At MCNtalk we found this Op Ed piece in The New York Times to be particularly poignant. Firstly, it reminds us, as we enter the tenth year of armed conflict, of the very real and tragic cost of war. It is after all our war, and on our behalf that people — Americans and Afghanis both — are suffering: “If all goes according to plan, by the end of the year, 10,000 American soldiers in Afghanistan will be home with their families — and their memories. As many as 20 percent of them will suffer from post-traumatic stress disorder, anxiety or depression, while suicide rates have reached tragic new highs among veterans.”

Additionally, for MCN it reminds us of the human, and very complicated, side of the IME business, that of determining causality and disability: “After all, gauging the prognosis of mental injury in the wake of war is not as straightforward as assessing a lost limb. What’s more, it is very difficult to predict the pace and extent of a patient’s progress when the odds of success also depend heavily on non-medical factors: the veteran’s own expectations for recovery, availability of family and social support, and the intimate meaning the patient makes of his or her distress, wartime hardships and sacrifice.”

And reminds us in the IME business of what we don’t do for claimants—provide direct treatment: “Instead, Veterans Affairs should adopt a treatment-first approach. The sequence would begin with treatment, move to rehabilitation and then, if necessary, assess a patient for disability status, should meaningful functional deficits persist.

“At the same time, veterans too fragile for employment while in intensive therapy and rehabilitation—which, for some, could last up to a year—should receive financial support. Not disability payments, mind you, with their specter of permanent debilitation; call it a ‘recovery benefit’—as generous as total disability, but temporary.

“With some exceptions, it is both realistic and important to instill the expectation in veterans that they will get better and find a comfortable and productive niche within the community and family. The road home from war is already an arduous one — the mental health system shouldn’t make it any longer than it already is.”

And of course we  found this piece to be refreshing because the author not only outlines a problem, she attempts to find a solution while neither ignoring nor minimizing the factors involved. Read more…