Psychiatrist deployments

[JerryMouse]

I’m very curious about what psychiatrists do when they are deployed to a location outside of the US (ex. from the National Guard or Reserves). Does anyone here have any experience with this?

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[DrMetal]

I’m very curious about what psychiatrists do when they are deployed to a location outside of the US (ex. from the National Guard or Reserves). Does anyone here have any experience with this?

They see the mental health complaints, sort out the "real deal" from the malingerers, treat the former, kick the ass of the latter. Psychiatrists are quite busy during deployments. Mine's was very busy, and he save us some 30-40 medevacs. I wish I had 2 more of them. By contrast the general surgeon was very bored!

 

[TheEarDoc]

I’m very curious about what psychiatrists do when they are deployed to a location outside of the US (ex. from the National Guard or Reserves). Does anyone here have any experience with this?

Usually in role III med facilities or major med centers. You see soldiers who are brought in from out in the field to sort them out through evaluation, write profiles, work on recommendations for med boards, etc..

The Psychologists usually are out at the COSC or role II facilities doing a lot of the field work.

This doesn't mean this won't change with what's going on if things get heated.

 

[JerryMouse]

They see the mental health complaints, sort out the "real deal" from the malingerers, treat the former, kick the ass of the latter. Psychiatrists are quite busy during deployments. Mine's was very busy, and he save us some 30-40 medevacs. I wish I had 2 more of them. By contrast the general surgeon was very bored!

Appreciate the reply! What setting were you in during your deployment?

 

[DrMetal]

Appreciate the reply! What setting were you in during your deployment?

At sea, in the Navy, part of an amphibious battle group.

 

[JerryMouse]

At sea, in the Navy, part of an amphibious battle group.

So the psychiatrist and general surgeon were both on a ship? That's incredible. I didn't even know that is possible.

 

[DrMetal]

So the psychiatrist and general surgeon were both on a ship? That's incredible. I didn't even know that is possible.

On the big ships---the aircraft and amphibious/helicopter carriers--Yes. The smaller ships do not, but you can transfer a patient form the smaller to the larger ship. That's the blue Navy construct at least. Ground forces have similar setups with field hospitals, etc.

 

[JerryMouse]

On the big ships---the aircraft and amphibious/helicopter carriers--Yes. The smaller ships do not, but you can transfer a patient form the smaller to the larger ship. That's the blue Navy construct at least. Ground forces have similar setups with field hospitals, etc.

This is all very interesting to learn about. It seems like psychiatrists have to do a lot of gatekeeping for people seeking a medevac and/or a psychiatric diagnosis (this is obviously not to say that all soldiers/sailors are doing this for secondary gain). Is there a lot of resentment towards psychiatrists?

 

[DrMetal]

Is there a lot of resentment towards psychiatrists?

No, not necessarily. The good ones (who quickly dispo, differentiating between the real deal and the malingers, and then make a decision to treat, or send home) are worth their weight in gold. Really the line commanders are looking for that decisiveness and maybe some consistency.

The mental health system in the military is unfortunately flooded right now. There's a ton of secondary gain, a ton of malingering, and we're dealing with a new generation of kids that seem to have no coping skills, thinking every setback in their lives is a catastrophe requiring the utmost attention. We also have weak leadership that's afraid to kick anyone's ass and allows every soldier/sailor's grip to become a Congressional investigation. What's worse is, amongst all this "noise", those who are really mentally ill and require help stay quiet too often and don't seek help.

We're also a very bored military right now (unless we go to Ukraine), and boredom does not bode well for mental health.

What's your story, are you thinking of joining? If you're already practicing, consider the reserves (not full time active duty). I'm becoming a big proponent of the reserves, I think most of the Medical Corps should be in a reserve status.

 

[ProwlerturnGas]

No, not necessarily. The good ones (who quickly dispo, differentiating between the real deal and the malingers, and then make a decision to treat, or send home) are worth their weight in gold. Really the line commanders are looking for that decisiveness and maybe some consistency.

The mental health system in the military is unfortunately flooded right now. There's a ton of secondary gain, a ton of malingering, and we're dealing with a new generation of kids that seem to have no coping skills, thinking every setback in their lives is a catastrophe requiring the utmost attention. We also have weak leadership that's afraid to kick anyone's ass and allows every soldier/sailor's grip to become a Congressional investigation. What's worse is, amongst all this "noise", those who are really mentally ill and require help stay quiet too often and don't seek help.

We're also a very bored military right now (unless we go to Ukraine), and boredom does not bode well for mental health.

