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Veteran Issues

The Latest From The VA

Subject: VHA Directive:Purple Heart Eligibility

Importance: High

Department of Veteran Affairs VHA DIRECTIVE 2000-006
Veterans Health Administration
Washington, DC 20420 February 29, 2000


1. PURPOSE: This Veterans Health Administration (VHA) directive implements new eligibility and enrollment requirements for veterans awarded the Purple Heart.
2. POLICY: Public Law 106-117, the Veterans Millennium Health Care and Benefits Act, which amended the law to place veterans awarded the Purple Heart in enrollment priority group 3, and to exempt those veterans from co-payment requirements associated with provision of hospital care and outpatient medical services.
a. Veterans awarded the Purple Heart may submit appropriate documentation (i.e., DD 214, service records, orders of award, certificate, etc.) for inclusion into the veteran's Consolidated Health Record (CHR) folder. Field stations are also to fax these documents to
the Health Eligibility Center at (404) 235-1355.
b. As an interim measure, the Health Eligibility Center will provide each Department of Veterans Affairs (VA) health care facility with a partial listing of Purple Heart recipients to assist facilities in manually exempting these veterans from co-payment requirement associated with hospital care and outpatient medical services. The Office of Information (19) will develop software to capture data on veterans awarded a Purple Heart and effect other changes in the VHA information systems necessary to accommodate provisions to Public Law 106-117 relating to Purple Heart Award recipients.
c. Field stations must ensure that those veterans awarded a Purple Heart who were previously, or would be, classified in enrollment priority groups 4 through 7 are placed in enrollment priority group 3 and not charged co-payments.
d. Manual tracking is necessitated until Veterans Health Information Systems and Technology Architecture (VistA) software modifications are implemented to ensure these veterans are not inappropriately billed medical care co-payment charges.
e. Veterans awarded the Purple Heart are to be reimbursed for any medical care co-payments paid for VHA care provided on or after November 30, 1999.
f. VHA officials must have verifiable evidence that veterans received the Purple Heart before reimbursing any co-payments or changing veterans' enrollment status.

4. REFERENCE: Public Law 106-117, dated November 30, 1999.


5. FOLLOW-UP RESPONSIBILITY: Health Administration Services (10C3) is responsible for the content of this directive.

6. RESCISSION: This VHA Directive will expire March 1, 2005.

S/ by Frances Murphy, M.D. for

Thomas L. Garthwaite, M.D.
Deputy Under Secretary for Health
Distribution: CO: E-mailed 3/1/2000
FLD: VISN, MA, DO, OC, OCRO and 200 n FAX 3/1/2000
EX: Boxes 104, 88, 63, 60, 54, 52, 47, and 44 n 3/1/2000

Susan McCrea

VA Intergovernmental Affairs


VA Response
to November 24, 1999, "20/20" Segment
on PTSD Ratings

On Wednesday, November 24, ABC's newsmagazine 20/20 broadcast a story whose premise was that veterans lie in order to receive benefits for post-traumatic stress disorder (PTSD). VA Under Secretary for Benefits Joe Thompson and Dr. Laurent Lehmann, the associate chief of psychiatry and PTSD programs, were interviewed for the story.

The story had a definite slant, and the interviewer, Jay Schadler, had a definite point of view. During an interview of more than an hour -- taped in March in Mr. Thompson's office -- Schadler asked over and over about the appearance that veterans are on a VA "gravy train." The implication is that a number of veterans have discovered ways to cheat the system and fraudulently receive benefits for PTSD, up to "$3,000 per month tax free" (his words).

To be fair, 20/20 acknowledged that PTSD is real, and that thousands of veterans are receiving benefits legitimately. But Schadler insisted on what he called the "common sense" approach that far too many veterans are receiving benefits in error. He even went on to question why Vietnam veterans are still coming to VA for PTSD claims 25 years after the war.

Throughout the interview, Mr. Thompson and Dr. Lehmann tried to educate Schadler about the claims process, and about how PTSD affects veterans, but Schadler stuck to his premise that this was an enormous rip-off. He even interviewed a VA claims representative who indicated that he had personal knowledge of hundreds of claims that had been allowed improperly.

PTSD is a medical condition. We know that Dr. Lehmann was interviewed, and we know he gave compelling information about the nature of PTSD and other mental health issues VA deals with. Nothing he said made it to broadcast.

VA's Position

20/20 managed in this shoddy piece to undo years of hard work by VA and by veterans' advocates to recognize PTSD and to encourage veterans to come to VA for help. With this one story, ABC may have re-stigmatized veterans, and scared them away from the help they need. That is tragic, and the network's news division should be ashamed.

