I have been reading many of the posts on here and wanted to offer some information that may be helpful.

VA Disability

As many people know, the Department of Defense and the Veterans’ Affairs Administration are completely different entities. The Department of Defense addresses issues with active duty soldiers and they have their own psychologists, psychiatrists, physicians, and the like. Veterans’ Affairs only works with Veterans who have left the service, although they have started working with active-duty personnel as well based upon the current emphasis of the DOD and the VA working together more.

The Veterans’ Affairs is split up in three different areas. The first area is for burial and cemetery affairs. The second area is for pension and compensation (this is the area responsible for determining if a service member is disabled and will receive disability compensation). The third area is medical and psychological services ONLY that I will call the “services” side. Professionals who contract with the VA or VA personnel will interview a person who is applying for disability for psychological or medical reasons. Those folks have NO involvement in the decision made by the compensation and pension, they only provide medical or psychological information as a professional. So, if a person is denied by the C&P, the medical professional on the “services” side is not the one determining if the Veteran is “disabled.” These entities are very separate from one another on purpose. The “services” provider should not be put in a position to determine disability on the Veteran with whom they have a professional and oftentimes an appropriately personal relationship. That is unfair to the service provider, but more importantly, the Veteran. Disability evaluations are too important to not be objective.

PTSD

Post-traumatic stress disorder is all over the news but the information can be conflicting and confusing. PTSD became an official diagnosis in the 1970s, once mental health folks started to see patterns in the behaviors of returning Vietnam Veterans. It was previously known as “shell shock” but little was understood about it. Keep in mind that much is still not known about PTSD and how it affects a person’s brain. PTSD is officially an anxiety disorder and is medically coded as such. There is a “lesser” diagnosis of Acute Stress Disorder that would be appropriate for PTSD-like symptoms that are only a few months old. Most people who even present with classic PTSD-like symptoms are VERY unlikely to be diagnosed as such until the psychologist/psychiatrist is familiar enough with the Veteran to be able to make such a heavy diagnosis. Believe me, the last thing you want to do is overdiagnosis someone because of how stigmatizing it can be to someone. Also keep in mind that PTSD can be difficult to truly see for a while because one of the hallmarks of PTSD is avoidance and numbing. Well, if a person is avoiding their trauma, they sure aren’t going to want to talk about it. Then, the clinician is left trying to figure out what is going on. Would you want a psychologist/psychiatrist to be guessing at your diagnosis and acting like they know what is going on when they don’t? It can take some time for the Veteran to know they can trust you and open up about their troubles. PTSD also can look to recurring childhood trauma, it can look like a general anxiety disorder, it can look like depression, or traumatic brain injury, and on and on. What you do not want to do is diagnosis someone with something when in fact they have something else. The reason for this is that there are often varying treatment options that work best for each diagnosis. Ethical behavior is knowing what is PTSD, what is traumatic brain injury, or is it both? Or is it something else?

Another difficult thing is that people are just plain complex and psychology is a very young field. Psychology has only been around for around 100 years. Compare that to the history of medicine and consider how difficult it is to figure out what physical diagnoses are.

Most people that are exposed to trauma never meet the diagnostic criteria for PTSD. Many people are able to work through things for a million different reasons. Other people who may have had multiple traumas (polytrauma), different levels of exposure to trauma, childhood traumas, or other things can have a much tougher road than someone with “simple” trauma. Additionally, as we all know, people are wildly different and things affect everyone differently. Your personal healthcare provider will help you in determining if you have PTSD and they will treat you accordingly. If that treatment doesn’t work, they should try another. If you do not like your psychologist/psychiatrist PLEASE PLEASE PLEASE ask to see another professional. Simply tell the professional that your relationships is not a “great fit” and that you would like to try someone older, youngest, male, female, or whatever your preference. It is your VA and you can choose who provides you with care. Most folks in mental health will understand this and if they don’t – good riddance. Keep in most mental health care folks do not specialize in trauma. It is a complex and difficult field that is only one part of the services offered at the VA for psychology or psychiatry.

