Proposals for meeting the health needs of combat vets have been speeding through Washington and this week President Bush added another to streamline the process of determining eligibility for disabilities.

But as the recommendations multiply, it is unclear whether they will postpone or speed closing the substantial gaps faced by vets and their families for mental health care. While the goal is not in doubt, concerns about duplication and oversight clearly are.

As the Army Times noted, the president's plan came "just days after the Veterans' Disability Benefits Commission issued its recommendations on improving compensation and rehabilitation programs." His proposal "appears to be based more on recommendations from yet another commission, the President's Commission on Care for America's Returning Wounded Warriors." This leaves the Army Times:

Concerned that the administration's plan unveiled last week could end up delaying work on the Wounded Warrior Assistance Act already approved by the House and Senate. Sen. Daniel Akaka, D-Hawaii, and other Democrats on the Senate Veterans' Affairs Committee sent a letter to Bush on Monday seeking his help in building Republican support for the ongoing negotiations to hammer out a compromise wounded warrior bill instead of allowing debate to take on a partisan tinge.

Akaka's letter expressed deep concerns about the administrations position:

We have deep misgivings about the provisions of your bill that would provide a basis for drastic changes to VA's disability compensation system. As you know, these provisions would abrogate Congressional authority, and would give the Secretary of Veterans Affairs the authority to comprehensively rewrite VA's compensation system. Further, it would inappropriately require the Secretary to accomplish this monumental task over the span of mere months. Based on testimony at the Committee's recent hearing, especially from the Chairman of the Veterans' Disability Benefits Commission, we do not believe this time line is realistic.

At committee hearings to discuss the "Mental Health Improvements Act of 2007" (S. 2162) two days later (October 24), Michael J. Kussman, MD, Under Secretary of the Veterans Administration, said the bill was "well-intended" but "overly prescriptive and more importantly altogether unnecessary." He explained that the “VA does not support the provisions” which would

carry out a program of research into co-morbid PTSD and substance use disorder. The purpose of this program would be to address co-morbid PTSD and substance use disorder; provide systematic integration of treatment for these two disorders; develop protocols to evaluate VA's care of veterans with these disorders; and, facilitate the cumulative clinical progress of these veterans.

Why? Kussman said they are "essentially duplicative of VHA's on-going efforts in this area, particularly the research efforts being carried out by VA's National PTSD Center." He added, the "VA is a world-recognized leader in the care of both PTSD and substance use disorders, particularly when these conditions co-exist in an individual."

The claim of duplication was challenged by a retired navy captain, and the parent of a disabled soldier. "Expanded VA efforts to treat co-occurring disorders would be welcome, and is long overdue," said Capt. Constance Walker. The proposed bill would

establish new VA requirements and re-emphasize existing VA programs for the treatment of PTSD and substance use disorder (SUD), with special procedures for VA to address the treatment of veterans who suffer from co-morbid association of these disorders. It would require VA to expand its offering of services for SUD, including counseling, outpatient care, prevention, aftercare, opiate substitution and other pharmaceutical treatments, detoxification and stabilization services, and other services.

To complicate the picture even more, it is not clear which treatments offered for PTSD are successful. Last week a report from the Institute of Medicine (IOM), which was commissioned by the Veterans Administration, indicated a need for more data about treating PTSD. Roughly 12 percent of the military in Iraq, and 6 percent returning from Afghanistan, have experienced symptoms of PTSD. About 7 percent of the population experiences an element of PTSD during their lifetime. The findings, said panel chairman Alfred Berg, "underscore the urgent need for high-quality studies that can assist clinicians in providing the best possible care to veterans and others who suffer from this serious disorder."

Additional links:
Wounded Troops Overwhelm Care
Veterans’ Disability Benefits Commission