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Comment by spamuel | Hacker News Reader

Not unlikely. My alternate hypothesis is disability compensation inflation. There is a LOT of this in the military. 100% VA disability is ~$4,000/mo (increasing every year) for the rest of your life. That is more than a typical enlisted retirement pension. And there are a handful of unfalsifiable conditions that will take you straight to 100% - PTSD (for any reason, not just combat), MST ('military sexual trauma'), and a variety of "oh my back or knees hurt, but there's nothing amiss on the MRI" type claims.

There are a lot of perfectly healthy people out there receiving 100% VA disability because they just had the inclination to play the system.

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That is a remarkable take on disabled vets, when you see 15 year long fights to get covered for brain damage received in combat due to IEDs, but there are no visible wounds. Cancers and breathing problems from burn pits. Untreated mental illness leading to a much higher rate of suicide and alcoholism than the rest of the population.

But I guess we should go after those disability queens right? Screw the warfighters who signed up to take incoming rounds for the promise of a dodge charger and a communications degree.

I love that you scoff at PTSD being a mention it and get 100% condition. You must be smoking the good stuff.

(I agree with your points, and gentle reminder on HN's conventions of discourse: https://news.ycombinator.com/newsguidelines.html )

IMHO, many disabled veterans not getting all the help they need, which the US could muster, seems to be a real and unconscionable problem.

As well as there being tragedies of veterans who the US can't help enough. (Recently including a friend of a friend, who died young, believed due to burn pits.)

This context is another reason we should be careful about vocal speculation of benefits/aid fraud. Dismissive-sounding talk risks making a terrible situation even worse, for many genuinely injured people.

I am not sure which HN discourse bullet you were referring me to, but if it’s not being snarky… fair.

I’m only snarky about this to avoid just losing my cool, to hear someone talk about disabled vets like some kind of freeloading liars, just sucking off the system drives me up the wall. I can’t imagine a more evil and cynical way to talk about people who were willing to lay down their lives so people on here can live a cushy existence, in the peak of empire, wrapped in the warm blanket of safety and security that our overwhelming military force provides these “titans of industry.”

This statement I responded to casts doubt on every PTSD or sexual assault claim made, ignoring the difficulty in making these, glossing over the idea that going to a foreign country and killing people, watching your friends die and be dismembered, or being assaulted by people that you were supposed to trust with your life, has on someone’s mental health. I find it maximally disgusting, and I stand by what I said.

Understood, and agreed.

You find it maximally disgusting that someone would acknowledge that there are a lot of people lying about being hurt, so they can steal money. Got it. I acknowledge that you feel this way.

I'm explicitly talking about the people getting VA disability for things they're making up or exaggerating. I think I was very clear about that.

I am a combat veteran, and I think it's ridiculous that the guy who was such a behavior issue that we wouldn't let him off the FOB now pulls in $4k/mo for his "PTSD" from making sure the MREs were accounted for.

What if you're mistaken with these 2 theories?

Someone (a doctor, so an especially credible reporter) is claiming a miserable, debilitating medical condition.

For the sake of the scenario, let's assume the doctor is correct.

With that assumption, if they're being told that they're probably either imagining it or lying, isn't that adding insult to injury? And maybe slowing down whatever help they could get with the condition?

That seems like an overly pessimistic valance to bring to the hypothetical conversation about the factual possibilities which obviously include fictitious disorder, somatization, or, yes perhaps but not necessarily, malingering.

This unbelievably cynical. I don’t buy it.

Same. Are they faking the abnormally high rates of suicide too?

Why not? Disability benefits always have this problem. The UK did a massive effort some years ago where everyone claiming disability was re-reviewed, because there had been a constant run of stories in the press and complaints to MPs about people claiming it fraudulently. There were people who were claiming they couldn't leave the house who were caught going on foreign vacations, people who were acting like they couldn't walk who were caught on CCTV outside the assessment center walking perfectly healthily and so on.

Where there's free money, there will be people who find ways to get it. Was ever thus.

What you’re describing is just generic fraud, and is expected to be uniformly distributed. Thus you’d expect to see it across the CIA at random and not in a big non-uniform lump with people spending time in Cuba all reporting similar conditions.

Then you also have the fact that damage to their vestibular system can be seen.