Diagnosis

All psychologists and psychiatrist will diagnosis on a five axis diagnosis. It looks something like this.

Axis I PTSD (there is also a number code for it but it is not included)
Axis II This is where personality disorders and mental retardation is coded ONLY
Axis III Medical Diagnosis
Axis IV Social Issues
Axis IV Global Assessment of Functioning or GAF score.

If you are interested, you can look all of these up online or you can use the Diagnostic and Statistical Manual – Fourth Edition for a thorough explanation. PTSD and TBI are not the same thing and will never be the same thing. The symptoms can look alike, but they are wildly different as well. Sometimes, a person can have both. If a person has a personality disorder (there are 10 of them with readily available information on the web) that can also sometimes look like PTSD to an untrained person. The DSM is in the process of being rewritten and will likely include extensive changes to the way we diagnosis trauma.

Psychiatrist/Psychologist

Psychiatrists and Psychologists sound the same, and they work together, but they have very different jobs. Both are usually referred to as a “shrink.”

Psychiatrists are medical doctor (M.D.) and they attended medical school. After medical school they did a residency in psychiatry to specialize, much like a cardiologist, pediatrician, etc. would. Their schooling is approximately 4 years undergrad, 3 years medical school, 1 year internship, and then their residency, usually two or three years or so. These folks graduate from medical school with an M.D. and then they do their residency, required for licensure as a physician. So, when you see them in the hospital, they are called doctors while they are doing their residency. So, you will hear them called residents, chief residents, etc. until they can practice completely by themselves. All residents are always supervised by a “full doctor” or what is called an attending physician. As a result of being a medical doctor, they are primarily concerned with the biological processes of your body. In other words, they will be the ones to write your prescriptions and they absolutely specialize in medications. For those of you with medication usage, get a good psychiatrist, they will help you.

Psychologists are academic doctors (Ph.D.) and they attend graduate school. After their graduate programs, they attend a residency and then do what is called a post-doc. This is required for licensure as a psychologist. Their school is approximately 4 years undergrad, 2 years for a Master’s degree, and approximately 4 more years for a doctorate. They then do a one year residency and a one to two year post-doc. In addition, they will write a research-based dissertation of original research, about 200 to 300 pages long. They are not called doctors until they are finished with their 9 to 10 years of academic work and their residency. As a result, you will hear them called residents when they are on their last year of train (prior to Ph.D.) and when the officially graduate, they are then doctors. All residents and post-docs are supervised by a “full doctor” or what is called an attending psychologist. As a result of being an academic doctor, they are primarily concerned with research, psychological theory development, and providing therapy to folks. They do not prescribe medication because they are not focused on the biological aspects of a person, they are concerned with thought processes, brain functioning, social influences of behavior, and behavior modification. In other words, they are the ones who will provide short or long term therapy with someone to reach long term goals. For those of you with long standing behavioral issues, get a good psychologist and they will help you.

So, if you go to the VA, the psychiatrist will prescribe your medication and adjust it as needed. Remember, biology is their focus, not therapy. You will also talk with them about your general health issues as they relate to your mental health issues. They will likely meet with you every month to three months for around 30 minutes or so. The psychologist will meet with you for approximately 45 minutes each week or every other week. It may be more often for someone actively suicidal or in crisis. Psychologists will work with people with PTSD, personality disorders, autism, ADHD, depression, suicidal behavior, etc. They will provide assessments for people (think neuropsychological tests, personality tests, etc.). Also keep in mind that many psychologists work in the VA that do not specialize in trauma, that is a subset of psychology. Most psychologists are somewhat familiar with trauma, but it is a difficult specialization.

So, this is just some hopefully helpful information. I would be happy to add if people would like additional information.

Good job in your research! If you want more information go here.