Murphy's Law: Stress From Stress


April 21, 2010: PTSD (post-traumatic stress disorder) is becoming a major medical problem for veterans. Mental disorders have always been a major part of veteran disability, and those who receive compensation (disability payments) for it. About ten percent of veterans receive disability payments. Some 23 percent of disabled World War II vets were suffering mental problems. This went down to 17 percent for Korean War vets, and 13 percent during Cold War years when there was no war (about 75 percent of the time). But it went up to 32 percent for Vietnam vets, and then down to 21 percent for the Gulf War, but went up again, to 26 percent, for veterans of fighting since September 11, 2001.

There has always been a major problem with mental disability as a result of military service. This has become more the case in the last decade, as improved methods have been developed for detecting it. Still, in many cases, it's unclear who has it. But as the current wars go on, more troops are coming back who might have it. For example, since September 11, 2001, over 5,000 troops have been evacuated (as medical cases) from Iraq and Afghanistan for mental disorders. Only 16 percent of those were confirmed PTSD cases, the rest were for more familiar things like severe depression. Moreover, most of the troops in Iraq and Afghanistan are not involved in combat. Yes, they are living in a combat zone, but aside from an occasional mortar shell or rocket (which usually causes no injuries), most troops tend to have air conditioned sleeping quarters, gyms, Internet access, video games, good food and excellent medical care. It's unclear how many troops actually have PTSD, although many who are in combat, definitely are stressed out and in need of help. Over the last seventy years, the majority of veterans receiving disability payments for mental problems were not in combat.

The U.S. Veterans Administration is spending over $300 million a year on PTSD (out of nearly $100 billion spent on veterans annually.) Lawyers are increasingly soliciting troops coming back from duty overseas, and urging them to claim they have PTSD, and apply for disability benefits. Other nations have similar problems. The involvement of crooked lawyers in disability scams has been big business in the United States for decades. In the 1990s, the problem reached scandalous proportions as more lawyers discovered how easy it was to get money from the Veterans Administration for Vietnam veterans (and keep a portion of it for themselves.) The current flood of disability claims has caused a backlog of over half a million applications.

The problem with the lawyers assisting troops in scamming the government for benefits payments is nothing new. It has been going on for years in the civilian disability insurance and social security disability systems. Lawyers involved in class action suits, for large numbers of victims have been caught doing coaching, and records falsification, on a large scale. Veterans groups are trying to stem this sort of fraud, as it diverts money needed by veterans with real injuries, into the pockets of scammers. With the growing number of combat veterans coming home, the demand for resources will be higher than it has been for decades.

It's estimated that about three percent the 25 million American veterans suffer from PTSD. About ten percent of all veterans were in combat. Currently, only about half the veterans getting treatment for PTSD, are receiving disability payments (which largely go to those who have physical loss). But better detection tools are revealing that PTSD is more widespread than previously thought. Perhaps 4-5 percent of vets may have it, including many who were not in combat, but were stressed out simply by being in a combat zone.

Despite the careful psychological screening of recruits, there are also many (about two percent of all recruits) discharged for psychological reasons that are not related to military service. About fifteen percent of those discharges were for troops who had spent time in a combat zone. A new policy mandates more careful scrutiny of these discharges. That is because non-service related psychological problems, make the subject not eligible for disability payments.

The basic problem is that being in the military is itself a scary situation. For that reason, basic training is intentionally stressful, both to prepare troops for combat, and to screen out those who cannot handle combat, or just the military life. This stress screening is not unique to the military. Police and fire departments have to do the same thing. Medical professionals (doctors and nurses) are purposely stressed throughout their training, to find out who would get rattled. That can be fatal for a patient being treated in an emergency room, or during surgery. Those medical professionals who can't handle the stress, either switch to another profession, or go work in less stressful medical jobs.

PTSD (also known as shell shock or combat fatigue) usually first manifests itself while troops are still in the combat zone, if not always actually in combat. This has meant stationing lots of mental health personnel as close to the fighting as possible. Getting troops to acknowledge that PTSD is just another combat injury has proved difficult. But there is progress, albeit slow, in getting the troops to report problems they are having. But the crooked lawyers will coach troops to exhibit the right symptoms, and then guide them through the application process, in return for a portion of the disability payments received.

PTSD was first noted after the American Civil War. That war was one of the first to expose large numbers of troops to extended periods of combat stress. The symptoms, as reported in the press a century and a half ago, were not much different from what you hear today. At the time, affected veterans were diagnosed as suffering from "Irritable Heart" or "Nostalgia." Symptoms noted included fatigue, shortness of breath, palpitations, headache, excessive sweating, dizziness, disturbed sleep, fainting and flashbacks to traumatic combat situations. Many of these symptoms were noted while troops were still in uniform. During the 20th century, the condition came to be known as PTSD.

While the casualty rates in Iraq and Afghanistan have been a third of what they were in Vietnam, a greater portion of those wounded have severe injuries. These require expensive treatments, which sometimes last for decades. Like Vietnam, and World War II in the Pacific, troops often pick up exotic diseases, which are poorly understood back home, and these require expensive research to even find out exactly what the problem is. Then more money is needed to develop treatments.

Psychological injuries have always been difficult to treat, if only because they are often difficult to detect and measure. This has led to all manner of fraud and mistreatment of veterans. Research using brain scans, and better understanding of how the brain works, is making it easier to actually "see" PTSD, and other mental disorders. But until these afflictions can be identified as easily as a broken bone, or shell fragment in the arm, troops, and taxpayers, are going to be leery about it all.




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