Silent Screams: The Ongoing Shame of Invisible Illnesses

The United States Department of Veterans Affairs (VA) is crucial for providing financial assistance to former military personnel dealing with physical and mental health issues. However, establishing a link between invisible illnesses aggravated or developed in military service is challenging compared to traditional physical illnesses. In particular, past errors in documentation and societal attitudes toward mental health add to the complexity. Together, let’s explore the difficulties faced by veterans seeking compensation for these invisible illnesses developed or aggravated during service. Before we continue, It’s essential to acknowledge these invisible illnesses as legitimate illnesses akin to diabetes and cancer.

The primary obstacle is the persistent stigma around mental health, preventing veterans from seeking timely disability benefits. Those who experienced close quarters in service are particularly familiar with this shame. Because society’s misconceptions about mental health persist. VA Adjudicators who are immersed in them, likely carry societal bias into their decisions. In another, future post, I’ll explore the daunting task of seeking mental health treatment in service, covering topics like boot camp, obedience to authority, and the Uniform Code of Military Justice (U.C.M.J).

The Burden on the Veteran: Prove It or Lose It

Unlike physical injuries, mental health issues lack clear proof, complicating their assessment. Diagnosis often relies on verbal disclosure. Because of its private nature, veterans face challenges in proving their conditions. For example, they are required to produce items like diaries, third-party corroboration, regular treatment, or psychometric testing. Unfortunately, these items can be extremely difficult to obtain.

The evidence expected from veterans is unreasonable, aside from the Nexus Letter. Consider this: How many civilians maintain diaries or journals? The answer is roughly 16%, or rather, a relatively small amount of people. Additionally, mental illnesses, characterized by isolation and altered behavior, hinder veterans’ ability to secure third-party corroboration. Relationships strained by the illness make obtaining corroboration impossible or uncomfortable. The compensation system fails to assess invisible illnesses holistically thereby forcing claims to satisfy a rigid and unreasonable checklist that ends too often in rejection. Furthermore, the VA needs to ensure comprehensive support and documentation immediately following military service if they are going to require it as evidence for compensation.

Delusive Demands: The Dilemma in Diagnosing Invisible Illnesses

Veterans grapple with proving service-connected illnesses amid deficiencies in mental health diagnoses. While our understanding of these invisible illnesses has grown in recent decades, diagnostic challenges persist. Ayano’s groundbreaking study in Ethiopia highlighted these misdiagnoses. The study revealed a 39% misdiagnosis rate upon initial evaluation. The most notable conditions included schizoaffective disorder (75%), major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%).

For the second evaluation, the study utilized Structured Clinical Interview for DSM Disorders (SCID). SCID proved crucial, accurately recording diagnoses for schizophrenia (76.29%) and bipolar disorder (72.22%). Despite this progress, misdiagnoses are still likely upon initial evaluation of an illness. Recognizing this likelihood of misdiagnosis, especially for veterans with a pre-service invisible illness, is essential. Therefore, VA adjudicators should accept prior mental health documentation as evidence for worsening conditions, irrespective of individual diagnostic congruence.

With invisible illnesses, any two diagnoses are not separate. As an example, during his 2008 research, Singh explained that “Bipolar disorder is a disabling psychiatric illness” and “often misdiagnosed, especially on initial presentation.” Misdiagnosis results in ineffective treatment, which further worsens the outcome.” Singh’s 2008 research highlights the disabling nature and frequent misdiagnosis of bipolar disorder, emphasizing the need for a more nuanced approach. Additionally, the bipolar condition, when misdiagnosed, will worsen or aggravate until it is corrected. Our Veterans, through no fault of their own, receive inaccurate medical diagnoses, and those diagnoses are then used to deny a veteran’s claims. Because of this, supportive action is imperative to persuade Congress to mandate that pre-existing mental health diagnoses be used as valid, supportive evidence of the veteran’s post-service diagnosis, irrespective of agreement in the diagnoses.

Misdiagnoses: They are not a Tool to Deny Compensation

Assuming diagnoses are isolated and unrelated is dangerous and unfair. The adjudicators might ask a veteran what led to their diagnosis. Naturally, the veteran responds with the catalyst, but may not disclose all the significant symptoms and subtleties leading up to the catalytic event. It becomes then, very easy for an adjudicator to determine a record was an isolated event and thereby deny compensation.

