Diagnoses Reversed

The problems at Madigan began when some soldiers contended that their initial diagnoses of PTSD were reversed during disability evaluations and suggested that cost might have been a factor.

In May, the Army began a review of mental-health diagnoses and evaluations made at all its medical facilities. That review was followed by one ordered across the military services by Defense Secretary Leon Panetta.

Sen. Patty Murray (D-WA), who had been instrumental in pushing for these investigations, suggested that the reversal of PTSD diagnoses could be widespread and pressed DoD officials during congressional hearings to get to the bottom of the matter.

“I do continue to have a number of concerns, not only about the situation at Madigan but the implication for our soldiers across the Army who may have also struggled to get a proper diagnosis, adequate care and an honest evaluation during the integrated disability system process,” she told Army Surgeon General Lt. Gen. Patricia Horoho, RN, at a hearing in March.

At a separate hearing in June, she told Panetta that “at Madigan to date, over 100 soldiers and counting have had their correct PTSD diagnosis restored after being told they were exaggerating their symptoms, lying and accused of shirking their duties. So, understandably, a lot of our servicemembers’ trust and confidence in the disability evaluation system has been seriously shaken in the wake of these events.”

In speaking about the military-wide review, Panetta acknowledged the seriousness of the matter.

“We’ve got to do everything we can to make sure that the system itself is working to help soldiers, not to hide this issue, not to make the wrong judgments about this issue, but to face facts and deal with the problems up front and make sure that we provide the right diagnosis and that we follow up on that kind of diagnosis,” he said at a DoD suicide conference in June.

Forensic Psychiatry

According to the Army statement, MAMC developed the forensic psychiatry service to perform a variety of functions, “including completing behavioral health evaluations on soldiers in the disability evaluation system to make the most accurate diagnosis possible.” The review found that the forensic psychiatry service applied “a strict interpretation of the diagnostic criteria found in the Diagnostic and Statistical Manual.”

At a press conference recently at MAMC, Commanding General of Western Regional Medical Command Maj. Gen. Richard Thomas explained that forensic psychiatry is a “valuable tool” that can be used for several specialized areas. However, it was found to be inappropriate for evaluating PTSD cases in the disability evaluation system. Rather, this review is better completed by general behavioral health practitioners.