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12.08.2015 07:55
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Distinguished members of the Subcommittee on PTSD of the Gulf War & Stress: Health Project new balance sale online , Vietnam Veterans of America (VVA) thanks you for the opportunity to present for the record our views on the current state of clinical diagnoses and the disability compensation claims process as accorded our nation's veterans suffering from PTSD. * First, Vietnam Veterans of America applauds this Committee for its obvious concern about the mental health care of our troops and veterans. VVA cautions, however, that providing the appropriate PTSD clinical diagnoses and services to assist these women and men requires both an understanding of the stresses and stressors to which they have been exposed and the willingness to commit the financial and personnel resources necessary to help these veterans cope and perhaps eventually recover. Evidence overwhelmingly supports the need for early intervention and treatment of PTSD and related mental health disorders not only for active duty troops and veterans but for their families as well. We must accept that only through early intervention and treatment can we hope for the recovery of our troops and veterans from the mental health diseases caused by the trauma of war. But as Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs observed in his testimony before the House Subcommittee on Military Personnel in October 2005, "no one who goes to war remains unchanged." There is no longer any doubt that the combat experiences of veterans can and often do cause mental health injuries that can be just as debilitating as physical wounds. If left untreated, post-traumatic stress disorder and other psychological traumas can affect combat veterans to the point that, over time, even their daily functions become seriously impaired. This places them at higher risk for self-medication and abuse with alcohol and drugs new balance uk sale , domestic violence, unemployment & underemployment, homelessness, incarceration, suicide, and even medical morbidities such as cardiovascular diseases and cancer (1). No one really knows how many of our troops in Iraq and Afghanistan have been or will be affected by their wartime experiences; despite the early intervention by psychological personnel, no one really knows how serious their emotional and mental problems will become. However, recent reports have suggested that troops returning from service in Afghanistan and Iraq are suffering mental health problems at a rate higher than the levels seen in Vietnam War veterans (2, 3 new balance sale uk , and 4). In fact, VVA has no reason to believe that the rate of veterans of this war having their lives significantly disrupted at some point in their lifetime by PTSD will be any less than the 37 percent estimated for Vietnam veterans by the National Vietnam Veterans Readjustment Study (NVVRS) conducted some 20 years ago. Since 1980, when the American Psychiatric Association (APA) added PTSD to the third edition of its "Diagnostic and Statistical Manual of Mental Disorders (DSM-III)" classification scheme, a great deal of attention has been devoted to the development of instruments for assessing PTSD [see Keane et al., (5)], as well as to psychotherapy and pharmacotherapy PTSD treatment modalities [see Foa et al., (6) and the National Center for PTSD's Fact Sheets (7)]. Under intense pressure from Vietnam veterans and their Congressional supporters, the Department of Veterans Affairs subsequently developed a unique range of mental health diagnoses and care services to assist veterans with managing or even overcoming the most troubling of the symptoms associated with PTSD, and the VA disability nike shox r4 womens , compensation, pension, and benefits system was amended to provide appropriate financial redress for the debilitating effects of PTSD or other mental health disability compensation claims related to military service. But the adjudication of PTSD claims continues to be a complex, constantly evolving exercise affected by regulations, legislation, and the latest medical research. Often the VA orders a compensation examination by a VA clinician or contractor to establish proof of a service-connected PTSD disability. However, by the outset of the "Global War on Terrorism", Congressional investigations and G.A.O. reports noted that the VA was experiencing a chronic and growing claims back log which it has had little success in reducing. Because of reductions in staff at both the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA) -- mental health staff in particular -- and other key organizational capacities in general since 1996, too many clinicians and adjudicators (mis)-placed an emphasis on productivity rather than quality or accuracy and believed that they must see clients quickly nike shox tl womens , even if their examinations did not yield accurate clinical data or the correct information upon which to adjudicate the claim. Veterans' complaints of 15-minute or 30-minute examinations that were by the very nature of the process grossly inadequate to the point of being malfeasant (with strong pressure to continue these unconscionable practices) became commonplace. Many incorrect diagnoses have undoubtedly occurred as a result. Subsequent VA attempts to address the problem led to significant variations in disability ratings by region and adjudicators for PTSD-related claims and other mental health disorders. Although post-traumatic stress disorder is a commonly compensated condition (i.e., awarded PTSD claims constitute about half of all awarded claims and about a quarter million veterans are currently compensated), it is important to note that PTSD is NOT the most variably rated disability; there are other disabilities for which ratings differ far more drastically, infectious diseases, for example. But this misconception has led to extravagant claims by some that the majority of PTSD-related claims are fraudulent and that a "secret underground network advises veterans where to go for the best



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