State Department on PTSD Workers’ Comp Claims: How Well Is This Working?

— Domani Spero
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We received a note recently from a reader who is deeply concerned about his/her State Department friend diagnosed with PTSD from an assignment in a war-torncountry. The condition is allegedly aggravated by the lack of understanding on the part of the officer’s superiors who “pressured” the employee to return to another “very stressful/high pressure work duties.”

“My friend was not shot, raped, tortured or maimed by explosive devices. No single, well-defined, event happened. That said, s/he/it now lives a life far more constrained by physiological barriers due to time spent in dangerous climes.”

That got us looking at what resources are available to State Department employees suffering from PTSD.  We found the following information on

Employees working in high threat environments such as Afghanistan, Iraq, Pakistan, Libya and Yemen may develop symptoms of Post Traumatic Stress Disorder (PTSD) as a result of their performance of duty.

PTSD may be basis for a workers’ compensation claim under the Federal Employees’ Compensation Act (FECA). The FECA is administered by the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP). If an OWCP claim is accepted, benefits may include payment of medical expenses and disability compensation for wage loss.

When an employee develops any mental health symptoms, including symptoms of PTSD, he/she is encouraged to make a confidential appointment with a counselor in the Office of Medical Services (MED)’s Employee Consultation Services (ECS) office. If the initial evaluation indicates symptoms suggestive of PTSD, ECS will refer the employee to MED’s Deployment Stress Management Program (DSMP) for further evaluation. A psychiatrist designated by DSMP will document the initial symptoms for the OWCP claim form (CA-2) and CA-20 (Attending Physician’s Statement). If the employee requires assistance in completing the OWCP claims package, HR’s Office of Casualty Assistance (OCA) will help the employee gather the required documentation, complete the necessary paperwork, and submit the claims package.

OWCP has advised the Department that PTSD claims will be handled expeditiously. PTSD claims from Department employees have been successfully adjudicated by OWCP in the past. The Office of Employee Relations (HR/ER) will remain the point of contact with OWCP. HR/ER will provide consultation, advice and guidance on the OWCP process and on issues regarding the employee’s use of leave (annual, sick, and use of FMLA), disability accommodation options, and benefits. HR/ER will manage the employee’s claim after OWCP receives it and continue in its liaison role with OWCP to meet the employee’s needs.

Some PTSD patients may require treatment by a specialist outside of the Department of State. For such cases, MED/DSMP may refer the employee to an outside provider. MED will cover the initial cost of treatment until OWCP accepts the claim, submitted by the employee through HR, and OWCP will reimburse MED once the claim is accepted. If OWCP does not accept the case as work-related, the employee should submit the medical bills to his/her insurance carrier to reimburse MED for the initial treatment costs. Subsequent treatment costs will be the responsibility of the employee’s health insurance provider.

Throughout this process, the Office of Casualty Assistance (OCA) will assist the employee and his/her family as they adjust to the employee’s medical condition and explore various options affecting their career with the Department. OCA’s role is to assist the employee with paperwork and coordinate with other Department offices as appropriate.

Workers’ Comp Resources: (* = Intranet Website)

DoL Workers’ Compensation Program Website
OWCP Forms: CA-2 CA-2a CA-20 (pdf)
DoL’s Publication CA-801

DoS Office of Casualty Assistance (OCA)* Tel: 202-736-4302
DoS Office of Employee Relations (HR/ER)*



Frankly, the Office of Casualty Assistance (OCA) has not been terribly impressive. So we’d like to know how responsive is OCA at State when it comes to offering assistance to employees with PTSD who had to deal with worker’s comp?

And how well is DOL’s Workers’ Comp program working if you have PTSD?

We must add that while PTSD is typically associated with assignments to high threat environments such as Afghanistan, Iraq, Pakistan, Libya and Yemen, Foreign Service employees and family members are assigned to over 280 posts around the world.  Some of these assignment are to war-torn countries in Africa that are not priority staffing posts like AIP or are in critical crime posts such as some cities in Mexico, the DRC, and several posts in the Western Hemisphere (looking at Honduras, Guate and El Salvador). Studies show that crime events are also associated with high rates of PTSD.   The focus on PTSD and employees in high threat environments in the information above excludes a long list of critical crime posts and appears to discount, by omission, crime-related PTSD and post-traumatic experience in posts not located in Afghanistan, Iraq, Pakistan, Libya and Yemen.

