Sam Jones 
Member since Oct 30, 2015

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Re: “Army still under fire for PTSD handling

ptsd can be a difficult diagnosis to make correctly.

very dependent on what the patient reports as symptoms. it can be easy to overlook a diagnosis if the patient is not forthcoming about symptoms, or denies any problems at all in order to exit the mental health care system as fast as possible. it can be hard to show that the diagnosis does not appear to apply to a patient whom you suspect does not have ptsd, but who would like to get the automatic 50% disability that comes with that diagnosis, especially if there is already another medical reason for discharge from the military.

unfortunately, in any disability system, military or civilian, there is always a percentage of patients who will, depending on the length of time they are in the disability system, whom they have advising them, and their sense of entitlement, think they deserve a maximum medical retirement and the monetary and other benefits that come with it.

at FT Lewis, in Tacoma, Washington, they had a forensic psychiatry unit evaluate 'questionable' cases of PTSD, that was pretty controversial. they eventually had to close the unit, and a number of patients they had denied the ptsd diagnosis to were re-evaluated at Walter Reed in D.C. it turned out that half the reviewed patients DID have PTSD. their diagnoses were re-instated, and that is good.

what is also significant is that half of the reviewed patients were determined NOT to have had PTSD. these appear to have been patients working hard to obtain the diagnosis in order to obtain an increased disability determination, and medical retirement.

there is a spectrum here. do you make a diagnosis of PTSD for everyone who claims the symptoms, insuring that most everyone who really has it gets the disability determination and medical retirement, but also insuring that many who do not have PTSD also get those same benefits (and the easier you make the criteria for diagnosis, the more will take advantage of it)? or do you make it impossible to make the diagnosis, insuring that patients who really have PTSD may not get the help they need for the rest of their lives?

clearly, not the latter. but, as a taxpayer, not sure the first is best either. perhaps a transparent second and/or third level review of 'gray zone' cases is reasonable.

but i'd also suggest a more vigorous effort to search out those who have PTSD but who deny it (because real troops don't get PTSD), or who don't seek out medical help because they don't understand what is happening to them, and end up in other difficulties. all troops who are subject to administrative discharge for issues of misconduct or non-performance should have a thorough evaluation for possible PTSD prior to discharge from service. but, there will always be people in the service who had problems before they came in, and we have to remember that too.

Posted by Sam Jones on 10/30/2015 at 1:06 PM

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