PTSD is a psychiatric disorder that can develop in a person who witnesses, or is confronted with, a traumatic event. PTSD is said to be the most prevalent mental disorder arising from combat. In April, the RAND Corporation released a study that said about 300,000 U.S. troops sent to combat in Iraq and Afghanistan are suffering from major depression or PTSD, and 320,000 received traumatic brain injuries. Since October 2001, about 1.6 million U.S. troops have deployed to the wars in Iraq and Afghanistan. Many soldiers have completed more than two tours of duty meaning they are exposed to prolonged periods of combat-related stress or traumatic events.

“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, a researcher at RAND who worked on the study. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need.”

The VA said it has hired more than 3,000 mental healthcare professionals over the past two years to deal with the increasing number of PTSD cases, but the problems persist.

Two veterans advocacy groups, Veterans for Common Sense and Veterans United for Truth, sued the VA last year for allegedly failing to provide treatment to veterans returning from Iraq and Afghanistan who are suffering from PTSD The veterans groups said Perez’s email underscores arguments plaintiffs’ attorneys made during a two-week trial in April that a systematic breakdown at the VA has led to an epidemic of suicides among war veterans. The advocacy groups claim the VA has turned away veterans who have sought help for posttraumatic stress disorder and were suicidal. Some of the veterans, the plaintiffs’ lawsuit claims, later took their own lives.

The groups want Conti to issue a preliminary injunction to force the VA to immediately treat veterans who show signs of PTSD and are at risk of suicide Attorneys representing both organizations asked the judge to reopen their case and consider admitting Perez’s email into evidence after another veterans group publicly disclosed it last month.

Justice Department attorney James Schwartz sent a letter to Conti last Wednesday saying the email has no bearing on the plaintiffs’ lawsuit. Schwartz said the email was an isolated incident and in no way reflected VA policy. He added that Perez had been “counseled.”

"It was the action of a single individual that in no way represented the policies of VA, that, once discovered, was dealt with quickly and appropriately," Schwartz wrote in the letter to Conti.

The email sent by Perez, however, comes on the heels of another explosive electronic communication sent by a top VA official a month earlier suggesting the issue is part of a pattern to downplay the rising number of PTSD cases surfacing as a result of multiple deployments in the Iraq and Afghanistan wars.

The Feb. 13. 2008, email, disclosed in the federal court trial in San Francisco in April, was sent to Ira Katz, the VA’s mental health director by Ev Chasen, the agency’s chief communications director.

Chasen sought guidance from Katz about interview queries from CBS News, which reported extensively on veterans suicides last year.

“Is the fact that we’re stopping [suicides] good news, or is the sheer number bad news? And is this more than we’ve ever seen before? It might be something we drop into a general release about our suicide prevention efforts, which (as you know far better than I) prominently include training employees to recognize the warning signs of suicide,” Chasen wrote Katz in an email titled "Not for CBS News Interview Request."

Katz’s response is startling. He said the VA has identified nearly 1,000 suicide attempts per month among war veterans treated by the VA. His response to Chasen indicates that he did not want the VA to immediately release any statistical data confirming that number, but rather suggested that the agency quietly slip the information into a news release.

“Shh!” Katz wrote in his response to Chasen. “Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

The February email was sent shortly after the VA gave CBS News data that showed only a total of 790 attempted suicides in 2007 among veterans treated by the VA. In an email sent to the network Monday after Katz's email was disclosed in court, he denied a "cover-up" and said he did not disclose the true figures of attempted suicides because he was unsure if it was accurate.

In a December email Katz sent to Brig. Gen. Michael J. Kussman, the undersecretary for health at the Veterans Health Administration within the VA, that roughly 126 veterans of all wars commit suicide per week. He added that data the agency obtained from the Center for Disease Control showed that 20 percent of the suicides in the country are identified as war veterans.

The “VA’s own data demonstrate 4-5 suicides per day among those who receive care from us,” Katz said in the email he sent to Kussman.

The email Perez sent in March was the subject of a hearing last week before the Senate Veterans Affairs Committee, where Perez attempted to explain the context of her note. She said she used a poor choice of words to convey the message to counselors that instead of PTSD diagnosis VA counselors could diagnose veterans with “adjustment disorder,” a less severe condition. The email seems to imply that Perez was interested in saving money for the VA as opposed to providing veterans with an accurate diagnosis.

Perez vehemently denied that cost-cutting measures were behind her suggestions to VA counselor.

“Several veterans expressed to my staff their frustration after receiving a diagnosis of PTSD from a team member … when they had not received that diagnosis during their Compensation and Pension examination,” Perez said in prepared testimony http://www.senate.gov/~veterans/public/index.cfm?pageid=16&release_id=11687&sub_release_id=11725&view=all before the Senate Veterans Affairs Committee. “This situation was made all the more confusing and stressful when a team psychiatrist correctly told them they were displaying symptoms of combat stress, but did not meet criteria for the diagnosis of PTSD.”

"In retrospect, I realize I did not adequately convey my message appropriately," Perez told Senators. But "my only intent was to improve the quality of care our veterans receive."

Paul Sullivan, the executive director of Veterans for Common Sense, doesn’t buy Perez’s claims of innocence.

“Once again VA's political appointees were taken to the woodshed by an alert Congress for repeatedly failing our veterans,” Sullivan said in an interview. Veterans for Common Sense “remains disappointed that the VA leaders selected by President Bush lied again to Congress when said that VA has enough resources to assist veterans. During the hearing, the Temple, Texas PTSD director, who is not a political appointee, Dr. Norma Perez, told Congress that veterans were scheduled only for a half-hour psychological assessment for PTSD claims. She said some veterans require a more complete assessment that could take up to three hours. This was a stunning admission that VA lacks the proper number of mental healthcare professionals to accurately and consistently evaluate veterans seeking healthcare and disability benefits for PTSD.”

Sullivan added that incomplete evaluations might be leading to the large number of incorrect diagnoses that veterans have been complaining about. The average wait time for disability benefits is more than six months.

“As of June 2008, VA diagnosed 75,000 Iraq and Afghanistan war veterans with PTSD,” Sullivan said. “Yet VA is providing disability benefits for PTSD to only 37,000 of those veterans.”

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