Ronald Nesler of Las Cruces, N.M., a Vietnam veteran rated 100 percent disabled by post-traumatic stress disorder, learned this month that his case, as decided in 1997 by the Department of Veterans Affairs, lacked documents to support the finding of service-connected PTSD.

The VA regional office in Albuquerque advised Nesler in an Aug. 11 letter that he had 60 days to provide evidence that he was exposed to the stressful wartime incidents described in his claim papers years ago.

“Otherwise, benefits, if confirmed entitlement is not established, may result in a change in your disability claims compensation,” the VA letter warned.

Nelser’s “permanent and total” disability award is suddenly at risk because of a VA inspector general review of 2,100 randomly selected PTSD cases with 100 percent disability awards. The inspector found that about 25 percent, or 527 of them, lacked documents to verify veteran-reported evidence.

The review was released in May, as part of a 200-page report on variances in VA disability compensation across the nation.

Many more than 527 PTSD cases are at risk, however. The VA has announced it will review documents of 72,000 PTSD cases, those awarded 100 percent disability ratings from Oct. 1, 1999, through Sept. 30, 2004.

Over those five years, the number of veterans awarded compensation for PTSD jumped by 80 percent, from 120,000 cases in fiscal 1999 to 216,000. The planned review of the 72,000 cases likely won’t begin until January, said VA spokesman Scott Hogenson.

“Everybody talks about how PTSD is a very subjective diagnosis. This is not about diagnosis,” said Hogenson. “This is about collecting the empirical paperwork that says, ‘Yes, this individual was in this set of circumstances during this time in which these things happened, which may have led to post-traumatic stress.’”

Legitimate stressors in a veteran’s service jacket might be descriptions and dates of combat engagements or “de facto” stress indicators like a Combat Infantry Badge or Purple Heart.

The aim is to verify exposure to conditions that might leave a veteran with PTSD. The inspector’s study suggested that claim examiners have been lax in demanding documents.

From 1999 to 2004, the inspector said, PTSD payments jumped from $1.7 billion a year to $4.3 billion.

To show the potential cost of not seeking evidence of stressors in PTSD cases, the inspector said a 25 percent error rate would have caused “questionable payments” of $860 million for VA in 2004 and $19.8 billion over those veterans’ lifetimes.

Nesler, who has a wife and handicapped stepdaughter, receives PTSD compensation of a little over $2,500 a month. He said VA officials have assured him that a decision to lower his PTSD rating would reflect a VA mistake. They also have assured him, though not in writing, that his VA compensation won’t fall. They do so, most likely, because Nesler has a 100 percent rating for prostate cancer. The VA presumes this cancer, if suffered by Vietnam veterans, is from exposure to Agent Orange, a defoliant used widely during that war.

Nesler said his disability for cancer is not “permanent and total” like his PTSD award. He knows of many veterans treated for cancer who have seen their rating, and thus their pay, drop sharply following treatment.

A 1967 draftee, Nesler reached Vietnam in 1970. He served for 13 of his 14 months as a meteorological observer for B Battery, 6th Battalion, 32nd Artillery, part of the 1st Field Forces Vietnam.

His most disturbing memories, he said, are of atrocities committed by soldiers. Nesler said he saw an American soldier detonate a directional mine toward a small bus, filled with Vietnamese women and children, near the town of Ninh Hua.

The VA ruled in 1997, based on “un-refuted evidence,” that Nesler had served in a combat zone, had witnessed “a bus being bombed” and had a well-founded diagnosis of PTSD. It found “total occupational and social impairment.”

“I have emphysema. I have cancer. I have a torn ligament in my shoulder. I have severe arthritis. I have PTSD. … And I get this (letter) dropped in my lap. Right now my life is on hold till I find out what’s going to happen,” Nesler said.

Originally published: August 20th, 2005 12:01 AM (PDT)

Source:
The News Tribune