Yes, agreed, in this particular case it sounds a bit odd to be fraud. I'm just pointing out that the belief in disability benefits fraud in general isn't unbelievably cynical, it's pretty rational. In this case maybe it's offset by specific details of the cases.

“Why not?” (!)

You're missing the killer context to that UK story in that it turned out they'd been denying legitimate applications on a worrying scale, the fraud rate was actually fairly low

The system's own claims of fraud rates can't be taken seriously; claimed fraud rates were low before the big re-assessment but abuse was sufficiently widespread for it to become a major political issue anyway. All disability benefits systems are always riven with fraud, this isn't exactly a secret. The CIA is based in the US which is a particularly extreme example: there the numbers on long term disability closely tracks general economic performance, with big rises when there's a recession and subsequent fall when the economy recovers.

The UK certainly had many cases of outright "fraud" (whereby you should consider a claim fraudulent if the person is clearly exaggerating their inability to work). That's why at the start of the re-assessment there were over 7,000 people claiming they were unfit to work because they had sexually transmitted infections, and 10,000+ because they were too fat. Huge numbers of people voluntarily stopped receiving disability payments rather than be assessed at all!

Looking it up, the overall rate at which decisions in the UK were appealed against was ~40%. About 60% of appeals were denied. If you wanted to you could therefore consider that the fraud rate was 24% towards the end of the program. But in the earlier days the fraud rate was more like 75%! That's a high fraud rate by any definition, but even so is certainly an under-estimate. The people in question are unemployed, they've got time and there are no downsides to appealing. Meanwhile the appeals authority is, again, entirely un-incentivized to deny applications beyond the fact that if they never did they'd be replaced. We should expect a massive false negative rate on denials.

The original system ATOS used was check-box and computer driven for that reason: it's much easier to design an objective and fair system when you're not in front of someone who's crying and saying they're in pain. It would take a heart of stone to deny people "free" money which is what benefits creates at the point of individual assessment, so you can't rely on individual's subjective judgements. They will almost always side with the complainant, especially if they have to do it in person. There's tons of psychological and emotional downsides to being the "bad guy" and zero reward.

I'm sorry, have you engaged with the benefit system at all or are you basing this entirely from articles you've read? This all reads so incredibly backwards as someone who's assisted a disabled person through this process.

> The system's own claims of fraud rates can't be taken seriously; claimed fraud rates were low before the big re-assessment but abuse was sufficiently widespread for it to become a major political issue anyway.

The system's own claims of fraud rates should be taken much more seriously than widepsread political opinions, the history of the UK wrt "Benefit Street" etc mean that there's a big juicy voter wedge there, the numbers from the actual institutions tell the story much more evenly than the politicians do.

> Looking it up, the overall rate at which decisions in the UK were appealed against was ~40%. About 60% of appeals were denied. If you wanted to you could therefore consider that the fraud rate was 24% towards the end of the program. But in the earlier days the fraud rate was more like 75%! That's a high fraud rate by any definition, but even so is certainly an under-estimate. The people in question are unemployed, they've got time and there are no downsides to appealing. Meanwhile the appeals authority is, again, entirely un-incentivized to deny applications beyond the fact that if they never did they'd be replaced. We should expect a massive false negative rate on denials.

The rate that the appeals pass or reject does not map to the fraud rate, some applicants lack the agency to appeal and those who can appeal often can't do so repeatedly. The profoundly disabled are screened out at this point - this is where those "My dad was ruled fit to work and died of cancer the next week" stories crop up from.

> The original system ATOS used was check-box and computer driven for that reason: it's much easier to design an objective and fair system when you're not in front of someone who's crying and saying they're in pain."

This was widely, infamously abused to deny people benefits.

This "objective and fair" system marked my husband as capable to work a full time job because he could climb a single flight of stairs with my assistance, ATOS staff were encouraged to deflate scores and deny benefits. It was not objective or fair in the least, it was a rigorous exercise in accelerating toward the minimum number of people receiving benefit awards from that ATOS examination site.

If a system can be gamed, it will be gamed eventually.

Cynical about the literal CIA? I'm still not convinced it's not some weird counter-productive PSYOP.

It’s about the people working for them. Not the organization itself.

And what would be gained?