What's your story, are you thinking of joining? If you're already practicing, consider the reserves (not full time active duty). I'm becoming a big proponent of the reserves, I think most of the Medical Corps should be in a reserve status.

Much truth in your second paragraph! You nailed my experiences as well. Not a psychiatrist but see plenty of mental health issues. Command climate makes all the difference

 

[JerryMouse]

No, not necessarily. The good ones (who quickly dispo, differentiating between the real deal and the malingers, and then make a decision to treat, or send home) are worth their weight in gold. Really the line commanders are looking for that decisiveness and maybe some consistency.

The mental health system in the military is unfortunately flooded right now. There's a ton of secondary gain, a ton of malingering, and we're dealing with a new generation of kids that seem to have no coping skills, thinking every setback in their lives is a catastrophe requiring the utmost attention. We also have weak leadership that's afraid to kick anyone's ass and allows every soldier/sailor's grip to become a Congressional investigation. What's worse is, amongst all this "noise", those who are really mentally ill and require help stay quiet too often and don't seek help.

We're also a very bored military right now (unless we go to Ukraine), and boredom does not bode well for mental health.

What's your story, are you thinking of joining? If you're already practicing, consider the reserves (not full time active duty). I'm becoming a big proponent of the reserves, I think most of the Medical Corps should be in a reserve status.

Can't thank you enough for your insight. I have no experience with the military, so any bit of information is valuable.

I thought about active duty in the past, but decided against it because I find my job at the VA to be meaningful (at least some of the time, ha!) and don't want to quit to go work at a MTF. Malingering/secondary gain and the threat of Congressionals are not new, given it's the VA population. Fortunately, I've not had to go through a White House report or Congressional myself and the administration at my VA is very supportive and non-malignant. I'm certainly considering the reserves, mainly because I enjoy working with the military population and want to be available to help out in case there is a future conflict, but it seems like people in the reserves are just used to backfill at MTFs mostly, even during times of relative peace.

 

[DrMetal]

Can't thank you enough for your insight. I have no experience with the military, so any bit of information is valuable.

I thought about active duty in the past, but decided against it because I find my job at the VA to be meaningful (at least some of the time, ha!) and don't want to quit to go work at a MTF. Malingering/secondary gain and the threat of Congressionals are not new, given it's the VA population. Fortunately, I've not had to go through a White House report or Congressional myself and the administration at my VA is very supportive and non-malignant. I'm certainly considering the reserves, mainly because I enjoy working with the military population and want to be available to help out in case there is a future conflict, but it seems like people in the reserves are just used to backfill at MTFs mostly, even during times of relative peace.

If you're a VA psychiatrist, you're already serving the Armed Forces well, in my opinion. If you feel the dire need to put on a uniform, check out the reserves, in which you might deploy, you might backfill a MTF, it's anyone's best guess. It would really depend on what service and what reserve unit you join.

Or, you can open your own tele-psych service and make a killing, I hear that's the new fad!

 

[DOswag]

The mental health system in the military is unfortunately flooded right now. There's a ton of secondary gain, a ton of malingering, and we're dealing with a new generation of kids that seem to have no coping skills, thinking every setback in their lives is a catastrophe requiring the utmost attention. We also have weak leadership that's afraid to kick anyone's ass and allows every soldier/sailor's grip to become a Congressional investigation. What's worse is, amongst all this "noise", those who are really mentally ill and require help stay quiet too often and don't seek help.

This paragraph right here is spot on. From the malingering/secondary gain, to the lack of coping skills, to the leadership hamstrung by the fear of investigations/IG complaints etc. It's extremely sad when this impacts those who are truly mentally ill and either don't seek help or it makes us question every patient that comes in if they're malingering for an MEB and service connection. I've had plenty of patients off handedly tell me they looked up certain diagnosis and know how much they'll get in disability compensation if they get an MEB for said diagnosis. I've decided that this is unofficially an additional criteria for a personality disorder and will likely lead to an admin sep which in general is not accepted well by a patient that is absolutely convinced based off of their internet readings they have bipolar, PTSD, MDD, OCD, and ADHD...

 

[DrMetal]

This paragraph right here is spot on. From the malingering/secondary gain, to the lack of coping skills, to the leadership hamstrung by the fear of investigations/IG complaints etc. It's extremely sad when this impacts those who are truly mentally ill and either don't seek help or it makes us question every patient that comes in if they're malingering for an MEB and service connection. I've had plenty of patients off handedly tell me they looked up certain diagnosis and know how much they'll get in disability compensation if they get an MEB for said diagnosis. I've decided that this is unofficially an additional criteria for a personality disorder and will likely lead to an admin sep which in general is not accepted well by a patient that is absolutely convinced based off of their internet readings they have bipolar, PTSD, MDD, OCD, and ADHD...

