Lawyers for the veterans fought to get testimony from Dr. Michael J. Kussman, the under secretary for health at the V.A. Asked on the stand whether he was playing down the traumatic stress issue, Dr. Kussman said, “It is unfair and inappropriate to stigmatize people with a mental health diagnosis when they are having what most people believe are normal reactions to an abnormal situation.” Gordon P. Erspamer, the lead lawyer for the plaintiffs, said [Kussman’s] answer indicated that the V.A. had failed to recognize the problem. “That is 19th-century thinking about PTSD and mental health issues,” he said, referring to post-traumatic stress disorder, a combat trauma.
Closing Arguments in Suit on Veterans’ Mental Care
May 1, 2008, San Francisco, CA — The issue of whether veterans with mental health problems are neglected or whether their sheer numbers are overwhelming the system divided closing arguments on Wednesday in a class-action lawsuit in federal court here.
Arturo J. Gonzalez, the lawyer arguing on behalf of the Veterans for Common Sense and the Veterans United for Truth, the two groups who brought the lawsuit against the Department of Veterans Affairs, said that the agency had failed to fully put into effect an action plan it developed four years ago.
The fact that it takes more than 180 days to process a veteran’s claim for benefits represents a “pattern of neglect,” Mr. Gonzalez said, adding that anyone who enters an appeal has to wait four and a half years for a resolution.
“I don’t know how any veteran can stand it and stick with it and get to the end of this process,” Mr. Gonzalez said.
He also emphasized the high rate of suicide attempts, 1,000 a month, among the 5.6 million veterans that the V.A. treats, as a sign that mental health issues need far greater attention.
Daniel Bensing, who made the closing arguments for the V.A., noted that 838,000 claims were filed last year, an increase of 25 percent, because of the jump in veterans from Iraq and Afghanistan and a surge from aging Vietnam veterans. While acknowledging the delays were lengthy, he said that the increase in claims for help was one of four factors causing problems.
The others he cited were that the claims are highly complex, not least because the ties linking veterans’ military records to their medical problems have to be investigated; that the claims process is an open one that allows veterans to add information at any time; and budgetary limitations.
While acknowledging suicide as a serious problem, Mr. Bensing also emphasized that change takes time given that the V.A. runs the largest health care system in the country. “It cannot all be done immediately like plaintiffs seem to think,” he said.
The plaintiffs were not seeking monetary damages but want the judge, Samuel Conti, to intervene to force the V.A. to run more efficiently. The judge, who is expected to rule in June, said he would concentrate on what legal role the Federal District Court should play. Mr. Bensing said it should be up to Congress to change the system.
Lawyers for the veterans fought to get testimony from Dr. Michael J. Kussman, the under secretary for health at the V.A.
Asked on the stand whether he was playing down the traumatic stress issue, Dr. Kussman said, “It is unfair and inappropriate to stigmatize people with a mental health diagnosis when they are having what most people believe are normal reactions to an abnormal situation.”
Gordon P. Erspamer, the lead lawyer for the plaintiffs, said the answer indicated that the V.A. had failed to recognize the problem. “That is 19th-century thinking about PTSD and mental health issues,” he said, referring to post-traumatic stress disorder, a combat trauma.
Underlying the arguments were the long-debated questions swirling around the PTSD diagnosis itself, which experts said one trial will not settle. One view maintains that all veterans suffer some mental trauma, while others argue that the symptoms among veterans with PTSD are more sustained and definitely need treatment.
Several experts also noted that the suicide statistics were not a reliable index as to whether the treatment program was viable because it is severe depression that usually leads to suicide and not post-traumatic stress disorder. PTSD can prompt depression, but it is not automatic.
“Suicide can be a red herring in all this,” said Dr. Mardi Horowitz, professor of psychiatry at the University of California, San Francisco, who helped pioneer stress diagnosis for Vietnam veterans in 1980. “There are abnormal events and there are normal responses. The question is when it goes over an ambiguous line and becomes a diagnosable mental disorder.”
Soldiers relieved to escape combat usually do not develop the problems right away; they develop later, which is why the role of the V.A. is considered so crucial.
