As more veterans say they have PTSD, the VA looks for fraud

From The Associated Press:

Editor's note: This story is the fourth in an occasional series of Associated Press stories about post-traumatic stress.

Moved by a huge tide of troops returning from Iraq and Afghanistan with post-traumatic stress, Congress has pressured the Department of Veterans Affairs to settle their disability claims -- quickly, humanely, and mostly in the vets' favor.

The problem: The system is dysfunctional, an open invitation to fraud. And the VA has proposed changes that could make deception even easier.

PTSD's real but invisible scars can mark clerks and cooks just as easily as they can infantrymen fighting a faceless enemy in these wars without front lines. The VA is seeking to ease the burden of proof to ensure that their claims are processed swiftly.

But at the same time, some undeserving vets have learned how to game the system, profitably working the levers of sympathy for the wounded and obligation to the troops, and exploiting the sheer difficulty of nailing a surefire diagnosis of a condition that is notoriously hard to define.

"The threshold has been lowered. The question is how many people will take advantage of that," said Dan G. Blazer, a Duke University psychiatrist who has worked with the military on PTSD issues. PTSD, he adds, is "among the easiest [psychiatric] conditions to feign."

Mark Rogers, a longtime claims specialist with the Veterans Benefits Administration, agrees. "I could get 100 percent disability compensation for PTSD for any [honorably discharged] veteran who's willing to lie," said Rogers, a Vietnam-era vet who is now retired.

Some claims are built on a foundation of fake documents; in other cases, the right medals -- plus a gift for storytelling -- secure unearned benefits.

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Consider » Gulf War veteran Felton Lamar Gray told a VA psychologist he was spattered with "blood and chunks of head" when his "best friend" was shot in the face in Iraq. But only after the VA rated Gray 100 percent disabled did anyone check into his stories -- and discover the comrade he spoke of is very much alive and said he barely knew Gray.

Vietnam-era veteran Keith Roberts said he was traumatized when he was prevented from rescuing a friend being crushed under a Navy airplane, and was eventually granted 100 percent disability. But when the case was reopened, investigators could find no evidence that Roberts was even present when the accident occurred.

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Millions of dollars » Each of these cases represents potentially millions of dollars in tax-free benefits over the veteran's lifetime -- benefits that may continue while the veteran works and even into retirement.

"There's pressure from the public to sympathize with veterans and treat them with respect," said Assistant U.S. Attorney Craig J. Jacobsen in Roanoke, Va., who prosecuted Barnhart and has handled other such "stolen valor" cases. "And you don't want to go questioning their stories unless you have a very good reason to do so."

PTSD is an undeniably real sickness whose symptoms -- flashbacks, vivid nightmares, intrusive thoughts, exaggerated startle response, emotional numbness -- can be debilitating. As of Fiscal Year 2009, nearly 390,000 veterans were receiving benefits for PTSD, making it the fourth-most prevalent service-connected disability, according to the VA.

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Sheer numbers » Authorities have tried to brace the public for a tidal wave of psychically damaged veterans from the current wars. Of the roughly 1.6 million troops who have served in the war zones of Afghanistan and Iraq, more than 134,000 had been seen at VA health care facilities for "potential PTSD" as of late last year, according to a government report. Researchers suggest the numbers of actual sufferers are much higher.

Veterans groups have sued the VA over an enormous backlog, complaining that claims take months and even years to be approved, and that some veterans had committed suicide as a result.

Last year, U.S. Rep. John J. Hall, D-N.Y., introduced legislation to streamline the VA claims process, especially for veterans in traditionally noncombat roles. The claims process, he said, had become an obstacle to healing, "inflicting upon the most noble of our citizens a process that feels accusatory and doubtful of their service."

VA Secretary Eric K. Shinseki responded last summer with a proposed rule change. Until now, the agency has required independent proof that a traumatizing event -- or "stressor" -- occurred. Under the proposed changes, a veteran's "lay testimony" about what happened to him would suffice, as long as it "is related to the veteran's fear of hostile military or terrorist activity" and is "consistent with the places, types, and circumstances of the veteran's service."

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No fact-checking » Already, VA officials are legally bound to resolve "any reasonable doubt" in the veteran's favor. And Rogers, the retired claims specialist, and others say the system is vulnerable to fraud because of the way it was designed: Doctors make diagnoses without fact-checking the veteran's story, and once that diagnosis is made, claims raters' hands are essentially tied.

