In my last blog entry I promised that I would update you on how my first official appointment with the VA went, and, well, that appointment has come and gone.  It was interesting, but not really what I had expected.  Or what I was hoping for.  It was, however, insightful because it provided a glimpse into the road that lay before me as a “customer” of the VA healthcare system as well as introducing me to many of my fellow veterans who frequent the local clinic.

The appointment was with the VA Clinic’s PTSD Services unit.  As I wrote in my last post, I spent an hour or so with my designated social worker whose job it is (among other things) to assess whether or not I needed to be evaluated for the effects of combat stress.  Her assessment was based on our meeting as well as the sixteen page questionnaire that I completed beforehand.  Since the questions were all about combat, and having spent a whole lot of time in and around a significant amount of combat in two different war zones, she determined that it was certainly appropriate for me to go for an evaluation.

A week later, I returned to the clinic for my first appointment: the Post-Traumatic Stress Disorder Services Orientation.  I wandered into the clinic’s Mental Health Services waiting room and, after checking in, was handed yet another set of forms to fill out.  After ten minutes of answering questions about my propensity for self-harm, manic episodes, and depression, I was finished.  Just in time, too, because as my government issued pen scratched out the last checkmark a young woman opened the waiting room door and asked those of us waiting for the PTSD orientation to follow her.

I joined a rather eclectic group as we accompanied her to a smallish room ringed with chairs padded with leather seats and backrests colored in the oddly disturbing green that is prevalent in hospitals and movies about psychiatric institutions.  They must have got them on sale somewhere, because I don’t think they would match anyone’s home decor.  To their credit, though, they were actually pretty comfortable.

Out of the twenty odd-colored seats ten or so were filled by my fellow attendees and me.  There was an elderly veteran of the Second World War, Korea, and Vietnam (as his hat proudly proclaimed), a man in his sixties, a few gentlemen in their 50’s, a young woman who never took off her sunglasses, a tattooed young man barely out of his teens, and me.  Not at all what I was expecting, to be honest.  I had figured that my meeting would be with young veterans from the recent decade of war, but to my surprise we veterans of Iraq and Afghanistan were in the minority.  There were three of us, one veteran of Desert Storm, the aforementioned WWII vet, and the rest were from the Vietnam War.

I know this because the young woman who led the session (another clinical social worker) had us introduce ourselves before we began the session.  In addition to asking where we served, she asked us to share why we were here.  The recently discharged veterans were pretty obvious, but the others were a surprise.  Each of them had been referred to the session by their primary care provider, which I found to be fascinating.  After hearing their introductions and listening to their conversations it became evident to me that many of these veterans were just now entering the VA medical system.  To me, that was a surprise because I had never really considered not entering the system.

That reveals a tremendous difference between the experiences that “new” veterans have in juxtaposition to the “old” ones.  Our transition process from active duty included a mandatory introduction to the VA, along with an education in the basics that the VA provides.  Many veterans of WWII, Korea, Vietnam, Desert Storm, and the Cold War received no such exposure to the Veterans Administration.  As a result, thousands and thousands of veterans who are eligible for help and care never bothered to pursue it until they really need the services that the VA provides.  Unfortunately, for many of them, the help that the VA provides ends up trying to make up for years or decades of neglected conditions.  That was the explanation for why so many of the people in the room with me were there for the first time despite having removed their uniforms back when Disco Fever ruled the dance floor.

Anyhow, back to the session.  After introductions, the social worker ran through a dozen or so power point slides that described the multitude of programs that the VA offered in the clinic.  This particular clinic was focused on combat veterans who were at risk for PTSD, and the services that they provide were all focused on countering and healing the effects of combat stress.  She started with textbook (according to the American Psychiatric Association, who writes such things) definition of PTSD, which included things like experiencing traumatic events, re-experiencing previous trauma, hyper-vigilance and hyper-arousal, and avoidance of things that remind you of traumatic events.  Considering that everyone in the room has served in combat, the probability that at least some of these symptoms would apply to us rocketed up to about 100%.

After the explanation of what PTSD was completed she assured that recovery from PTSD was possible.  They offered over a dozen different methods to assist with recovery; including individual and group sessions on topics like anger management, coping, spiritually based recovery, couples and family therapy, anxiety disorders, and women’s groups.  The goal of each program is to help the veteran reach a positive outcome within three months, with a positive outcome being that the veteran being better able to cope with his or her condition.

Not surprisingly the clinic was overwhelmed with veterans who needed help.  The wait time to join in the programs was eight weeks or more.  The social worker explained the process for getting into one of the groups, and that is where I realized that this was actually not the appointment I was looking for.  Actually it was not even really an appointment, but instead just an introduction and orientation to the clinic.

Towards the end of the session she explained that for us to participate in any of the offerings we would have to set up another appointment in which we would actually meet with a healthcare provider who would then assign us to a group.  An intake appointment, she called it.  That was the first indicator that this was not the appointment I was looking for.  The second indicator was her announcement that the clinic did not have anything to do with disability claims.

As you know from my previous posts, I was actually hoping to get my disability claim back on track.  It had been five months since I had been notified that the claim had been partially settled and that I should wait to be contacted by the VA for further evaluation.  After spending almost half a year listening to the sound of no telephones ringing I called the VA to get the ball rolling.  I had wrongly assumed that once I was in the system that the claims process would proceed as a matter of course.

Nope.

I would need to call another number for that, or I could stop by the Veterans Service Office that happened to be just across the hall.  They would be able to help those of us working on our claims, she said, but unfortunately not today because their office was closed.

D’oh.

She then reviewed all of the forms that we completed prior to the session, and then she called each of us out individually to set up appointments for the intake interview.  I was a bit disgruntled, but resigned myself to just go with the flow and left the session with an appointment for an intake appointment some six weeks in the future and the phone number to the clinic’s VSO office which would help me with my claim.

I also left reminding myself that the VA was a bureaucracy and that patience was a virtue.  I was still disgruntled, though, and not feeling particularly virtuous.  So it goes.

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Lessons Learned:

1.  The medical side of the VA is different from the disability claims side of the VA.  Make sure to stay engaged with your VSO to ensure that your claim is moving forward, and also be specific with the VA representatives when you are making your appointments.  I was not specific enough because I made some errant assumptions, and as a result I have lost another month or two of forward progress on my claim.

2.  Be ready to devote a lot of time to the VA.  There are great programs available, but it will take a long time and plenty of seemingly repetitive red tape, paperwork, and meetings to actually see a provider.  Breathe deep, think happy thoughts, and go to your happy place.  Time will pass and you will get the help you need.  It will just take a lot more time than you would like.

3.  Ask questions up front.  Had I asked whether or not this appointment would help with my disability claim I would have saved some valuable time.  Assume nothing!