Senators call for investigation into Montana’s VA mental health care

Baucus and Tester ask Inspector General for ‘thorough review’ for Montana vets

(HELENA, Mont.) – Montana's two U.S. Senators want the VA's top investigator to get to the bottom of recent news stories that show Montana veterans get the short end of the stick when it comes to mental health care.

Senators Max Baucus and Jon Tester today wrote a letter to VA Inspector General George Opfer, asking him to launch a "thorough review" of the quality and availability of mental health care at Montana's VA facilities.

The letter asks the Inspector General to look into the following specific areas:

• The 'significant disparity' in post-traumatic stress disorder (PTSD) ratings given to Montana's Iraq     and Afghanistan     veterans.  A recent investigation by McClatchy News Service found     that veterans who are given a disability rating for PTSD generally appear     to be given ratings far below that of their peers in other parts of the     country.
• The quality of care for veterans who suffer from PTSD.  Baucus and Tester     especially want to know why the VA service region that includes Montana is     considered by newspaper reports "the lowest-performing region in terms of     effectiveness of mental health treatment."
• Wait times for Montana     vets in need of mental health care.  The senators want to know why     half of Montana's     veterans who seek care for PTSD in the VA system reportedly have to wait     longer than 30 days.

Baucus and Tester specifically asked the Inspector General to identify the reasons behind the PTSD rating disparity and wait times, and asked for recommendations to improve the system.

"The VA needs to shine a spotlight on the mental health issues facing veterans in Montana," Baucus said.  "Getting answers for the public will improve our ability to advocate for legislative or administrative changes that will make the lives of our veterans better."

"It's time for the VA to do some housekeeping and answer to the folks in Montana," Tester said.  "We want to know the nuts and bolts of the situation so we can make sure our vets get the fair shake they deserve."

Tester, a member of the Senate Veterans Affairs Committee, recently secured $125 million in funding to increase the VA's mileage reimbursement rates for disabled vets who travel to receive health care, from 11-cents to 28.5-cents per mile.  The rate has been 11-cents per mile since 1977.

The senators' letter to Inspector General Opfer follows.

January 17, 2008

Mr. George Opfer

Inspector General

Department of Veterans Affairs

801 I Street, NW

Washington, DC 20410

Dear Inspector General Opfer:

We write to request an investigation into the quality and availability of mental health services at VA facilities in Montana, as well as a disparity that exists between disability ratings awarded by Montana's VA hospitals and other VA hospitals across the country.  A recent investigation by the McClatchy News Service indicated that the VA in Montana lags behind the nation in the quality of its mental health services for recent veterans and its disability benefits for recent disabled veterans.  The reports identified two primary areas of concern in the Montana VA healthcare system: 1) the disability compensation rates for post-traumatic stress disorder (PTSD) and 2) the availability and quality of mental health-care services. 

On behalf of Montana's approximately 102,000 veterans, we request a thorough review of the validity of the reports and a detailed recommendation of how to improve the VA health care services available in Montana.

Disability Compensation Rates for Post Traumatic Stress Disorder

A recent study revealed dramatic differences between the disability ratings awarded by VA hospitals across the U.S.  For example, the study showed that 56 percent of veterans processed by the VA office in Albuquerque, New Mexico have high ratings for PTSD, while only 18 percent of veterans processed by the VA office at Fort Harrison, Montana earned such a rating.  Six percent of New Mexico's veterans were assigned the highest possible disability rating, while an equivalent rating was awarded to only one percent of Montana's veterans.  We understand that rating decisions remain highly subjective.  It is clear, however, that a significant disparity still exists among regional offices in training staff and identifying severity of PTSD claims. Therefore, with regards to disability compensation, we request the following from your office:

1. Please confirm whether there continue to be significant disparities between the disability ratings awarded by different VA benefits offices across the country, as well as the progress VA has made in implementing your previous recommendations to reduce disparities in the ratings process.

2. Please identify reasons why mental-health-related disability ratings are so much lower among Montana veterans than for other veterans around the country.

3. Please provide any additional recommendations that the VA can implement to eliminate the disparity in disability ratings across different VA benefits offices. 

4. Estimate the number of veterans in Montana and nationally who have received unfairly low disability ratings due to the disparity in disability ratings.

5. Estimate the cost of providing the retroactive payments that are due to veterans both in Montana and nationally who have received an unfairly low disability rating due to the disparity in disability ratings.

Availability and Quality of Mental Health-Care Services in Montana

The McClatchy News Service investigation also reported that Montana's veterans have poorer access to the VA's mental health care services than veterans in other parts of the country.  Veterans in Montana face the third-highest wait times in the nation.  The report claimed that nearly half of Montana's veterans who seek care for PTSD faced waiting times over thirty days.  Further, out of 139 VA hospitals nationwide, the Montana VA system ranked 123^rd in the proportion of its budget that goes toward specialized mental-health treatment.  We understand that a share of Montana veterans' need for mental health-care is provided by contracting and fee-basing to community providers, which may partially account for this ranking.  With regards to mental health-care services we request the following:

1. Explain why veterans in Montana face longer wait times than nearly every VA system in the nation. 

2. Determine whether Montana's veterans are receiving the specialized mental health care services they need. 

3. If the health care services veterans in Montana are receiving are determined to be inadequate, list what resources or systemic changes must be made in order to correct the deficiencies in care provided.

Thank you for your consideration of this request.  We look forward to your prompt and thorough response.