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Originally published Friday, March 8, 2013 at 7:36 AM

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Army task force calls for improving care of soldiers with PTSD

The Army has found no evidence of a systemic problem with changing the diagnosis of soldiers with PTSD. But a new task-force report still had recommendations to improve behavioral-health care.

Times staff and news services

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An Army task force that
reviewed more than 150,000 casesfound no evidence that diagnoses of post-traumatic stress disorder were reversed in excessive numbers in the post 9/11 era.

But the task force did document other problems that still hamper the diagnosis and treatment of soldiers with PTSD, according to findings released Friday.

Improving mental-health care has been a high priority for the Army as suicide rates in recent years have swelled. Last year, it tallied 350, the highest yearly total on record.

The task force was formed last year in response to complaints from soldiers at Joint Base Lewis-McChord who believed their PTSD diagnoses were improperly reversed by doctors at Madigan Army Medical Center. Some tagged as possible malingerers said they felt humiliated by the change in diagnosis, which also put at risk their chances for pensions and other medical-retirement benefits.

Reviewing records back to 2001, the task force found that more than 6,400 soldiers’ behavioral-health diagnoses had been modified. But in evaluations for medical discharges for those soldiers, there were about as many new PTSD diagnoses as there were cases from which the diagnosis was removed.

“I can’t stress enough that what happened at JBLM was not a systemic issue,” said Lt. Gen. Patricia Horoho, the Army surgeon general, during a Friday briefing with reporters.

The 58-page report contains 47 recommendations to improve the complex diagnosis and evaluation process for medical discharges.

Some of the report's recommendation are already being implemented, according to Army officials. They include “embedding” behavioral health-care providers in brigades, improving guidance for soldiers and families, and designating a director of psychiatric health at each installation.

Sen. Patty Murray, D-Wash., last year investigated the complaints of JBLM soldiers and pressed the Army to examine the behavioral-health-care system.

“The only way to truly make headway on reversing the troubling trends we have seen, including the fact that suicide deaths continue to outpace combat deaths, is to change the culture associated with identifying and treating behavioral-health conditions,” Murray said in a statement released Friday.

At Madigan, the controversy over the reversal of PTSD diagnoses was stoked by concerns that a screening team led by forensic psychiatrists might have been reversing diagnoses to try to reduce the cost to taxpayers of pensions and other medical retirement benefits. The forensic team typically used tests such as the Minnesota Multiphasic Personality Inventory to assess the severity of PTSD symptoms, or whether symptoms were feigned.

Army officials say an as-yet-unreleased investigation of Madigan found no evidence diagnoses were changed to save taxpayers money. But the Army last year did end the use of forensic psychiatrists on the Madigan screening teams.

Horoho, the Army surgeon general, said Friday that Madigan was the only medical center where forensic teams screened soldiers, and that introduced what she called “variance” into the Army’s diagnostic efforts.

Last year, the Army established new review teams that re-evaluated 257 soldiers. Fifty-seven percent of those soldiers did have PTSD, according to the task-force report.

Under the system now in place, an evaluation team that typically includes a psychiatrist and psychologist or nurse practitioner evaluates patients under consideration for a medical separation, according to a statement released by Madigan on Friday.

Among the problems the report documented was that Army bases don’t have a person on site dedicated to overseeing behavioral-health issues, despite the many problems they can cause: suicide, alcohol abuse, drug abuse, and child and spouse abuse.

Army Secretary John M. McHugh said in a statement that the Army will work to place behavioral-health experts “at the command and installation levels to provide better consultation, guidance, coordination and recommendations to improve behavioral health care for our soldiers.”

The task force found that of the soldiers surveyed, 37 percent had never received any information about the Army’s disability-evaluation system or had to seek the information out on their own.

It also said it was confusing and inefficient for troops to navigate the vastly different disability systems maintained by the Army and Veterans Affairs.

The Army and VA plan to have by 2017 a joint disability system under which health-care providers in either organization will have access to records.

Seattle Times staff reporter Hal Bernton and Associated Press writers Gene Johnson and Pauline Jelinek in Washington, D.C., contributed to this report

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