Complains of too many disability claims being filed by veterans

An investigative report by the Washington Post released today finds that a VA Psychologist who leads the post-traumatic stress disorder (PTSD) program for returning veterans in Texas has instructed medical staffers to refrain from diagnosing PTSD because too many veterans are seeking veterans' disability benefits for their condition.

Christopher Lee, Washington Post, reports that Norma Perez, Ph.D., has issued an email to staff at the Olin E. Teague Veterans' Center in Temple, Texas recommending that instead of a diagnosis of PTSD they should "consider a diagnosis of Adjustment Disorder". 

In the March 20, 2008 email she writes that "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" for returning veterans."

Perez also wrote that Texas VA staff members "really don't * have time to do the extensive testing that should be done to determine PTSD."

Adjustment disorder is a less severe reaction that PTSD, with a shorter duration.  Veterans diagnosed with PTSD can be eligible for disability compensation up to $2,527 per month depending upon severity.  Adjustment disorder usually results in less severity and reduced compensation payments.

Perez's e-mail was obtained and released publicly yesterday by VoteVets.org, 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.

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.

COULD PEREZ HAVE BEEN DOING SOME PERSIAN GULF WAR VETERANS A FAVOR?

Although it is outrageous that a lead psychologist for the veterans' PTSD program would appear to be advocating the misdiagnose of the disability conditions of returning veterans, on closer examination, Perez could hypothetically been doing some Gulf War veterans a slight favor.

PTSD claims for veterans are notoriously complex and can be difficult to prove.  Basically PTSD requires medical proof of a diagnosis of PTSD, a link established by medical evidence between the current symptoms and the in-service occurrence, and evidence that the claimed stressor actually occurred. 

However, Congress has afforded Persian Gulf veterans unique and different rules for disability under the VA.  This is because many returning Gulf War veterans are suffering new, multisymptom disabilities that are poorly understood by current medical providers and may often be classified as "undiagnosed", or "chronic fatigue syndrome", or "chronic multisymptom" by treating doctors.  This is because Persian Gulf War veterans are being exposed to new biological and other toxins and hazards, vaccines and medications, whose effects are not yet well known by the medical community. 

Thus, Congress enacted special rules under Title 38 USC Sec. 1117 for Persian Gulf veterans to pay disability compensation to veterans for a "qualifying chronic disability".  A "qualifying chronic disability" requires in part medical proof of an "undiagnosed Illness" or of a "medically unexplained chronic multisymptom illness". 

Thus, strange as it seems, for returning Persian Gulf War veterans, it may to be their advantage in so far as compensation benefits are concerned, to have her doctor be unable to link any disabling symptoms to a medical diagnosis because then she may qualify for service connection disability under the "undiagnosed illness" provisions. 

However, if the treating doctor instead tries to fit the Persian Gulf veteran's disabling symptoms into one certain diagnosis, then she cannot win disability compensation, as the disability is no longer an "undiagnosed illness".  Once a diagnosis is made, at least for returning Persian Gulf War veterans, then the veteran must resort to the more difficult proof of linking the current illness to her service, etc.

Perez was indeed wrong to instruct her staff not to diagnose PTSD for returning Gulf War veterans.  Veterans who have PTSD should be afforded that diagnosis, treatment and benefits. However, as strange as it sounds, for those Gulf War veterans whose symptoms were and are not clear and had no medical diagnosis at all been made leaving them only with an "undiagnosed illness", those veterans would likely have have an easier path to proving their entitlement to disability than those veterans who were promptly diagnosed with PTSD.