Multi-site Confirmatory Efficacy Treatment Trial of Combat-related PTSD

Inclusion Criteria: * Veterans of Post-9/11 military conflicts * with diagnosis of PTSD based on CAPS-5 related to Post-9/11 military combat Exclusion Criteria: * current enrollment in an acute experimental treatment for PTSD or trauma-focused psychotherapy treatment * PTSD-inducing trauma exposure occurring within the last 3 months prior to pre-enrollment evaluation * history of epilepsy or seizure disorder, a history of major head trauma, * any neurologic condition likely to increase risk of seizures, * brain tumors, * moderate to severe substance use disorder in last 3 months or any substance use that puts the participant at increased risk or significant impairment * stroke, and blood vessel abnormalities in the brain, * dementia, * Parkinson's disease, Huntington's chorea, or multiple sclerosis * a high suicide risk * a lifetime history of psychotic disorder or bipolar disorder * inability to stop taking any medication that significantly lowers the seizure threshold * pregnant or nursing * metal fragments in the head, or any metal objects in or near the head that cannot be safely removed * We will screen for a history of traumatic brain injury and exclude potential participants from the study if they have a history of severe TBI or are at high risk for seizures. * history of seizures * non-English speakers because not all of the screening forms, questionnaires, and tests are available in any language except for English * cardiac pacemaker, implanted medication pumps of any sort that would increase the risk of rTMS * any current medical condition that could preclude being able to safely participate in TMS treatment, * use of prescription medication or illegal substances that lower the seizure threshold * previous rTMS