Here’s the problem is conspiracy theories: when you divorce yourself from needing any evidence to draw a conclusion (nothing that could go before a court of law or a scientific paper), then anything is possible. No means to confirm or refute it! Why not claim that actually the CIA agents are working for Cuba and trying to reduce moral for the rest of them? That’s equally plausible as a generic psyop, but would at least have a more clear outcome. And I just made that up… or did I? Maybe I’m working for the CIA! I mean Cuba! No Russia!

Once you go down that rabbit hole, you throw away everything. So the baby goes with the bath water. You’re totally ungrounded, and at that point you’re totally manipulatable to whenever wants to create a conspiracy for their own agenda, even if that agenda isn’t very clear or sophisticated (eg aliens are doing X).

A healthy amount of skepticism is important. Too much and you’re wrong most of the time yet no logical argument or lack of evidence convinces you. If this happens at the societal level, it’s devastating.

Well the grandfather comment talked about disability compensation inflation, aka, simple fraud. I don't think it overly outrageous to consider that someone that works for an organization that (recently!) backed death squads, would stoop to fraud for personal gain. They have done literal illegal human experimentation (MKUltra) on random people or even on their own.

I'm not saying that I KNOW this is X plot with Y intentions (most probably it's just mass psychosis) It's just that I do not take what a CIA operative says at face value.

I don't think an individual working for the CIA inherits anything from the CIA training militias in South America any more than I think the guy who refills the coke machine at my job inherits national socialist sympathies.

A CIA doctor talking to a TV doctor on CNN. I'm not buying it.

You should visit the South of Italy

Reminds me about Japan and their supposed superior aging. Though the general population believes Japaneses people live longer, turns out its probably not true. In the early 2010s there was some effort to find out why Japanese people live to 100+ more often. When researchers went to find these centurions...whoops most of them don't exist anymore and died 20+ years ago. Turns out that Japan is very lax in checking its social security payouts. They were finding a huge numbers of these people were simply never reported dead and the families kept on cashing the checks that came every month.

I don't really know how it works in the US but I would assume some medical professional will have to give you a diagnosis.

Haha, are you familiar with the way diagnosis is obtained for "mental disorders", such as bipolar disorder, ADHD, PTSD?

There are no clinical scans, blood tests, there is no way to rule out these conditions. They are not illnesses but they are clusters of symptoms that have been labeled so as to medicate or "treat" them without promising cures or healing.

Therefore all you need to do is convince a few psychiatric clinicians that your mental processes and behaviors are sufficiently non-standard and boom, you've got a mental illness that will never be cured, never be healed, and makes you a highly-valuable repeat customer up to and beyond the hour of your death.

And that's how you get 100% VA disability. Congratulations!

I really doubt it's that easy. These are professionals who have studied for thousands of hours. I don't doubt there are cases were someone who isn't actually ill slips through but I doubt it would be more then a few percent.

You're right, it's not that easy. I worked in the VA system for three years during residency, and it was relatively rare to see a veteran who was considered 100% service connected. I had a patient who was exposed to Agent Orange and later developed Hodgkin lymphoma, and while the cancer was treated successfully, the surgery and radiation left him with permanent disabilities that impaired his day to day life. Even he was not determined to be 100% service connected. (He came close - something like 80% if I remember correctly - but not 100%.)

I personally never saw someone who was determined to be 100% service connected purely for PTSD, but I am also not a psychiatrist so it's possible that there is a selection bias there.

And even if they did slip through at a higher rate. The answer wouldn't be to make it abitrarily harder to claim, because real people with real issues would inevitably be hurt.

If the system had 0% fraud rates, then it kind of implies that many real people have been denied because they failed to jump through the hoops.

These professionals are trained in the halls that brought us the biggest replication crisis ever.

And we have collected data on humanity for 20 years in Google and FB. If science goes were the data is, the true neuro-science/psychology today is proprietary and sold in chunks as a service to governments.

Might aswell ask Palantir directly about what humanity is really like without the grand illusions of a surplus of resources spend on postponing the eternal crisis that is our home.

No need to take Freuds last standing followers serious, just because they perpetuate a "Can-do-fix-all-things" illusion, we cling to while drowning in the things we can't fix.

I'm sure "Mental Disorders" was probably not meant to denigrate the giant chunk of humanity that does suffer from such disorders, especially not those in the military that are probably most at risk? Particularly because the US military is volunteer based and mostly recruits from disadvantaged citizens?

Also, if this is a legit shadow practice in the US military, the issue isn't people claiming disability, but our collective lack for caring for them.

