PTSD given mis-diagnosis by military -
Army Times ~ May 04, 2007
[helping to reduce the cost for VA treatment and care-(RN)]
After several solders came forward claiming they were discharged for personality disorders but diagnosed with post-traumatic stress disorder and traumatic brain injuries, officials at Fort Carson, Colo., say statistics show 56 of the 276 soldiers discharged with personally disorders in fact had PTSD.
But officials say those PTSD cases were mild to moderate and the soldiers were discharged because of personality disorder issues.
Fort Carson soldiers have accused Army officials of everything from deploying them to Iraq with brain injuries to punishing them for behavior related to their combat injuries.
The soldiers also say that after Veterans for America asked for an investigation by the Army inspector general, no one from the IG’s office talked to them before submitting a report that essentially said no problems had been found.
Steve Robinson, director of veterans’ affairs for Veterans for America, said he then contacted members of Congress, six of whom asked the Government Accountability Office to investigate whether mental health cases are being properly handled in the Army. Robinson talked with reporters April 30.
Post officials said they welcome the scrutiny. “Fort Carson hosts Senate and House delegations frequently,” said Karen Linne, Fort Carson spokeswoman. “This will be our fourth visit this year, and we are proud to show the staff delegates our post.”
One visit, in fact, displayed Fort Carson’s system of monitoring every soldier for traumatic brain injuries. “However, we don't know the entire scope” of the GAO’s upcoming visit yet, she said. “We've received a draft itinerary that included the names of only nine soldiers.”
Veterans for America say they have investigated situations involving 35 soldiers, and have 18 open cases.
“We keep hearing from soldiers that there are problems, and the cases just don't stop,” Robinson said. “It’s not just a Fort Carson issue, but a national issue. It exists everywhere.”
Linne sent Military Times a presentation on soldier readiness and mental health care given in April by Col. Steve Knorr, chief of behavioral health at the post.
It states that each soldier is screened for behavioral health issues, and that, since 2003, 1,703 soldiers have been diagnosed with PTSD at Fort Carson. Of those, 282 soldiers were sent to the military disability retirement system.
Another 276 soldiers were out processed for “personality disorders”— and this is where Robinson sees a problem. Of those soldiers, according to the document, about 20 percent had been diagnosed with PTSD “with or without” a traumatic brain injury.
Under Army regulations, for combat soldiers to be diagnosed with a personality disorder, they must have — somewhere in their medical records — evidence of having been diagnosed or treated for a mental health issue at some point before going to war.
The document said Knorr reviewed the medical charts of 52 of the soldiers — without talking with any of them — and of the 48 diagnosed with PTSD, 25 had mild PTSD and 23 had moderate PTSD.
“None of the soldiers chaptered for personality disorder had severe PTSD,” the document states. “A diagnosis of severe PTSD is a requisite to undergo initiation of a PTSD-related medical evaluation board. Col. Knorr surmises that the diagnosis was made within primary care and was not severe enough to warrant consultation to behavioral health.”
In other words, the problems stemmed from personality disorders that hadn't been picked up in the years before the soldier went to combat — not the PTSD they acquired in war.
In each case, the document states, “providers made a clinical determination that the primary dysfunction was the personality disorder, and a medical board was not warranted.”
Soldiers chaptered out for pre-existing personality disorders receive no medical benefits and no disability retirement pay. Those chaptered out for PTSD get medical benefits and severance or disability retirement pay.
Of 120 soldiers at Carson sent to mental health services by their commanders because they were receiving bad-conduct charges, five were not approved and were chaptered out through the military disability retirement system, the document states.
‘Falling through the cracks’
Military Times talked with two soldiers accusing the Army of ill treatment. Spc. Paul Thurman said he was shipped to Southwest Asia with a traumatic brain injury even though his profile said he could not deploy.
In Kuwait, he injured his head again when a mock explosive device went off near him. When he returned, his rear detachment commander gave him an Article 15 for refusing to follow an order. But the write-up doesn't say Thurman felt a seizure — a symptom of his brain injury — coming on, had asked to get his medication, was told no, and then left formation to get it anyway. He has requested a court-martial.
Spc. Jon Town was diagnosed with a traumatic brain injury after a rocket blew up 2½ feet above his head, but the Army diagnosed him with a pre-existing personality disorder and discharged him with no medical benefits or retirement pay.
Town’s former platoon leader told Military Times that Town had been a great soldier with no history of bad conduct or a personality disorder.
Andrew Pogany, a former soldier who investigates cases for Veterans for America, said he received eight new cases from different bases in the 72 hours before the April 30 news conference.
Every case that I have is backed up with documentation, Pogany said. They are falling through the cracks.
... there are enormous gaps in care.”
Part of the reason, Robinson said, may come from the PTSD training that leaders at Fort Carson receive.
Military Times obtained a series of slides dated April 2007 used for training Fort Carson commanders about PTSD. The presentation states that it is the opinion of Lt. Col. Carl Castro, chief of military psychiatry at the Walter Reed Army Institute of Research, based on personal observation and research findings. Castro did not respond to a request for an interview.
At first glance, the slides promote just what psychiatrists say needs to be done: Recognize and treat PTSD, don’t ignore warning signs, such as alcohol or drug abuse, and work to decrease the stigma of mental health issues.
Then the briefing goes into how to address “extensive media and congressional interest regarding unsubstantiated claims.”
One slide states: “Fact: Lots of soldiers may have PTSD and never go AWOL, use crystal meth, etc. PTSD is not an excuse for bad behavior.”
Yet, according to the Center for the Study of Traumatic Stress, people who don’t get treatment for PTSD often try to self-medicate with drugs or alcohol in a “misguided attempt to reduce stress.” In fact, the center considers that a PTSD symptom.
Robinson and Pogany say soldiers have been dishonorably discharged for bad behavior based on their use of drugs or alcohol even if they had never had such issues before going into combat.
But Pogany said he hasn’t been able to get the numbers of service members discharged for “patterns of misconduct” — or soldiers who have several violations that lead commanders to believe they should be separated from service.
That bad-conduct discharge leaves the service members with no health benefits from either the Defense Department or the Department of Veterans Affairs.
Soldiers have told Pogany and Robinson that even if they get a mental health appointment, that doesn’t necessarily mean they're being treated. In 30 minutes, they might get, “How are you today?” and “Make sure you take your meds,” and, “Don’t go ballistic on your family,” Pogany said. Soldiers tell him counselors aren't specifically addressing the reintegration needs of someone dealing with PTSD, he said.
In Knorr’s written statement, he said the majority of mental health appointments last from 20 minutes to 120 minutes, and that they are treated with a “holistic approach” that may include individual or group therapy and “sometimes medication.”
Castro’s slide briefing states that if training conflicts with a mental-health appointment, soldiers should reschedule. Unfortunately, they often must be rescheduled for a couple of weeks out, Pogany said.
The GAO investigation was due to begin May 5, Robinson said, and congressional staff members will go to Colorado the following week to personally talk with soldiers. Sens. Barack Obama, D-Ill.; Barbara Boxer, D-Calif.; Christopher Bond, R-Mo.; Joe Lieberman, I-Conn.; Tom Harkin, D-Iowa; and Claire McCaskill, D-Mo., signed the letter seeking the GAO inquiry.
Pogany said the same names come up when soldiers talk about people who are doing an “awesome” job — and four or five other names always appear when soldiers complain they're being treated poorly.
“I had a senior leader tell me the other day he cannot put himself in a soldier's shoes to get what he's going through,” Pogany said. “There seems to be this ... large inability to step up to the plate and say, ‘Let's fix it.’ ”