“We often mistake ‘the romance’ for the facts,” he asserted. “But I think VA has done more than any other organization – from the scientific community to veteran support – to get the facts out. This is something we are exceptionally good at.”
More Clients
Kudler credits the increased number of veterans being assisted by the VA for PTSD to “a combination of factors.”
“One is the increasing awareness of PTSD in the community,” he explained. “Another is the fact that the criteria for being diagnosed in VA for service-connected PTSD changed a few years ago.”
Shay Little, a medical assistant in family practice at the Naval Medical Center Portsmouth, Virginia, explains the PTSD Coach to a staff member during National PTSD Screening Day 2013. U.S. NAVY photo by Mass Communication Specialist 2nd Class Anna Arndt
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.
“That opened the gates,” Kudler said. “And another reason [for the increase] is the aging and retirement of the Vietnam generation, because that’s still our largest cohort. As many people as we have from Iraq and Afghanistan, there were more than three times that number of Vietnam veterans. And as they age [many of them] have been driven towards VA as the only place they can possibly get assistance.”
He noted that the apparent retirement bubble reinforces earlier World War II- and Korean War-generation findings that veterans often used their work to distract themselves from some of their symptoms, and that the post-work environment allowed many of these symptoms to come forward.
“These are all factors, I believe, in why we are seeing more people,” he said. “And frankly I think it’s a good development.”
Another tier of support has been the development of PTSD clinical teams or PTSD specialists at every VA Medical Center in the nation. In addition, the VA’s community-based outpatient clinics – some serving 5,000-10,000 people – either have their own PTSD specialist or can reach back to their “parent facility” medical center for this expertise.
And those numbers are likely to increase. According to Kudler, the National Vietnam Veterans Longitudinal Study used a representative sampling of veterans to project that 250,000-275,000 living Vietnam veterans would have PTSD.
“And they haven’t all come yet,” he observed. “In fact, most of them aren’t even enrolled in VA.”
Citing other findings from the 1990 National Vietnam Veterans’ Readjustment Study, he added that “80 percent of the veterans who actually had PTSD from Vietnam had never, at the time of the study, sought VA mental health services. So there was a huge group that had never come – and might never come. But I’m glad to say that I think they are coming now and I think you are seeing that reflected in the growing numbers.”
Responding to the Challenge
Kudler said that VA’s response to the growing challenge begins with the “screening” of every enrolled veteran, with current rules calling for annual screenings for the first five years following return from combat and then shifting to every five years after that.
Another tier of support has been the development of PTSD clinical teams or PTSD specialists at every VA Medical Center in the nation. In addition, the VA’s community-based outpatient clinics – some serving 5,000-10,000 people – either have their own PTSD specialist or can reach back to their “parent facility” medical center for this expertise.