VA to review 72,000 PTSD claims.

The VA will review the claims of some 72,000 veterans who now receive disability compensation for post-traumatic stress disorder (PTSD). The yearlong review will cover veterans rated 100% disabled due to PTSD whose claims were approved between 1999 and 2005.

If the review finds a claim does not have adequate proof of a "stressor"--the specific event or events that trigger PTSD--the veteran will have to provide more information and could ultimately lose benefits.

"This is perhaps the largest review of veterans' claims ever undertaken by the VA and will divert much-needed resources from the VA's overload of disability compensation claims yet to be processed," said National Service Director Randy Reese.

"Another serious concern is that the review is focused on claims that may have been improperly granted, yet there are no plans to review claims that may have been improperly denied," Reese said.

Secretary of Veterans Affairs James Nicholson ordered the review after the VAs Inspector General (IG) found inconsistencies in the way claims were decided. In examining 2,100 randomly selected PTSD cases, the IG study found that the likelihood of a 100% disability rating varied widely in regions across the country, calling into question the VA's evaluation procedures. For example, VA statistics for 2004 show that an average of 8.9% of veterans in Arkansas, Maine, New Mexico, Oklahoma, Oregon, and West Virginia received a 100% disability rating for PTSD. Yet, an average of 2.8% of veterans received the maximum rating in Connecticut, Illinois. Indiana. Michigan. New Jersey, and Ohio.

Over the five-year period, the IC study noted an 80% increase in the number of veterans receiving compensation for PTSD, from 120,000 cases in 1999 to 216,000. PTSD disability payments have risen by 149%, from $ 1.7 billion a year to $4.3 billion.

The report also found that in one out of four cases, VA staff failed to fully document the events that triggered trauma for veterans who later received a 100% disability rating for PTSD. Documented stressors in a veteran's service record might be descriptions and dates of combat engagements or de facto stress indicators such as a Combat Infantry Badge or Purple Heart medal.

In assessing problems with rating PTSD claims, the study found that Veterans' Benefits Administration (VBA) procedures were not always followed and that methods used by rating specialists to develop and verify veteran-reported evidence of a stressor event differed from state to state.

The Inspector General's office then recommended a review of all PTSD cases rated 100% to identify specific claims that were not supported with the required documentation and rework those cases accordingly. However, a follow-up evaluation at three regional offices revealed that the VBA's quality review program failed to detect the problems identified by the Inspector General's office.

To help pin down specific problems, the Inspector General's office surveyed nearly 2,000 rating specialist's and decision review officers for their perspectives. Problems cited included:

* Insufficient staff to ensure timely and quality service.

* Some claims were not ready to rate when presented for rating.

* Some claims were actually rated without all the needed information.

* Training was not a high priority.

"The VA has long struggled with training, accountability, and quality control problems which have plagued the claims adjudication mid benefits delivery system," said Reese. "And while the VA says the massive review of PTSD claims is needed to preserve the integrity of the rating system, devoting the necessary resources to ensure the accuracy and timeliness of claims decisions should be the top priority."

"Evaluating PTSD claims can be highly subjective, which leads to inconsistencies, as the Inspector General's study clearly shows," Reese said. "Both the VA and veterans would be better served by developing nationwide standards and consistently applying them across the board."

Reese said the DAV will continue to closely monitor the PTSD claims review process and will work with veterans and the VA to help ensure fairness and equity.