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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. V101 (93) P-2155 (VA 6096) between the National Academy of Sciences and United States Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
PTSD compensation and military service / Committee on Veterans’ Compensation for Posttraumatic Stress Disorder, Board on Military and Veterans Health, Board on Behavioral, Cognitive, and Sensory Sciences.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-0-309-10552-1 (pbk. : alk. paper)
ISBN-10: 0-309-10552-8 (pbk. : alk. paper)
1. Post-traumatic stress disorder—United States. 2. Disabled veterans—Mental health—United States. 3. Disabled veterans—Pensions—United States—Evaluation. 4. Military pensions—United States—Evaluation. 5. United States. Dept. of Veterans Affairs. I. Committee on Veterans’ Compensation for Posttraumatic Stress Disorder.
[DNLM: 1. Combat Disorders—United States. 2. Stress Disorders, Post-Traumatic—United States. 3. Disability Evaluation—United States. 4. Veterans Disability Claims—United States. WM 184 P975 2007]
RC552.P67P82 2007
362.2′5—dc22
2007021841
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Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press.
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COMMITTEE ON VETERANS’ COMPENSATION FOR POSTTRAUMATIC STRESS DISORDER
NANCY C. ANDREASEN, M.D., Ph.D. (Chair), Andrew H. Woods Chair of Psychiatry and Director,
Neuroimaging Research Center, University of Iowa Carver College of Medicine, Iowa City, IA
JACQUELYN C. CAMPBELL, Ph.D., R.N., F.A.A.N., Professor and Anna D. Wolf Chair,
The Johns Hopkins School of Nursing, Baltimore, MD
JUDITH A. COOK, Ph.D., Professor of Psychiatry and Director,
Center on Mental Health Services Research and Policy, University of Illinois, Chicago
JOHN A. FAIRBANK, Ph.D., Associate Professor of Medical Psychology, Duke University Medical Center; Co-Director,
National Center for Child Traumatic Stress, Durham, NC
BONNIE L. GREEN, Ph.D., Professor of Psychiatry and Director,
Georgetown Center for Trauma and the Community, Georgetown University Medical School, Washington, DC
DEAN G. KILPATRICK, Ph.D., Distinguished University Professor and Director,
National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston
KURT KROENKE, M.D., Professor of Medicine,
Division of General Internal Medicine and Geriatrics, Indiana University, Indianapolis
RICHARD A. KULKA, Ph.D., Senior Vice-President of Strategic Business Development, Abt Associates Inc.; Senior Research Scientist,
Center for Demographic Studies at Duke University, Durham, NC
PATRICIA M. OWENS, M.P.A., Independent Consultant,
Minisink Hills, PA
ROBERT T. REVILLE, Ph.D., Director,
RAND Institute of Civil Justice, Santa Monica, CA
DAVID S. SALKEVER, Ph.D., Professor of Public Policy,
University of Maryland-Baltimore County, Baltimore, MD; Research Associate, National Bureau of Economic Research, Cambridge, MA
ROBERT J. URSANO, M.D., Professor of Psychiatry and Neuroscience, Chair,
Department of Psychiatry, and Director, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD
Gulf War and Health Committee Liaison
JANICE L. KRUPNICK, Ph.D., Professor of Psychiatry,
Georgetown University, Washington, DC
Consultants
ROBERT J. EPLEY, Independent Consultant,
Waxhaw, NC
CAROL S. NORTH, M.D., M.P.E., Nancy and Ray L. Hunt Professor of Crisis Psychiatry,
UT Southwestern Medical Center; Director, Program in Trauma and Disaster, VA North Texas Health Care System, Dallas
ALFRED V. RASCON, Reserve Major,
U.S. Army Medical Service Corps, Laurel, MD
Program Staff
DAVID A. BUTLER, Ph.D., Senior Program Officer and Study Director
AMY R. O’CONNOR, M.P.H., Research Associate
JON Q. SANDERS, B.A., Program Associate
EILEEN SANTA, M.A., Research Associate
FREDERICK (RICK) ERDTMANN, M.D., M.P.H., Director,
Board on Military and Veterans Health and Medical Follow-up Agency
CHRISTINE HARTEL, Ph.D., Director,
Board on Behavioral, Cognitive, and Sensory Sciences
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Kathryn Karusaitis Basham, Ph.D., M.S.W., Professor and Chair, Human Behavior in the Social Environment Sequence; Smith College School for Social Work
Lisa B. Dixon, M.D., M.P.H., Professor, Department of Psychiatry, and Director, Division of Services Research, University of Maryland School of Medicine; VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center
Edna B. Foa, Ph.D., Professor, Department of Psychiatry and Director, Center for the Treatment and Study of Anxiety, University of Pennsylvania
Richard G. Frank, Ph.D., The Margaret T. Morris Professor of Health Economics, Department of Health Care Policy, Harvard Medical School
Nathan Hershey, L.L.B., Professor, Health Policy and Management, University of Pittsburgh Graduate School of Public Health
David Silbersweig, M.D., Stephen P. Tobin and Dr. Arnold M. Cooper Professor in Consultation Liaison Psychiatry, Department of Psychiatry, Weill Medical College of Cornell University
Robert D. Sparks, M.D., Board of Directors, The TASER Foundation
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dan G. Blazer, M.D., Ph.D., Duke University Medical Center, and Edward B. Perrin, Ph.D., University of Washington School of Public Health. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Acknowledgments
This report could not have been prepared without the guidance and expertise of numerous persons. Although it is not possible to mention by name all those who contributed to the committee’s work, the committee wants to express its gratitude to a number of them for their special contributions.
Sincere thanks go to all the participants at the public meetings convened on May 2 and July 6, 2006. The intent of the workshops was to gather information regarding issues related to posttraumatic stress disorder (PTSD) compensation; in particular, the conduct of compensation and pension examinations, the evaluation of PTSD claims, and the granting of compensation by the Department of Veterans Affairs VA). The speakers, who are listed in Appendix A, gave generously of their time and expertise to help inform and guide the committee’s work. The committee also acknowledges the help of the staff of the Veterans’ Disability Benefits Commission, who shared the information they gathered in the course of their work; and Tom Pamperin, Sandie Harms-Taylor, and Dan Cunningham of the Veterans Benefits Administration, who provided the committee with compensation and pension data.
We are deeply indebted to three hard-working people who served as consultants and made major contributions to the content of this report: Robert Epley applied his encyclopedic knowledge of the VA’s compensation and pension system to answer the committee’s myriad questions; Carol North shared her expertise on traumatic stress; and Major Alfred Rascon (USA), who is currently supporting soldiers in the field in Iraq and Af-
ghanistan as an individual mobilization augmentee, helped the committee understand the realities of war and service from his perspective as a Vietnam veteran and Medal of Honor recipient. Thanks are also due to Janice Krupnick, who served as liaison from the Institute of Medicine’s Committee on Gulf War and Health–Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress.
The committee extends special thanks to the dedicated and hardworking staff from the Institute of Medicine’s Board on Military and Veterans Health who supported and facilitated their work. Board Directors Rick Erdtmann of the Institute of Medicine and Christine Hartel of the National Research Council helped to ensure that this report met the highest standards of quality.
Finally, the committee would like to thank the chair, Nancy Andreasen, for her outstanding work, leadership, and dedication to this project.