No one knows the full extent of PTSD fraud. But there have been some hints.

A 1990 law allows the Veterans Benefits Administration to crosscheck its rosters with federal tax and Social Security databases to find "unemployable" veterans reporting work-related income. In 2004, this program identified 8,846 such veterans who reported at least $6,000 in earnings, including 289 with income of $50,000 or more.

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Felton Gray » In the case of Felton Gray, the Gulf War veteran told a psychologist at the VA medical center in Portland, Ore., that he'd put "hundreds of Iraqi soldiers in bags," and that his best friend was hit in the face with a bullet during a mission to clear an enemy trench, spraying Gray with gore.

"This man has suffered severe enough traumas to qualify for a diagnosis of post traumatic stress disorder and in fact has serious symptoms," Ruth Parvin wrote in her evaluation. With other, physical problems, that finding earned Gray a designation of "individual unemployability" -- and 100 percent compensation.

Trouble is, none of what Gray told the doctor happened.

Gray was charged with murder in the Aug. 4, 1998, shooting of former NFL linebacker Marquise Leslie Thomas at his Beaverton, Ore., apartment. He was convicted of first-degree manslaughter and sentenced to 10 years in prison.

Gray's attorney initially planned to mount a PTSD defense. When Beaverton police checked out Gray's war stories, they fell apart, police and court records show.

Although his "best friend," Ronald Rowe, did have an M-16 explode in his face during a training exercise in a mock-up of an Iraqi entrenchment, he only had "a little scratch on my face and ringing in my ears" and didn't require medical attention, he told the AP recently from his home in Madison, Tenn.

As for handling dead Iraqis, Rowe said: "Everybody we captured was alive. There wasn't no body bags."

When the Board of Veterans Appeals granted Gray a 70 percent rating for PTSD, the panel acknowledged that it did so without verifying his stressors or even his dates of service. The board accepted Gray's Combat Infantryman Badge "as sufficient evidence of in-service stressors."

The AP recently contacted Gray, 42, at his home in Tigard, Ore. "There was no fake," Gray said. He declined to open his updated VA file but insisted that his disabilities have been "validated." The VA would say only that Gray is currently drawing $2,882 a month -- 100 percent disability.

Gray "fooled me. It's easy," said Dr. Landy F. Sparr.

Sparr -- former acting chief of psychiatry at the Portland VA Medical Center -- conducted a forensic examination of Gray and confirmed the PTSD diagnosis. He said the three hours recommended by the VA for a compensation and pension exam are hardly sufficient to form an opinion.

But once a diagnosis of PTSD is given, the rater is "prohibited from cross-examining the veteran," said Rogers, who worked at the VBA for nearly 30 years.

VBA workers say they are under enormous pressure to push claims through. Richard Allen, a Vietnam-era veteran who worked in the VBA's Wichita, Kan., office, recalls one manager telling him, " 'You don't get it. Your job is to pay.' "

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Keith Roberts of Gillett, Wis., was stationed at the U.S. Naval Air Facility in Naples, Italy, in February 1969 when Airman Gary Holland was crushed to death in the wheel well of a C-54 Skymaster transport plane. Roberts, then a 20-year-old aircraft lineman, said he tried to rescue his "very good friend" by having a forklift raise the craft's nose, but that superiors nixed the plan to avoid damaging the plane.

Starting in 1987, Roberts filed a string of disability claims with the VA, eventually blaming PTSD for everything from smoking addiction to arthritis. In 1999, Roberts was declared 100 percent disabled and got a lump sum payment, retroactive to August 1993.

But investigators later determined that Roberts didn't even participate in the rescue effort and was not as close to Holland as he'd claimed. The Board of Veterans Appeals said the VA's regional office "simply conceded" Roberts' claims "without obtaining credible supporting evidence."

After losing his benefits, Roberts was convicted of wire fraud, sentenced to 48 months in prison and ordered to pay $262,943.52 in restitution. Last month, the U.S. Court of Appeals for Veterans Claims concluded in a 45-page ruling that Roberts "committed fraud in securing VA benefits for his PTSD" and affirmed the BVA's decision to sever them.

In a recent telephone interview, the 62-year-old veteran denied that he lied, but argued that under VA rules, he could have PTSD from merely being "vicariously aware of the situation."