1. Legal aspects: PTSD cases in Denmark

2. Attorney-at-law, Copenhagen Specialized in Litigation / Personal Injury / Workmen’s Compensation Have represented almost 50 veterans – in cooperation with The Soldier’s Grant Most cases are about compensation for PTSD (Workmen’s Compensation) Mads Krøger Pramming

3. From 1992 – 2010: 26.000 soldiers deployed Danish Health and Medicines Authority (2010): “conservative estimate: 5 to 10% suffers from PTSD” ”approx. 100 new veterans with PTSD require treatment each year“ Special problems with veterans from Balkan (former Yugoslavia) Denmark's first experience with veterans (since 1864?) No real program for returning soldiers – no help provided Denmark on the battlefield

4. Traumatized veteran from Balkan No initial treatment or contact with doctors Has coped with psychological problems for many years Social disruption: No residence, Abuse of alcohol/drugs, living in forest or on the streets, suicide attempts etc. Picked up by the system at some point (hospital, social workers etc.) Diagnosed with PTSD by specialist doctors Case begins:Workmen’s Compensation is applied for… Typical client

5. Workmen’s Compensation Insurance compulsory no-fault Veterans with PTSD – should be “easy cases” but no! From 1997-2009: 1.725 veterans with PTSD applied for compensation 72% (1.242) have been rejected! Why? Legal Problems in Denmark

6. Government has chosen to use the WHO ICD 10 classification system (an alternative is the DSM IV as used in the USA) DSM IV might be the better system (most research is based on this, most up-to-date, USA “invented” PTSD) Most significant difference between the systems is that the WHO system operates with a short latency period. Onset of PTSD within “few weeks to months” from the trauma. In guidelines to WHO ICD 10: “6 months” The PTSD Diagnosis

7. WHO ICD 10 criteria: 1.Event or situation of an exceptionally threatening or catastrophic nature 1.Onset of symptoms within “few weeks to months” (6 months) The PTSD Diagnosis

8. Doctors: “PTSD” Government lawyers (perhaps skeptical about mental illness): Test the evidence: (easy criteria for a caseworker – no x-ray, blood analysis or medical knowledge necessary) 1. Traumatic events confirmed by the Defense? (any other evidence? Witnesses?) 2. Symptoms within 6 months? Only one type of evidence accepted: “entries in doctors records” no entry = no compensation (72%) Doctors vs Government Lawyers

9. 1996 – Bosnia Comrade stepped on a landmine (while walking next to Richard) Richard walked though minefields Found a man with his head chopped of (butcher) Threatened with a loaded gun Grenades thrown into the camp and exploded close to him Found a body with all limps blown to pieces Many “code red” alarms Child prostitution Richard comes home in late 1996 with massive psychological problems and start drinking, cannot sleep, is aggressive etc. CASE – ”RICHARD”

10. PTSD case has been REJECTED by the Government: “Does not meet the WHO ICD-10 criteria”: No confirmation from the Defense (to begin with - has now been accepted) No symptoms within 6 months (no entry in doctors record) THE EVIDENCE: Entry in doctors record after 9 months: ”has big problems. Gets Angry. Things go wrong at home…” Statements from family and ex-wife: “major problems immediately after he returned” Early retirement because of PTSD (local government) CASE – ”RICHARD” Elmer & Partnere

11. Senior psychiatric consultant at Rigshospitalet’s military psychiatric clinic: "PTSD as a result of battlefield experience” Senior psychiatric consultant at Odense University Hospital: ”PTSD as a result of battlefield experience” AND 3 more doctors: 1 psychologist: “PTSD as a result of battlefield experience” CASE – ”RICHARD” Elmer & Partnere

12. Government (NBII): Case rejected – does not meet the WHO criteria: “did not seek medical advice directly after he came home or within 6 months” + ”the consultations with his doctor and his a family’s statements are not evidence” Case awaits legal aid – will probably go to court next month THE DEFENSE HAS PAID COMPENSATION (first time they disagree with the NBII – as far as I know) CASE – ”RICHARD” Elmer & Partnere

13. No veterans have taken their case to court before June 2011 (goes to trial this winter) Now a total of 3 cases filed (and 2 more in August) - all cases initially funded by The Soldier’s Grant (now legal aid) Hope that Danish judges will not only accept one single form of evidence (doctors records). Hope that Danish judges will let the doctors diagnose the veterans – and refrain from applying legal tests. The Lawsuits

14. Veterans in Denmark with (even minor) psychological problems MUST: 1.Contact a doctor a.s.a.p. 2.Make a list of traumatic events and a list of witnesses who can confirm the events (while they can remember) In Denmark the burden of proof is on the veteran. Legal Advice in conclusion