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Sticker shock over shell shock

The U.S. government is reviewing 72,000 cases in which veterans have been diagnosed with severe post-traumatic stress disorder, claiming that misdiagnosis and fraud have inflated the numbers. Outraged vets say the plan is a callous attempt to cut the costs of an increasingly expensive war.

Matt LaBranche has memories of Iraq that he does not want to have. He was a gunner who protected convoys for a National Guard company out of Bangor, Maine. Once, during his nine-month tour in Iraq, his truck got separated from a convoy headed to Tikrit. He couldn't raise anyone on the radio. Insurgents ambushed. He remembers tumbling out of the truck just as a roadside bomb went off, slamming him against the truck, breaking his coccyx and knocking loose an eye tooth. He remembers pulling the driver out of the truck and laying down fire with his M249 SAW machine gun until he thought the barrel would melt.

There are more memories he can't shake. Some are worse. Some include children. We agree that I won't print details, but he cries when he tells them to me. LaBranche, 41, also supports the war and has little patience for those who don't.

I first met LaBranche in the summer of 2004 when he was at Walter Reed Army Medical Center in Washington. He was clearly a troubled man. He spent a month in the lockdown psychiatric unit, Ward 54, and a year receiving outpatient treatment. He is still haunted.

"I dream about it every fucking night," he tells me in a telephone conversation from his home in Maine. "I am on so many drugs for nightmares. Sometimes days go by and I don't even know what day it is."
LaBranche lives in a house in the woods with a lot of guns. He never suffered from mental illness before going to Iraq. But twice since returning, he says, he has put a gun barrel in his mouth or under his chin. Since the war, he has lost his house and his wife because of where his mind is at. He is not in close contact with his two sons. Once, in a rage, he almost killed a man. "There are some days," he says, "when I get up and think, What the fuck? I lost my house, I lost my kids, everything I went over there to protect is gone."

After being discharged by Walter Reed late last year, LaBranche approached the Department of Veterans Affairs, which cares for soldiers after they leave the military and pays them disability payments if needed. He was diagnosed with PTSD (post-traumatic stress disorder), a widely studied and validated psychiatric condition that can follow life-threatening experiences, with symptoms that include nightmares, flashbacks, insomnia and rage. The V.A. gave LaBranche a "100 percent PTSD rating." Although LaBranche didn't reveal how much money he received from the department, in most cases those diagnosed with a 100 percent rating get the maximum payout, a monthly check of about $2,000.

LaBranche, however, may have to prove to Veterans Affairs a second time what the war has done to his mind. In a recent move that has set off a firestorm among veterans, the Department of Veterans Affairs has decided to go back and review more than 70,000 individual cases of vets who in the past five years are considered disabled and unemployable because of mental trauma. Veterans like LaBranche now stand to lose some or all of their monthly payments.

To outraged veterans groups, the review smacks of a convenient way to cut costs during an increasingly expensive war and reflects a reluctance by the department to take PTSD seriously. "The V.A. hopes to trim costs for existing war veterans and recently returning war veterans by targeting PTSD," says Steve Robinson, executive director of the National Gulf War Resource Center, a veterans advocacy organization in Silver Spring, Md.
"This is a desperate and despicable move by an administration caught without a plan, the money, or the staff to care for our nation's wounded warriors."

The Department of Veterans Affairs decided to undertake the review after the department's inspector general issued a report last May, showing the agency had been inconsistent in granting a 100 percent PTSD rating to veterans. It found that the likelihood of a veteran's getting the maximum payment varied widely in regions across the country, calling into question the evaluation procedures. For example, in 2004, VA statistics show that an average of 8.9 percent of veterans in New Mexico, Maine, Arkansas, West Virginia, Oklahoma and Oregon received a 100 percent PTSD rating. On the other hand, an average of 2.8 percent of vets received the maximum payment in Indiana, Michigan, Connecticut, Ohio, New Jersey and Illinois.

Once a soldier is out of the military, he can make a claim at the V.A. to receive compensation for wounds, illnesses or mental trauma from service.
Doctors perform examinations and make recommendations to adjudicators, who use a ratings system to decide how much money, if any, a veteran will receive. To grant payments to a veteran for PTSD, the agency documents "stressors," the traumatic events that occurred. It examines military records, reviews combat awards like Purple Hearts, and in some cases interviews veterans' war buddies. The V.A. report found that in one out of four cases, agency staff may have failed to fully document the events that triggered trauma from veterans who later got full payments for PTSD.

The report expresses concern that the number of veterans receiving payments for PTSD is growing rapidly, from approximately 120,000 cases in
1999 to 216,000 in 2004. PTSD benefit payments, it notes, have soared from
$1.7 billion in 1999 to $4.3 billion in 2004.

It also raises the specter that some veterans might be engaging in fraud, stating that 2.5 percent of cases where veterans were getting some money for PTSD were "potentially fraudulent." "We noted an abundance of Web sites providing advice to veterans filing PTSD claims or offering ways to compile less than truthful evidence to obtain approval," the report reads.
It notes that one Web site sells a fake Purple Heart for $19.95.

Veterans groups, already enraged that the department might go back and take money from vets, have assailed the accusations of fraud. "It is like accusing somebody of sexual battery or a sexual offense," says Steve Smithson, deputy director for claims services at the American Legion.
"Even if that person is later proven innocent, there is still going to be that shadow around him. They are trying to give people the impression that people are gaming the system."

Rick Weidman, director of government relations at Vietnam Veterans of America, says when the department briefed him on the inspector general report, agency officials used the word "fraud" seven times. "They used that as a pretext to find that the whole system was fraudulent and there was insufficient documentation of stressors," Weidman says. "It is outrageous. Say it is 2 percent? I'm willing to guess that the rate of fraud in travel and expenses among high-level V.A. officials is 2 percent.
Let's investigate every one of them."

Veterans advocate Robinson, a retired Army Airborne Ranger, who served in the Gulf War, says that in all compensation systems there will always be some individuals who try to pull a fast one on the system. But in this case, he adds, the number of people unfairly being denied compensation "far outweighs" any losses from veterans involved in fraud.

(End Part 1)