PTSD and the VA: Just who's malingering?

By Neal Powers

In 1944 when an uninjured private, Charles H. Kuhl, said he "couldn't take it anymore," Gen. George S. Patton called him a "yellow coward," slapped him, and threw him out of the hospital tent. The U.S. military has always had difficulty discriminating between members disabled by mental health issues like Post-Traumatic Stress Disorder and malingering.

Many in the Department of Veterans Affairs would have us believe that PTSD is unique to military personnel, but that is not true. Law enforcement officers, firefighters, even missionaries and relief workers in Haiti can suffer. So can many victims of rape, abuse or other violent crime. Anyone witnessing death or dismemberment is a potential candidate. The critical difference is whether they get the opportunity to talk about it and work through it. That's where the military culture becomes a barrier.

In the modern military mindset, only the lowest of the low would let his buddies down, fail to do the job or abandon the mission. As a result, it is often only after family lives are destroyed by night terrors, panic attacks, violent outbursts, emotional numbness and substance abuse that many combat veterans seek help. Today, the VA feels like an adversary to many veterans.

Until recently, to get help they had to prove they weren't malingering. They were required to document the very experiences that were ruining their lives, including getting statements from corroborating witnesses.

I have never been in combat, but I have been diagnosed with PTSD. In my case, it was a result of investigating scores of fatal aircraft accidents. As an Federal Aviation Administration safety inspector, I soon learned that at somewhere around 100 miles per hour it no longer matters whether the human body is the target or the missile. Dump in a hundred gallons of burning fuel, and the crash site begins to look like a combat zone.

The nightmares are the same. The panic attacks are the same. The flashbacks are the same and the depression is the same.

But here is the part that the VA is not telling. Their psychiatrists and psychologists aren't supermen. They graduated from the same institutions as private practitioners all across the country. Putting on a uniform after graduation doesn't make them better than their classmates. It just means they go to work in a different suit.

And every one of them follows the same manual: the fourth edition of the Diagnostic and Statistics Manual of the American Psychiatric Association, or DSM IV. The criteria for diagnosing PTSD is spelled out there in language so plain that any layman can understand.

Although the VA has relaxed its documentation rules, it still retains the sole authority to diagnose PTSD. The VA staff is not even required to entertain the opinions of their civilian counterparts. Because of this, the credibility of the VA is at risk.

If you really wanted to know what happened on the Deepwater Horizon in the Gulf of Mexico, would you settle for the story as told by British Petroleum, or would you rather have an engineering report from an independent expert without a dog in the fight? As I see it, the VA could use a little validation from independent experts. To the best of my knowledge you can't fake night terrors. You can't fake a panic attack. You can't fake depression. And you can't fake suicide.

Americans face an unprecedented crisis. We have combat veterans who have seen two, three even four rotations in Iraq and who are now on their way to Afghanistan. Suicide rates are unacceptably high on active duty. At home, combat veterans already account for 20 percent of today's suicides.

This is the wrong time in history for the VA to engage a turf war with people who are just as smart as they are. They will need help from their civilian counterparts. The VA's unfinished business will eventually fall on the churches, communities and families of our returning servicemen and women. For once, let's call it the way it is and get our patriots the help they need.

Neal Powers of O'Fallon, Mo., is a retired U.S. Air Force captain, flight instructor and aviation safety instructor for the Federal Aviation Administration.