DoD, TRICARE and VA:  United in Treating Posttraumatic Stress Disorder in Service Members

With the ongoing wars in Iraq and Afghanistan, post-traumatic stress disorder (PTSD) in returning active duty service members (ADSMs) is on the rise. According to the National Center for Posttraumatic Stress Disorder (NCPTSD), the occurrence of PTSD in this population happens:

The Department of Defense (DoD), TRICARE and the Department of Veterans Affairs (VA), are all heavily focused on performing post-deployment screenings and reassessments for the proper diagnosis and treatment of all behavioral health disorders, including PTSD, in returning ADSMs.
 
Additional research from the NCPTSD also reveals that an individual suffering from PTSD will most likely seek care first from his or her primary care manager (PCM). As a result, the DoD, TRICARE and VA are relying on PCMs to take an active role in identifying PTSD symptoms and ensuring these trauma survivors get the appropriate help and treatment they need.
 
It is important for PCMs to recognize that combat veterans, while wanting help, may exhibit some hesitancy in talking to you about their behavioral health issue in order to avoid a perception of weakness. Consequently, communication with military patients can be challenging. To assist providers in approaching military patients, the DoD and VA created clinical practice guidelines. Note: Some of the treatments may not be covered under TRICARE covered benefits. Please verify coverage before starting any treatments on benefiiaries diagnosed with PTSD. Call ValueOptions, Inc., Humana Military’s behavioral health care partner in the TRICARE South region, at 1-800-700-8646.

PTSD is an anxiety disorder that occurs after someone has been through a traumatic event. Indirect trauma, e.g., seeing another person in a life-threatening situation, can trigger PTSD as well.
 
After such events, victims may feel scared, confused or angry. The trauma is persistently re-experienced as intrusive recollections, images, thoughts, dreams, dissociative flashbacks or intense reactions to situations that resemble an aspect of the traumatic event. Additionally, the affected individual will avoid things associated with the trauma (or respond in a numb manner). A victim may display general avoidance of all activities, a restricted ability to experience emotion and an inability to recall certain aspects of the  trauma.
 
Other less specific symptoms that also may be present include increased arousal and startle response, difficulty sleeping, irritability and poor concentration. There may be guilt, coexisting depression, panic disorder or substance abuse.
 
When these symptoms don’t go away or they get worse, a person may have PTSD. To accurately diagnose PTSD in a patient, symptoms must be present for at least one month and significantly impair function.
 
The NCPTSD Web site provides screening tools to assist you in evaluating and diagnosing PTSD. In addition, the American Psychiatric Association has compiled evidence based guidelines on the treatment of acute stress disorder and PTSD.

ADSMs can ordinarily seek care for symptoms of PTSD at their military behavioral health care (BHC) clinic on base without a referral from their PCM. However, in instances where behavioral health care services are unavailable on base, ADSMs should secure a referral from either their onbase BHC clinic or PCM for treatment of PTSD from a civilian provider. For any contact or discussions (other than submission of the contractually required consult report) to occur between a civilian provider and designated third party—i.e., a military provider, either on-base BHC clinician or military treatment facility (MTF) PCM—a civilian provider may require a Health Insurance Portability and Accountability Act (HIPAA)-compliant authorization signed by the ADSM, allowing the release of information to the specified third party.

Family members and retirees can obtain PTSD coverage or other BHC services through their behavioral health benefits from military or civilian network providers.

For more information about PTSD, visit the NCPTSD Web site. For more information about TRICARE behavioral health care benefits, resource tools for your patients or additional Web resources, visit the Provider Portal of our web site.