The United States has compensated military veterans for service-related injuries since the Revolutionary War, with the current indemnity model established near the end of World War I. The Department of Veterans Affairs (VA) began to provide disability benefits for post-traumatic stress disorder (PTSD) in the 1980s after the diagnosis became part of official psychiatric nosology.
Post-traumatic stress disorder (PTSD) is a serious, potentially debilitating psychiatric disorder that can develop after experiencing one or more terrifying or horrific events. It is characterized by (1) re-experiencing the trauma(s) in the form of vivid intrusive memories, dissociative flashback episodes, or nightmares; (2) avoidance of trauma-related thoughts and memories; and (3) frequently feeling under threat manifested as, for example, hypervigilance and intense startle reactions.World Health Organization, "6B40 Post traumatic stress disorder," International Classification of Diseases, 11th Revision, 2018, rev. April 2019.van der Kolk, Bessel A. "The History of Trauma in Psychiatry." In Handbook of PTSD Science and Practice, edited by Matthew J. Friedman, Terence M. Keane, and Patricia A. Resick, 19–36. New York: Guilford, 2007.
Some research suggests that VA disability benefits achieve their goal of helping veterans who have PTSD. The Veterans Benefits Administration (VBA), a component of the Department of Veterans Affairs, processes disability claims and administers all aspects of the VA disability program. Since 1988 VA disability claim decisions have been subject to federal court review.
Disability ratings theoretically represent a veteran's "average impairment in earnings capacity", on a scale from 0 to 100. Veterans who file a disability claim due to PTSD almost always receive a compensation and pension examination (C&P exam) by VA-employed or VA-contracted psychologists or psychiatrists. Social scientists and others have expressed concern about the consistency and accuracy of PTSD C&P exam findings, although the VA generally rejects such concerns as unfounded or exaggerated.
Recent efforts to change VA disability benefits for PTSD include urging the VA to place more emphasis on vocational rehabilitation and treatment versus cash payments; revising the General Rating Formula for Mental Disorders to better reflect problems experienced by veterans with PTSD, and considering a veteran's quality of life when determining the disability rating.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event. It is characterized by several of the following signs or symptoms: unwanted re-experiencing of the traumatic event—such as vivid, intense, and emotion-laden intrusive memories—dissociative flashback episodes, or nightmares; active avoidance of thoughts, memories, or reminders of the event; hyperarousal symptoms such as always being on guard for danger, enhanced (exaggerated) startle response, insomnia, trouble concentrating, or chronic irritability; anhedonia, social detachment, excessively negative thoughts about oneself or the world, marked guilt or shame, or a persistent depressed or anxious mood.World Health Organization, Post traumatic stress disorder (6B40) , International Classification of Diseases, 11th rev., ICD-11 for Mortality and Morbidity Statistics (April 2019).Shalev, Arieh Y. and Charles R. Marmar. "Conceptual History of Post-Traumatic Stress Disorder." In Post-Traumatic Stress Disorder, edited by Charles B. Nemeroff and Charles Marmar, 3–30. New York: Oxford University Press, 2018. PTSD is the third-most compensated disability after hearing loss and tinnitus.
Traumatic stressor Matthew J. Friedman of the National Center for PTSD notes that PTSD is unique among mental health problems because of the great importance placed upon the cause, the traumatic stressor.
A traumatic stressor is an event that meets Criterion A of the DSM-5 diagnostic criteria for PTSD, which requires, in part, that an individual "... was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence ...."Posttraumatic stress disorder, 38 C.F.R. § 3.304(f), ("Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with §4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred.")Diagnosis of mental disorders, 38 C.F.R. § 4.125(a), ("Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association (2013), is incorporated by reference into this section ....")
Veterans filing a disability claim for PTSD complete a form describing the traumatic stressors they endured during their military service. VA has separate forms for PTSD generally and PTSD "secondary to personal assault".Dep't Veterans Aff., Veterans Benefits Admin., Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault (VA Form 21-0781a, rev. July 2017)
Diagnosis Prior to 2014, VA C&P examiners determined if a veteran had PTSD based on DSM-IV diagnostic criteria for the disorder. VA updated most of its relevant regulations in August 2014 to reflect the publication of DSM-5.Schedule for Rating Disabilities—Mental Disorders and Definition of Psychosis for Certain VA Purposes, Section 4.125: DSM Reference and DSM–5 Nomenclature Change , 79 Fed. Reg. 45093, 45094 (August 4, 2014) (codified at 38 C.F.R. §4.125(a))
VA disability benefits for PTSD The United States provides a range of benefits for veterans with post-traumatic stress disorder (PTSD), which was incurred in, or aggravated by their military service. The United States Department of Veterans Affairs (VA) provides benefits to veterans whom the VA has determined have PTSD that developed during, or as a result of, their military service. These benefits not only include tax-free cash payments but can also include free or low-cost mental health treatment and other healthcare, vocational rehabilitation services, employment assistance, independent living support, and more.
