see also, this Vietnam Veterans of America article.) Only this time they're disguising it as the Veterans' Mental Health Treatment First Act (Search S.2573 at www.thomas.gov for brief text.)

They like to characterize this latest proposed legislation as "helping wounded veterans" -- but that is far from the truth. For a person who has decried the "victimization" mentality, she and the Senator are doing a damn fine job of victimizing veterans with PTSD.

It is clear that this woman DOES NOT GET IT. Her AEI biography says she worked as "Staff psychiatrist, West Haven (CT) VA Medical Center, 1988-1993" although the Wiki bio says, "She completed her residency in psychiatry at Yale University between 1988 and 1993" so I assume she conducted her residency at the VA (that means she graduated from medical school and got to "practice" at the VA. Other than her political appointments and testimony before government agencies, it appears her only other work as a psychiatrist (per the NYTimes) is a sum of "12 hours a week as a psychiatrist at Dr. Clark's [Oasis] methadone clinic in northeast Washington." Oh... and she was a professor and is now a lecturer. Oh. Author. Although in her testimony before various Congressional Committees she says she "formerly worked with disabled Vietnam veterans", it is apparent she never listened to those vets. And it's clear she has no clue about patients coming directly or near-directly from the military to the VA.

While I find something rational in her reservations about veterans who 25 or 40 years after their military service suddenly develop PTSD) she has certainly never worked in a military setting when she says, "Judging an individual to be doomed to a life of invalidism before he has even had a course of therapy and rehabilitation is drastically premature, even reckless." [emphasis added]

I don't challenge the portion of her latest (2005) tome, "One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance" which she posits that a diagnosis of PTSD is too often assigned to people who just can't seem to deal with life's little annoyances (like minor auto accidents and moviegoers who have seen The Exorcist), but I can hardly imagine that anyone the VA has found to be disabled to a significant degree by PTSD is lounging around on that stipend and refusing to work.

First off, Dr. Satel, no one who has been found to be suffering from PTSD (or sought treatment for it) while in the service has simply been handed a ticket out of their commitment and then handed a check. There are evaluations, counseling and treatment requirements -- in both the military and the VA. If someone has been found unfit for duty as a result of his or her PTSD, they have been through more evaluations, counselings and reports than are ever required of anyone in the civilian sector. And, if they have been judged to be 100% disabled as a result of PTSD or some other mental impairment -- trust me, THEY ARE NON-FUNCTIONING. They are not just sitting around waiting for the check to come in... and they are most definitely not sitting around thinking, "Well I must be an invalid for the rest of my life because the government is paying me to be an invalid."

In her most recent OpEd, Satel says that $2,500 a month is nice for a struggling vet... and then goes on to say how detrimental this disability payment is, "By abandoning work, the veteran deprives himself of its therapeutic value: a sense of purpose, distraction from depressive rumination, a structure to each day, and the opportunity for friendships." You're kidding, right? Lady, you frick'n need to visit the real world on occasion. Other than the 100% disabled veteran, you assume that a veteran with PTSD is just sitting at home and NOT working. I have news for you, Doctor: Few veterans receive a 100% disability rating for their PTSD and few get even a 50% rating (which would translate to less than $750 per month)... for a 30% disability they would receive $348 per month. And you think they can afford to sit home and ruminate depressively? I also posit that if an OIF/OEF veteran has received a 100% disability, it was/is most likely as a result of a combination of his/her physical conditions and less for [claimed] mental impairments [if any]. The VA Compensation tables are here. See for yourself.

The people with whom I am personally familiar that have PTSD (whether mild or chronic and officially diagnosed or not) want principally to get on with their lives... but above all, they want to NOT have the symptoms of PTSD. All find their own ways to cope: counseling... medications... drinking... hard physical activity... sleeping with the light on... a combination of things. But I can assure the good doctor that these vets are not sitting around watching the soaps, eating bonbons and waiting on the direct deposit. Are there exceptions? Sure.

Dr. Satel in this current OpEd says, "Remarkably, something essential is missing from the claims process: treatment." No, it's not. Treatment is available for every Veteran who wishes it. And veterans who claim a service-connected disability for PTSD have to be evaluated by a clinician -- they have to have real symptoms and credible evidence that their service was a cause. Does the criteria for long-delayed claims (25 or 30 years later?) need to be revised? Probably. But this legislation doesn't address that problem.

I am highly uncomfortable not only with with Dr. Satel's 2005 pronouncement that "...the VA must beware of the disability trap: Veterans should not be urged to obtain long-term disability payments for at least two years after their return from overseas. In most circumstances, psychiatric conditions will be temporary. Moreover, generous disability payments provide an economic incentive to remain ill. In fact, work is often good therapy, providing structure, a sense of purpose and social opportunities" but also with her continued 2006 assault, "With a new generation of soldiers returning from Iraq and Afghanistan, the Veterans Affairs Department needs to look at post-traumatic stress disorder in a new way: the department must regard it as an acute but treatable condition." [emphasis added.] Treatable? Yes... although not always successfully and not always completely. And.Not.Curable.

And back in 2006 Satel proclaimed that, "Only in rare instances should veterans be eligible for lifetime disability..." So, let's follow Dr. Satel's logic: if a veteran loses a leg, the military or the VA provides a prosthetic and the Veteran learns to walk again, should we also end their disability compensation because they have been treated although not cured??

Dr. Satel and the Senator forget the principle of Veterans' Disability Compensation: The purpose of VA disability compensation benefits is to compensate veterans who suffer from disability related to service for an average impairment of earning capacity related to their disability. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (2002). [emphasis supplied]

Is the VA a perfect system? Hell no. But there are much more meaningful changes and modifications that have been recommended that will help it improve.

Are there those who take advantage of the system? Well yes. As with any system, once you know the rules you can beat it... but there are few (and Dr. Satel is one) who believe the fraud is widespread. Do we need to be sure that benefits are paid to those who truly need them? Of course. But this legislation does nothing of the sort.

Do we need a whole 'nother system of applying, certifying and paying? Hell No. Veterans already complete reams of paper work and forms for everything they do: getting into the services, seeking medical treatment in the services, leaving the services, getting into the VA system, and receiving care in the VA system. Veterans do not need one more layer of bureaucracy and paper work. The VA is not a welfare organization -- it is a system to reward (as in GI Bill, VA loans, small business incentives...) and to care for and compensate VETERANS when they need it. They have earned it.

Will this program actually encourage Veterans to get treatment and reduce the stigma of seeking treatment? Highly unlikely and No.

This proposed legislation should be sh*tcanned. The Senator would better spend his time trying to get legislation that is tied up in committee that actually responds to recommendations OUT of committee and before the Congress. And the money that would go to fund this useless piece of feel-good-does-nothing legislation would be better spent paying back the poor veterans who have had to REPAY the military branches for their medical severance payments or continue health insurance for medically discharged veterans.