Institute of Medicine (IOM) Post-Traumatic Stress Disorder

Before you read this report by Steve Robinson of Veterans for America let me point out a very important point regarding DSM IV (Differential Diagnosis of PTSD). This applies particularly to our Vietnam Veterans.

“Topics Discussed: substance abuse; substance use disorders; substance-induced disorders;

"toxic substance exposures".

“The first question that should always be considered in differential diagnosis is whether the presenting symptoms

arise from a substance that is exerting “a direct effect on the central nervous system (CNS).” … the next step is to determine whether there is an etiological relationship between it and the psychiatric symptomatology.”

I would suggest the whole United States Government process for their self-protection is not even considering the first step in the differential diagnosis of PTSD for at least our Vietnam Veterans as well as our Gulf War 1 Veterans.

It also seems our Veterans for over 40 years now have been caught between a war of medical communities and opinions (psychic causations versus mental effects of the toxic substance causations), toxicologists, chemical company congressional and presidential campaign protection money, and treating mental and physical health doctors who are not interested in the “why it happed” only to try and treat the symptoms with little or no interest in helping the Veteran in his or her fight against the VA for the government causations.

Those that have read my book have seen how neuropsychiatric tests on those cohorts our government clearly stated it was using to determine health effects of toxic exposures scored significantly higher in neuropsychiatry and neuropsychological world recognized mental health tests used in identifying these disorders. This study cohort was not made up of combat Veterans with a long line of stressor events combat related or otherwise.

Therefore, while I do not disagree with the IOM assessment of the process; I would conclude they left out one very important part discussed above that our government as well as our nations mental health doctors are not considering.

If a Veteran is being treated that has other medical issues that are associated to his toxic exposures (the real scientific world associations - not the VA culled associations based on money and numbers of victims) then the first step of the "differential process" must be considered “primary.” This is especially factual if there are found “cognitive deficits” present as well.

Because the VA denies the associations does not mean our nations doctors should not consider the neurotoxicity of Agents; Orange, Super Orange, White, Blue, Green, Pink, Purple and the other twelve variants of the commercially named herbicides that were used at “unprecedented dose rates” and “unprecedented toxic strengths.”

If the very prestigious IARC can state in 1977 one of the most prevalent results from exposures to dioxins are personality changes and the restate the facts again in 1986. How the VA, our own government that caused the issues, and the treating VA doctors deny this toxic chemical neurotoxicity connection is simply mind-boggling and weighed down with direct government/VA bias.

Steve Robinson
Government Relations Director
Veterans for America
Srobinson@vi.org
202-557-7593

Today (Fri 16 Jun 06) I attended the meeting of the Institute of Medicine (IOM) Post-Traumatic Stress Disorder (PTSD) review.

At the request of the Department of Veterans Affairs, the Institute of Medicine (IOM) conducted a study to validate Post-Traumatic Stress Disorder (PTSD) as a diagnosis and to ensure the DSM-IV and other objective measures used in the diagnosis of PTSD were evidence based and scientifically sound.

The committee found that PTSD is a well-characterized medical disorder and that the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for diagnosing PTSD are evidence-based, widely accepted, and widely used. This is an important finding which should end once and for all any claims that veterans were filing fraudulent claims. In fact, I asked the Chairman of the committee if he believed a veteran could game the system by memorizing the DSM-IV to present false answers to a mental health care provider. He stated emphatically that it would be almost impossible because the DSM-IV has built in tools to detect deception and only a minute fraction of society had the ability to pull it off. Soldiers who serve in our wars are honorable men and women who only expect that their voices are heard and their needs are met when they come home. This study should be sent to your elected Representatives.

Additionally the committee found that only health professional with experience in diagnosing psychiatric disorders (e.g., primary care physicians, nurses, social workers) using the DSM-IV criteria are trained to make the diagnosis. The committee also stated that the diagnosis should take place in a private setting with a face-to-face interview that can last an hour or more. We all know that DoD clinicians are not spending an hour with returning veterans and they are not using the Clinical Practice Guidelines for PTSD published by the Department of Veterans Affairs. By the way, if used, the Clinical Practice Guidelines takes at least three hours to complete for one soldier.

The committee also commented on screening tools and diagnostic instruments for the assessment of PTSD. The committee commented that, “these tools cannot substitute for an evaluation by an experienced professional.” This statement is important because the way DoD screens for PTSD is the DD-Form 2796 or Post Deployment Health Assessment. This form is administered by clerks, admin staff, and persons who do not possess the skill to interpret the results because they are non-mental health personnel. How many soldiers are falling through the cracks because of the cost saving DD-Form 2796?

Clearly, this committee believes there is only one validated way to screen and diagnose PTSD. Why is the DoD allowed to make up it’s ”own rules and screening tools?

The committee wrote that because ALL veterans deployed to a war zone are at risk for the development of PTSD, it would be prudent for health professionals to query veterans about their wartime experiences and their symptoms, when presenting at primary care and other health facilities (inpatient or outpatient) and this task must be done by trained professionals using validated screening tools.

This committee said the only validated screening tools were:

CAPS - Clinician Administered PTSD Scale
SCID - Structured Clinical Interview for DSM-IV
DIS-IV - Diagnostic Interview Schedule for DSM-IV
PSS-I - PTSD Symptom Scale - Interview Version
SIP - Structured Interview for PTSD

Based on this report DoD is in willful violation of established and validated screening and diagnostic recommendations.

I wonder who will suffer because they don’t follow the rules.

For further information on the report email: gulfwarandhealth@nas.edu