Unfortunately we're a very undisciplined force right now. Let's hope the Russians don't attack a NATO country.

 

[JerryMouse]

If you're a VA psychiatrist, you're already serving the Armed Forces well, in my opinion. If you feel the dire need to put on a uniform, check out the reserves, in which you might deploy, you might backfill a MTF, it's anyone's best guess. It would really depend on what service and what reserve unit you join.

Or, you can open your own tele-psych service and make a killing, I hear that's the new fad!

Based on what you guys have told me, I will wait until there is a conflict and a true need before joining. If I get called up to backfill a MTF, I'll have to stop seeing my veteran patients, which doesn't seem very worth it in the end when the MTF population is much healthier.

This paragraph right here is spot on. From the malingering/secondary gain, to the lack of coping skills, to the leadership hamstrung by the fear of investigations/IG complaints etc. It's extremely sad when this impacts those who are truly mentally ill and either don't seek help or it makes us question every patient that comes in if they're malingering for an MEB and service connection. I've had plenty of patients off handedly tell me they looked up certain diagnosis and know how much they'll get in disability compensation if they get an MEB for said diagnosis. I've decided that this is unofficially an additional criteria for a personality disorder and will likely lead to an admin sep which in general is not accepted well by a patient that is absolutely convinced based off of their internet readings they have bipolar, PTSD, MDD, OCD, and ADHD...

The secondary gain is much worse now, with a myriad of resources available on the internet on how to get the maximum disability benefits possible. (For example, this) Looks like active duty psychiatrists bear the full brunt of this ever increasing surge of personality disorder and malingering. VA work looks benign in comparison because the majority of veterans have already maximized their service connection %, though secondary gain is still very much present. Some people will continue to get themselves admitted to the psych unit by any means possible until their service connection % is upgraded from 70% to that sought-after 100%.

 

[TheEarDoc]

This paragraph right here is spot on. From the malingering/secondary gain, to the lack of coping skills, to the leadership hamstrung by the fear of investigations/IG complaints etc. It's extremely sad when this impacts those who are truly mentally ill and either don't seek help or it makes us question every patient that comes in if they're malingering for an MEB and service connection. I've had plenty of patients off handedly tell me they looked up certain diagnosis and know how much they'll get in disability compensation if they get an MEB for said diagnosis. I've decided that this is unofficially an additional criteria for a personality disorder and will likely lead to an admin sep which in general is not accepted well by a patient that is absolutely convinced based off of their internet readings they have bipolar, PTSD, MDD, OCD, and ADHD...

Yep it seems to be the typical game anymore. I see it all the time in the VA. Dirtbag soldier gets booted out, but plays the MEB card and gets out either on mental health diagnosis that if truth be told should have been investigated and would reveal fraudulent enlistment by not disclosing issues prior to joining, but they get a nice lifetime tax free paycheck for it. Or the other thing I see is they get out then start coming to the VA and find out how lucrative the mental health diagnoses are and how little evidence most of the claims require and they start filing claims and eventually they find someone who will rubber stamp it.

I see the other most commonly malingered issues of impaired hearing and tinnitus. It's quite insulting dealing with fakers on a daily basis taking up appointment slots for veterans I could truly be helping.

 

[JerryMouse]

This paragraph right here is spot on. From the malingering/secondary gain, to the lack of coping skills, to the leadership hamstrung by the fear of investigations/IG complaints etc. It's extremely sad when this impacts those who are truly mentally ill and either don't seek help or it makes us question every patient that comes in if they're malingering for an MEB and service connection. I've had plenty of patients off handedly tell me they looked up certain diagnosis and know how much they'll get in disability compensation if they get an MEB for said diagnosis. I've decided that this is unofficially an additional criteria for a personality disorder and will likely lead to an admin sep which in general is not accepted well by a patient that is absolutely convinced based off of their internet readings they have bipolar, PTSD, MDD, OCD, and ADHD...

Quick question for you, if someone is administratively separated for a personality disorder, do they still get a disability pension of some kind?

 

[DOswag]

Quick question for you, if someone is administratively separated for a personality disorder, do they still get a disability pension of some kind?

Administrative separation is not subject to disability processing from DoD. The member can still go to the VA and file claims if they want and that's on the VA to give them service connection or not. They won't get it for personality disorder but VA dishes out PTSD diagnosis like candy so they can still get disability compensation from them after separation from active duty.

