MISPLACED REWARDS - VETERANS-ADMINISTRATION SYSTEM AND SYMPTOM MAGNIFICATION

The process of disability determination in the Veterans' Administratio n system and the maladaptive patterns of behavior that may develop in veterans attempting to qualify for disability benefits have been subje cts of considerable interest to those who care for these individuals. The potential misuse of disability payments by veterans, especially fo r purposes of financing drug and alcohol dependence, is a related issu e of concern, The quest for disability status is frequently an all con suming process, as the veteran attempts to document the presence and s everity of his or her disorder to the degree necessary to obtain appro val for compensation, Veterans' Administration patients may engage in symptom magnification as a means of convincing healthcare workers of t he veracity of their complaints and to establish the necessary paper t rail for their disability claims, It is clear when dealing with this c hallenging patient population that it is exceedingly difficult to know when a patient has a prominent psychologic overlay to his or her cond ition, is embellishing existing symptoms, or is prevaricating in an ef fort to obtain disability payments, Although it is essential to focus on the objective signs of disease while attempting to evaluate the sub jective correlates, it is also important to determine the motivation o f the patient, Rewarding individuals for pain and disability, particul arly on a long term basis, can have numerous negative consequences and ultimately may be a disservice to the patient.