Dr. Lehmann patiently explained the diagnosis and treatment of these veterans to the interviewer, but to no avail.

Mr. Thompson explained that the process of reviewing claims for service- connected disability does not encourage a situation in which lying is rewarded. He was ignored.

Near the end of the interview, Mr. Thompson summed up his concern. He said that as a Vietnam veteran he had seen a number of negative labels unfairly assigned to Vietnam veterans. "Please don't add 'charlatan' and 'fraud' to the list," he said. Unfortunately, that plea never made it on the air.

The resulting story showed what can happen when a producer and a reporter are closed-minded and care only about how a broadcast can be made to fit their pre-conceived notions.

VA assures all veterans, their families and their advocates that its commitment to the treatment and compensation for PTSD is ongoing. We encourage all veterans who need help to come to VA. We will continue to process all claims for disability in accordance with the law, while showing the measure of concern and compassion the American people expect to be afforded the country's defenders.




December 1, 1999

Mr. Victor Neufeld
Executive Producer
147 Columbus Avenue
New York, NY 10023

Dear Mr. Neufeld:

Your November 24 story about how the Department of Veterans Affairs (VA) grants disability compensation to veterans with post-traumatic stress disorder (PTSD) will likely have a significant impact, just not the one you expected.

For months your producer and Jay Schadler have been looking for some facts to back up the suspicion that the stories in the book Stolen Valor are the norm and not the exception. The fact that they failed miserably doesn't matter.

What matters is that with one thoughtless piece of "journalism," ABC has run the risk of re-stigmatizing vulnerable veterans with a chronic and debilitating psychological problem. For 30 years veterans' advocates have been pressing the government to look into the psychological condition that has come to be known as PTSD.

For 20 years (since the diagnosis was officially recognized by mental health experts), VA has been providing treatment for PTSD and pays a range of compensation to veterans who suffer from the condition. Only recently, after years of outreach by the veterans' community and VA have an increasing number of veterans come to VA to seek help for the illness.

20/20 might have undone that work with one 16-minute segment.
You should look at the one-hour-plus grilling that your correspondent put two VA officials through in March. I've seen the entire piece, and I had a difficult time squaring that with what your network decided to use. Time and again your correspondent tried unsuccessfully to cajole our representatives into making gross generalizations or guessing about the percentage of claims that might be adjudicated improperly in favor of veterans. Those attempts failed, of course.


Page 2
Mr. Victor Neufeld

Further, we can see no evidence that Mr. Schadler tried to get even ballpark numbers of "fraudulent" claims from his only other VA source. He didn't ask why that person did not report his suspicions that "hundreds" of claims are being rewarded fraudulently. At one point in the un-aired portion of the interview Schadler said that there was pressure to approve claims. Of course, he offered no corroboration or support for this foolish notion.

I thought you might like to know the truth.

 There are 25 million veterans in the U.S. About 118,000 of them receive disability payments for PTSD from VA. Twenty-four percent of those veterans are rated as 100-percent disabled.

The granting of compensation for PTSD is more complicated than your 20/20 crew was willing to accept.

First, a veteran needs a diagnosis of PTSD. Our doctors don't look at what the veteran thinks caused the PTSD. They subject the veteran to tests, interviews and evaluations. Once that is done, VA's benefits staff examines the veteran's service record for any evidence that he or she might have been exposed to a stressor during military service. Additionally, there are factors that we are required to consider as situations that presume that PTSD exists. In other words, if a veteran has a Purple Heart decoration, a Combat Infantry Badge, a Silver Star or any other "valor" medal, or was held as a prisoner of war, the condition is presumed to be connected to service in the military.

The veteran's story is not considered to be proof of anything. We look at military records and apply the facts in accordance with the law. It's a very fair process, and it works.

It's clear to us that Mr. Schadler had a point of view and spent months trying unsuccessfully to prove it. That is unfortunate. It is also clear that he spent a good deal of time bullying a vulnerable Vietnam veteran for no good reason. That is inexcusable.

Maybe the real story is that Stolen Valor pointed out ABC's lack of thoroughness in one of its earlier features. If that's the case, Mr. Schadler should have just apologized for airing a lie, and gone about his business on legitimate stories.


Page 3
Mr. Victor Neufeld

We do not know how many veterans will fade back into America's fabric and suffer silently as a result of this dreadful piece of work. We'll do our best to let veterans, their families and their advocates know that we will not let unsubstantiated charges affect how we do our business.

I realize that any commercial television program depends on excitement and controversy to attract viewers. It is too bad that ABC chose innuendo over fact, and in doing so did a grave disservice to the veterans and families who depend on VA for help.


John Hanson