 

[JerryMouse]

Administrative separation is not subject to disability processing from DoD. The member can still go to the VA and file claims if they want and that's on the VA to give them service connection or not. They won't get it for personality disorder but VA dishes out PTSD diagnosis like candy so they can still get disability compensation from them after separation from active duty.

Thank you! My current understanding of military disability benefits is as follows. Is this correct?

Option 1: separation for medical reasons
The veteran gets a DoD disability retirement pension based on the ratings for the medical conditions they are found to have. The veteran can still apply for VA service connection, but they cannot “double dip” and have to choose between the DoD pension vs the VA service connection payment.

Option 2: separation for administrative reasons
The veteran gets no pension payment from the DoD but can apply for VA service connection (and will pretty much get 100% if they are personality disordered and/or addicted to substances 😉).

 

[DOswag]

Thank you! My current understanding of military disability benefits is as follows. Is this correct?

Option 1: separation for medical reasons
The veteran gets a DoD disability retirement pension based on the ratings for the medical conditions they are found to have. The veteran can still apply for VA service connection, but they cannot “double dip” and have to choose between the DoD pension vs the VA service connection payment.

Option 2: separation for administrative reasons
The veteran gets no pension payment from the DoD but can apply for VA service connection (and will pretty much get 100% if they are personality disordered and/or addicted to substances 😉).

I’m Air Force so other branches may be a little different as far as what criteria needs to be met for medical retirement.

So in option 1: if a member is found to have an unfitting condition and meets certain criteria in the medical standards directory (commonly referred to as the MSD) a whole package gets sent to AFPC in San Antonio and they have an office of people that reviews the case and determines if the member should go through a full medical evaluation board (an MEB). AFPC could also decide to return them to duty. During this process (if full MEB is determined), the member gets a certain percentage rating from the DoD. It’s actually an integrated disability evaluation system (IDES) where they also get evaluated by the VA. They get a percentage rating from the VA as well (sometimes this is a different percentage than DoD). Those 2 percentages from DoD and VA are combined into a final percentage (they’re not necessarily added together but some formula to combine them to come up with a final number) so the member actually sort of is double dipping as it is integrated. This final percentage determines the disability compensation or pension they receive. The whole process takes typically 6-9 months before they’re officially retired.

Option 2: administrative separation does not get DoD disability ratings. After separation the member can go to the VA with all their personality disorders and substance use issues or whatever lol. The VA will still do a separate evaluation and frequently they end up giving them MDD, GAD, PTSD or something that is eligible for disability ratings even if we separate the member for a personality disorder or something else. But the financial compensation will only come from the VA, not both VA and DoD.

 

[JerryMouse]

I’m Air Force so other branches may be a little different as far as what criteria needs to be met for medical retirement.

So in option 1: if a member is found to have an unfitting condition and meets certain criteria in the medical standards directory (commonly referred to as the MSD) a whole package gets sent to AFPC in San Antonio and they have an office of people that reviews the case and determines if the member should go through a full medical evaluation board (an MEB). AFPC could also decide to return them to duty. During this process (if full MEB is determined), the member gets a certain percentage rating from the DoD. It’s actually an integrated disability evaluation system (IDES) where they also get evaluated by the VA. They get a percentage rating from the VA as well (sometimes this is a different percentage than DoD). Those 2 percentages from DoD and VA are combined into a final percentage (they’re not necessarily added together but some formula to combine them to come up with a final number) so the member actually sort of is double dipping as it is integrated. This final percentage determines the disability compensation or pension they receive. The whole process takes typically 6-9 months before they’re officially retired.

Option 2: administrative separation does not get DoD disability ratings. After separation the member can go to the VA with all their personality disorders and substance use issues or whatever lol. The VA will still do a separate evaluation and frequently they end up giving them MDD, GAD, PTSD or something that is eligible for disability ratings even if we separate the member for a personality disorder or something else. But the financial compensation will only come from the VA, not both VA and DoD.

Thank you SO much for this detailed explanation. Option 1 (being medically discharged) is more complex than I thought. No wonder people would prefer this option because it automatically grants them a VA service connection percentage as well. Maybe the total compensation can even exceed the max VA service connection payouts, which would make this option more attractive.

As for option 2, I have no clue what incentivizes the VA to give these personality disordered people a service connection. Doesn’t the person doing the evaluation have access to the DoD records? Does the comp & pen evaluator face potential backlash if they don’t handout enough service connection diagnoses? I guess we will bankrupt the country first before things will change.

I’ll be saving this for future reference.

