Army Reviewing a Decade of Overturned PTSD Diagnoses

The American Psychiatric Association revised the PTSD (post-traumatic stress disorder) diagnostic criteria in 2000. Now the U.S. Army intends to review the diagnoses at all of its medical facilities going back to October 2001. Following recent complaints that numerous PTSD diagnoses were improperly overturned, Army officials aim to develop a plan to correct any mistakes in diagnosis, policy, or procedure.

"We owe it to every soldier to ensure that he or she receives the care they need and deserve," Army Secretary John McHugh said, "(The Army) must ensure that our processes and procedures are thorough, fair and conducted in accordance with appropriate, consistent medical standards."  

The complaints claim that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state had a habit of reversing PTSD patients’ diagnoses for financial rather than medical reasons. They based their decisions on the expense of providing care and benefits to members of the military instead of the symptoms they displayed.

The Diagnostic and Statistical Manual of Mental Disorders’ criteria for PTSD include history of exposure to a traumatic event as well as a response that involves intense fear, helplessness, or horror and a variety of symptoms including but not limited to:

• Markedly diminished interest or participation in significant activities
• Feeling of detachment or estrangement from others
• Restricted range of affect (e.g., unable to have loving feelings)
• Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Recurrent distressing dreams of the event
• Sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes

Of the cases that involved candidates screened at Madigan for retirement since 2007 more than 40 percent have been overturned. 690 patients had been diagnosed with post-traumatic stress disorder but the psychiatric team there reversed more than 290 of those diagnoses.

Head of the Senate Veterans Affairs Committee, Sen. Patty Murray, D-Wash. states, "The bottom line is that the Army needs to fix the inconsistencies we have seen in diagnosing the invisible wounds of war. Out of this review, the Army needs to provide a uniform mental health policy so that service members are given the care they need."  

So far the reviews at Madigan have resulted in 100 service members having their PTSD diagnoses returned and disability pensions reinstated after their PTSD diagnoses were changed by the Madigan forensic psychiatry team.

But there’s more work to be done.

Murray states, “The most important thing is that these service members and their families are provided with answers on why cost was a factor in the treatment they sought for the invisible wounds of war and that the Army takes the right steps to fix it.”

She recognizes that this is the Army's opportunity to correct the mistakes of the past and ensure that veterans and their families don't need to "wade through an unending bureaucratic process to get proper access to care."