I was asked if the VA's crappy record on overmedicating PTSD-afflicted veterans was a policy issue or a legal issue.
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It's not political or legal, it's cultural.
Science still has only a broad strokes concept of what PTSD is, and no (reliable) method to effectively diagnose, treat, or consider treated and cured. And that's just science. The civilian world thinks "PTSD," and thinks about some Punisher wannabe shooting up the place. The military thinks PTSD and sees a huge blinking neon sign that says UNRELIABLE.
So the Civilian side gets nervous and wants it to be Not Our Problem. And since that sector includes employers, universities, Child Protective Services, and just about any other official aspect of life, it's effectively a scarlet letter. Despite the fact that one of the few things we do know about PTSD is that those who suffer it are far more likely to kill themselves rather than harm anyone else.
So nobody among the cake-eaters trusts a veteran with PTSD. And they especially don't trust one with a weapon or even discussing weapons. Which is a maddeningly helpful attitude to have towards former military, or anyone who truly gives a flying fuck at a rolling doughnut about personal freedoms, for that matter.
On the military side, nobody wants someone under them who's UNRELIABLE, and nobody especially wants someone leading them who's UNRELIABLE. Which means that being a sufferer and asking for help is a career death sentence. Periodically we get this General or that claiming there's no shame in asking for help. Each and every one of them is full of shit and they damn well know it.
If PTSD was a physical injury like a broken leg, there would be measurable diagnosis, recovery time, and standard to return to. So someone would be on light duty, convalescent leave, or a medical discharge, depending on the extent of their injuries and how soon they could return to full duty. Since nobody knows fuck-all how to do that for PTSD, they instead diagnose sufferers as UNRELIABLE, with no idea of duration or successful treatment.
What the military absolutely does have is a system to replace losses. A military unit knows it will lose people to death, injury, jail, or simple career progression. It knows how to process that. A PTSD sufferer, on the other hand, is a big shiny UNRELIABLE sign taking up a slot that's not being filled by a reliable person instead.
Hence, the entire military's response to PTSD sufferers is "get them off my roster." The same way someone in prison or too badly injured to return to full duty in a reasonable amount of time would be. The second they have someone like that gone, the quicker they can ask for a replacement to be transferred in.
So they're dumped on the VA. Which is it's own cauldron of shit. Not the least of which being that pill cocktails are reliable sales and have a much higher profit margin than a therapist's billable hours.
But that's just those who admit they need help, who are believed, who are medically discharged. This doesn't include the hardcores or those who aren't believed. Who wind up self-medicating. They manage to last somewhat longer. Until they pop a piss test for opiates or get yet another DUI or are found abusing their spouses. Usually after their performance has taken a nose dive too. Once they've become a miscreant instead of simply an afflicted, the Military suddenly has a procedure in place. So the military drops them: Administrative, other than honorable, or the Big Chicken Dinner (Bad Conduct Discharge).
Those have the bonus of saving the VA money, since whether or not they can successfully file a claim is way up in the air. Then they're introduced to civilian life, see above.
So yeah, until science can get a reliable diagnosis of both suffering and successful treatment, until the civilian world stops seeing the punisher, and until the Military finds an alternative to the big UNRELIABLE sign, we're gonna keep seeing this.