By Donna St. George
Washington Post Staff Writer
Tuesday, June 20, 2006
More than 30 years after their war ended, thousands of Vietnam veterans are seeking help for post-traumatic stress disorder, and experts say one reason appears to be harrowing images of combat in Iraq.
Figures from the Department of Veterans Affairs show that PTSD disability-compensation cases have nearly doubled since 2000, to an all-time high of more than 260,000. The biggest bulge has come since 2003, when war started in Iraq.
Experts say that, although several factors may be at work in the burgeoning caseload, many veterans of past wars reexperience their own trauma as they watch televised images of U.S. troops in combat and read each new accounting of the dead.
"It so directly parallels what happened to Vietnam veterans," said Raymond M. Scurfield of the University of Southern Mississippi's Gulf Coast campus, who worked with the disorder at VA for more than 20 years and has written two books on the subject. "The war has to be triggering their issues. They're almost the same issues."
At VA, officials said the Iraq war is probably a contributing factor in the rise in cases, although they said they have conducted no formal studies.
PTSD researcher John P. Wilson, who oversaw a small recent survey of 70 veterans -- nearly all from Vietnam -- at Cleveland State University, said 57 percent reported flashbacks after watching reports about the war on television, and almost 46 percent said their sleep was disrupted. Nearly 44 percent said they had fallen into a depression since the war began, and nearly 30 percent said they had sought counseling since combat started in Iraq.
"Clearly the current Iraq war, and their exposure to it, created significantly increased distress for them," said Wilson, who has done extensive research on Vietnam veterans since the 1970s. "We found very high levels of intensification of their symptoms. . . . It's like a fever that has gone from 99 to 104."
Vietnam veterans are the vast majority of VA's PTSD disability cases -- more than 73 percent. Veterans of more recent wars -- Iraq, Afghanistan and the 1991 Persian Gulf War -- together made up less than 8 percent in 2005.
VA officials said other reasons for the surge in cases may include a lessening of the stigma associated with PTSD and the aging of the Vietnam generation -- explanations that veterans groups also suggest.
PTSD is better understood than it once was, said Paul Sullivan, director of programs for the group Veterans for America. "The veterans are more willing to accept a diagnosis of PTSD," he said, "and the VA is more willing to make it."
In addition, as Vietnam veterans near retirement age, "they have more time to think, instead of focusing on making a living all the time, and for some this is not necessarily a good thing," said Rick Weidman, executive director for policy and government affairs at Vietnam Veterans of America.
Max Cleland, a former U.S. senator from Georgia and onetime head of the VA who was left a triple amputee by the Vietnam War, said the convergence of age and the Iraq war has created problems for many of his fellow veterans -- as well as for himself.
"As we Vietnam veterans get older, we are more vulnerable," he said. When the war started in 2003, he said, "it was like going back in time -- it was like 1968 again."
Now he goes for therapy at Walter Reed Army Medical Center and is wary of news from Iraq. "I don't read a newspaper," he said. "I don't watch television. It's all a trigger. . . . This war has triggered me, and it has triggered Vietnam veterans all over America."
PTSD has become a volatile topic lately, with some skeptics questioning whether the rise in claims is driven by overdiagnosis or by financial motives. A report last week from the Institute of Medicine, part of the National Academies, concluded that "PTSD is a well characterized medical disorder" for which "all veterans deployed to a war zone are at risk."
VA's growing PTSD caseload became an issue last August, when the agency announced a new review of 72,000 PTSD compensation cases, expressing concerns about errors and a lack of evidence. That probe was dropped after a sample of 2,100 cases turned up no instances of fraud.
Still, some experts are not convinced that the Iraq war has driven up the caseload. "I'm skeptical that it accounts for a broad swath of this phenomenon," said psychiatrist Sally Satel, a resident scholar at the American Enterprise Institute. "These men have had deaths in their families, they had all kinds of tragedies over 30 years that surely affected them emotionally but they coped with."
Although a small percentage of veterans might be deeply affected, she said, she doubts "they have become chronically disabled because of it."
Around the country, many veterans dwell on the similarities between the wars in Vietnam and Iraq: guerrilla tactics, deadly explosives, fallen comrades, divisive politics. The way they see it, "Iraq is Vietnam without water," Weidman said.
"We have people who have symptoms that they haven't had in a long time," said Randy Barnes, 65, who works in the Kansas City offices of Vietnam Veterans of America. For some, "the nightmares and flashbacks have been very hard to deal with," he said. Group therapy sessions are "much more crowded," he said, "with Vietnam veterans particularly, but now also with the Iraq and Afghanistan veterans."
Barnes served as a combat medic in Vietnam from 1968 to 1969 and went into treatment only in the late 1990s. By the time the Iraq war started, he said, he felt steadier -- but then his symptoms ramped up again.
"Depending on what I saw or heard that day or read, I would have night problems -- nightmares, night sweats," he said. Sometimes, he said, he would roll out of bed and wake up crawling on the floor, "seeking safety, I guess."
A study published in February by VA experts showed that veterans under VA care experienced notable mental distress after the war started and as it intensified. While younger veterans, ages 18 to 44, showed the greatest reactions to the war, "Vietnam era VA patients reported particularly high levels" of distress consistently, the study reported.
Powerful images of war have revived combat trauma in the past. "Traumatized people overreact to things that remind them of their original trauma," said Scurfield, the PTSD expert in Mississippi.
When the movie "Saving Private Ryan" was released, World War II veterans sought mental health help in great numbers, said Wilson of Cleveland State. "It rekindled it all," he said.