Senators appeared unsatisfied Wednesday by the Veterans Affairs Department's efforts to diagnose and care for veterans suffering from post-traumatic stress disorder.

A Senate Veterans Affairs Committee hearing focused on a March 20 e-mail written by Norma J. Perez, a former coordinator of the post-traumatic stress disorder (PTSD) clinical team at the Temple, Texas, veterans hospital.

She recommended that her staff avoid diagnosing the psychological ailment in veterans - in favor of "adjustment disorder," a diagnosis that often lowers disability payments. Adjustment disorder is generally considered less intense than PTSD.

"Given that we are having more and more compensation seeking veterans, I'd like to suggest that we refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder," Perez wrote in the e-mail. "Additionally, we really don't have time to do the extensive testing that should be done to determine PTSD."

Perez and other department officials defended their handling of veterans suffering from PTSD, but senators were skeptical.

"This issue needs more oversight and more resources," panel Chairman Daniel K. Akaka, D-Hawaii, said. "We must act swiftly to address this critical issue. No expense can be spared."

A RAND Corp. study released in April found roughly 20 percent of troops deployed to Iraq or Afghanistan have symptoms of major depression or post-traumatic stress disorder.

Perez said that by initially diagnosing veterans with adjustment disorder, psychiatrists would have more time to probe for signs of PTSD and could change the diagnosis if or when it was supported by strong evidence.

"I am not satisfied," responded Akaka. "This incident was both disturbing and disappointing,"

Patty Murray, D-Wash., added "I sincerely hope this e-mail is the only one of its kind. I have reason to be skeptical."

Michael Kussman, the undersecretary for health at the department, said Perez's explanation is consistent with the a strategic plan designed to make veterans diagnoses evidence-based, but acknowledged the department has more work to do to make the process transparent to veterans.

The department plans to spend roughly $3.5 billion in fiscal 2008 to provide veterans with mental health care services and projects it will spend approximately $3.7 billion in fiscal 2009.

Kussman told the panel he believes the department has sufficient resources to effectively tackle the PTSD issue, despite an e-mail that suggests there may be staffing issues.

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