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Spreading the Wealth: Training Mental Health Providers Nationwide to Work with Veterans

By Johanna (Hans) Buwalda

John is a Vietnam veteran in California and has never before tried to get treatment for his Post Traumatic Stress Disorder (PTSD). He now wants to apply for VA benefits, and needs supporting documentation from a mental health provider. Amanda is an Afghanistan veteran in Georgia. She received an other-than-honorable discharge and was told by her local VA that she is not eligible for VA services. Amanda needs a discharge upgrade and VA care for her service-connected mental health problems. Brian is a Gulf War veteran from Pennsylvania and feels so overwhelmed every time he enters the crowded VA hospital that he has not been able to keep his appointments.

They find their way to VVAW Military and Veterans Counseling because of the VVAW website, through the GI Rights Hotline, Iraq Veterans Against the War, The Soldiers Project, Civilian Medical Resources Network, or through a friend.

I am a licensed mental health provider and work with VVAW's Military and Veterans Counseling Service in Chicago. But there are more veterans in need of help than I can work with and they are spread all across the country. That is why we are developing a network of providers across the country that is willing to provide free, quality mental health services. I am often struck by these providers' amazing generosity. Some are familiar with veteran issues, but others are willing to go at great length to learn about this work. In addition, they need to learn how to write the supporting documentation to get the benefits and services these service members and veterans need.

Many people assume that I spend most of my time talking to veterans and service members, and that is often true. But I also spend very large chunks of time training generous colleagues from all over the country over the phone and online, making it possible to serve more veterans and creating a larger pool of skilled providers who understand military and veteran mental health. They are going to be even more crucial if the VA does cut its budget, at a time that huge numbers of men and women return from combat zones.

So what is it that providers need to know when they write supporting evidence? I usually send them a sample report. While each provider has their own way of writing evaluation reports, they find it helpful to see how I write them. My reports are often considered a little lengthy and extensively detailed. However, I find it important that a veteran or service member feels heard. I also find it important that after all they have gone through, these men and women have the right to have their story recorded in their own words and in as much detail as they like to share. That is why I spend as much time as it takes for a veteran or service member to complete this evaluation. We take breaks, go for walks, have a cup of coffee, or get together more than once or twice — whatever it takes to get the process done in a way that is as painless as possible.

Regardless of how a provider chooses to write the evaluation report, there are several statements that are crucial. The first statement is essential for veterans like Amanda who received an other-than-honorable discharge after she could no longer meet the standards in the military because her best friend had been killed. This statement is often called a "Nexus Statement." This establishes that the diagnosis is connected to military service. It is very important to understand that just because a veteran has a diagnosis, it doesn't establish that it was caused by military service. As long as the diagnosis is not documented to show it is connected to their military service, the VA can refuse to treat it and doesn't have to consider providing disability benefits to this veteran.

The second statement is needed to establish what the VA calls "Character of Service." If the character of their service can be deemed honorable, even when the veteran has an other-than-honorable discharge, this veteran can receive services at the VA to treat service-connected problems. Basically, what this evaluation report can show is that this veteran was unfairly discharged and should have received proper treatment for his or her service-connected mental health problem and/or a medical discharge instead.

In addition, I always send the mental health provider a copy of the VA rating scale and explain why using the language of the scale is necessary. While a diagnosis is important, the VA Benefits Administration bases how much money a veteran may receive depending on the impact this diagnosis has on the veteran's daily functioning. For example, "intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)" versus "neglect of personal appearance and hygiene" can result in hundreds of dollars difference in benefit payments.

Providers usually send me multiple drafts (of course with identifying information removed because of privacy) and ask for feedback. They call with questions and concerns, want me to suggest books and websites for them to read, and email me about their progress. This process usually becomes the basis for a long and fruitful collaboration between mental health providers in other states and myself.

Together through this process, we are able to complete the evaluation report needed by the VA, and most importantly, provide treatment for veterans in need across the country.

If you are a mental health provider interested in helping, please contact me at (773) 370-4789 or vetcounseling@vvaw.org. For more information on VVAW's Military and Veteran's Counseling services, please visit: www.vvaw.org/mc/.