In testimony before the U.S. Senate Committee on Veterans’ Affairs in late November 2014, medical representatives from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) quantified more than two million service members who had deployed to Iraq or Afghanistan since Sept. 11, 2001.
In the past, veterans had to prove that they were in a specific traumatic incident in a specific location at a specific time. Under the new criteria, if a VA psychiatrist says that a client meets the symptom criteria for PTSD, and they have documentation that they physically served in a particular war zone, that will be accepted as criteria for service-connection.
What is surprising to some is the fact that this recent group of veterans reflects just one-third of the number of Vietnam veterans in America today, while other veterans cohorts trace their service to the Korean War or World War II.
In total, there were approximately 22.5 million living U.S. veterans in FY 14. Of that number, approximately 9 million were enrolled in the VA, with 5.7 million of those actually receiving services.
And an increasing number of those services involve mental health treatment.
Highlighting the continuing development and expansion of the VA mental health system, VA Chief Consultant for Mental Health Dr. Harold Kudler explained at the committee hearing that the number of veterans receiving specialized mental health treatment from VA had risen each year; from 927,052 in FY 06 to more than 1.4 million in FY 13. Reasons cited for the increase included proactive screening to identify veterans experiencing symptoms of depression, substance-use disorder, those who have experienced military sexual trauma, or post-traumatic stress disorder (PTSD).
Kudler’s career with the VA began in 1980, coincidentally the same year that the American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme. The significant change ushered in by the PTSD concept was the stipulation that the triggering agent was a traumatic event outside the individual rather than an inherent individual weakness.
The 32nd Vice Chief of Staff of the Army, retired Gen. Peter W. Chiarelli, leads a discussion about suicide, post-traumatic stress disorder, and traumatic brain injury with senior leaders from across Joint Base Lewis-McChord, Washington, Sept. 24, 2014. Chiarelli was an early leader in calling attention to and seeking help for victims of PTSD. DOD photo by Staff Sgt. Bryan Dominique
“I’ve seen what [the] VA looked like when it didn’t recognize PTSD at all,” Kudler told The Year in Veterans Affairs and Military Medicine almost a year after his Senate committee testimony. He described that early environment as so new that treatment studies “required researchers to invent their own scales to measure treatment effects,” adding that his earliest experiences with veterans quickly convinced him that the concept of PTSD was “valuable and valid.”
“It helps people understand their own situation,” he said. “But what was really a shocker was that it wasn’t until the ’90s that people went back and asked World War II veterans, ‘What about you? Do you have these 17 symptoms?’ And the answer was: Yes, they did. But nobody had asked them.
“So it’s important to note that PTSD is an important issue and continues to be over 40 years,” he said.
Kudler expressed hope that the large body of Department of Defense (DOD) and VA studies of PTSD would help to dispel what he dubbed “the romantic notion” of some underlying issues as depicted in movies like Rambo.