Fictitious cases of Vietnam-related post-traumatic stress disorder (PTSD) present a difficult diagnostic problem. In settings where the motives of avoiding criminal responsibility or gaining financially are apparent, the clinician is alerted to possible fictitious cases. But there are a variety of other reasons for fictitious presentation of PTSD that the clinician needs to consider. These other reasons include psychotic disorders, concealing other behavior, gaining special attention in a Vietnam veteran PTSD role, explaining and covering up a dysfunctional life, and factitious disorder. Case examples are presented of these various fictitious presentations of post-Vietnam PTSD.