Electronic Letters to:
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eLetters: Electronic letters published:
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A Misleading Premise and Flawed Methodology
- Joseph R Moore (24 July 2005)
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Individual Military Personnel Records Are a Valid and Important Data Source
- B. Christopher Frueh, Anouk L. Grubaugh, and Jon D. Elhai (12 September 2005)
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Joseph R Moore, Attorney Bergmann & Moore, LLC
Send letter to journal:
britishjp{at}veteranlaw.com Joseph R Moore
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The study "Documented combat exposure of US veterans seeking treatment for combat-related post-traumatic stress disorder" is dangerously misleading. It is based on a misleading presumption and its basic methodology is fatally flawed. The star statistic from this study being cited is that combat exposure could not be verified for 59% of the veterans being treated for PTSD. The implication is of course that 59% of veterans receiving PTSD benefits are lying or cheating the system. What the study does NOT mention, however, is the following: 1. The survey sample was veterans being treated for PTSD, not those who are service connected for PTSD, or even those who had filed claims for PTSD. There is an enormous difference. Veterans are treated for non service-connected disabilities all the time by VA. This study clearly implies that all veterans being treated for PTSD are seeking benefits or being paid disability benefits for PTSD. This is simply untrue. 2. The designation of combat in this study was based on each veterans’ service medical and service personnel records (primarily on a form called a DD-214). But this is not where one goes to verify combat. All a veteran's service records will show is whether that veteran has a Combat Infantryman Badge or a Purple Heart (if they do, combat is presumed by VA). But that does not mean only those veterans have verified combat. This is not just speculation. This fact has been legally recognized by VA. There are guidelines as to where a VA adjudicator should go to verify claimed stressor events. In order to verify a stressor event, Company and Battalion level records need to be obtained. Soldiers in Vietnam did not each have an individual clerk who transcribed into that soldier’s personnel records every stressful event that occurred. But Companies and Battalions did, which is why those are the records used to verify claimed inservice stressor events. The authors of this study did not find verification of combat for the majority of veterans in this study because they did not look in the records commonly used by VA to verify combat. I challenge the authors to obtain the unit records for each veteran in the study and have them reviewed by a legal professional. This would undoubtedly change the results substantially. Combat designation is a legal question, not a medical or military one. A lawyer should have been used to review the records. This study was clearly conducted with an eye towards adjudication outcomes, as evidenced by the “Clinical Implications.” Yet the standards used by the authors for verifying combat fall well short of the standards used in adjudicating a benefits case. It is therefore hoped the authors of this study have the courage to admit their mistakes and retract it before it can be used to hurt the interests of disabled veterans on a wide scale. Joseph R. Moore Managing Partner Bergmann & Moore, LLC 332 Main Street, Suite 200 Gaithersburg, MD 20878 P: 301/519-1683 F: 301/519-1684 DECLARATION OF INTEREST I am Managing Partner of a law firm, Bergmann & Moore, LLC, which represents veterans against the Department of Veterans Affairs in the U.S. Court of Appeals for Veterans Claims. Previously, I was an attorney with the Department of Veterans Affairs’ Board of Veterans' Appeals for three years. My financial interests and that of my law practice will only be benefited by publication of this flawed study, since we make money off claims which are denied erroneously by VA. This study will embolden VA to deny more PTSD claims. The fact is, there is a legal standard as to what defines “combat,” and there is years of caselaw regarding that subject. This study will make the VA deny a greater percentage of worthy PTSD claims, but will not affect the jurisprudence of the Court of Appeals for Veterans Claims. |
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B. Christopher Frueh, Professor of Psychiatry Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, SC, Anouk L. Grubaugh, and Jon D. Elhai
Send letter to journal:
fruehbc{at}musc.edu B. Christopher Frueh, et al.
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Dear Editor, Mr. Moore makes a strong accusation that our study is “dangerously misleading.” However, there are several important factual errors in his letter and we respectfully disagree with his conclusion. First, we did not, as he asserted, imply that all veterans being treated for PTSD are seeking disability benefits. In fact, we clearly described our sample as treatment-seeking and reported that 62% reported applying or intending to apply for Veterans Affairs (VA) disability compensation. Second, we did not, as he asserted, use any individual DD-214 forms as the basis for our research. We obtained publicly available individual military personnel records from the U. S. National Personnel Records Center in St. Louis. These records include far more information than a DD-214, including military training experiences, military occupational specialties, overseas duty assignments, dates, and frequently narrative descriptions of combat activities. As acknowledged in our Discussion, individual military personnel records are imperfect, but then so is every other possible source, including unit records and individual memory for past experiences. While we appreciate that military record keeping during war time was occasionally incomplete at the individual level, one cannot “invalidate” a source of data in either social science or historical scholarship by an act of Congress. A legislative action is a political or legal event; it has no bearing on the evidential merit of the archival data. We agree that Company and Battalion level records might provide useful additional information in some cases. However, the historical documentation of a large military unit deployed over a large geographical area and responsible for a wide range of different military duties cannot necessarily tell us much about the experiences of individuals within that unit. Further, someone claiming to have had Special Forces experience, POW status, or Vietnam service should easily have such documentation in their individual military personnel records. The results of our study are consistent with a report (2) recently released by the Department of Veterans Affairs Office of Inspector General (OIG). The OIG investigators found that 25% of veterans recently awarded high levels of service connected disability for PTSD had insufficient documented evidence of verifiable military stressors, with an estimated monetary risk to the VA of $19.8 billion. They also found that most veterans’ symptoms of PTSD got worse over time until they reached the 100% disability level at which point there was an 82% drop in use of VA mental health services, but no change in other VA medical service use. This is ample cause for concern. The results of our study will not “make the VA deny a greater percentage of worthy PTSD claims,” as asserted by Mr. Moore. In fact, we believe and hope they will have quite the opposite effect. As we stated in our article: “Ultimately it is hoped that the VA will take steps to ensure that its scarce resources are directed towards those veterans who are both deserving and in need. Such efforts are critical to guard the legacy of actual combat veterans from being trivialized (pp. 472).” Sincerely, B. Christopher Frueh, Ph.D.1 Anouk L. Grubaugh, Ph.D.1 Jon D. Elhai, Ph.D.2 1Veterans Affairs Medical Center, Charleston, SC and Medical University of South Carolina, Charleston, SC 2Disaster Mental Health Mental Health Institute The University of South Dakota, Vermillion, SD References 1. Frueh BC, Elhai JD, Grubaugh AL, Monnier J, Kashdan TB, Sauvageot JA, Hamner MB, Burkett BG, Arana GW. Documented combat exposure of U. S. veterans seeking treatment for combat-related post-traumatic stress disorder. British Journal of Psychiatry 2005; 186:473-475. 2. Department of Veterans Affairs Office of Inspector General (2005). Review of State Variances in VA Disability Compensation Payments (#05-00765-137). Washington D.C. Declaration of Interest: This work was partially supported by grants MH01660 and MH61983 from the National Institute of Mental Health to Dr. Frueh. This work was also supported by the Office of Research and Development, Medical Research Service, Ralph H. Johnson VA Medical Center, Charleston, SC. |
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