Sandeep Rao

For a system facing a backlog, a misdiagnosis of psychiatric condition not only helps reduce the number of patients seeking treatment for service-related disabilities, but also the accompanying compensation. Soldiers diagnosed with PTSD may receive monthly disability compensation up to a few thousand dollars, while those classified under the lesser categories of personality and adjustment disorders are not eligible for remuneration.

In 2008, Senate congressional committees looked into a Texas VA medical center PTSD coordinator who suggested considering diagnosing more soldiers with adjustment disorder, since the VA did not have the time to do the necessary testing for PTSD.

Attorneys for the veterans groups say the VA has attempted to stem the backlog by hiring social workers rather than physicians to manage treatment. Veterans are also provided cheaper group therapy sessions, as opposed to individually tailored treatments. Additionally, facing reduced numbers of hospital beds, treatment involves resorting to faster outpatient visits versus inpatient hospitalization.

In order to increase access of mental health services, the VA has routed veterans through primary care channels in order to deflect the stigma commonly associated with seeking mental health services.

However, access means nothing without availability. While a national health care system like the VA provides entry and potential access for thousands of new patients, all these new insured patients ultimately may not receive timely medical care due to the lack of available doctors. The backlog of patients needing treatment at the VA portends potential problems with the Patient Protection and Affordable Care Act ("Obamacare"). Without increasing the numbers of primary care doctors, or the gatekeepers of the medical system, any universal access health program will fail to meet the expectations of its patients by creating long waiting lists, as seen by the underfunded and undermanned VA system.

Sandeep Rao

Sandeep Rao MD, MBA is a fellow at Johns Hopkins Hospital specializing in vascular and interventional radiology.