From attorney
Dorothy C Sims, Esq
Sims, Stakenborg & Henry, P.A.

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
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.