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	Mark Dombeck, Ph.D. Essays and Blogs Concerning Mental and Emotional Health
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Earlier this month, Dr. Norma Perez an employee of a VA hospital somewhere in America wrote the following email and sent it out to a number of VA clinical employees:

"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. Consider a diagnosis of Adjustment Disorder, R/O PTSD."

"Additionally, we really don't or have time to do the extensive testing that should be done to determine PTSD"

"Also, there have been some incidence where the veteran has a C & P, is not given a diagnosis of PTSD, then the veteran comes here and we give the diagnosis and the veteran appeals his case based on our assessment."

"This is just a suggestion for the reasons listed above"

Sounds awful, doesn't it? At first glance it seems to be confirmation that the VA is motivated to withhold care and benefits from needy veterans. It may well mean exactly that too; we don't know yet. Apparently, Democratic presidential candidate Senator Barack Obama, who serves on the Senate Veteran's Affairs Committee has asked for an investigation, and maybe we'll learn more as a result of that. Time will tell. Whatever else the above email indicates, it is certainly an internal communication that was never intended to be broadcast publicly, and it certainly looks bad.

Because people may be wondering what exactly goes into a diagnosis of PTSD, and what exactly Adjustment Disorder R/O PTSD might be, I thought I'd write on these subjects so as to provide some clarification.

The Nature of PTSD

PTSD stands for Post Traumatic Stress Disorder. It is a disorder that can occur after (post) someone has been exposed to trauma which has caused intense stress. Trauma, used in this context, has a specific meaning. It refers to situations that involve death, or the likely threat of death, or at the very least, intense violence. People sometimes define trauma more loosely saying things like, "it was traumatic for him when his parents divorced". While that sort of situation is undoubtedly traumatic in a lessor sense, that is not really the sort of situation that can cause PTSD. Trauma of the sort that triggers PTSD may occur in the wake of a serious car accident, torture (including water boarding), a rape, a violent beating, a threat of lethal force, a bomb explosion, a natural disaster involving death or threat of death, a combat operation. We need a new term for lesser but still significant emotional traumas.

The simplest way to think about PTSD is to think of it as an interrupted grief process. What is grief but a stressful adaptation to significant (and often rapidly occurring) life change? Think of times in your life when you've experienced a sudden, overwhelming loss, such as at the death of a close friend or family member; one you've depended on deeply. People's reactions to such an event tend to be polarized and intense. Reactions vary between excruciating, unrelenting emotional pain, and numbness and unreality, often swinging between these extremes. Seldom is there a feeling of normality. Mood swings typically continue for weeks and months, perhaps varying in intensity at different moments, but ultimately the trend is for the intensity to die down. Grief never entirely ends, but at the conclusion of the practical grief process, people feel back to normal again and their moods do not swing noticeably more than they did prior to the loss.

Substitute a trauma experience (or more than one) for a grief-triggering loss and you have PTSD. Except a few things happen differently than in a typical grief progression. For one thing, the emotional intensity of the trauma experience is significantly greater than that which accompanies a typical loss. In grief, we mourn for people we have loved and lost. This is personal and painful, but not as personal or painful as trauma. In grief there is generally no actual threat to our own lives or to our most fundamental beliefs. In trauma, however, we are directly threatened ourselves, as are in many cases, our fundamental understanding of the world as a safe, predictable place.

The trauma experience violates and shatters expectations in a way that normal losses do not. This combination of intensity and expectation violation causes the trauma experience to become indelibly written into the trauma victim's memory, such that it becomes impossible for the person to stop thinking about that experience without resorting to heroic and often self-destructive methods.

The major symptoms of PTSD mostly are a reaction to the "burned in" and intense quality of trauma memory.

Intrusion:

First, the trauma victim experiences intrusive trauma memories at inconvenient times. Often there is an intense clarify of recall such that the memory is more vivid than a regular memory and more like a recreation of the trauma event. Nightmare recreations are common, and even hallucinations of trauma related events can occur. The threshold for recall of trauma memories is very, very low, making it quite inevitable that they will be triggered to reoccur at the smallest provocation.