 

[DOswag]

Thank you SO much for this detailed explanation. Option 1 (being medically discharged) is more complex than I thought. No wonder people would prefer this option because it automatically grants them a VA service connection percentage as well. Maybe the total compensation can even exceed the max VA service connection payouts, which would make this option more attractive.

As for option 2, I have no clue what incentivizes the VA to give these personality disordered people a service connection. Doesn’t the person doing the evaluation have access to the DoD records? Does the comp & pen evaluator face potential backlash if they don’t handout enough service connection diagnoses? I guess we will bankrupt the country first before things will change.

I’ll be saving this for future reference.

For people that get 100% service connection it comes out to about 4K per month in non taxable income plus healthcare for life. For option 2, unfortunately the VA doesn’t have access to the DoD records even though we can see their records. I think the backlash is what they’re afraid of so seemingly over diagnose stuff and dish out money for them. It’s sad because there are some who actually need it and meet criteria for it. But plenty don’t.

 

[JerryMouse]

For people that get 100% service connection it comes out to about 4K per month in non taxable income plus healthcare for life. For option 2, unfortunately the VA doesn’t have access to the DoD records even though we can see their records. I think the backlash is what they’re afraid of so seemingly over diagnose stuff and dish out money for them. It’s sad because there are some who actually need it and meet criteria for it. But plenty don’t.

I could have sworn I heard from someone that the people doing comp & pen exams do have access to the DoD records... Either way, the VA comp & pen evaluator is probably reviewing DoD records minimally based on some of the stories I heard.

 

[DOswag]

I could have sworn I heard from someone that the people doing comp & pen exams do have access to the DoD records... Either way, the VA comp & pen evaluator is probably reviewing DoD records minimally based on some of the stories I heard.

The patients are supposed to get their records before out processing and bring them to the VA but I’m not aware of the VA providers having access to DoD EMR (I could be totally wrong about this though). Does CPRS have some kind of back door way to view AHLTA/Genesis records? In AHLTA and now the new EMR Genesis, we can see VA records through something called joint legacy viewer (JLV).

 

[TheEarDoc]

Administrative separation is not subject to disability processing from DoD. The member can still go to the VA and file claims if they want and that's on the VA to give them service connection or not. They won't get it for personality disorder but VA dishes out PTSD diagnosis like candy so they can still get disability compensation from them after separation from active duty.

No the VA would most likely give them either some high rating for personality disorder "made worse by service" or PTSD or anxiety or some other BS. The vast majority of the time most likely it was truly fraudulent enlistment, but people look the other way and just send the check.

 

[TheEarDoc]

I could have sworn I heard from someone that the people doing comp & pen exams do have access to the DoD records... Either way, the VA comp & pen evaluator is probably reviewing DoD records minimally based on some of the stories I heard.

They have access to whatever records are pulled from DOD and placed in VBMS. Sometimes it's the entire medical record and sometimes it is just what the service member has cherry picked to be added and sometimes it's nothing. Sadly what I see a lot of is people just taking everything the person says as the truth and never even reviewing records.

 

[TheEarDoc]

The patients are supposed to get their records before out processing and bring them to the VA but I’m not aware of the VA providers having access to DoD EMR (I could be totally wrong about this though). Does CPRS have some kind of back door way to view AHLTA/Genesis records? In AHLTA and now the new EMR Genesis, we can see VA records through something called joint legacy viewer (JLV).

We can get into some medical records from DOD via JLV, but that system is trash and takes forever to load and many C&P's are handled outside the Va in the private sector so they do not have access to JLV.

 

[DOswag]

We can get into some medical records from DOD via JLV, but that system is trash and takes forever to load and many C&P's are handled outside the Va in the private sector so they do not have access to JLV.

Yeah from what I've seen it looks like there isn't much of a record review done. Whether that's because they don't have ample access to all the records, don't have adequate time to review the records, or just choose not to review anything I don't know lol. I wasn't sure if VA had access to JLV like we do. It's been a while since I used CPRS and I don't think I used JLV when I did have access. But I was in a combined mil/civ residency and had access to AHLTA at the time anyway. Now on active duty I do have JLV through genesis (previous access when we had AHLTA). Genesis isn't an upgrade from AHLTA like was promised to us (shocking I know). Agree JLV is terrible to try and conduct record review. Super slow and difficult to find what you're looking for.

I am interested in working for VA following my active duty time though. Hopefully not doing the mental health portion of C&P exams though.

