Why we should worry about malingering in the VA system: Comment on Jackson et al. (2011)

Abstract

In a recent survey, Jackson et al. (2011) found that clinicians who evaluate veterans for service-connected disability pensions rarely use recommended best practices to assess for posttraumatic stress disorder (PTSD) within the Department of Veterans Affairs (VA). We share their dismay, and we hope that their article will help foster evidence-based assessments for diagnosing PTSD in veterans. Jackson et al. briefly discussed scholarship on malingering among applicants for service-connected disability compensation for PTSD, concluding that concerns about malingering are largely unfounded. The data they adduce, however, in support of this conclusion actually provide reasons for concern as we document in this article. We cite recent work by labor economists in support of our argument.

Mental Health Service Utilization before and after Receipt of a Service‐Connected Disability Award for PTSD: Findings from a National Sample

“…There have been concerns voiced regarding whether some Veterans may seek mental health services to establish a basis for a PTSD claim and then disengage from mental health treatment after the claim is adjudicated (Frueh et al. ; McNally and Frueh ). A related concern is that Veterans’ use of VHA mental health services could abruptly diminish upon reaching a disability rating of 100 percent (Frueh et al.…”

The reality of malingered PTSD among veterans: Reply to McNally and Frueh (2012)

“… Abstract In this reply to McNally and Frueh (2012), we offer some additional insight into the studies they use to support their argument that we should be worried about malingering among veterans. We also describe other research on the disability system of the Department of Veterans Affairs and compensation‐seeking behavior that challenges their conclusions. …”

“…Concerns about the validity of disability claims are inherent to any disability system—not just the Department of Veterans Affairs' (VA's) Compensation and Pension program and not just for the diagnosis of posttraumatic stress disorder (PTSD). The commentary by McNally and Frueh (2012) expresses particular concern, however, regarding the legitimacy of PTSD claims by veterans in recent years. At issue is the interpretation of a documented increase in PTSD claims and the explanation for this increase.…”

“…McNally and Frueh (2012) base their argument primarily on results from three studies. The first is a study of PTSD treatment‐seeking Vietnam veterans, 62% of whom reportedly had applied for or intended to apply for PTSD service connection at a VA hospital in South Carolina (Frueh et al, 2005).…”

Posttraumatic Stress Disorder: Controversies, Diagnosis, and Malingering

“…McNally and Frueh ( 2012 ) had argued that research by Frueh et al ( 2005 ) had found an elevated rate of malingering had taken place. But Marx et al ( 2012 ) argued that McNally and Frueh did not consider factors such as war zone exposure, in general, being a risk factor.…”