VA Department Adapts to New Kinds of Battle Scars

July 17, 2007 — -- A suburban Virginia hotel replete with chandeliers, carefully arranged tables and air conditioning seems an unlikely place to discuss the harsh realities of war.

It is far from the roadside bombs, civilian deaths, baking desert temperatures and constant threat of attack U.S. troops face on the ground in Iraq and Afghanistan.

But it was in this comfortable setting that the Department of Veterans Affairs met Monday for a forum on the mental health of returning veterans.

"The wounds of war are not always the result of explosions and rocket fire. They can sometimes be unseen, and cloaked in silence," said VA Secretary Jim Nicholson, who announced his resignation Tuesday, just one day after the conference.

"Whether it's called soldier's heart … shell shock ... battle fatigue … or post traumatic stress disorder, the effects of the stress of combat demand and deserve our full and immediate attention," Nicholson, himself a decorated Vietnam Veteran, said.

Wounds of War Beneath the Surface

Signs on either side of the podium read "Caring for the Whole Veteran" -- referring to mental and physical health -- and it was this message of bipartite coverage that was conveyed to the audience of mental health professionals and VA staff.

Nicholson emphasized his agency's flexibility in handling veteran's health care in the 21st century, pointing to a five-year plan to implement the VA's comprehensive Mental Health Strategic Plan.

Currently at the midpoint of its implementation, the plan calls for increasing the number of mental health workers (more than 9,000 are employed) and standardizing coverage in all facilities.

According to Nicholson, every VA facility now has the capacity to handle post traumatic stress disorder.

PTSD is caused by a severe traumatic even, and the VA recognizes the condition among those who have experienced symptoms for 30 days or more.

It is a treatable condition that afflicts "a significant minority" of returning veterans and is addressed with a combination of psychiatric medications and cognitive therapy, among other techniques.

Mental Health of Soldiers

Mental health has long been a closeted issue within the military, where many soldiers view depression, anxiety, PTSD as signs of a weak character instead of the recognized medical conditions that they are.

The American Psychological Association recently reported that one-quarter of soldiers and Marines returning from Iraq had psychological disorders.

About 15 percent of veterans returning from the war in Iraq are diagnosed with PTSD, and the diagnosis is roughly equal among male and female soldiers, according National Center for PTSD statistics.

Alfonso Batres, chief readjustment counseling officer at the VA, spoke about the necessity of outreach efforts for veterans returning from Iraq and Afghanistan, many of whom are National Guard troops without the solid support of the traditional military structure.

"A lot of soldiers would not access care because of the stigma," Batres told the crowd, calling for a "safe haven for these veterans" to assist in their readjustment and treatment.

Quality of Care in Question

Even those who seek treatment upon returning from abroad have often had difficulty receiving the care they need.

Numerous reports of inadequate coverage and unaddressed concerns have outraged the public and led to legislative inquiry on the matter. There was little comment on those concerns at the conference, which focused on progress being made within the VA.

Earlier this month ABC News reported on the questionable treatment of Iraq War veterans under Chapter 5-13, a procedure that allows for discharge based on a "maladaptive pattern of behavior of long duration."

Some of those discharged on those terms, including Army Spc. Jonathan Town, claim that their mental illness was caused not by a pre-existing condition but by their experience in Iraq.

After such a discharge, the military no longer has to compensate soldiers for their treatment.

Dr. Matthew Friedman, executive director of the National Center for PTSD, was a speaker at the VA forum.

He explained that while he cannot comment generally on the issue of pre-existing mental illness, it is logical that a "person with pre-existing problems may have been functioning quite well" with minor mental issues that were exacerbated by the war or that their mental illness could be "a completely new issue" caused the conflict.

Recent research indicates post-traumatic stress could be caused by long-term exposure to a high-stress situation, events like prolonged combat exposure, in addition to the usual diagnosis that seeks to pinpoint a singular cause such as the death of another soldier or an explosion.

That specific definition limits some veterans from qualifying for compensation.

Dr. Ira Katz, a psychiatrist and deputy chief consultant for patient care services for Mental Health at the VA, told the Washington Post in a recent interview, "One of the things I puzzle is, what if someone hasn't been exposed to an IED but lives in dread of exposure to one for a month? According to the formal definition, they don't qualify [for compensation]."

When asked by ABC News why a lead mental health official in the VA disagreed with the organization's own policy, Nicholson explained that there was a broader "legal framework" surrounding that apparent contradiction.

He did concede, however, that "the manuals are out of date" and that as part of the department's mental health modernization efforts, it "will be updated."