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Here’s another sad story about the federal government trying to screw our brave, wounded soldiers who are simply trying to collect their disability benefits.  A psychologist who helps lead the post-traumatic stress disorder program at a medical facility for veterans in Texas told staff members to refrain from diagnosing PTSD because so many veterans were seeking government disability payments for the condition.

“Given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out,” Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs‘ Olin E. Teague Veterans’ Center in Temple, Tex. Instead, she recommended that they “consider a diagnosis of Adjustment Disorder.”

In my opinion, it is unethical for Dr. Perez to instruct VA psychologists to assign a particular diagnosis to a patient they have yet to meet.  The specific diagnostic criteria for each mental disorder are contained in a publication called Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).  This publication is used as a diagnostic reference by most, if not all, American psychologists.  DSM-IV §309.81 says the “essential feature of Post traumatic Stress Disorder (PTSD) is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury….”  Having an improvised explosive device blow up one’s Humvee sure seems to fit this feature.  The person’s response to the traumatic even must involve intense fear, helplessness, or horror.  The characteristic symptoms include persistent re-experiencing of the traumatic event.  The full symptom picture must be present for more than 1 month.  The point is that one either fits or does not fit the specific diagostic criteria for this particular anxiety disorder. 

On the other hand, the disorder that Dr. Perez coaxed her subordinates to “consider,” adjustment disorder,  is a less severe reaction to stress than PTSD.  DSM-IV specifically cautions that a diagnosis of adjustment disorder “should not be used if the disturbance meets the criteria for another specific Axis I disorder (e.g., a specific Anxiety or Mood Disorder)….” 

Why are folks within the the VA doing this to our vets?  Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition. According to the VA, those found to have adjustment disorder generally are not offered such payments.

Perez’s e-mail was obtained and released publicly yesterday by, a veterans group that has been critical of the Bush administration’s policies in Iraq and Afghanistan, and Citizens for Responsibility and Ethics in Washington (CREW), a nonprofit government watchdog group.

“Many veterans believe that the government just doesn’t want to pay out the disability that comes along with a PTSD diagnosis, and this revelation will not allay their concerns,” John Soltz, chairman of and an Iraq war veteran, said in a statement.

Melanie Sloan, executive director of CREW, said in a statement: “It is outrageous that the VA is calling on its employees to deliberately misdiagnose returning veterans in an effort to cut costs. Those who have risked their lives serving our country deserve far better.”

This is not the first report of our government using its medical resources against those risking their lives in Iraq.  Earlier this year, it was reported that the government was subjecting injured military contractors to controversial, neuropsychological malingering tests, which can be manipulated to accuse a patient of faking or magnifying his or her symptoms.

 A Rand Corp. report released in April found that repeated exposure to combat stress in Iraq and Afghanistan is causing a disproportionately high psychological toll compared with physical injuries. About 300,000 U.S. military personnel who have served in Iraq or Afghanistan are suffering from PTSD or major depression, the study found. The economic cost to the United States — including medical care, forgone productivity and lost lives through suicide — is expected to reach $4 billion to $6 billion over two years.

The New York Times has run a series of articles concluding that, as bad as the numbers are concerning PTSD, traumatic brain injury, is the signature injury of the Iraq war.  Those with brain damage have more than just an anxiety disorder, their brains have been physically damaged.

Most Americans would gladly sacrifice to make sure these vets receive correct diagnoses and proper care.  Our government should stop sweeping this problem under the rug by attacking the wounded vets.

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