History
Since the founding of the country, the United States has compensated the men and women who have served in its armed forces and uniformed services.Duty periods, 38 C.F.R. § 3.6(b)(2) ("... Full-time duty (other than for training purposes) as a commissioned officer of the Regular or Reserve Corps of the Public Health Service ...").Duty periods, 38 C.F.R. § 3.6(b)(3) ("Full-time duty as a commissioned officer of the Coast and Geodetic Survey or of its successor agencies, the Environmental Science Services Administration and the National Oceanic and Atmospheric Administration ..."). Near the end of World War I, the U.S. Congress passed legislation establishing an indemnity model for veterans' disability benefits. Since that year, compensation has been provided to veterans who have physical or mental disabilities that were incurred during, or aggravated by, military service, and which have adversely impacted their ability to work. The amount of compensation provided—both cash payments and VA-sponsored services—is based on the veteran's "average impairment in earnings capacity".An Act To amend and modify the War Risk Insurance Act, ch. 16, 41 Stat. 371, 373 (1919) ("A schedule of ratings of reductions in earning capacity from specific injuries or combinations of injuries of a permanent nature shall be adopted and applied by the bureau. Ratings may be as high as 100 per annum. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations and not upon the impairment in earning capacity in each individual case ...").
Service-connection Service-connected means that a veteran has a disease or injury that is connected to his or her military service; that is, the disease or injury was incurred in, or aggravated by, their military service.
Effectiveness Whether disability benefits adequately compensate veterans with PTSD for loss in average earning capacity has been debated. A 2007 study found that older veterans (age 65 and up) rated at 50% disabled or higher for PTSD, including individual unemployability (IU) benefits, receive more in compensation (plus any earned income and retirement benefits such as Social Security or pensions) than non-disabled veterans earn in the workforce or receive in Social Security and other retirement benefits. However, younger veterans (age 55 and below) generally receive less in compensation benefits (plus any earned income) than their non-disabled counterparts earn via employment. For example, the "parity ratio" for a 25-year-old veteran rated 100% disabled by PTSD is 0.75, and for a 35-year-old veteran rated 100% disabled by PTSD the ratio is 0.69. The parity ratio for a 75-year-old veteran receiving IU benefits is 6.81.
Research based on data collected in the 1990s indicates that veterans receiving disability benefits for PTSD experience a reduction in PTSD symptom severity and have lower rates of poverty and homelessness. A 2017 study found that "denied" veterans (those who applied for—but did not receive—disability compensation) exhibit significantly worse overall health, functional limitations, poverty, and social isolation when compared to veterans who were awarded VA disability benefits.Fried, Dennis Adrian, Marian Passannante, Drew Helmer, Bart K. Holland, and William E. Halperin. "The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation". Health & Social Work 42, no. 1 (2017). https://doi.org/10.1093/hsw/hlw051
In addition to lost income, a Congressionally mandated commission, argued that the VA disability benefits program should compensate veterans for non-economic losses, such as a decline in the veteran's quality of life. The U.S. Government Accountability Office (GAO) analyzed this recommendation and suggested that it be considered as one of three major changes to modernize the VA disability benefits program.
Some scholars argue that the VA disability benefits program is counter-therapeutic because it provides no incentives to overcome symptoms and problems caused by the disorder, and, in fact, rewards veterans for staying sick. In a similar vein, a military scholar suggests that current VA disability benefits policy inculcates in veterans a lack of self-efficacy and fosters dependency. However, some VA researchers take issue with this assertion.
Claims process Eligibility In order to be eligible for VA benefits, a veteran must have been discharged under "other than dishonorable conditions". Stated differently if a veteran received a "Bad Conduct" discharge or a "Dishonorable" discharge they will, under most circumstances, not be eligible for VA benefits.
Types of military service
Federal regulations describe three categories of military service, "active duty", "active duty for training", and "inactive duty training".Duty periods, 38 C.F.R. § 3.6 (2019). Eligibility for VA disability compensation requires that the veteran's service falls under one of these three categories. The definition of "active duty" military service includes "service at any time as a cadet at the United States Military, Air Force, or Coast Guard Academy, or as a midshipman at the United States Naval Academy".Duty periods, 38 C.F.R. § 3.6(4) (2019).
In line of duty and exceptions