Little research has been done to explore the integrity of emotion-based decision-making performance in individuals with posttraumatic stress disorder (PTSD). In the current study, performance on two decision-making tasks with both positive and negative reinforcement, the standard Iowa Gambling Task (IGT) and the variant Iowa Gambling Task (vIGT), and measures of mood symptoms, were compared between U.S. active-duty soldiers diagnosed with PTSD (n = 23) and soldiers with no PTSD (n = 23). The results revealed that the PTSD group, when compared to controls, reported significantly higher anxiety and depression symptoms. The PTSD group showed similar behavioral performance as controls on the standard IGT but failed to choose advantageously on the vIGT, which has been shown to reflect hypersensitivity to punishment. Medicated participants, being treated with antidepressants, showed significantly better overall performance on the IGT but not on the vIGT compared to nonmedicated participants. The results suggest that soldiers being treated for PTSD have a unique decision-making pattern that may be attributed to difficulty in processing delayed reward when presented with immediate punishment.