June 10, 2008 – A Senate hearing called to determine if the Veterans Affairs Department is systemically denying veterans’ post-traumatic stress disorder claims in favor of less-costly diagnoses devolved into a circus of denials, backtracking, evasive answers and even an inappropriate joke.
The latest controversy began when Norma Perez, mental health integration specialist at the VA Medical Center in Temple, Texas, sent an e-mail to her staff stating: “Given that we are having more and more compensation-seeking veterans, I’d like to suggest you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder, [rule out] PTSD. Additionally, we really don’t … have time to do the extensive testing that should be done to determine PTSD.”
“It’s very frustrating to read this e-mail and see resources are an issue,” Sen. Patty Murray, D-Wash., said at the June 4 hearing. She said she wanted to make sure veterans aren’t being shortchanged due to insufficient resources, especially since lawmakers have asked VA officials repeatedly if they needed more resources and were told no.
Murray added that a recent Pentagon announcement that PTSD rates have risen by half and another from the Army that suicide rates among soldiers are the highest ever recorded have her concerned that even more veterans will soon seek help.
Perez said the e-mail was an effort to encourage her staff to diagnose PTSD correctly, but she didn’t address the part of her e-mail that indicated her VA center lacked the staff and resources to diagnose and treat the problem.
She said “several” veterans “expressed frustration” after initially being diagnosed with PTSD and then later having had their diagnoses changed to “symptoms of PTSD,” rather than the full disorder. Later in her testimony, she said only two veterans out of at least 1,000 had been wrongly diagnosed with PTSD and said her e-mail emphasized “careful diagnosis.”
“I realized I did not … convey my message appropriately,” she said, but she did not apologize for the message that was conveyed.
Sen. Daniel Akaka, D-Hawaii, chairman of the Senate Committee on Veterans’ Affairs, said the e-mail is just the latest in a series of troubling missteps by VA officials.
For example, Ira Katz, VA’s top mental health doctor, recently sent an e-mail — with the subject line “Shh!” — about whether the department should make public new data showing that 1,000 veterans under VA care were attempting suicide each month.
Sen. Jon Tester, D-Mont., said that after a veteran complained to his office about the treatment he received from VA, the veteran “was threatened with lesser disability” payments.
Michael Kussman, VA’s undersecretary of health, said there is no systemic or individual attempt to deny PTSD claims. He said VA needs to better communicate what it is doing and work harder to ease the stigma linked to mental health care.
Kussman then said: “Perhaps people think I should have gone to a mental health clinic.
“Not to make light of it,” he added.
VA rules violation?
Murray asked Perez about the part of her e-mail that talked of ruling out PTSD and diagnosing adjustment disorder instead.
If the symptoms of adjustment disorder last more than six months after the incident that caused them, veterans should be moved to the PTSD category, according to VA rules. Murray said most veterans receiving care at VA experienced their stressors during their time on active duty, so it should be past the time for an adjustment disorder diagnosis.
“It’s curious to me that you would suggest it outside that time,” she said.
“That’s why it’s just a suggestion,” Perez answered.
But Katz said Murray was correct. “My read is actually closer to yours, and I would respectfully disagree with my colleague,” he said.
Murray asked if the e-mail represents VA policy. Patrick Dunne, acting undersecretary for benefits, said it did not.
Kussman said psychiatrists should not make a diagnosis of adjustment disorder if they “don’t think that’s what it is.”
In a lawsuit filed against VA in federal court in California by a veterans group that says the department is not adequately caring for veterans, Kussman recently said it would be “unfair and inappropriate to stigmatize people with a mental health diagnosis when they are having what most people believe are normal [adjustment] reactions.”
After the hearing, Akaka, Murray and Tester held a news conference with two veterans who said they received a diagnosis of adjustment disorder that caused them to lose benefits.
VoteVets.org and Citizens for Responsibility and Ethics in Washington also attended. The groups filed a Freedom of Information Act request seeking all VA e-mails referring to PTSD.
“There was a lot of spin here today,” said Jon Soltz, an Iraq war veteran and chairman of VoteVets.org. “But we hear about these stories every day.”
Murray said the VA inspector general is looking into the Perez memo. Asked whether she believed Perez’s testimony, Murray noted that the memo “explicitly” stated that diagnoses should be based on costs rather than needs.
“I listen to everything the VA says with a very large grain of salt,” Murray said.