The constant re-experience of the trauma memories is horrifying, overwhelming and generally agitating, just as is the case with grief. Unlike grief, however, in PTSD, trauma memories do not become less horrifying and agitating with time. This is a critical aspect of the disorder and probably the defining thing that makes it a diagnosable illness rather than just a variety of grief or stressful adaptation. There is no simple way to face and adapt to the trauma memory as there is in normal grief. As a consequence, a lot of trauma memory avoiding occurs, and irritability results, along with fear reactions (which could be termed panic attacks), and anger problems. Trauma victims can become so irritable that they end up attacking the people around them, or running away from those people so that they don't attack them.

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Avoidance:

In an effort to escape the vivid trauma memories, trauma victims do what they can to numb themselves or escape from trauma-memory-triggering stimulation. Frequently, this takes the form of substance abuse (on the theory that if you drink or drug yourself into oblivion, you can't re-experience the trauma memories). Another common strategy is to hide from other people, sometimes quite literally by moving to very rural locations, or by becoming a recluse. The idea here is to minimize irritation and stimulation by minimizing exposure to stressful interactions (which can becomes most all interactions in some cases).

Arousal:

The third major symptom is jumpiness and startle. This is not so much a reaction to the trauma memory as it is a byproduct of the process by which that memory became so vividly burned into the victim's brain. All people have a fear threshold pass which they will experience startle and panic. Exposure to trauma has the effect of lowering people's fear threshold so that it takes very little to get them into a state of fear, startle and hyper-awareness.

The VA's Conflicting Dual Roles

With this background information in place, we can return to the issue of diagnosing PTSD as spelled out in the email we started with.

The VA system is more than a healthcare system; it also pays out cash disability payments (called service connections) in monthly installments to veterans who have been disabled during their service. Becoming service connected means that you will receive, often for the rest of your life, a monthly payment in partial compensation for your disability. Unfortunately, as dispenser of service connection payments, the VA system has to worry about the possibility of fraud; a scenario where a veteran would claim a disability payment that is unjustified. In this time of uncritical support for the troops, this is perhaps not something nice to discuss, but there is is. I don't think this sort of thing is particularly common, but it does occur nevertheless.

To combat the possibility of inappropriate payment, the VA likes to be careful about signing off on diagnoses that might lead to a service connection. In cases like PTSD, they like to do things like document that a trauma actually occurred. When I worked at a VA hospital in the mid 90s, it wasn't enough to take a veteran's word for where they had served. Instead, we would have to verify with documentation that tours of service actually matched veteran's claims.

In her email, Dr. Perez suggests that clinicians not diagnose PTSD right away, but instead diagnose Adjustment Disorder R/O PTSD. In order to unpack the meaning of this statement, we need to define Adjustment Disorder.

To quote DSM (page 681), "Adjustment Disorder is a residual category used to describe presentations that are a response to identifiable stressors and that do not meet the criteria for another specific Axis I disorder." In other words, if someone comes to you for diagnosis after encountering a stressor, if you can't legitimately fit their issue into a defined disorder category within DSM, what you should do is to give them the Adjustment Disorder diagnosis, which tells everyone who needs to know that something significant is going on in the wake of a stressful event, but it doesn't fit criteria for some other illness. Adjustment disorder might be diagnosed in the wake of a person's breakup from a treasured relationship, or in the wake of the loss of a job, if the person displays significant anxiety or depressive symptoms that seem to stem from that stressful event.

The use of the abbreviation "R/O" above stands for "Rule Out". This is a clinical term telegraphing to clinicians that another condition may be present, but cannot yet be diagnosed cleanly, so that other diagnosis is not being made. The idea is to rule the other disorder in or out conclusively by collecting more definitive diagnostic data.

So, the line of thinking Dr. Perez was suggesting in her email suggesting was probably something like the following:

1. PTSD is both a complex diagnosis to make, requiring documentation and testing that generally takes more than a single visit, and also a desirable diagnosis to have because of the possibility of service connection disability payments.
   
