Double Whammy for Veterans Seeking Disability Benefits, Medical Care

This occurs against a background of budget cuts at the VA and growing evidence of a link between understaffing at VA facilities and veteran medical malpractice. Flag waving aside, injured vets, especially those who suffer from latent or “invisible” injuries, like post-traumatic stress disorder, just can’t seem to catch a break.

Denial of disability benefits

Joshua Bufkin served in the Air Force from late 2005 to early 2006. Although Bufkin intended to join the military police, he could not pass the required training classes. Bufkin blamed his poor performance on marital stress. He reported that his wife opposed his service and had threatened to commit suicide if he stayed in the military. Bufkin ultimately requested and obtained a nonprejudicial hardship discharge. Seven years later, Bufkin sought disability benefits from the VA. He claimed that his military service caused several psychiatric conditions, including PTSD.

His VA physician had diagnosed him with PTSD and opined that the primary stressor was the perceived threat to his wife’s life. However, subsequent examinations cast doubt on this diagnosis. The VA denied his claim and Bufkin’s appeals were unsuccessful.

Norman Thornton served in the Army from 1988 to 1991. After being honorably discharged, Thornton applied for and received benefits for an “undiagnosed illness.” Years later, he sought additional benefits for service-connected PTSD. The VA granted benefits for his claim, initially rating his condition as 10 percent disabling and later increasing the rating to 30 percent. In 2015, Thornton applied for another increase to his PTSD disability rating and underwent a new VA medical examination. The physician questioned whether PTSD was the cause of those symptoms. Nevertheless, the regional office increased Thornton’s PTSD disability rating to 50 percent.

Thornton then sought an additional increase to 70 percent and underwent another medical evaluation. The regional office declined to increase his rating beyond 50 percent. His appeals, like Joshua Bufkin’s were unsuccessful.

What these two cases have in common, beyond a denial of disability benefits, is a diagnosis of PTSD. This may be where the real issue lies.

PTSD – hard to diagnose and easy to dismiss as “faking bad”

Since 1980 when PTSD was first recognized as a formal diagnosis, patients and clinicians have become more aware of the disorder. But it remains hard to diagnose for several reasons. The diagnosis relies largely on self-disclosure of trauma. Patients sometimes avoid doing this as part of a “coping strategy” to avoid emotional pain. Coping strategies to avoid negative emotions can, in turn, make the problem worse. The symptoms of PTSD can also overlap with other psychiatric issues such as depression, panic disorders and ADHD, as well as physical injuries, like traumatic brain injury.

Veterans are also sometimes suspected of exaggerating their symptoms to increase their benefits. While exaggeration undoubtedly happens in a medical system as huge as the VA, it is also important to realize that the term “malingering,” when used in a clinical sense, is also defined as a psychological disorder that may be the result of trauma.

PTSD can be a house of mirrors.

“Benefit of the doubt” standard protects vets and docs

Medical malpractice may include not only maltreatment of a patient, as for example, when a surgeon neglects to retrieve a sponge or clamp from a surgical patient’s abdominal cavity. It also may include the negligent failure to diagnose or treat a patient in accordance with professional standards. Both kinds of medical malpractice can irreparably harm or kill a patient. Either kind can also ruin a doctor’s career.

How to get out of this mess?

In context, the VA’s “benefit of the doubt” evidentiary standard seems like a relatively humane way out of the PTSD dilemma. Although it applies only to benefit determinations and not to the professional standards for medical diagnosis, it can reduce the risk of foreseeable harm to a patient, a factor in calculating a doctor or hospital’s legal liability. Giving the benefit of the doubt to veterans who report symptoms consistent with PTSD could reduce risks for both medical professionals and veterans.
Or was it just about cost cutting?

Budgets are not the Supreme Court’s business. However, in the context of deep cuts at the VA, it is impossible not to wonder if the Court may have been (perhaps subtly) influenced. The Justices are ultimately political animals, too.