The VA:  No Man Left Behind

The Veterans’ Administration’s policy was to refuse recognition as “service-related” any neuropsychiatric problems appearing more than one year after a soldier’s discharge.  Consequently, treatment from the VA was difficult to obtain and disability compensation largely unavailable.[i]   

It was not until the mid-1970s that the Disabled American Veterans (DAV) funded the Forgotten Warrior Project, a groundbreaking study of the long-term social consequences of combat exposures conducted by John P. Wilson, PhD. As a result, the DAV opened storefront Vietnam Veteran Outreach Programs in more than seventy cities across the United States, staffed by volunteer counselors. The program’s success prompted Congress to establish the Veterans’ Administration “Vet Centers” throughout the country.[ii]

But post-traumatic stress disorder was not formally recognized by the American Psychiatric Association [APA] until 1980, and its etiology is still passionately debated. Dr. Michael Cohen, an Army 1st Cavalry infantryman who served in Vietnam, became a clinical psychologist and team leader at the San Francisco Vet Center.  As a member of the advisory board for the PTSD Team at the Fort Miley Veterans’ Affairs Medical Center, Dr. Cohen admitted that, even among the professionals who acknowledge the existence of PTSD, there are opposing theoretical camps. He called them “residualists” and “predispositionists.”

Cohen thought there was validity in both points of view. “The extent or duration of combat has a great deal of influence on the readjustment problems of the veteran,” he said, “but I also think that pre-military experience and development sets someone up to react to the chaos and horror of the war around him. We do know that the problem continues with time. It does not go away by itself and we have to deal with both the developmental and war issues in order to treat it.”   

The APA’s official criterion for rendering a diagnosis of PTSD is that an individual has developed “characteristic symptoms following a psychologically traumatic event generally outside the range of usual human experience.”[iii] While one might reasonably assume this could be applied to all combat veterans, only those who can prove service connection for delayed psychological disabilities are eligible for treatment and compensation.  And that’s not so easy to do. According to a number of vets, the VA claim forms demand the veteran’s ability to succinctly describe what is wrong with him, and someone who cannot articulate his distress stands a slim chance of being compensated. One who communicates well, and understands the rules of the game, fares much better.  

“I have run into psychiatrists who don’t believe in PTSD,” said Gary, a decorated veteran of Korea and two tours in Vietnam. “They’re used to shell-shock victims—comatose, catatonic—and anything else is bullshit. Everybody’s reading different books.” Gary entered the VA Hospital in Helena, Montana in 1986 and subsequently the PTSD Treatment Unit in Menlo Park, California, where he spent nine months as an inpatient and another four in an outpatient self-help program. Gary claimed the VA took an adversarial stance toward vets applying for treatment. “If they can show some guy is a slow learner, a bit dyslexic, or came from a screwed-up environment before he was in the Army, then the government’s off the hook. [It] has nothing to do with what happened in Vietnam. It has to do with now. You hold the same job for eighteen years and you’re married to the same chick, you ain’t got PTSD. These guys don’t work for you, they work for the government.”