   
2. When it isn't absolutely crystal clear that a PTSD diagnosis is correct, a rule out diagnosis the best policy should be to be conservative and withhold the PTSD diagnosis. Care must be taken to get the diagnosis right, so that the possibility of fraud is minimized.
   
   
3. The Adjustment Disorder diagnosis can be made instead of the PTSD diagnosis, so as to inform other clinicians that PTSD is likely.

Adjustment Disorder is a residual diagnostic category. It is what you use when you can't use something more specific, as is the idea of a rule out diagnosis. It is also a stress disorder in its own right, and not at all inappropriate to use when PTSD is suspected but not confirmed yet. I should clarify that last statement: It is entirely appropriate to diagnose Adjustment Disorder when the the intention is to follow through over time with the research and documentation that is necessary to confirm or reject PTSD and ultimately make the most appropriate diagnosis. The acceptable reason for delaying diagnosis is to insure accuracy. If the goal is not accuracy but rather to substitute a less specific diagnosis for a more specific one for political purposes (e.g., to save the VA from having to pay out money to a disabled veteran), then that more or less would amount to malpractice.

Even the desire to avoid fraud is not reasonable under the present war-time circumstances, however. The serious issue is not how soon veterans get a service connection; it is how quickly can they can get the care they need to address their healthcare concerns. I don't know whether the delay in diagnosing PTSD for purposes of being careful about service connection payments also results in a delay of connecting veterans to appropriate care for their PTSD. The important question for us to ask becomes, "If a veteran has been diagnosed with Adjustment Disorder, R/O PTSD, are they eligible to be included in PTSD treatment programs?" If the answer to this question is No, the VA would be basically saying with their policies that it is more important to conserve money than it is to provide expedient care to those who need it. I hope this is not the case. It should not be the case, ethically and morally. I suspect that it could easily be the case, however. Removed as they are from the consequences of their decision-making, policy-making bureaucrats all too frequently seem to think in just such inhuman, abstracted terms.

If it is the case that the VA is more concerned with money conservation than with fast and accurate matching of patients to care and the provision of that appropriate care, it is particularly ironic and disgusting inasmuch as there is certainly no shortage of money available for continuing the war. We're happy to fund the actions that break our troops, but not to fund the actions that help to put them back together again.

To summarize my points:

1. Dr. Perez's email looks worse than it actually is, I think. It looks like the VA doesn't care about veterans at all. What it probably more likely reveals is that the VA is worried about the possibility of fraudulent disability claims.
   
   
2. While taking time to make correct diagnoses and to avoid fraud might be a legitimate concern during peace-time when there are fewer wounds to work on, it seems less appropriate to a period of war-time when there are many urgent wounds that need caring for right now.
   
   
3. If a veteran can't get a legitimate diagnosis of PTSD because the VA wants to save money; and if this keeps the veteran from getting timely PTSD care, that would be especially disgusting and wrong.

All of which lead to a final point on which I'll close:

The VA has a dual relationship with the veterans it cares for. It is both their healthcare provider, and also their judge as to whether they are disabled. The intermingling of the service connection and healthcare divisions of the VA puts VA clinicians into a dual role that interferes with their ability to do their jobs. They become, in effect, both clinician and judge, and veteran patients can't help but sometimes feel that their clinician is judging them, or denying them due benefits by failing to make a desirable diagnosis. The care process can start to feel adversarial in such an environment, and that gets in the way of good provision of care. It would be far better if the VA divisions that handle disability and health care were wholly split into different groups with a strong firewall between them. Compensation judgments should never be allowed to impact care decisions.

If someone who has recent VA experience has any information that could help clarify the issues and concerns I've written about here, I'd appreciate it greatly if they could share that information with us in the form of a comment below.

Mark Dombeck, Ph.D. is Director of Mental Help Net (a public service of CenterSite.Net - a provider of website and internet services and educational content to employee assistance and behavioral health organizations), and a licensed Psychologist in the state of Ohio (License #5698).

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Thank you!