Veterans with pre-service mental health diagnoses deserve fair consideration in VA disability claims. I Implore Congress to prevent pre-existing mental health diagnoses from serving as evidence that severs the connection to post-service mental health conditions. Anything contrary ignores the science of mental health and perpetuates the stigma.

Halt the Stigma: Invisible Illnesses are Physical Disorders

Not only are these congressional policies draconic and ignorant, but claims adjudicators might not know enough about mental health problems either. For example, Dr. Carter, an expert in bipolar disorder, explains that “You cannot ‘become’ bipolar…in reality, the person has always had bipolar but it may not have developed into a disorder” (39). Awareness should have eliminated the requirement for bipolar claims to prove pre-existing, invisible illnesses. What’s worse is that the requirements led to misjudging evidence and wrongly rejecting thousands of claims. 

Now Imagine if those same requirements existed for Crohn’s disease as it does for bipolar disorder. Crohn’s disease despite being lifelong, often receives a misdiagnosis of IBS, food intolerance, and even food allergies. I can’t imagine telling a veteran that they never had Crohn’s disease so it couldn’t have been aggravated in service. This disparity between physical and mental illness needs to stop. The VA must provide comprehensive training to ensure there is a fair and informed evaluation of mental health claims. As a direct result of this dilemma in the diagnosis of invisible illnesses, veterans have no choice but to submit inaccurate diagnoses that the VA treats as fact.

Untangling the Web: Mental Health Disability Claims

We’ve discussed mental health stigma as a barrier to veterans seeking services, the challenges in proving service connection, and a compensation requirement discrepancy for aggravation in service. We’ve acknowledged that not all service members admit to being ill and highlighted the negative influence of persistent stigma. We uncovered that for veterans with an invisible illness, proving service connection is unfairly difficult. We’ve decided that the VA should presume, by law, that a veteran’s prior mental health documentation supports their claimed condition. We’ve also recognized its flipside, that a veteran’s related pre-service mental health diagnosis should not serve as proof of a current condition’s absence during service. A veteran’s testimony alone is not evidence of exclusivity in these two diagnoses unless the veteran is a trained doctor in that field. Therefore, Congress needs to make these changes and the VA must provide ongoing training for VA adjudicators in holistic case evaluations.

Quelling Fears: Compensate our Veterans

Some argue that veterans would exploit the system without meeting all the proof requirements on mental illness disability claims. This argument continues the stigma and prevents a holistic view of each veteran’s illness, especially for veterans who served during their formative years. Their sacrifice exposes them to various traumas and takes a toll on their bodies throughout early adulthood. By the time a veteran has exited service, they have endured repeated physical and psychological challenges that significantly contribute to the aggravation of their invisible illness. They experienced consistent mental health triggers such as little sleep, frequent travel to different timezones, trauma, overwhelming stress, and/or violent conflicts.

The argument that a veteran must provide irrefutable proof to prevent veteran exploitation is logically flawed for two reasons. Firstly, focusing on potential abuse is irresponsible and ignores the majority of people who genuinely need support. That exploitation concern also would apply to most compensation programs that exist today in our country (i.e. EBT, Section 8, ObamaCare, etc.). Secondly, there is indeed tangible proof that invisible illnesses are exacerbated as a regular part of military service. The military is full of serious triggers that worsen nearly all mental health conditions. Factors such as sleep deprivation, loneliness, and living as members of closed communities uniquely impact and shape veterans in a manner distinct from civilian life. Therefore, In the absence of vital, veteran-provided proof, adjudication should consider the aggravation of mental illness as presumptive. Veterans need to be evaluated holistically, considering all available proof and presuming all applicable military triggers.

Action Plan: Making the Invisible Illnesses Visible

To support veterans’ mental health, we must update outdated ideas and tackle challenges in connecting a veteran’s illnesses to military service. The VA needs to enhance assistance for stress-related mental health issues. Congress needs to make an honest examination of how stigma permeates their system and create new laws that aid veterans in proving that their invisible illnesses are aggravated in service. These laws must include that related mental health diagnoses are enough to prove a single mental health condition and that aggravation of a mental health condition is presumed in service. Identifying and addressing these problems is vital for the well-being of veterans, requiring systemic improvements and new rules so that they are compensated for their sacrifice.

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Works Cited