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Jim,

I wanted to share with you some of my recent research, and I hope that you will in turn share it

with your readers.

The attitude of VA Rating Officers, to include all persons who may come in contact with a

veteran or a veterans claim is governed by 38 U.S.C. § 4.23 Attitude of Rating Officers.1 

Unfortunately this is not always followed. For example, on May 28, 2008 in VCS, et al. v Peake

(Shinseki) the court was made aware of an email filed by Norma Perez a veteran’s health PTSD

coordinator. That email read:Subject: Suggestion

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.

Also there have been some incidence where a 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 the case based on our assessment.

Just a suggestion for the reasons listed above.2 

This email was validated by the Department of Veterans Affairs council as genuine. What

followed was a firestorm of political debate and inquiry in Washington D.C. about the

apparently now substantiated allegation that VHA mental health professionals where stacking

the deck against veterans meritorious claims for service connected benefits.

Unfortunately, the treatment of “Compensation Seeking” as pathology is sadly not new. It has

been the subject of clinical research since at least 19963. More to the point it did not end with

the controversy and congressional hearings of 2008. Rather it has continued to the present

year.4 The concept of “Compensation Seeking” as pathology has been partially carried forward,

and partially denounced by the “Best Practice Manual for Posttraumatic Stress Disorder (PTSD)

Compensation and Pension Examinations.” 5. It reads on page 7:

1 38 U.S.C. § 4.23 Attitude of Rating Officers 

2 VCS, et al. v Peake (Shinseki) , et al Case No. 07-03758 Document 231 (USDC ND Cal 2008) 

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 Compensation seeking status and psychometric assessment of combat veterans seeking treatment for PTSD. Frueh BC, Smith DW, Barker SE. J Trauma Stress. 1996 Jul;9(3):427-394 Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at

unprecedented rates? McNally RJ, Frueh BC.J Anxiety Disord. 2013 Jun;27(5):520-6. doi:

10.1016/j.janxdis.2013.07.002. Epub 2013 Jul 26. 5 Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension

Examinations. Watson P et al, Compensation ad Pension Service Veterans Benefits 

 Administration 

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There has been evidence to suggest that compensation-seeking veterans

endorse higher levels of psychopathology across measures and produce elevated

validity indices on the MMPI and MMPI-2 as compared to non-compensation

seeking veterans (Smith & Frueh, 1996; Frueh & Kinder, 1994). Sample sizes in

these studies, however, are small, and clinicians were not correlating scores on

the MMPI with collateral sources of data suggestive of overreporting. Even in

non-compensation-seeking settings, the preponderance of evidence suggests

that people with PTSD report significantly higher subjective distress than those

without PTSD.

This neutral response to the concept of the ‘Compensation-Seeking’ veteran is starkly

contrasted by the National Center for PTSD publication PTSD Research Quarterly6 This

publication referenced the ‘Compensation-Seeking Veteran’ throughout. That VA funded

publication of the National Center for PTSD featured abstracts from 19 professionally published

and well circulated journal articles that seek to pathologize veterans for seeking their rights

under Federal Law and Regulation. An additional ten articles on the topic are cited in journalfootnotes.

In a 2005 article published by the Journal of Military Medicine, and conducted by the

Minneapolis VAMC it was concluded that “ VA disability benefits for PTSD reduced odds of

impoverishment for psychiatrically ill veterans. This effect appeared to be especially important

 for African American veterans and for veterans self-identifying as disabled.” 7 . 

Also a 2011 DVA Health Services Research and Development Service national meeting had as

one of its featured presentations a paper titled “Treatment Expectations, Compensation-

Seeking Status, and Therapeutic Alliance in a Sample of Military Veterans with PTSD”8 that was

generated by the cornerstone of the DVA’s PTSD research arm at Palo Alto, California.  Thisarticle implied that veterans who seek to overcome the financial hardships of potential poverty

and homelessness by applying for veterans disability benefits lack a ‘strong alliance’ with

treatment providers.

Compare the above allegation that the ‘compensation seeking veteran’ lacks a clinical alliance

with the mental health community with the following excerpt from Post-Traumatic Stress

Disorder Implications for Primary Care9 which is a VA published independent study course for

primary care doctors.

6 PTSD Disability Assessment PTSD Research Quarterly 2011; 22(4)

7 Mitigating effect of Department of Veterans Affairs disability benefits for post-traumatic stress

disorder on low income. Murdoch M, van Ryn M, Hodges J, Cowper D Mil Med. 2005

Feb;170(2):137-408Treatment Expectations, Compensation-Seeking Status, and Therapeutic Alliance in a Sample of

Military Veterans with PTSD 9 Post-Traumatic Stress Disorder Implications for Primary Care 

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Even when the veteran is successful in his or her pursuit of PTSD disability

benefits, the process of obtaining such benefits can be extremely stressful (e.g.,

Eldridge, 1991). As in criminal proceedings, victims must recount their traumatic

experiences to multiple people, all of whom serve in a forensic capacity. This

repeated revisiting of the veteran’s traumatic experiences in itself may

exacerbate PTSD and lead to acute decompensation. The patient may find itparticularly devastating, if the claim is denied. Primary care providers should

counsel their patients about this possibility and should encourage them to

establish a stable, therapeutic relationship with a mental health provider before 

the veteran pursues a disability claim. Since veterans’ physical symptoms also

may flare during this time because of stress, primary care providers should

consider offering more frequent follow-up visits during the veteran’s C&P

process. (page 71-72 underling added)

According to the Government Accountability Office, VHA wait times for Mental Health

Appointments are both unreliable and unacceptably long.10

 See (GAO-13-130). But it is

important to note that the veteran isn’t being asked to wait to file for benefits until after they

have a mental health appointment. Rather the veteran is being asked to wait to file until after

they have established a “Stable therapeutic relationship”. What then is a “Stable therapeutic

relationship?”  Does it involve trust, closeness, communication, and problem solving? Certainly.

However, according to the National Center for PTSD’s own website11

, lack of trust, lack of

closeness in relationships, poor communication, and poor collaborative problem solving are

hallmark symptoms of PTSD. Rhetorically, then, isn’t VHA policy telling the veteran, “You want

to file a claim for PTSD to resolve your financial or homelessness problem? Whoa! Hold on

there. Wait until after you’re cured.” 

In Cushman v. Shinseki, 576 F.3d 1290, 1298 (Fed. Cir. 2009)

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 it was held that veterans have avested property interest in their veterans disability claims. As such access to VA disability

claims is protected by the 5th

 Amendment to the US Constitution, obstruction of which creates

its own issues.

Respectfully,

Eric Lee Hughes

10 GAO-13-130 

11 http://www.ptsd.va.gov/public/pages/ptsd-and-relationships.asp 

12 Cushman v. Shinseki, 576 F.3d 1290, 1298 (Fed. Cir. 2009)