VA Difficulties - 3rd ID- Mike - Aug 21st 2009

I have been diagnosed with moderate to severe PTSD.  I initially placed a claim with the VA 3 years ago.  It took 12 months before I could be reviewed for this case, all I was looking for at the time was compensation for therapy due to my severe social anxiety and insomnia.  After an additional 4-5 months I was awarded 10% compensation for my PTSD.  If you are unfimiliar with disability claims, 10% is basically a B.S. number that they typically give people they are trying to brush off.  I appealed this after 3 months and I was finally given the opportunity to talk to a review officer regarding this, she immidiatly told me that just from her review of my file that I should be awarded at least 50% and possibly more.

Now it has been almost 3 years since my initial contact with the VA and I am waiting again to get reassessed for my condition. I am expecting to wait for another 6 months before this is finalized.  Does 3 1/2 years sound like an appropriate time frame for a review on PTSD?

One thing the VA should consider is that most people with PTSD have Anxiety issues, I get severe anxiety due to these appointments and meetings...  the longer they drag on the worse it gets.  How can the VA justify doing this?  3 years!  

One Million Veteran Backlog - Notorious Kelly - Jun 26th 2009

We all know that there is the 'face' of an issue, and then the reality of it.

A soldier says he is joining the military to "serve my country", but the primary reasons are employment, job training, travel and college money.

Likewise, the Machine expresses 'concern' over the dismal situation of veterans, but pays little more than lip service to the issue.

Meanwhile, gerdillions of taxpayer dollars go to the IMF and other foreign interests.

Why? Because we aren't raising enough hell.

Walkking in Our Shoes - Andrew - Jun 26th 2009

When I retuned from Iraq a very moronic DR tried to gaignose me with a personality disorder. It was soon changed to PTSD. I experience anxiety on dsily basis, my wifee gets beat up at night when I sleep beside her because of my violent dreams. Some days I feel like just shooting myself toend the constant painand turmoil in my head. Does that sound like someone faking? I have moments where I just want to lash out in public. Im always onalert, I cant sleep. And I just want the peace of mind I had before. Is that too much to ask? I would love someone to come up and tell me i was faking. When I got done he would need Treatment for PTSD

For Warriors Wounded by PTSD and Misdiagnosed by DOD or VA - Dr. Diane England - May 26th 2009

If you are a wounded warrrior who is quite certain you have PTSD but was misdiagnosed--propably with an adjustment disorder or a personality disorder--and therefore are not currently entitled to benefits, but must get your records changed to facilitate this process, you might find an article I wrote helpful . I had wanted to include it in a self-help book I have coming out in August, 2009 called The Post-Traumatic Stress Disorder Relationship. However, the publisher claimed it was too long to include--even in an Appendix. Therefore, I decided to place it on my website. Thus, please go to www.PTSDRelationship.com if you are facing this challenge. You'll find helpful links within the article as well as others at the website.

I sincerely hope this article proves helpful to you--and I certainly wish you the very best with this, your latest battle. I so regret this country has not treated many of you harmed in the war zone more decently. But please, make sure you somehow get treatment for the PTSD--and do pursue the benefits you'll need likely for the future. Also, don't hesitate to utilize the help of others to accomplish this. As a PTSD sufferer, you might find it nearly impossible to fulfill everything you must if you take this on alone.

Go join the army Jodie! - 03 04 OIF IRaq Vet - May 16th 2009

WOW.... Some of the comments...  I love when people are so angry they say things that put down people that in most cases put their life on the line so most of you wouldn’t have to.  I am just a young guy.  Joined the Army in January of 2001, and was shipped off to war in 03 to Iraq.  I was there when Bush and Clowns said we would be greeted as liberators.  The day you are sitting under a sky of fire and you’re digging a whole just so you can hide yourself from the bullets and the motor/rocket fire raining down on you begging to Jesus, Muhammad, and anything else that might be listing.  Only then will you have the right to sit there and call it a sham.  Everyone has their reasons for why they do what they do.  Sure there are scammers throughout the whole world no matter what, but unless you have served and you where standing next to the hero in his boots, in his war zone, don’t you judge.  Every day I am reminded of the war, every little thing takes me back to that point in my life.  I feel no matter what I will wake up with it in my head till the day I die.

