Frederica Freyberg:
Now, this news.  A medical breakthrough this week for thousands of young military veterans returning from service in Iraq and Afghanistan.  This week the Department of Veterans Affairs took a major step to make it easier to get insurance and benefits for post-traumatic stress disorder.  No longer required is the time-consuming and difficult documentation to prove that a specific event caused PTSD.  Under the new rules, a veteran only needs to demonstrate that they served in a war zone.  The latest figures show nearly 366,000 vets were treated in 2009 for PTSD, and the numbers are rising.  One reason given for the increase is proactive screening.  More than 3,700 VA mental health professionals have been trained to deal with PTSD.  One of those is Dr. Tracey Smith.  We spoke with her at the VA Hospital in Madison.  We started by asking why the new rules allow for treatment and benefits even without a specific combat incident. 

Tracey Smith:
The change has to do with where you were, what kind of job you served in the military.  For example, I treated a vet who was a photographer in Vietnam.  One day he’d be shooting generals and movie stars, and the next day he’s being flown out in a helicopter to document, for instance, dead bodies.  So he’s somebody who would have a job that you wouldn’t normally think of as having a military-related stressor, but he clearly had PTSD from his service. 

These newer veterans, a lot of veterans who served in Iraq and Afghanistan, they might not have one big event, but they’re driving truck all day and at any given time there could be an IED explosion.  And while they might not be near the IED, they are driving that road every day, and they have seen other people die in IED explosions.  So they don’t have a specific event.  It’s more like their entire service was pretty stressful. 

Frederica Freyberg:
Can you fake PTSD? 

Tracey Smith:
Some people try to fake PTSD.  I think if you’ve been in this business for a long time, you start to get a sense of who is and is not accurately portraying their symptoms.  We don’t have a test like an x-ray where we can sort of diagnose PTSD, so it’s possible.  I’d say more often than not, you can tell if somebody’s --

Frederica Freyberg:
What constitutes a diagnosis of PTSD? 

Tracey Smith:
Well, the first one and the one that we’re sort of talking about is that you have what we call a criterion, a stressor.  So it’s a stressor where your life or the lives of others’ life or limb really is threatened.  So it’s quite a severe stressor.  That’s the first criterion.  And that your reaction was one of helplessness or horror.  And then, there’s these three criteria of re-experiencing, which is nightmares, intrusive thoughts, flashbacks, emotional numbing and avoidance, so working hard not to think about the event, avoiding crowds, avoiding certain people and places, hard to feel positive emotions.  The last one is hyper-arousal or vigilance. That is, always feeling like you’re on guard, doing perimeter checks around your house, having an increased startle response, so you hear a car backfire and you’re on the ground.  So you’re looking for a certain number of each one of those to give a diagnosis of PTSD. 

Frederica Freyberg:
What kinds of new treatments are you undertaking here successfully? 

Tracey Smith:
We offer both cognitive processing therapy and prolonged exposure.  They’re two very effective treatments for post-traumatic stress disorder.  And we collect data locally in our own clinic, so we have what are called large effect sizes, meaning when you look at people’s PTSD symptoms before and after treatment, there’s quite a big improvement.  So, you know, we offer good treatments.  Really, the hard part is getting veterans to come in and do the treatments, because the treatments are challenging.  Part of what we ask people to do is talk about their worst traumatic event.  So, you know, most people aren’t like, “sign me up, that sounds great,” you know.  So it’s a challenge getting people in.  But if they do come in, if they get treatment, we can be helpful to them.  And these are treatments that we didn’t have way back when the Vietnam veterans first came home.  So even now we can do these treatments on Vietnam veterans, even though they’ve had PTSD for a long time, can get markedly better. 

Frederica Freyberg:
Dr. Smith, thank you very much. 

Tracey Smith:
Sure. 

Frederica Freyberg:
The Veterans Administration has chosen Milwaukee as one of two sites in the country to pilot a walk-in clinic that may make it easier for veterans to file compensation claims.  One congressional analysis puts the cost of the new PTSD changes for vets at $5 billion.