On December 4, 2009, CREW posted documents released by the Department of the Army in respect to CREW’s Freedom of Information Act Request (FOIA) for documents about the diagnosis of Post Traumatic Stress Disorder (PTSD) for Army soldiers. The FOIA request stemmed from a Salon.com article about an Army sergeant who recorded a doctor at an Army medical facility at Fort Carson, Colorado, telling him during an appointment, “clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder [instead.]”

CREW asked for records related to guidance given to army staff and contractors regarding the diagnosis of PTSD. So far we have received about 143 pages, all of which have been posted on www.governmentdocs.org. The documents include an investigative report conducted by the Army into the allegations that medical staffers were pressured to improperly diagnose PTSD at Ft. Carson. Unsurprisingly, the investigator did not find evidence of doctors being pressured or that anyone in the chain of command attempted to influence diagnosis.

What the report did find however, was:

". . .evidence of potential systemic pressures inherent in the Army physical disability evaluation processes that may influence MEDCOM [U.S. Army Medical Command] behavioral health providers in the course of conducting PTSD evaluations. These potential pressures may lead providers to avoid making a diagnosis of PTSD on medical boards contrary to their clinical judgment." (emphasis added)

These pressures seem to spring from two main sources. First, mental health providers interviewed in the report claim that understaffing and overwork have led them to look for, in the words of the report, “more efficient ways to get the job done.” One interviewee commented, “I have heard staff describe that it would be easier to diagnose Anxiety Disorder NOS because the MEB [Medical Evaluation Board] would be less likely to be returned. . .”

Second, the report’s author writes that the “requirements for evaluating PTSD are more strenuous than for any other mental disorder.” Providers need to document years of history for patients and corroborate facts regarding the traumatic event with the patients’ commanders or other sources. (In a December 2009 memo, the Army did slightly back off the requirement that MEBs and soldiers “provide credible supporting evidence of a PTSD stressor” but maintained that a traumatic stressor is required for a proper PTSD diagnosis.) As one interviewee put it, “Documenting the diagnosis of PTSD sufficient to withstand review by the PEB [Physical Evaluation Board] and the US Army PDA [Physical Disability Agency] is at times a challenge.” The same interviewee noted that the Army published an extensive, 20 plus page, guideline on the proper diagnosis of PTSD, but not for any other mental health condition. A different interviewee commented that, “I may have heard that a PTSD diagnosis is reviewed more carefully by the PEB.”

While it remains to be proven if commanders have advocated for a diagnosis cheaper or easier than PTSD, it seems clear, even from the small number of interviews conducted for this report, that Army mental health providers are facing systemic pressure to not diagnose PTSD.

From these documents, it also appears the Army’s mental health doctors are overworked, understaffed, and remain overburdened by bureaucracy and paperwork. The Army and the Defense Department should investigate further and ensure that these factors aren’t denying our soldiers the care they need and deserve.

CREW also requested PTSD documents from the Department of Veterans Affairs, and those can be found here.

In April, Salon printed an article with additional evidence, on tape, of Army medical personnel talking about the pressure to deny the diagnosis of Post-Traumatic Stress Disorder (PTSD) to military personnel. CREW has taken an active role in this issue.

In May, in light of those news reports that the Army has instituted the cost-cutting practice of ordering doctors to misdiagnose soldiers returning from battle with anxiety disorder rather than post traumatic stress disorder (PTSD), CREW and VoteVets.org today asked the chair of the House Armed Services Committee to investigate the extent of this outrageous practice.  Our letter can be found here.

We've been trying to get information from the Army, to no avail. So we're going to court.

Today, CREW filed a lawsuit against the Army, CREW v. Dep't of the Army, challenging the Army's failure to produce records in response to CREW's FOIA request seeking documentation of Army guidance that discourages diagnoses of post traumatic stress disorder (PTSD). The Veterans Affairs has issued similar guidance that CREW also is seeking to document through a FOIA request that is also the subject of pending litigation.

Our CREW's complaint and FOIA request can be found here.