Literature Review of Mediation and Advocacy
BSHS 441
April 11, 2012

Advocacy for the Veteran
The Veteran’s Administration (VA) can be a helpful asset to American Veterans. However, before the help comes, there must be a diagnosis that often times is fraught with a long line of exams, tests, evaluations and even a few hoops to jump through in order to receive the proper care and treatment the veteran is seeking. The benefits of being in the military can be amazing, but often times they can be difficult to obtain when it comes to medical problems that are often a result that comes from military service. When beginning the process there is often a “gatekeeper” (Lomas & Berman, 1983) of sorts, the person that decides the level of the veteran’s disability and thereafter the level of disability determines the amount of care and money the veteran will receive. The money is given based on the difficulty the veteran has in finding and maintaining a job as a result of this disability.
When an advocate is helping obtain a psychological diagnosis for the veteran, the process is often much more frustrating. The reason for this is that a psychological diagnosis cannot be deduced as quickly as a test for cancer or diabetes or a missing limb. Psychological diagnosis comes from an opinion by a doctor and the description of symptoms by the patient himself. “Add to this the unique context of the VA system in that the psychiatrist examining the veteran is diagnosing for an administrative, rather than therapeutic, purpose, at the request of the VBA gatekeeper; his role is less a helper and more a pseudo-gatekeeper, and he is certainly more skeptical or adversarial with a veteran seeking part of a finite pool of money than he might be with a client he planned to treat for the long haul.” (Lomas & Berman, 1983)
Often times a diagnosis for a veteran with Post Traumatic Stress Disorder (PTSD) is something that is not easily diagnosed because the veteran is not willing to talk about it due to certain misgivings about the person which he is talking to or even lacks the ability to talk about it at all. It is the responsibility of the advocate to ensure that he first understands the background of the veteran, his culture and beliefs and the reasons for his symptoms such as those that come with PTSD. For example if a man has a problem with his psychiatrist because he looks just like a man that died is his arms on the battlefield or worse, looks like a man he killed in battle. If the sound of the psychiatrist’s voice or the smell of his office leads to flashbacks, how will the message get back to the psychiatrist as anything less than an inability to cooperate? If the advocate is aware of the situation and the history of the veteran, he will be more able to stand up and advocate for the proper care and awareness for his client.
“This idea builds on our ever-increasing understanding by focusing on the specific context of advocating for veterans who have psychological disability claims in the VA disability system, a context in which culturally-aware communication can be of critical importance to the outcome of a veteran’s claim and future livelihood.” (Bryant 2001-2002) Communication with the veteran and the doctor is vital in order the get the proper diagnosis and the best care possible for the current time and for the future of the veteran. The advocate must ensure that the benefits earned through battle are the ones that the veteran receives.

References
Harvey D. Lomas & Jonathan D. Berman, Diagnosing for Administrative Purposes: Some Ethical Problems, 17(4) Soc. Sci. Med. 241, 241-242 (1983)
Susan Bryant, The Five Habits: Building Cross-Cultural Competence in Lawyers, 8 Clinical L. Rev. 33, 41 (2001-2002).
Veterans Compensation Benefits Rates Tables – Effective 12/1/11, U.S. Dep’t Veterans Affairs, http://www.vba.va.gov/bln/21/Rates/comp01.htm (last visited Aug. 23, 2012).