 

[TheEarDoc]

Yeah from what I've seen it looks like there isn't much of a record review done. Whether that's because they don't have ample access to all the records, don't have adequate time to review the records, or just choose not to review anything I don't know lol. I wasn't sure if VA had access to JLV like we do. It's been a while since I used CPRS and I don't think I used JLV when I did have access. But I was in a combined mil/civ residency and had access to AHLTA at the time anyway. Now on active duty I do have JLV through genesis (previous access when we had AHLTA). Genesis isn't an upgrade from AHLTA like was promised to us (shocking I know). Agree JLV is terrible to try and conduct record review. Super slow and difficult to find what you're looking for.

I am interested in working for VA following my active duty time though. Hopefully not doing the mental health portion of C&P exams though.

I wish I had access to medpros using my DOD CAC, but unless you are on a .mil network you can't access MEDPROS. I can usually find a lot of what I need for audiology though in DOEHRS (the hearing conservation database), but since they took C&P's out of most of the VA's I no longer do C&P exams (which I actually enjoyed) and they moved them to the private sector where I think most of the time no records reviews are being done and people with no knowledge of the military are doing the exams so they have no idea when a veteran is lying or being untruthful and they of course think every veteran would be honorable and not lie for financial gain or fake (I wish this were true!), and so I see a lot of people coming in with high disability ratings and horrible hearing losses and when I test them for amplification I get normal hearing after they try and play their games. I used to though go straight to DOEHRS when I did C&P's and check for audio records when I had C&P's and in less than 5 minutes I could know exactly whether it was a valid claim or not.

 

[comp1]

White House or Congressional inquiries aren't that bad or uncommon. If you haven't seen one at the VA already, you probably just have a good supervisor who handles them for you.

 

[JerryMouse]

They have access to whatever records are pulled from DOD and placed in VBMS. Sometimes it's the entire medical record and sometimes it is just what the service member has cherry picked to be added and sometimes it's nothing. Sadly what I see a lot of is people just taking everything the person says as the truth and never even reviewing records.

Exactly. Zero record review (even of VA records) and just going by whatever the person says because most evaluators just want to get the exam over with the least amount of work. I have been able to view DoD records in JLV, but the records are not viewable if they are prior to the 1990s. It is impossible to make a psychiatric diagnosis based on one meeting without prior records in a situation so plagued by secondary gain. Psychiatry has no other ways of diagnosing besides through history and interview, which is a problem in the information age. It is so easy nowadays to go online and look up what you need to say for the diagnosis and service connection % you are seeking.

Yeah from what I've seen it looks like there isn't much of a record review done. Whether that's because they don't have ample access to all the records, don't have adequate time to review the records, or just choose not to review anything I don't know lol. I wasn't sure if VA had access to JLV like we do. It's been a while since I used CPRS and I don't think I used JLV when I did have access. But I was in a combined mil/civ residency and had access to AHLTA at the time anyway. Now on active duty I do have JLV through genesis (previous access when we had AHLTA). Genesis isn't an upgrade from AHLTA like was promised to us (shocking I know). Agree JLV is terrible to try and conduct record review. Super slow and difficult to find what you're looking for.

I am interested in working for VA following my active duty time though. Hopefully not doing the mental health portion of C&P exams though.

Yes! Come work at the VA after you're done. It is a mostly fulfilling experience if you are at a VA with good admin. The VA has outsourced C&P exams to contractors mostly. You won't have to worry about doing them.

 

[DOswag]

Exactly. Zero record review (even of VA records) and just going by whatever the person says because most evaluators just want to get the exam over with the least amount of work. I have been able to view DoD records in JLV, but the records are not viewable if they are prior to the 1990s. It is impossible to make a psychiatric diagnosis based on one meeting without prior records in a situation so plagued by secondary gain. Psychiatry has no other ways of diagnosing besides through history and interview, which is a problem in the information age. It is so easy nowadays to go online and look up what you need to say for the diagnosis and service connection % you are seeking.


Yes! Come work at the VA after you're done. It is a mostly fulfilling experience if you are at a VA with good admin. The VA has outsourced C&P exams to contractors mostly. You won't have to worry about doing them.

That's good to hear lol. I'd say as of right now, VA is at the top of my list of where I'm looking after I separate from active duty.

 

[TheEarDoc]

White House or Congressional inquiries aren't that bad or uncommon. If you haven't seen one at the VA already, you probably just have a good supervisor who handles them for you.

Ah the good old "I'm gonna file a congressional" or "I'm going to tell my senator about you!" threats. Handled many. I used to get so many from fakers when I did C&P's. I got to the point I would just ask them to come with me to the release of information office and add me and their senator to their medical records as an approved contact so if/when their senator or congressman's office called I could freely discuss their medical records/evaluation with them. Never had a patient take me up on it.