U.S.M.C./OIF - ADAM C. MILLER - May 16th 2009

THE V.A. DOES NOT CARE ABOUT VETS!!! I HOPE THAT OUR COUNTRY WILL REALIZE THAT MANY YOUNG AMERICANS SUFFER! AND IT'S A HARD AND A MISERABLE WAY TO LIVE, BUT THAT'S WHAT WE GET FOR SERVING OUR COUNTRY...  THANKS TO ALL THOSE WHO  SUPPORT THE TROOPS!!! BUT HOW DO YOU SUPPORT THEM???

PTSD benefits - Larry Brooks - Feb 28th 2009

There may be some folks that might try to take advantage of the system but I can tell you that V.A. has shown me no sign of being even slightly interested in helping vets with PTSD.  I am not seeking benefits at all, just merely asking for some help with bad dreams that I have about past experiences that haunt me.  I don't like being treated as a person that shows up asking for help as if I am after benefits with some false intentions.    Veterans Administration has a lot of hype on their website and on the internet about us reporting PTSD problems and that they care to help.  However when I go to talk to them I only get the runaround and "no help" at all.  I can't afford to see a private psychologist about this.  There are veterans living in hell right now and V.A. is doing nothing to help them.   Ms. Perez should be ashamed of herself but to me its perfectly obvious that her stance merely reflects V.A.'s upper managements position and strategy.  Based on what I am seeing, its V.A. wide and just a game to them.  If they gave a shit about helping vets with PTSD, they would be talking to them and setting up appointments for counseling with qualified people.  I heard a Dr. say that vets returning from war merely miss the adrenolin rush they felt in war !!!  Are you kidding me ????@#   Imagine a Dr. believing this?   They don't want to go back to war for an adrenolin fix, they live it every night in their dreams, and want peace.  How can doctors have this attitude and really convince anyone that they know what a vet feels?   I wish some doctors could spend one of my nights and see what I see then they might take some action to help others.   Its not all about benefits folks, maybe V.A. thinks it is but its not, its about helping these people with a real problem.  Call it whatever you wish but this problem will shut you down and ruin your life.

PTSD diagnosis - Larry Brooks - Feb 11th 2009
I was diagnosed with PTSD years ago from a shooting incident which triggered horrible nightmares that has lasted since 1996.  I did not go after VA. benefits (I am a veteran).  When I went to a dr. in georgia recently the first thing out of her mouth as that she needed to diagnose me with what could be either PTSD or personality disorder.  I told her that I merely needed advice or help to reduce my dreams so I could get some sleep and that I was not after benefits.  It became very clear to me what her agenda was and that was exactly what Ms. Perez wrote about.   I sincerely believe that VA. has instructed their staff to avoid using PTSD in any communications and to diagnose veterans with anything but PTSD in an effort to keep vets from getting any benefits.  I saw a pchychologist and she said she did not have time to treat me and that some kind of group therapy would be best in a few months, nice huh?   V.A. currently does not seem to care about getting vets help with PTSD and are obviously focused on blocking benefits to people that have trouble dealing with others, are withdrawn and suffer from sleepless nights.  It pisses me off to no end and you are so wrong about your position defending Ms. Perez.  If you ask the vets dealing with her they will tell you the truth.

Veterans - Allan N Schwartz - Jan 21st 2009

Hi Mark,

Sorry to disagree strongly with you but I must. You see, I have met with and worked with many of these men and know that what you are stating is fundamentally wrong. First, whoever gave you the notion that PTSD cannot be objectively diagnosed? This is not true. Second, one of the characteristics of the PTSD suffered by these veterans is TBI or Traumatic Brain Injury. TBI is very real, carries with it vast bain damage, amnesia, uncontrolled emotional outbursts, insomnia and PTSD. This is not opinion, this is fact. In addition, did you know that these veterans, with what you are calling their "fake" PTSD come home and experience multiple divorces and remarriages, alcoholim, suicide attempts and successful suicides?

Are you going to say that these veterans commit suicide because they did not receive enough money? Come on, now!!

