VA denies money a factor in PTSD diagnoses

WASHINGTON -- A Veterans Affairs psychologist denies she was trying to save money when she suggested counselors make fewer diagnoses of post-traumatic stress disorder in injured soldiers.

Norma Perez, who helps coordinate a post-traumatic stress disorder clinical team in central Texas, indicated she might have been out of line to cite growing disability claims in her March 20 e-mail titled "Suggestion." She said her intent was simply to remind staffers that stress symptoms could also be adjustment disorder. The less severe diagnosis could save the VA millions of dollars in disability payouts.

"In retrospect, I realize I did not adequately convey my message appropriately, but my intent was unequivocally to improve the quality of care our veterans received," Perez said in testimony prepared for delivery today before a Senate panel.

The Senate Veterans' Affairs Committee and the VA inspector general are investigating whether there were broader VA policy motives behind the e-mail, which was obtained and disclosed last month by two watchdog groups. The VA has strenuously denied that cost-cutting is a factor in its treatment decisions.

"One question that was raised repeatedly about this latest e-mail was, 'Why would a clinician be so concerned about the compensation rolls?'" said Sen. Daniel Akaka, D-Hawaii, who chairs the Senate panel. "As an oversight body, we must know whether the actions of these VA employees point to a systemic indifference to invisible wounds."

VA secretary James Peake has called Perez's e-mail suggestion "inappropriate." VA officials said this week that her e-mail was taken out of context.

"The e-mail, as characterized by others, does not reflect the policies or conduct of our health care system," said Michael Kussman, VA's undersecretary for health, in testimony prepared for the Senate hearing. "We certainly agree that it could have been more artfully drafted."

In her e-mail to staffers at the VA medical center in Temple, Texas, Perez wrote, "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. ... We really don't or have time to do the extensive testing that should be done to determine PTSD."

Many veterans and injured troops have long charged that the government might seek to reduce disability costs by assigning a lower benefits rating. Last year, retired Lt. Gen. James Terry Scott, chairman of the Veterans' Disability Benefits Commission, said he believed the Army might at least subconsciously consider cost. A lawsuit filed in San Francisco accuses the VA of misclassifying PTSD claims.

In her testimony, Perez said symptoms for PTSD and adjustment disorder are often similar, as are the treatments for them. She said by making an initial diagnosis of a lesser disorder, VA staff can begin treatment right away without going through the arduous process of deeming it PTSD.

Perez also noted that awarding disability benefits is not part of her staff's work, but she did not say why she chose to cite that as a factor in urging fewer PTSD diagnoses. Veterans diagnosed with PTSD are eligible to receive up to $2,527 a month in government benefits.

A recent Rand Corp. study found about 300,000 U.S. military personnel who served in Iraq or Afghanistan are suffering from PTSD or major depression, potentially saving the government millions of dollars if lesser diagnoses are used --rightly or wrongly -- in disability benefits decisions.

"Although our clinic is a treatment clinic, we all fully support the compensation process and the department's policy of erring in the best interest of the veteran whenever there is any doubt," Perez wrote.

Perez's testimony comes after Peake was called to Capitol Hill last month to answer questions about internal e-mails suggesting that VA officials were hiding the number of veterans trying to kill themselves. One of the e-mails, disclosed during a San Francisco trial, started with "Shh!" Some lawmakers have said the VA's top mental health official who wrote it, Dr. Ira Katz, should be fired, but Peake has said he has no plans to do so.

------

On the Net:

A copy of Perez's e-mail can be found at http://www.citizensforethics.org/node/31690

Department of Veterans Affairs: http://www.va.gov/

Senate Veterans' Affairs Committee: http://www.senate.gov/veterans/public/