 

[TheEarDoc]

Exactly. Zero record review (even of VA records) and just going by whatever the person says because most evaluators just want to get the exam over with the least amount of work. I have been able to view DoD records in JLV, but the records are not viewable if they are prior to the 1990s. It is impossible to make a psychiatric diagnosis based on one meeting without prior records in a situation so plagued by secondary gain. Psychiatry has no other ways of diagnosing besides through history and interview, which is a problem in the information age. It is so easy nowadays to go online and look up what you need to say for the diagnosis and service connection % you are seeking.

The narrative they send out after they get their ratings tells them exactly what to do/say to get a higher rating. I am amazed when patients come in and quote the lines to me.................

 

[JerryMouse]

The narrative they send out after they get their ratings tells them exactly what to do/say to get a higher rating. I am amazed when patients come in and quote the lines to me.................

Wow... I'm sure most evaluators just nod and sign off on the higher SC percentages. I'm honest shocked more people don't take advantage of this.

 

[TheEarDoc]

Wow... I'm sure most evaluators just nod and sign off on the higher SC percentages. I'm honest shocked more people don't take advantage of this.

Most do. It's unfortunately all a game.

 

[JerryMouse]

Most do. It's unfortunately all a game.

I wonder what percentage of veterans are service connected 20% or higher....

 

[TheEarDoc]

I wonder what percentage of veterans are service connected 20% or higher....

I would love to see the breakdown of the numbers.

I just wish they would break the VBA and VHA budgets apart and treat them as completely separate. IF the public realized that over 85% of the VA budget goes directly to veterans in the form of tax free payments for disabilities and less than 10% went to the actual healthcare they would be amazed how lean the healthcare budget runs for how big it is and the patient load it has. The VA is the largest healthcare organization in the world (larger than most developed countries) and our actual healthcare budget is pretty lean. All the public sees though is that huge budget and then they love to say the workers are overpaid and don't work. I know I see more hearing aid fittings in 1 month than most private practices see in a year.

 

[xffan624]

I would love to see the breakdown of the numbers.

I just wish they would break the VBA and VHA budgets apart and treat them as completely separate. IF the public realized that over 85% of the VA budget goes directly to veterans in the form of tax free payments for disabilities and less than 10% went to the actual healthcare they would be amazed how lean the healthcare budget runs for how big it is and the patient load it has. The VA is the largest healthcare organization in the world (larger than most developed countries) and our actual healthcare budget is pretty lean. All the public sees though is that huge budget and then they love to say the workers are overpaid and don't work. I know I see more hearing aid fittings in 1 month than most private practices see in a year.

Employment Data for Veterans With Disabilities | ADA National Network

(Printer-friendly PDF Version | 1021 KB) (Large Print PDF version | 333 KB) (Spanish Version) This factsheet provides data on employment rates for veterans with disabilities, which can be used to advocate for increased employment opportunities for veterans with disabilities.

adata.org

About 1/3 have a a disability and 12.6% have a service connected disability. I'm not sure whether that's lower or higher than you thought but it seems like a reasonable number considering the low bar to get a disability rating based on VA guidance. I have 40% for two bum knees, a shoulder, and a wrist. All of the injuries either happened during service or were worsened by them. All have medical documentation obtained when I was in that I provided with my application. Im sure there are plenty of veterans that game the system but they're not in the majority.

 

[JerryMouse]

I would love to see the breakdown of the numbers.

I just wish they would break the VBA and VHA budgets apart and treat them as completely separate. IF the public realized that over 85% of the VA budget goes directly to veterans in the form of tax free payments for disabilities and less than 10% went to the actual healthcare they would be amazed how lean the healthcare budget runs for how big it is and the patient load it has. The VA is the largest healthcare organization in the world (larger than most developed countries) and our actual healthcare budget is pretty lean. All the public sees though is that huge budget and then they love to say the workers are overpaid and don't work. I know I see more hearing aid fittings in 1 month than most private practices see in a year.