Dr. Schwartz

Money and PTSD - Mark Rogers - Jan 21st 2009

All of the above comments came from people seeking money for a disability that cannot be objectively tested.  The VA cannot possibly tell who has PTSD when so much secondary gain is at stake.  Take the money out of the system and then see how many people calim PTSD.  Offer unlimited treatment but no money and the claims will go away.  No?  Try to find someone getting PTSD money who would be willing to have his claim viewed by the public, even with his identity disguised.  I saw hundreds of these claims working at VA and never saw one that I thought a jury would buy, if there were someone arguing each side.

Civilian Contractot PTSD - - Jan 3rd 2009

 I went to the Dayton OH VA as a Cilvian Contractor with complaints of trauma issues. They diagnosed me with Adjustment disorder. I have no gain by them since my tour in Iraq was not service connected. I have seen a private psycholigist and he diagnosed me with PTSD. I am currently filing a claim with the DOL for PTSD issues. No I do not believe the VA diagnosed me properly since I spent 22 mo in Iraq experiencing many rocket attacks and small arms fire. 

Wife of a Veteran with PTSD - - Dec 15th 2008
I have an idea of how to diagnose a veteran with PTSD....talk to his wife or someone close to him/her. My husband is an Iraq veteran who served a 2 year deployment with the National Guard. This was his second deployment. We are struggling to recieve any benefits through the VA and they often tell us that they are "too busy" to deal with us. I think it is disgusting and inhumane the way that veterans are treated. My husband and I have been through more than any civilian marriage could ever handle and we are still here, waiting for some kind of recognition from the VA. People have no idea the persistent struggle veterans with PTSD have. My husband relives graphic scenes from combat on a daily basis which impairs everthing about his life. It's no wonder Vietnam vets are stereotyped as homeless beggers when the VA didn't help the majority of them. Currently the VA is trying to dispell the diagnosis of PTSD for my husband becaue "some kind of trauma could have happened after the deployment." !!!!!!!!!!!! He was in intense combat for TWO YEARS STRAIGHT! WHAT COULD HAVE HAPPENED AFTERWARDS THAT IS MORE TRAUMATIC THAN THAT???? I am so utterly disturbed and infuriated by the lack of support for veterans in this country. Sure, everyone has their little bumper sticker that says "Support Our Troops" but that shouldn't end when that soldier steps foot off the plane on home soil. People have no idea what veterans and their families go through on a daily basis and the VA should be ashamed to have withheld ANY kind of help--monetary or otherwise.

Money???? - - Dec 13th 2008

You have no idea what is like to be in combat, get hurt and see your friends die; you think money can replace that? F*CK YOU!!! and your welcome for the freedom you are enjoying.

Shocked!!! - - Dec 4th 2008

Not only is that e-mail insulting to those who have PTSD but so are some of the comments downplaying the severity of the illness. I am losing everything to this illness. I only wish it was something we made up in our heads. I only wish this was just another nightmare!

There is no amount of money that could pay for what I have lost.

contractors with ptsd - wallace mcnabb - Oct 21st 2008

 i was a contractor in iraq doing convoys and recovery for the military. hired by kbr. i was shot and have shrapnel in my hand and arm. this happened in 05 and i returned to iraq after i healed up because i wanted to help kill those sob's who shot me in wierd way. after i got back to the states i had some really bad nightmares and had bad startle responses and extreme vigilance.

i went back to iraq after 17 months in the states. i can not tell you why, i just had to go back. i now know it was a mistake. can anyone tell me why i felt the need to go back. i think it was because i wanted to get back on the horse and try to prove to myself i was ok, but i wasnt. i still have the symptoms and i took the tests and all that. aig, kbr's insurance company will not pay anything till a labor dept. judge says they have to. i cant afford treatment and i will not take any medicine because then they wont let me work. so i just have to wait to see if the insurance company will pay me. im having a rough time.

inside Kuwait City Limits - David W. Miller - Aug 27th 2008

We was inside Kuwait City Limits, when I seen 1st hand an Army Ranger spraded with shrapenal across hid waste line. It it did not hit him I was in the direct line of fire.   I have not opened up about this until now because of the security clearence I had, But Now I was told that all of Desert Storm is declassified.  Please help me if you can or send me into  the right direction.  Bye the was that Army ranger saved my life as he felt to the ground and I pulled him out of harmes way with his guts hanging out.

