Army investigating Madigan memo on PTSD costs

SEATTLE — The Army is investigating whether the cost of care and benefits is influencing the diagnosis of soldiers with post-traumatic stress disorder at Madigan Army Medical Center, a newspaper reported Tuesday.

The review by the Western Regional Medial Command and the Army Medical Command was prompted by a memo from an ombudsman who attended a lecture in September by a Madigan psychiatrist, The Seattle Times reported.

The psychiatrist told colleagues a soldier who retires with PTSD could receive $1.5 million in government payments and such costs could cause the Department of Veterans Affairs to go broke.

“He (the psychiatrist) stated that we have to be good stewards of the taxpayers’ dollars, and we have to ensure that we are just not ‘rubber stamping’ a soldier with the diagnoses of PTSD,” the ombudsman’s memo said. Names of the psychiatrist and ombudsman were removed from the copy of the memo obtained by the Times.

Last week, The Times reported that the leader of the forensic psychiatric team, Dr. William Keppler, and another Army doctor had been suspended from clinical duties while the Army investigation unfolds.

In a statement Monday, the Western Regional Medical Command and the Army Medical Command said they are “taking this issue very seriously, and have initiated investigations to look into the concerns outlined in the Memorandum For Record.”

“We are very sensitive to the issues that have been raised and are working hard to address them. Soldiers expect and deserve the best possible care with compassion, and our priority is to make sure that all soldiers are getting a fair clinical assessment and diagnosis in the Disability Evaluation System (DES) process,” the statement said.

Sen. Patty Murray, who chairs the Senate Committee on Veterans Affairs, has been monitoring the investigation. Doctors should not be taking financial consideration into account in a mental health diagnosis, she said.

“This is the opposite of everything that we are working for,” Murray said. “It is very disheartening to see this in writing.”

The Army Surgeon General’s office also has asked psychiatrists from Walter Reed Army Medical Center to evaluate the mental health of more than a dozen soldiers who complained that the Madigan team had unfairly dropped their PTSD diagnoses as they prepared for medical retirement. Some said the team branded them as malingerers who were lying or exaggerating their symptoms.

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

Soldiers are often diagnosed with PTSD as they move through the Army medical system. The forensic team at Madigan has been charged with making a final diagnostic review of soldiers under consideration for retirement.

At Madigan, the team’s validation of a PTSD diagnosis can help qualify a soldier for a medical retirement with considerable benefits that include lifelong health insurance for a retiree, spouse and dependents and monthly pay, and also can help qualify a retiree for disability benefits from the Department of Veterans Affairs.

Madigan is located at Joint Base Lewis-McChord, about 30 miles south of Seattle, which has sent tens of thousands of soldiers to Iraq and Afghanistan.

The September lecture was intended to help social workers, nurse case managers and others understand the role of the forensic team in the Medical Evaluation Board system.

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