Misplaced rewards: Veterans' Administration system and symptom magnification.

Abstract

The process of disability determination in the Veterans' Administration system and the maladaptive patterns of behavior that may develop in veterans attempting to qualify for disability benefits have been subjects of considerable interest to those who care for these individuals. The potential misuse of disability payments by veterans, especially for purposes of financing drug and alcohol dependence, is a related issue of concern. The quest for disability status is frequently an all consuming process, as the veteran attempts to document the presence and severity of his or her disorder to the degree necessary to obtain approval for compensation. Veterans' Administration patients may engage in symptom magnification as a means of convincing healthcare workers of the veracity of their complaints and to establish the necessary paper trail for their disability claims. It is clear when dealing with this challenging patient population that it is exceedingly difficult to know when a patient has a prominent psychologic overlay to his or her condition, is embellishing existing symptoms, or is prevaricating in an effort to obtain disability payments. Although it is essential to focus on the objective signs of disease while attempting to evaluate the subjective correlates, it is also important to determine the motivation of the patient. Rewarding individuals for pain and disability, particularly on a long term basis, can have numerous negative consequences and ultimately may be a disservice to the patient.