Insufficient Diagnosis - - Aug 21st 2008

I Have a brother who was in Vietnam and recently was granted 100% disability benefits for PTSD. After reading the criteria for diagnosis I have to say that he fits none of it. He once bragged to me how he beat the system by studying the symptoms for PTSD and apparently a website that tells what answers to give during the interview. In other words - he studied for the test. If it's this easy to just memorize some answers and get a $3000 check every month then it's no wonder there is fraud and the VA should rethink the entire process.

they should investigate all ptsd cases - JOHN - Jun 28th 2008

I think they should investigate all ptsd cases. I am retired from the air force and my brother who only served nine years gets more ptsd fraud money from the va then I receive in military retirement pay. My brother never went to war. He was stationed in england in 1988 and said he took leave to attend an air show in germany. Two italian planes hit each other in mid air and crashed into the people watching the show on the ground. Many were injured and killed . My brother said he saw all of this and now has ptsd. He did his homework and learned all about ptsd symptoms. He did take leave to go to germany but not at the time of the air show!! I reported the fraud to the va inspector general but they told me if they do not spend all the money they receive they will not get as much the next year . What a joke !!! I know for a fact there is ptsd fraud in the va and you can not tell me any different.. As a retired member of the air force I have seen it first hand!!!!!!!!

Find it - Chris - Jun 5th 2008

I was diagnosed with ptsd 11 yrs ago.  I was tramatized long before that.   Each person is different- I was not able to open up and talk about it- I denyed it and or anything happend.  I had my time with it and decided to move on from it a week or two later after it happend.  Within 2 weeks,- I I was in shock still- but this epsisode ended up for years and years- I couldnt open up.  I was not that way. I was a quiet laid back kid - loving parents and enjoyed life and fishing- nothing bothered me much- until those things happend. It was that and then- it all balled up. 

I agree- the sooner the treatment the better- the earlier the better- I was given serveral chances to talk but couldnt- I denied anything happend.  I lied- but it was documented- you cant make someone talk about it till they are ready and that only makes it worse by trying to make them talk.,  But my advice is- to the earlier the better but on the other side of the fence - be there for them when they are ready.  It could be years and years- like me and two divorces later and episodes later and snow balls.

here is a website i made and now what i need- a service dog out of it which is i beleive my symptoms will lower now. 

thank u for listening.

http://chrisa4animals.vets.yuku.com/

Good Help Is Hard To Find - - May 27th 2008

I married a man who not only lost his wife on 9/11 but narrowly escaped his own life. When I eventually recognized something was very wrong with him, it took me over a year to get him properly diagnosed and get him effective PTSD treatment. Many Psychologists, Social Workers, and Psychiatrists SAY they treat the illness but in fact they have no idea how to treat it. My husband was first diagnosed as a compulsive liar by a therapist, then was diagnosed with Bi polar disorder by a psychiatrist. He was heavily medicated with Bi polar meds which made him virtually unfunctionable. Without me constantly questioning the doctors and searching for better treatment I shutter to think what would have become of him. This is not to pat myself on the back but rather to point out that the very symptoms of PTSD make the sufferer incapable of seeking and evaluating treatment.

My advice: If the place you are going to is not administering a medically recognized PTSD test prior to treatment, Run, don't walk, out of there.

I eventually got my husband help at NYU Institute fro Trauma and Stress. 212-263-2488 . They tested him before treatment and ruled out Bi Polar disorder. His testing came back with a high PTSD rating.

They administered a 14 week program, with a very specific agenda (no 'tell me about your childhood' open ended discussions). Half way through the program, I met with them to ask them to find him a new psychiatrist so they could change his meds to PTSD appropriate meds. After two years of misery, I finally, within three months of this visit, began to see significant changes. Today he is back to work and I see more improvements every day.

If someone you know and love is suffering, I urge you to take the bull by the horns and get them effective help, and don't stop until you find it. My three year old daughter and I are happy we did.