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VA e-mail: Save money, do not diagnose PTSD

Two veterans advocacy groups have asked for copies of all documents relating to the Veterans Affairs Department’s post-traumatic stress disorder policies after an e-mail surfaced asking VA doctors to keep costs down by giving diagnoses of adjustment disorder instead.

Veterans diagnosed with PTSD are eligible for health benefits and, in some cases, disability retirement pay. Adjustment disorder, on the other hand, is considered a short-term diagnosis, and does not qualify veterans for benefits, said Brandon Friedman, vice chair of VoteVets.org, one of the advocacy groups.

“They can say, ‘Ah, you’ve got something temporary, it’ll go away, so we don’t need to pay you for the rest of your life,’ ” Friedman said.

He said several veterans have told him they were diagnosed with adjustment disorder rather than PTSD, and that they felt they had received the wrong diagnosis.

“We hear anecdotal evidence all the time that VA is trying to cut costs by not diagnosing PTSD,” said Friedman, a former infantry officer who served in Iraq and Afghanistan. “But we’ve never actually seen proof that it was being done in an organized way.”

The e-mail, which Friedman said came from a VA hospital’s PTSD program coordinator, was apparently sent to several VA employees at that hospital. A psychologist from the hospital in turn sent it to VoteVets.org, Friedman said.

“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,” the e-mail states. “Consider a diagnosis of adjustment disorder, r/o [rule out] PTSD. Additionally, we really don’t ... have time to do the extensive testing that should be done to determine PTSD.”

The e-mail also states veterans are appealing their compensation and pension ratings based on diagnosis from his staff.

VA Secretary James Peake acknowledged in a statement that the e-mail did come from a VA facility, but said it’s not official policy.

“A single staff member, out of VA’s 230,000 employees, in a single medical facility sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health-care organization,” he said. “The employee has been counseled and is extremely apologetic.”

VoteVets.org and Citizens for Responsibility and Ethics in Washington filed a Freedom of Information Act request May 14 asking VA for all documents relating to PTSD, said Naomi Seligman Steiner, spokeswoman for the latter group.

“We’re not head-hunting,” Friedman said. “There are a lot of great people who work at VA who have helped me and my friends. We had to file the FOIA to get to the bottom of this. Is it from the head of the VA? The presidential administration? Or individual hospitals? I would like to know where this directive is coming from.”

Peake said his staff “works hard” to make sure mental health issues are accurately diagnosed.

“VA’s leadership will strongly remind all medical staff that trust, accuracy and transparency is paramount to maintaining our relationships with our veteran patients,” he said. “We are committed to absolute accuracy in a diagnosis and unwavering in providing any and all earned benefits. PTSD and the mental health arena is no exception.”