40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of PTSD diagnoses at Madigan were reversed


Seattle Times staff reporter

A Madigan Army Medical Center screening team reversed more than 40 percent of the post-traumatic stress disorder diagnoses of patients under consideration for medical retirement since 2007, according to information released by U.S. Sen. Patty Murray.

The statistics were compiled as part of an ongoing Army Medical Command investigation into the screening team’s practices. The team has been suspended from PTSD evaluations, and the Army Medical Command is offering new evaluations to patients whose diagnoses were reversed.

Citing a need to “protect the integrity of the process” during ongoing investigations, the Western Regional Medical Command, in a statement released to The Seattle Times, declined to comment on the statistics released by Murray.

The investigation was triggered, in part, by soldiers who were concerned by the decision to take away their PTSD diagnoses and, in some cases, tag them as possible malingerers.

Originally diagnosed by other Army or Department of Veterans Affairs doctors, some had been receiving extensive treatment for months or years when the screening team evaluated them.

A PTSD diagnosis can qualify a soldier for the considerable financial benefits of a medical retirement. Those include a pension, health insurance for spouse and dependents and commissary privileges.

In a lecture to colleagues, a Madigan forensic psychiatrist stated that a PTSD diagnosis can cost taxpayers $1.5 million over the lifetime of a soldier who medically retires, according to a memo by an Army Medical Command ombudsman.

Investigators so far have checked the medical evaluations of more than 1,680 patients screened. Of those patients, more than 690 had a PTSD diagnosis. The team reversed more than 290 of those diagnoses, Murray told The Seattle Times this week.

Murray, a Washington Democrat who chairs the Senate Committee on Veterans Affairs, received the statistical breakdown from the Army surgeon general, Lt. Gen. Patricia Horoho.

Those statistics are not yet final and could change as more patients who went through the screening process are identified.

“What we know is that since 2007 over 40 percent of those service members went in the door with a PTSD diagnosis and that diagnosis changed to something else or was overturned entirely,” Murray said. “I worry that there are other service members that didn’t seek help because of what they have seen their fellow soldiers go through.”

PTSD is a condition that results from experiencing a traumatic event, such as a battlefield casualty. Symptoms can include recurrent nightmares, flashbacks, irritability and feeling distant from other people.

Some people recover from PTSD. For others, it may be a lifelong struggle.

Madigan Army Medical Center is located at Joint Base Lewis-McChord south of Tacoma and is one of the largest military installations in the country.

The special screening effort there was different from how medical-retirement evaluations were handled at other Army medical centers, sparking considerable controversy and a broader Pentagon review of how the military services diagnose PTSD.

The Army Medical Command already has begun re-evaluating patients whose diagnoses were changed by the Madigan screening team. Initial reviews earlier this year of 14 patients at Walter Reed National Military Medical Center resulted in six patients having PTSD diagnoses reinstated.

The Army Medical Command has assembled a larger team of mental-health specialists at Madigan to offer re-evaluations to more than 280 other patients.

The Army Medical Command investigation also is examining why an intensive outpatient treatment program for PTSD at Madigan was closed down in 2010, the year that some 18,000 soldiers returned to Lewis-McChord from tours of duty in Iraq and Afghanistan.

The investigation began earlier this year, weeks before a Lewis-McChord soldier, Staff Sgt. Robert Bales, was detained for allegedly killing 16 Afghan civilians, including nine children, during a nighttime rampage through two rural villages March 11.

Bales’ case has increased the scrutiny of mental-health resources offered to base soldiers.

Bales, who was on his fourth tour in a combat zone, received a mental-health check as part of a 2008 certification to qualify as a sniper. He also went through routine physical- and mental-health checks before deploying and after he returned from overseas duty.

Bales’ attorney, John Henry Browne, said he expect to argue that this client suffered from “diminished capacity,” such as an emotional breakdown. Brown and co-counsel Emma Scanlan are trying to understand more about their client’s mental health through a review of medical records, and interviewing Bales and family members.

They say there is no indication that Bales or his family sought mental-health counseling for the soldier at Lewis-McChord or Madigan.

He was deemed fit for deployment, and not under consideration for a retirement due to PTSD or other mental-health conditions. So Bales would not appear to be among those screened by the forensic psychiatric team.

The Army has been waging a campaign to reduce the stigma that some soldiers feel if they want to seek mental-health treatment.

Many soldiers are wary of coming forward for fear it could damage their career.

Meanwhile, there remains considerable dispute among health professionals about how to diagnose PTSD. Some believe it is overdiagnosed.

For the military, the financial stakes of PTSD screening dramatically increased after Congress in 2008 authorized a 50 percent disability rating for anyone leaving military service with that diagnosis.

That rating is well above the threshold required for an Army medical retirement.

After the law changed, several soldiers attempted to make false or exaggerated claims of PTSD for personal financial gain, according to a Feb. 16 memorandum by Dr. Paul Whittaker, a Madigan physician who serves on the medical board that examines soldiers under consideration for medical retirement.

Whittaker wrote that Madigan psychiatrists used objective testing to determine which soldiers had “significant mental illness that was compensable.”

One of those tests the Madigan forensic team used is called the Minnesota Multiphasic Personality Inventory (MMPI).

In one patient file reviewed by The Seattle Times, a forensic-team member said the validity of the MMPI has been confirmed by multiple studies and has “shown the best resolution” in separating “PTSD simulators from actual patients.”

But the Army Surgeon General’s Office, in a paper about the condition, said while the test might help evaluate some behaviors, it is “not one of the gold standards measures for PTSD” and is not recommended for routine clinical evaluation of PTSD.

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