Ronald Nesler of Las Cruces, N.M., a Vietnam veteran rated 100 percent disabled with post-traumatic stress disorder, learned this month that his case, as decided in 1997 by the Department of Veterans Affairs, lacked documents to support the finding of service-connected PTSD.

The VA regional office in Albuquerque advised Nesler in an Aug. 11 letter that he has 60 days to provide evidence he was exposed to the stressful wartime incidents described in his claim papers years ago.

“Otherwise, benefits, if confirmed entitlement is not established, may result in a change in your disability claims compensation,” the VA letter warned. The sentence was set off by bold-face and underlined type.

Nelser’s “permanent and total” disability award is suddenly at risk because of a VA inspector general review of 2,100 randomly-selected PTSD cases with 100 percent disability awards. The IG found that 25 percent, or 527 of them, lacked documents to verify veteran-reported evidence.

The IG review of PTSD cases was released in May, as part of a 200-page report on variances in VA disability compensation across the nation. Many more than 527 PTSD cases are at risk, however. The VA has announced it will review documents of 72,000 PTSD cases, those awarded 100 percent disability ratings from Oct. 1, 1999, through Sept. 30, 2004.

Over those five years, the number of veterans awarded compensation for PTSD jumped by 80 percent, from 120,000 cases in fiscal 1999 to 216,000. The planned review of the 72,000 cases likely won’t begin until January, said VA spokesman Scott Hogenson.

“Everybody talks about how PTSD is a very subjective diagnosis. This is not about diagnosis,” said Hogenson. “This is about collecting the empirical paperwork that says, ‘Yes, this individual was in this set of circumstances during this time in which these things happened, which may have led to posttraumatic stress.’”

Legitimate stressors in a veteran’s service jacket might be descriptions and dates of combat engagements or “de facto” stress indicators such as a Combat Infantry Badge or Purple Heart. The aim is to verify exposure to conditions that might leave a veteran with PTSD. The IG study suggested that claim examiners have been lax in demanding documents.

From 1999 to 2004, the IG said, PTSD payments jumped by 149 percent, from a $1.7 billion total a year to $4.3 billion. To show the potential cost of not seeking evidence of stressors in PTSD cases, the IG said a 25 percent error rate would have caused “questionable payments” of $860 million for VA in 2004 and $19.8 billion over those veterans’ lifetimes.

Nesler, who has a wife and handicapped step-daughter, receives PTSD compensation of a little more than $2,500 a month. He said VA officials have assured him that a decision to lower his PTSD rating would reflect a VA mistake. It should not raise suspicion of fraud. They also have assured him, though not in writing, that his VA compensation won’t fall. They do so, most likely, because Nesler has a 100 percent rating for prostate cancer. The VA presumes this cancer, if suffered by Vietnam veterans, presumably is from exposure to Agent Orange, a defoliant used widely during that war.

Nesler said his disability for cancer is not “permanent and total” like his PTSD award. He knows of many veterans treated for cancer who have seen their rating, and thus their pay, drop sharply following treatment.

A 1967 draftee, Nesler reached Vietnam in 1970. He served for 13 of his 14 months as a meteorological observer for B Battery, 6th Battalion, 32nd Artillery, part of the 1st Field Forces Vietnam.

The whole war experience was stressful, Nesler said, though his unit came under fire only seven or eight days while he was there. His most disturbing memories, he said, are of atrocities committed by soldiers. Nesler said he saw an American soldier detonate a directional mine toward a small bus, filled with Vietnamese women and children, near the town of Ninh Hua.

The incident, he said, was covered up but the screams and faces haunt him still. Nesler said he also feels guilt for not having filed an official incident report.

Nesler, a staff sergeant, was discharged in 1975 after eight years. He wasn’t feeling well and, as the years passed, he grew more anxious, had nightmares, insomnia and difficulty concentrating, all of which the VA later would tie to the war. In 1997, before VA approved his PTSD claim, Nesler gave to VA the names of a senior officer, two warrant officers and several senior enlisted soldiers who likely could verify the bus incident.

“I thought that was my proof,” he said. A VA official told him only recently that the names were never contacted. Still, the VA ruled in 1997, based on “unrefuted evidence,” that Nesler had served in a combat zone, had witnessed “a bus being bombed” and had a well-founded diagnosis of PTSD. It found “total occupational and social impairment” from a variety of symptoms.

Yet, Nesler said, he was in far better shape then than he is today.

“I have emphysema. I have cancer. I have a torn ligament in my shoulder. I have severe arthritis. I have PTSD … And I get this [letter] dropped in my lap. Right now my life is on hold till I find out what’s going to happen.”

If the VA experience with 2,100 PTSD cases is repeated in a review of 72,000 next year, one quarter of these vets, about 18,000, might feel their own stress levels rise as VA presses them to better document their claims.

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