> I'm sure "Mental Disorders" was probably not meant to denigrate the giant chunk of humanity that does suffer from such disorders

The suffering that they have is real, whether or not we debate the appropriateness or usefulness of the labels that have been placed on that suffering. Attempting to shame people for discussing those labels (even extremely negatively) as if the discussion itself damages the sufferers is darkly ironic, because the suppression of the discussion of that distress will result in a failure to improve the treatment of that distress.

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edit: I do understand the sentiment, but it's one that has long been cultivated through patients' groups that are founded and funded by pharmaceutical and other medical companies, and push the treatments that their funders push. Their funders are generally deeply invested in the status quo and cast objections to current received wisdom as attacks on the sick, unless they're trying to push a new drug, which is when they push change.

A patients' group can atrophy into an organization with no members, a single funding source, and a lawyer who spends an hour writing a press release every few months, and hires someone to update the website once a year.

I worked as a substitute teacher for a Asberger and Autism class. Half of them seemed to be there because they played Magic the Gathering. And the other half had obvious clinical difficulties with interactions.

I was quite perplexed by the width of severity of who was eligible for the class.

There was certainly a overprescription of needing to go in that class -- or maybe the diagnosis itself.

lol, someone gets it.

These doctors will have a really hard time proving that someone doesn't have PTSD or something similar. It's already hard enough to diagnose all the legit cases.

Yes, but again there are some conditions that are unverifiable or for which they don't verify.

For instance, if you have erectile dysfunction then it's a 10% disability claim. They take you at your word, no "proof" needed. Same with 10% for tinnitus (ringing of the ears).

For PTSD there is a screening process but if you were verifiably in combat, something that less than 5% of the military ever experienced even when the wars were actively going on, then the screening consists of a single session talking to a psychiatrist. It's known in the community what you need to say and do during that interview to get 100% rated.

Similar with you're a woman who claims you were sexually assaulted during your service. Basically, the only hurdle is you being willing to lie.

For chronic pain claims the process is more drawn out but essentially if you're willing to persistently lie then you can get a 100% rating. It will take a year or two of going to doctors' appointments and insisting that you're in pain regardless of what tests they run who but eventually you'll get a diagnosis of some unknown condition with a 100% rating.

I've never done this, but I know a few people who have to varying degrees of legitimacy. For what it's worth the 100% claims I've seen are far closer to exaggeration than outright fabrication. Someone who probably actually should be 60% rated or whatever working the system to get up to 100%. You hear stories out people completely faking it but I don't know them personally. That could just be my cohort though, I was in the Marine Corps Infantry on combat deployments during my time do pretty much everyone I know has something legit wrong with them.

And I will say the VA is an absolute nightmare. I feel some incredibly blessed to have a software career where I don't need to rely on the VA. I've never seen a better argument against socialized medicine in the US than just experiencing the VA firsthand.

If they start verifying these claims, I think we'd have a strong candidate for worst job in the world:

> if you have erectile dysfunction then it's a 10% disability claim. They take you at your word, no "proof" needed.

There was an ig nobel prize awarded for using stamps as an overnight test for erectile dysfunction.

A stamp technique was developed to detect complete nocturnal erections for the evaluation of impotence. The test correctly detected complete nocturnal erections in 22 potent men and absence of complete nocturnal erections in 11 impotent men (P value under 0.001). This is a simple, useful screening test for organic impotence. https://www.goldjournal.net/article/0090-4295(80)90414-8/

I bet it's pretty easy to get a diagnosis for a made-up syndrome caused by secret superspies using alien weapons, one that has no particular symptoms other than a general distress, and no particular physical indications of suffering.

edit: and getting a diagnosis for something real is probably a lot harder.

Same for Long Covid - both regarding mass psychosis as well as an easy way out into disability compensation.

Haha, you know I know a lawyer tell me the monthly payments to victims of torture was 10x what another human rights lawyer said, $2000 / mo vs $200 / mo. Yeah play the system. You know who else plays the system? Bosses insisting above 7 objections and ways out to perform repetitive strain injury with my back in order for me to have an injury that can't or won't ever be corroborated "by a medical professional". And get me to spend the rest of my life with backpain over $3 of labor, begging dogshit after dogshit to please believe me and diagnose my injury.

That's playing the system.

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