From attorney Dorothy C Sims, Esq Sims, Stakenborg & Henry, P.A. ocalaw.com 352.629.0480 dcs@ocalaw.com Dorothy C. Sims is the senior partner in Sims, Stakenborg & Henry, P.A.  She’s taken a number of depositions of defense medical experts who deny the DBA employee is injured.  In reviewing the material sent to her by other lawyers formulated this document to help lawyers and patients have proper tests to assist them in  educating the judge as to their condition. Post-Traumatic Stress Disorder/anxiety based disorders – How to Test for It.  How to prove it. First, remember that you do not have to prove you have PTSD to be entitled to DBA benefits.  There are other psychiatric disorders that can be caused by stress that may not rise to the level of PTSD, but still be related to incidents that occur overseas.   Proving Post-Traumatic Stress Disorder can be quite difficult. Not because it doesn’t exist or may be even clearly identifiable by the treating doctor but because of the prejudices juries, judges, and administrative law judges may have regarding the disease. Defense experts frequently claim that particular symptoms or particular timing of a symptom is proof that if the patient does not have PTSD.   This is contrary to the American Psychiatric Association’s definition of criterion for this disorder. The treating doctor is urged to go the Diagnostic and Statistical Manual as well as other protocols published by the Veterans’ Administration, the American Psychiatric Association which set forth the criteria for diagnosing Post-Traumatic Stress Disorder. The defense medical expert may very well claim certain criteria exist but when forced to produce science to support that conclusion rarely are there any peer reviewed journal or publication that supports his/her method. Since there appears to be a prejudice on the part of many judges and many jurors in regard to PTSD (it’s not real, too easily faked, etc.) the treating doctor  is urged to consider  the possibility of objective measures such as considering the following: Treating doctors may rarely provide any kind of Post-Traumatic Stress Disorder test or screening scale. Therefore, the treating doctor may consider  the possibility of actually administering Post-Traumatic Stress Disorder tests to determine the specific symptoms of the disorder. Research reveals that individuals with Post-Traumatic Stress Disorder actually have, contrary to what one might expect, lower than normal decreased basal Cortisol levels and increased glucocorticoid receptors. Therefore, if the doctor conducts blood work would be another recommendation to determine whether or not the blood level reveals the patient  are out of the normal reference range.  This can then be used as objective piece of evidence by which the doctor may rely fitting the puzzle together to determine the ultimate diagnosis. See Yehuda, Rachel, Biology of Post Traumatic Stress, J Clinical Psychiatry, 2001:62 (Suppl. 17).  The blood work also may show findings consistent with PTSD by showing suppression on DST (Dexamethasone suppression test) and negative feedback inhibition.  In chronic PTSD patients, “Chronic CRF release “leads to an altered responsiveness of the pituitary gland as it is true in anxiety disorders.”  In fact, if you have an MRI which shows lower than normal hippocampal volume, that can be related to PTSD as well. This next suggestion may be extremely uncomfortable the patient and the patient may needs clearance from the family doctor in order to confirm in fact the patient has PTSD. The doctor can monitor your patient’s heart rate while having your patient re-experience the trauma and/or showing him pictures or sounds of the event that resulted in the post-traumatic disorder and can objectively show any increase in his heart rate. Again, document his reaction.  Again, the APA indicates that chronic PTSD” may measured through studies of autonomic functioning (eg heart rate, electromyography, sweat gland activity)” Exposure to simulated trauma can cause increased sweating, rapid heart rate, etc. Research reveals that individuals with anxiety disorder have certain patterns on PET scans.  Sending your patient out for a PET scan under the circumstances, especially if he has been exposed to a blast injury may not be a bad idea either. Unfortunately, it is expensive and you really need somebody quite good at comparing your patient’s PET scan to individuals with anxiety disorders and a normal sample in order to draw a conclusion. But again, it can be an objective piece of evidence. The next piece of evidence is a well kept diary from the claimant as well as his family. Very often people don’t realize when their own behavior is bizarre or unusual and while the family may recognize it at the time they must document it clearly in a diary then there are explanations as to how the claimant or plaintiff as changed, become quite vague and somewhat useless. Our firm has a diary online and we urge patients  to download the diary and give it to their family members and tell them to keep a daily diary of behavior; morning, noon, and evenings, for 14 consecutive days. This has proven to be invaluable in many cases and it is also helpful to the treating doctor to understand the severity to the patient’s condition and thus how to treat the PTSD. Consider that the patient may not actually have PTSD,  but may have some other diagnosis such as adjustment disorder secondary to the trauma which is not required the same level of trauma as does PTSD but still can be compensable.   Watch for defense doctors who give the MMPI, then ignore it.  An elevated PK scale can indicate the presences of PTSD.  See The Essentials of MMPI2 and MMPIA Interpretation, 2nd ed., P. 170, Butcher, J., Williams, C., University of Minnesota Press. Watch for doctors who administer an abbreviated or shortened version of the MMPI because the shortened version won’t show the PK scale. That may be why doctors intentionally give the shortened version – so they don’t have to admit their own test shows evidence of PTSD.