I found this document that says Veteran Health Administration (VA hospitals and clinical services) costs are around 100 billion a year, at least as of 2020. Veterans Benefits Administration (service connection payments) costs are 130 billion a year. Not as bad as 75% of the budget going to service connection payments, but still over 50% and will probably get higher over the years now that internet and social media has made it very easy to apply successfully.

https://crsreports.congress.gov/product/pdf/R/R46459/2

VA costs have already grown. I found this document that says in 2017 VHA spent 70 billion and VBA spent 87 billion. In 2000, the total VA budget (VHA and VBA) was only 64 billion. Such a high rate of increase seems unsustainable…

Possible Higher Spending Paths for Veterans' Benefits

To help assess budgetary risks, CBO has projected spending by the Department of Veterans Affairs through 2028 under three scenarios, a modified version of CBO’s baseline and two other scenarios involving more rapid spending growth.

www.cbo.gov

Employment Data for Veterans With Disabilities | ADA National Network

(Printer-friendly PDF Version | 1021 KB) (Large Print PDF version | 333 KB) (Spanish Version) This factsheet provides data on employment rates for veterans with disabilities, which can be used to advocate for increased employment opportunities for veterans with disabilities.

adata.org

About 1/3 have a a disability and 12.6% have a service connected disability. I'm not sure whether that's lower or higher than you thought but it seems like a reasonable number considering the low bar to get a disability rating based on VA guidance. I have 40% for two bum knees, a shoulder, and a wrist. All of the injuries either happened during service or were worsened by them. All have medical documentation obtained when I was in that I provided with my application. Im sure there are plenty of veterans that game the system but they're not in the majority.

12.6% is way too low. This data seems to be from self report. If the VA is paying 130 billion a year in service connection benefits, there’s no way only such a small percentage of veterans is receiving it.

 

[TheEarDoc]

Employment Data for Veterans With Disabilities | ADA National Network

(Printer-friendly PDF Version | 1021 KB) (Large Print PDF version | 333 KB) (Spanish Version) This factsheet provides data on employment rates for veterans with disabilities, which can be used to advocate for increased employment opportunities for veterans with disabilities.

adata.org

About 1/3 have a a disability and 12.6% have a service connected disability. I'm not sure whether that's lower or higher than you thought but it seems like a reasonable number considering the low bar to get a disability rating based on VA guidance. I have 40% for two bum knees, a shoulder, and a wrist. All of the injuries either happened during service or were worsened by them. All have medical documentation obtained when I was in that I provided with my application. Im sure there are plenty of veterans that game the system but they're not in the majority.

Could be where I work with 2 of the top commonly claimed disabilities (tinnitus and hearing loss), and both are often faked and one of which has a very low bar and is subjective.

 

[TheEarDoc]

I found this document that says Veteran Health Administration (VA hospitals and clinical services) costs are around 100 billion a year, at least as of 2020. Veterans Benefits Administration (service connection payments) costs are 130 billion a year. Not as bad as 75% of the budget going to service connection payments, but still over 50% and will probably get higher over the years now that internet and social media has made it very easy to apply successfully.

https://crsreports.congress.gov/product/pdf/R/R46459/2

VA costs have already grown. I found this document that says in 2017 VHA spent 70 billion and VBA spent 87 billion. In 2000, the total VA budget (VHA and VBA) was only 64 billion. Such a high rate of increase seems unsustainable…

Possible Higher Spending Paths for Veterans' Benefits

To help assess budgetary risks, CBO has projected spending by the Department of Veterans Affairs through 2028 under three scenarios, a modified version of CBO’s baseline and two other scenarios involving more rapid spending growth.

www.cbo.gov

12.6% is way too low. This data seems to be from self report. If the VA is paying 130 billion a year in service connection benefits, there’s no way only such a small percentage of veterans is receiving it.

I agree that that percentage seems very low for amount of veterans receiving disability compensation.

I also agree the current system the way it is going is not sustainable.

Not sure what the answer is. The VA was not designed to be full time all of your care for life provider. I feel bad for a lot of the veteran's from Korean Conflict era and the Vietnam era because many of them were told healthcare for life when they signed up. I still think the retired military folks should get VA care. I know when I started in the VA we were under the category system where if you weren't service connected for it, you didn't get seen for it, a combat veteran coming off of deployment, or a certain income category you did not get seen for VA care. I am not sure if that is the answer or not. Above my pay grade as they say.

 

[JerryMouse]

I agree that that percentage seems very low for amount of veterans receiving disability compensation.

I also agree the current system the way it is going is not sustainable.

Not sure what the answer is. The VA was not designed to be full time all of your care for life provider. I feel bad for a lot of the veteran's from Korean Conflict era and the Vietnam era because many of them were told healthcare for life when they signed up. I still think the retired military folks should get VA care. I know when I started in the VA we were under the category system where if you weren't service connected for it, you didn't get seen for it, a combat veteran coming off of deployment, or a certain income category you did not get seen for VA care. I am not sure if that is the answer or not. Above my pay grade as they say.

Yeah, above our paygrade... With the healthcare for life guarantee, I have a feeling VA costs will eventually become comparable to DoD costs (seems to be around 600-700 billion per year lately). Not sure what's going to happen once we get to that point.