WASHINGTON — For the second time in a month, Department of Veterans Affairs leaders testified before Congress about an embarrassing e-mail which implied a cover-up of serious health problems among servicemembers.

This time, Democratic senators and veterans advocates called for an independent investigation of the department, saying they believe leaders have created a toxic culture for veterans seeking care.

"There is a sense, whether it’s perception or reality, that [VA officials] make decisions based on money and not on whether veterans are getting the best health care they need," said Sen. Patty Murray, D-Wash. "It’s disconcerting when we see things like this."

Jon Soltz, chairman of, said a VA bonus program to reward clinics that process the most cases has only exacerbated the problem, unintentionally encouraging managers to cut corners and opt for less-costly treatments.

But VA officials denied those charges. Dr. Michael Kussman, undersecretary for health at the department, said recent controversy surrounding the department is the result of poor publicity from a few missteps, but not a lack of effort by employees treating veterans.

"Any suggestion that we would not diagnose a condition, any condition, is unacceptable," he said. "Not only was there no systemic effort to deny diagnoses, there was not an individual effort to that end."

Last month Dr. Norma Perez, a psychologist and coordinator at a department’s clinic in Central Texas, circulated an e-mail warning colleagues not to diagnose post-traumatic stress disorder in new patients too quickly, noting the growing number of "compensation seeking veterans" coming in.

Instead she suggested diagnosing adjustment disorder — a condition which carries no disability rating — and following up with further PTSD tests.

On Wednesday she appeared before the Senate Veterans Affairs Committee to clarify her memo, insisting it was more about providing accurate and timely treatment options for patients than about costs for the department. The clinic does not perform any disability ratings or compensation work.

But senators on the committee said were skeptical of that explanation, pointing to lingering concerns with e-mails written by department Mental Health Director Ira Katz that were made public in April.

Those notes concerned higher-than-expected suicide rates among veterans. Last month Katz told a House committee that those memos — one note’s subject line reads "Shh!" and asks "Is this something we should carefully address … before someone stumbles on it?" — were poorly worded but not an effort at a cover-up.

"I’m very frustrated by the fact that whether I’m asking about veterans’ suicides or construction of a new clinic, the answer from the players at the VA bureaucracy seems to be the same: ‘It’s no big deal,’ " said Sen. Jon Tester, D-Mont. "It’s a big deal to me."

After the hearing, a pair of combat veterans spoke out about their problems navigating the system. Retired Army Pfc. Kenneth Gumm, who served in Iraq in 2005, said since then he has received several conflicting diagnoses from Perez’s clinic. The last one was for PTSD, which could mean a higher disability rating down the road.

"Money is nice," he said, "but I’d rather not have my problems."

Kussman said the department has made tremendous strides in treating mental health disorders in recent years, including hiring nearly 4,000 new psychologists and counselors since 2005. But he acknowledged the department still has more work ahead.

See the complete Perez e-mail here.

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