VA doctor advises staff to refrain from PTSD diagnosis

From the Washington Post

The physician in charge of 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, Texas. Instead, she recommended that they "consider a diagnosis of adjustment disorder."

Adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months, said Anthony Ng, a psychiatrist and member of Mental Health America, a nonprofit professional association.

Veterans diagnosed with PTSD can be eligible for disability compensation of up to $2,527 a month, depending on the severity of the condition, said Alison Aikele, a VA spokeswoman. Those found to have adjustment disorder generally are not offered such payments, but veterans can receive medical treatment for either condition.

Perez's e-mail was obtained and released Thursday 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, 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," Jon Soltz, chairman and an Iraq war veteran, said in a statement.

Veterans Affairs Secretary James Peake said in a statement that Perez's e-mail was "inappropriate" and did not reflect VA policy. It had been "repudiated at the highest level of our healthcare organization," he said.

Peake said Perez had been "counseled" and was "extremely apologetic." Aikele said Perez remained in her job.

A Rand Corp. report released in April found that repeated exposure to combat stress in Iraq and Afghanistan was 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 lives lost to suicide -- is expected to reach $4 billion to $6 billion over two years.

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