In September 2004, the U.S. Government Accountability Office (GAO) raised questions as to whether the VA could meet an increase in demand for PTSD services at its facilities, emphasizing, "The VA does not have a count of the total number of veterans currently receiving PTSD services at its medical facilities and Vet Centers." It also pointed out that at six VA facilities investigators visited, the staff said they were able to keep up with current number of veterans seeking PTSD services, but might not be able to meet an increase in demand (GAO, 2004).
One year later, Gordon H. Mansfield, deputy secretary of the VA, testified before the House Committee on Veterans' Affairs, "The VA is aware that there has been particular interest about mental health issues among OEF [Operation Enduring Freedom, Afghanistan] and OIF veterans and VA's current and future capacity to treat these problems, in particular PTSD," he said. "First, I want to assure the Committee that VA has the programs and resources to meet the mental health needs of returning OEF and OIF veterans. Second, in regard to PTSD among OEF and OIF veterans, I want to assure you that the PTSD workload that we have seen in these veterans has been only a small percentage of our overall PTSD workload. In [fiscal year] 2004, we saw approximately 279,000 patients at VA health care facilities for PTSD and 63,000 in Vet Centers. Our latest data on OEF and OIF veterans indicate that as of February 2005, approximately 12,300 of these veterans seen as patients at [VA medical centers] VAMCs carried an ICD-9 code corresponding to PTSD. It is important to note, however, that this represents approximately 4.5% to 5% of VA's overall PTSD population. Additionally, more than 3,500 veterans received services for PTSD through our Vet Centers. Allowing for those who have received services at both VAMCs and Vet Centers, a total of approximately 14,600 individual OEF/OIF veterans had been seen with actual or potential PTSD at VA facilities following their return from Iraq or Afghanistan. This figure represents only about 3% of the PTSD patients VA saw in FY 2004."PTSD Benefits Controversy
A controversy over benefits exploded last August when the VA, acting on its Inspector General (IG)'s report, said it would audit files of 72,000 veterans who were receiving full disability benefits for PTSD alone or in combination with other conditions. That announcement generated a widespread backlash. Some veterans groups protested that the review of PTSD cases was an excuse to cut benefits for older veterans and toughen qualifications for future ones. The Senate passed an amendment to a military/VA appropriation bill seeking to restrict the audit. Press reports linked one man's suicide to the impending review (Benjamin, 2005). In November 2005, the VA dropped its full-scale audit plans, stating that most of the problems came from administrative errors and not fraud.
The focus on VA benefits for PTSD originally grew out of complaints from veterans about regional inequities in disability ratings and payments. For example, less than 3% of Illinois' disabled veterans are rated 100% disabled for PTSD, as compared to almost 13% in New Mexico (VA Office of the IG, 2005). Because of those complaints, in May 2005 the VA Inspector General examined the files of 2,100 randomly selected veterans with PTSD disability ratings. It found that 527 (25%) lacked documents to verify that a traumatic service-connected incident occurred before compensation benefits were granted. That 25% error rate equates to $860.2 million in questionable compensation payments in FY 2004, the IG report said. The IG also cited a dramatic increase in veterans filing for disability compensation for PTSD since 1999 (Table).
After the VA conducted its own review of the 2,100 cases cited in the IG's report, VA Secretary R. James Nicholson released a statement saying, "The problems with these files appear to be administrative in nature, such as missing documents, and not fraud. In the absence of evidence of fraud, we're not going to put our veterans through the anxiety of a widespread review of their disability claims." Instead, the VA plans to improve its training for personnel who handle disability claims and toughen administrative oversight.
"Not all combat wounds are caused by bullets and shrapnel," Nicholson said. "We have a commitment to ensure veterans with PTSD receive compassionate, world-class health care and appropriate disability compensation determinations."