In recognition of an increasing number of service members engaging in combat and sustaining long-term psychological effects, the Supreme Court ruled recently that defense attorneys should use the effects of PTSD to protect veterans against certain sentences, specifically the death penalty. The Court, without dissent, overturned the death sentence of a Korean War veteran, noting that his “combat service unfortunately left him a traumatized, changed man.” Porter v. McCollum (08-10537).
The Court’s opinion appeared to address the broad impact of PTSD resulting from combat stress in rendering an opinion in this case, in which the veteran George Porter, Jr. murdered his ex-girlfriend and her boyfriend. The Court noted that “Our Nation has a long tradition of according leniency to veterans in recognition of their service, especially for those who fought on the front lines as Porter did. The relevance of Porter’s extensive combat experience is not only that he served honorably under extreme hardship and gruesome conditions, but also that the jury might find mitigating the intense stress and mental and emotional toll that combat took on Porter.” This appears to suggest that other cases may be able to use the conditions of PTSD, as they relate to post combat experiences, for means of defense in criminal cases.
In an effort to show the future necessity of a PTSD defense, the Court also cited Congressional testimony that approximately 23 percent of Iraq and Afghanistan war veterans being treated in a VA facility have been preliminarily diagnosed with PTSD. Further, the Court noted that many veterans returning from combat exhibit symptoms of PTSD. These findings by the Court appear to indicate that the use of PTSD as a defense in cases will become more common practice, as the United States continues to engage in lengthy wars in two countries, thereby increasing the number of veterans who may suffer from PTSD.
In this case involving George Porter, the court ruled that he was entitled to relief because the jury in his case should have had the opportunity to hear about his wartime experiences and testimony regarding his mental problems before rendering a decision. Had the jury heard this evidence, the Court concluded, the death penalty may have been avoided. The lack of evidence in his trial stemmed from his defense counsel’s failure to present such evidence, therefore resulting in Porter’s violation of competent counsel. The Court’s opinion allows for Porter’s sentencing to be heard again with the requisite mitigating PTSD evidence presented.
Although the Court’s opinion turns on PTSD as a defense in criminal cases, the language can be construed to support social security disability cases as well. The fact that more and more veterans are being diagnosed with PTSD and suffer from post combat stress may result in more disability claims being filed and more PTSD disability claims awarded.
Filed under Jurisprudence involving PTSD by on Dec 11th, 2009. Comment. 
In its May 16, 2008 edition, the Washington Post reports that a Texas VA psychologist named Norma Perez distributed an email to staff members under her supervision directing them to avoid making PTSD diagnoses:
“Given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out,” Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs’ Olin E. Teague Veterans’ Center in Temple, Tex. Instead, she recommended that they “consider a diagnosis of Adjustment Disorder.” VA staff members “really don’t . . . have time to do the extensive testing that should be done to determine PTSD.”
Why would the VA wish to discourage PTSD diagnoses? The Post reports that:
Adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months, said Anthony T. Ng, a psychiatrist and member of Mental Health America, a nonprofit professional association.
Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition, said Alison Aikele, a VA spokeswoman. Those found to have adjustment disorder generally are not offered such payments, though veterans can receive medical treatment for either condition.
Read more on Is the VA Directing Its Medical Staff to Avoid Using PTSD as a Diagnosis?…
Filed under VA benefits, Veterans Administration by on Nov 23rd, 2009. Comment.
A recent study shows that heart disease effects are perceived more acutely by individuals afflicted with post-traumatic stress disorder (PTSD). According to the study, people with PTSD felt more hampered by their heart disease than those with no PTSD diagnosis, despite the fact that their actual heart health was no worse by objective measures.
The study involved 1,022 men and women with heart disease. These results and the complete study review can be found in the November 2009 issue of the Archives of General Psychiatry. The study was conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.
The study methodology involved two-steps. First, the researchers examined many of the perceived effects of heart disease as reported by study participants; for instance, chest pain frequency and severity, limitations on their physical activity and overall daily functions. They also asked the patients to report about their overall perceived quality of life.
The second-step involved the researchers measuring the participants’ actual cardiac function. In order to measure this, they examined participants’ ability to exercise on the treadmill, their left ventricular ejection fraction (which measures how efficiently the heart pumps blood), and the participants’ inducible ischemia (which measures how much oxygen the heart receives during exercise).
Of all of the 1,022 participants, 95 of them reported having PTSD. These 95 patients reported much greater perceived symptoms of discomfort and greater physical burden and limitation. They also reported an overall lower quality of life. As mentioned, these participants reported these symptoms and level of discomfort even though their objective heart function was not any worse than that of the overall participant population. The authors of the study are working on a follow-up study, where they intend to examine the same participants in five years.
These study results point to the importance of treating PTSD alongside the treatment of a chronic condition such as heart disease. If you have PTSD, you may want to discuss this study with your doctor to ensure that you are adequately treating your condition, especially if you have heart disease.
Filed under Heart disease, Medical complications of PTSD by on Nov 17th, 2009. Comment.
