Changes Recommended to Better Support Veterans With PTSD Symptoms

Forty-five years ago, I began my career as a psychiatrist for the Veterans Administration (VA). Now at the end of my career, I am again working for the VA. I am treating a lot of veterans for posttraumatic stress disorder (PTSD). Some of these veterans have service-connected PTSD and some do not. Those who are not fall into one of three categories: (1) they have not applied for treatment of a service-connected disability because they did not know how to apply or did not have someone to guide them through the process; (2) even though they had symptoms of PTSD, the evaluator did not think that they had enough symptoms to qualify; or (3) they are like the case I saw this morning in which the evaluator documented that the veteran met all of the criteria for PTSD but diagnosed him as having something else because the evaluator didn’t think that the patient had enough “clinically significant distress or impairment in social, occupational, or other important areas of functioning” to qualify despite his traumatic nightmares and thrashing around in his bed at night.

We do not have this limiting criterion in many other areas of psychiatric diagnosing. In major depression we recognize mild, moderate, and severe levels, and if patients with mild or moderate depression still work out of personal fortitude or economic necessity, we do not say that they are not depressed. Similarly, in other areas of medicine we do not say that patients do not have cancer because they are not bedridden yet. I believe that psychiatry needs to correct this diagnostic limitation for the sake of our veterans and our patients in general.

K-Lynn Paul, M.D.

Fort Meade, S.D. ■