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5 responses

  1. Another comments received via the Burn Bag:

    As a PS, VA indicates the average time between trauma and treatment-seeking is eight years. The longer it is undiagnosed and treated, the more difficult to ameliorate. I have a formal diagnosis from VA, where I have been in treatment for the past ten months, but could not even get the name of a competent psychiatrist from DoS.

    The bulk of DoS PTSD claims are still a few years away (2008/2009 PLUS 8), with no competent preparation or process. Nothing on the web site page actually happens. I assume, based on my experience (two weeks of disavowals before the claim was even accepted), that many such claims have been discouraged, denied or delayed.

  2. “what’s equally worrisome is the culture of assigning prestige to diplomatic service in war zones or high threat areas. Prestige should rightly be assigned to diplomats who are making progress in international relationships — not those who sit in compounds with 24 hour security details, who can’t meet with locals or do the true work of a diplomat.”

    Spoken from someone who has served in a war zone, or who has not?

    I suspect the latter. War zone service is rewarded because there is a national need and people who volunteer for dangerous assignments are volunteering to put their lives on the line and separate themselves from their families to fill that need. People who don’t volunteer aren’t making that sacrifice.

    Saying war zone work is not ‘real diplomacy’ because it’s different from what people were typically used to is just absurd. I served in Iraq and Afghanistan and frequenly met with locals and left the compound, usually with no security detail. Most public facing diplomats in Afghanistan did the same. It’s as real as it gets.

  3. Below is an anonymous comment received via the Burn Bag:

    Hi, thank you for your post on PTSD and the State Department. I am also concerned about State’s treatment of folks suffering from PTSD as a result of their service, not just in war-torn areas but other regions that are becoming unstable and/or high stress.

    From what I have experienced, the FS culture shames folks who “aren’t tough enough” to handle unstable work climates. This concerns me for many reasons, the first being that the FS prides itself on being a family. But families don’t stigmatize members who are suffering from ailments such as cancer or broken bones, so why does the FS fail to take care of its own people when it comes to acknowledging and treating PTSD? Second, it concerns me because the militarization of the FS, whereby FSOs derive legitimacy and pride from service in danger or war zones, corrupts the spirit of the diplomatic corps. The USFS is not the military! But oddly, FSO chest-pumping speech has become equated with references to danger assignments.

    What happened to good old American diplomacy and the diplomatic corps? What happened to valuing the health and well being of some of our most devoted public servants?

    While State’s failure to properly address the mental health of its FSOs in such a volatile period in global politics is problematic, what’s equally worrisome is the culture of assigning prestige to diplomatic service in war zones or high threat areas. Prestige should rightly be assigned to diplomats who are making progress in international relationships — not those who sit in compounds with 24 hour security details, who can’t meet with locals or do the true work of a diplomat.

    In the future, I hope State will adjust its values and policies.

    Thanks again for the post on this important, under-discussed topic. Hoping there will be further discussion in the broader FSO community. I think it’s the elephant in the room no one is talking about for fear of shaming, blaming, and all the issues noted above.

  4. Below is a feedback we received via email from a State employee who requested that we not use his/her name:

    I actually thought State did a decent job with my PTSD. After I was subject to an attack in Kabul, the social worker at post was readily available and helpful. He indicated I could depart post immediately if I needed to (and many did after the attack). When I departed post I was screened for PTSD and referred to MED here in DC. After a few sessions here with MED, I was referred to a private psychologist who fixed things up in a few months.

    I actually feel like we were bombarded with PTSD awareness materials In Iraq and Afghanistan. People who claim State isn’t trying probably aren’t taking responsibility for their own health, or just didn’t recognize that their persistent issues – lack of focus, daymares, anger, memory loss, etc – are in fact PTSD. Every person’s health is their own responsibility and we can’t hold State responsible for times when an employee either doesn’t take care of themselves or doesn’t say ‘no’ when asked to do something they aren’t healthy enough to do.

  5. Hey there,

    When I was at FSI, there was a total of zero staff specifically available to counsel post-danger post students. I was surprised by that. There was obviously no thought given to the pressures of learning yet another new language us very odd and intensive circumstances, as if it were a gift after potentially PTSD circumstances. Happy to share more any time. Oh, there was a total of three staffers atMain State in the counseling office. Not very impressive!


    Sent from my iPad