Sometimes the terror strikes Daniel Hibbard, a 29-year-old Army veteran of the Afghanistan war, when he's driving and a song comes on the radio that he used to listen to while on patrol.
"I'll be thinking and thinking and visualizing being back in combat and I’ll break down and cry," he said.
Sometimes Hibbard is spooked at a bar or restaurant, where there are too many people and his back must be up against a wall. "I can feel something’s not right," he said. "I’m always looking around."
Hibbard served as a sergeant in Afghanistan between 2005 and 2006. While there, he shot and killed people, saw dead bodies and survived IED explosions and rocket-propelled grenade and mortar fire.
These traumatic experiences have transformed the father of two. "When I joined, I was 20 years old and there weren’t a damn thing wrong with me," Hibbard said. He joined in August 2003 and served for six years.
Hibbard, who lives in Louisville, Ky., has been twice diagnosed at Veterans Affairs facilities with post-traumatic stress disorder since 2010. But something unexpected happened last month: Hibbard received a letter reversing his PTSD diagnosis. His new diagnosis, which was assigned without an in-person examination or assessment, is personality disorder.
"It makes me feel like I’m being called a fraud, a fake," Hibbard said of the diagnosis. "You might as well and go ahead and burn my record and say I was never in the military."
Hibbard is contesting the decision, which will provide him with mental health care but strip him of PTSD-related financial benefits, with assistance from AMVETS, a nonprofit veterans' organization that helps service members trying to secure claims, benefits and medical diagnoses.
Gene Brainer, the Louisville-based AMVETS national service officer who is handling Hibbard's appeal, declined to discuss the specifics of the case, citing medical privacy regulations. He did say, however, that in the last several months VA doctors who review claims appear to be scrutinizing established medical findings more closely than in years past.
In particular, Brainer has noticed that the regional VA office has requested reviews for cases in which a veteran has already been evaluated by a board-certified doctor and given a diagnosis, which is used to determine monthly disability benefits. During a review, another board-certified doctor can issue a new diagnosis without seeing the veteran, thereby overturning the original doctor's finding.
"They are putting their opinions, exam results and diagnosis above the findings of their counterparts and rationalizing that they were more thorough and probing in their review and examination than the attending psychological counselors," he said of the reviewing doctors. Brainer, who has 20 years experience in the field, said he's seen this happen with as many as six veterans in the Louisville area recently. Many of the reversals, he said, were for veterans awarded disability benefits at 100 percent of the entitlement rate.
The Department of Veterans Affairs does not track diagnosis reversals, but maintains that reviews are rare and conducted when it is not clear from the clinician's examination or opinion that the diagnosis is correct.
"VA carefully considers the potential repercussions of any change in a previously assigned diagnosis," Josh Taylor, a spokesman for the Department of Veterans Affairs, told msnbc.com in a statement. "When any change in an evaluation is to be made, particularly where a mental disorder is involved, VA strives to reconcile the evidence and continue the previous diagnosis. Only where the prior diagnosis is shown to be clearly erroneous, will VA make a correction."
Taylor could not comment on Hibbard's case because of medical privacy regulations, but said that one's disability benefits can fluctuate as a mental illness worsens or improves over time.
Taylor also noted that in 2010 the VA simplified its PTSD diagnosis process and relaxed its standards for proving service-related PTSD. Since then, more veterans have been awarded PTSD-related mental health care and disability benefits. Of the 476,515 veterans who were receiving mental health services for PTSD in 2011, about 100,000 served in Iraq or Afghanistan, a 35 percent increase since 2008.
Jay Agg, a spokesman for AMVETS, told msnbc.com that the organization is concerned Hibbard's reversal may not be isolated. Another AMVETS service officer in Cleveland, Ohio, reported several unusual reversals as well. Agg said, however, that the small number of reports don't indicate a widespread practice in the context of the organization's overall caseload; AMVETS handled 93,000 claims on behalf of veterans in 2011.
David Autry, a spokesman for Disabled American Veterans, which has 250 service officers nationwide filing claims on behalf of former service members, said the organization has noted recent anecdotal instances in which cases were re-evaluated and some veterans received a new diagnosis or different disability rating. "It certainly does concern us," he said. "If it looks like it's becoming more widespread, we’ll certainly have to take a hard look at it." Veterans of Foreign Wars, which has 1,200-plus service officers around the country, has yet to see such cases.
AMVETS' concern comes in the wake of the Army's announcement last week that it will conduct a comprehensive, independent review of how it evaluates soldiers with possible PTSD. The latest reviews were triggered by revelations that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed more than 290 PTSD diagnoses based on the expense of providing care and benefits to members of the military.
In addition to the review, the Army announced in April new guidelines for diagnosing and treating PTSD, advising clinicians that fraudulent or exaggerated claims are "rare" and "unlikely." The guidelines also cautioned against attributing current symptoms associated with PTSD to certain diagnoses like personality disorder and adjustment disorder.
When Hibbard was first diagnosed with PTSD in early 2010 at a Veterans Affairs clinic in El Paso, Texas, he was awarded a 30 percent disability entitlement. After relocating to Louisville, he received a second PTSD diagnosis in December 2011, which led to an increased rate of 50 percent, or $969 a month.
Surprised by the VA's decision to overturn the previous two diagnoses, Hibbard called the VA and says he was told that his case was sent for review for a medical opinion. The letter, Hibbard said, described his PTSD as in remission, but he does not feel that is the case.
"I don’t know what a good day is like," Hibbard said. "I guess a good day would be where I’m not hyper-vigilant, where I’m not trying to protect myself where there’s not a reason to. I’ve never really had a so-called good day."
Hibbard's treatment has included counseling, anger-management courses and anti-depressant medication. Hibbard currently works as a dispatch manager for a national moving and storage company. When he has difficulty dealing with the PTSD symptoms, he takes a long drive with his 13-month-old chocolate lab, Sam.
Since receiving the letter from the VA, Hibbard said his "stress has been through the roof." The case will have a hearing, which he expects to be held in about a year.
What most upsets Hibbard is the idea of recounting his story yet again. "I’ve already had to talk about that stuff in detail twice," he said. "It’s the stress of having to go back and relive all that stuff over again."
The Associated Press contributed to this report.
Are you a veteran whose PTSD diagnosis has been recently changed or reversed? Tell us your story at firstname.lastname@example.org.
Rebecca Ruiz is a reporter at msnbc.com and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.
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