February 26, 2008 – Imagine you are a young soldier wounded in Iraq. Your physical injuries heal, but your mind remains tormented. You are flooded with memories of the bloody firefight you survived, you can’t concentrate, and sudden noise makes you jump out of your skin. At 23 years old, you are about to be discharged from the military, afraid you’ll never again be able to hold a job or fully function in society.
For the thousands of young men and women who apply for disability benefits upon return from Iraq and Afghanistan, these fears are becoming a reality.
When a veteran files a psychiatric disability claim with the Department of Veterans Affairs (VA), an examiner is assigned to determine the extent of incapacitation. As part of the assessment, the examiner requests a psychiatric evaluation to obtain the veteran’s diagnosis. Once the veteran is diagnosed with a service-related mental condition (typically depression, post-traumatic stress disorder or another anxiety disorder) the claims examiner assigns a disability rating.
The most severe level for a veteran leaving service is 100%. But even a 50% rating denotes significant impairment (e.g., “difficulty in understanding complex commands”), according to the Veterans Benefits Administration.
Remarkably, something essential is missing from the claims process: treatment. Veterans can go straight to a claims examiner and be granted psychiatric benefits without ever being treated for their mental illness. Some even do so as soldiers, just prior to discharge from the service. Judging an individual to be doomed to a life of invalidism before he has even had a course of therapy and rehabilitation is drastically premature, even reckless.
In the short term, yes, a monthly check of about $2,500 for full disability, tax-free, is a great relief to the struggling veteran and his family. But serious consequences can accompany a rush to judgment about a veteran’s rehabilitative potential.
First, a veteran told he is disabled may think: Why bother with treatment? But this would be a terrible mistake. The postdischarge period is when symptoms are most responsive to interventions such as behavioral techniques, medication, psychotherapy, family counseling or a combination. And full disability status may actually undermine the possibility of recovery. A veteran who thinks of himself as beyond recovery — the message carried by a high disability rating — risks fulfilling that prophecy.
By abandoning work, the veteran deprives himself of its therapeutic value: a sense of purpose, distraction from depressive rumination, a structure to each day, and the opportunity for friendships. The longer he sits at home, the more his confidence in his abilities erodes and his skills atrophy.
Last year the Government Accountability Office, the President’s Commission on Care for America’s Returning Wounded Warriors, and the Veterans’ Disability Benefits Commission all urged that the disability, compensation and rehabilitation benefits systems be reformed and updated. And last month, Sen. Richard Burr (R., N.C.), ranking member of the Senate Veterans’ Affairs Committee, introduced the Veterans’ Mental Health Treatment First Act.
The purpose of this bill is to induce new veterans to embark upon a path to recovery. Any veteran diagnosed with major depression, post-traumatic stress disorder or other anxiety disorder stemming from military activity would be eligible for a new program that provides a financial incentive of $11,000 distributed over the course of a year (or completion of recommended treatment, whichever comes first).
The compensation is offered in exchange for two commitments. First, the veteran must adhere to an individualized course of treatment. Second, he must agree to a pause in claims action for at least a year or until completion of treatment, whichever comes first. Should he fail to improve — and, sadly, this will happen to some — the veteran remains eligible for 100% long-term disability.
The great virtue of the Treatment First Bill is that it offers an opportunity to receive payment as a condition of trying to get better. Mr. Burr calls it a “wellness stipend” to distinguish it from a “disability benefit.” As it stands now, the only way a veteran can receive payment is to be disabled.
There are practical considerations, of course. For example, is $11,000 enough? For patients needing intensive treatment and still too fragile to work, the stipend falls short as income replacement. The constant stress of financial insecurity will not only impede the veteran’s clinical progress, it makes the formal disability option — the very alternative that Treatment First seeks to avert — look very attractive.
Nonetheless, the proposal delivers a bracing dose of clinical wisdom. Imagine giving young men and women permission to surrender to their psychological wounds without first urging them to pursue recovery. For many young veterans, a “treatment first” approach could be their road to recovery and a rich civilian life.