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Hon. Cliff Stearns, a Representative in Congress from the State of Florida

Mr. Chairman,

Thank you for holding this important hearing on Post Traumatic Stress Disorder (PTSD) and Personality Disorders among returning service members from areas of conflict.  I am pleased we are holding this hearing today, and look forward to participating in this discussion.

PTSD is the most prevalent mental disorder among returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) service members.  The hallmark characteristics of PTSD include flashbacks, nightmares, intrusive recollections or re-experiencing of the traumatic event, avoidance, and numbing.  When such symptoms last under a month, they are typically associated with acute stress disorder, not PTSD.  In order for a diagnosis of PTSD, symptoms have to persist for at least a month and cause significant impairment in important areas of daily life. However, some studies indicate that more than 80% of people with PTSD also experience a major depressive or other psychiatric disorder. Therein lies the difficulty in accurately evaluating a patient has suffering from PTSD, or a Traumatic Brain Injury (TBI) or as having a personality disorder.  I am pleased that beginning in 2005, the Veterans Health Administration created “Returning Veterans Education and Clinical Teams” in medical centers to help, educate, evaluate, and treat returning veterans with mental health and psychosocial issues.  These programs collaborate with other VA Medical Center PTSD, substance abuse and mental health programs, and with polytrauma teams, TBI and primary care services, as well as with Vet Centers in an attempt to provide comprehensive treatment.  By the end of this year, the VA anticipates that it will have 90 of these programs operational throughout the country.

While the treatment for PTSD is improving in the VA system, we are here today to ensure that all those who need such mental health services are correctly identified, getting the appropriate treatment, and able to receive the appropriate compensation for their disability.  A recent report from the Institute of Medicine regarding PTSD compensation was very interesting and raised some good points.  I was interested by the Institute’s finding that the VA’s current approach using the Global Assessment of Functioning (GAF) scale when evaluating severity of PTSD for compensation and disability claims was inaccurate and needed to be re-evaluated.  In fact, the report states that the GAF scale is, “only marginally applicable to PTSD because of its emphasis on the symptoms of mood disorder and schizophrenia and its limited range of symptom content.”  In particular, the Institute advocates that the system should look at the veterans’ everyday life and social interactions and not solely upon the impact upon the veterans’ employability. 

Among some of the Institute’s recommendations was the suggestion the VA use only experienced mental health professionals to diagnose patients claiming to suffer from the disorder, rather than standard claims processors.  The variation among evaluations spans sometimes from a 20-minute conversation to the recommended full 3-hour evaluation.  Standardization among these evaluations is imperative to ensure patients are diagnosed and treated correctly.  To that end, VA leaders should align their guidelines to those set by the American Psychiatric Association, and implement certification procedures for workers dealing with PTSD claims. 

I feel it is important to note that the focus of this Committee hearing should be on the VA claims process and criteria for PTSD claims.  While there have been publicized reports of problems with the screening and discharge processes at the Department of Defense, the jurisdiction and problem before this committee is how the VA processes and evaluates claims from veterans asserting PTSD for service- connected disability status.   It is a complex issue involving many psychiatric components, and I look forward to our panels of witnesses shedding light on the intricacies in these diagnoses for us today.

Thank you.