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Army: Forensic Psychiatry No Longer Used for PTSD Disability Evaluations

by U.S. Medicine

September 6, 2012

By Sandra Basu

WASHINGTON — The Army will no longer use forensic psychiatry to evaluate soldiers diagnosed with PTSD in the disability evaluation system, military officials announced. The announcement came after a firestorm of controversy erupted earlier this year at Madigan Army Medical Center (MAMC).

A number of soldiers there had PTSD diagnoses overturned in the disability evaluation system, which used forensic psychiatry methods instead of those typically used in military evaluations.

Forensic psychiatry incorporates the medical practice of psychiatry with legal issues and often is used to conduct administrative reviews in areas such as worker’s compensation. It has been criticized for placing too much emphasis on malingering.


Maj. Gen. Richard Thomas, commander of Western Regional Medical Command, speaks during a press conference last month at Madigan Army Healthcare System, Joint Base Lewis-McChord, WA, about the Army’s recent decision to discontinue the use of forensic psychiatry as part of its disability evaluation system. (U.S. Army photo by Sgt. Christopher M. Gaylord)

Rather than citing any wrongdoing, Gen. Lloyd Austin, the Army’s vice chief of staff, suggested in a statement that, after a review, officials concluded that “the forensic methods are not the right ones for the United States Army disability evaluation system.”

“We learned MAMC officials acted in accordance with the standard of practice for civilian disability evaluations,” he said. “But we also learned that, while the evaluation may be fair and appropriate, it’s simply not optimal for the unique cases that the Army diagnoses and reviews.”

Austin said new policies and procedures are now in place to review PTSD cases. Furthermore, he announced that Col. Dallas Homas was reinstated to his position as MAMC commander after the review found that “Col. Homas did not exert any undue influence over PTSD diagnoses and that he acted appropriately, enforcing standard medical guidelines.”

Homas had been temporarily suspended from his position as investigators examined how the PTSD cases were evaluated there.

Army: Forensic Psychiatry No Longer Used for PTSD Disability Evaluations

“They are trained to do that,” Thomas said.

In addition, he said, inconsistency was brought to the process, because, while forensic psychiatrists at MAMC may evaluate troops, this specialty was not necessarily available at other installations. “It introduced some variance in how we were evaluating these soldiers for their medical evaluation boards. We can’t have that,” he said.

Officials denied that cost had anything to do with the forensic psychiatry evaluations. “From a leadership side, that didn’t play in it at all,” said 1st Corps Commanding General Lt. Gen. Robert Brown.

It was determined that 450 soldiers from Madigan needed to come in for reevaluation, according to Thomas. MAMC continues to review diagnoses of troops with PTSD who had been evaluated by forensic psychiatry.

In addition, efforts are in place to improve the evaluation process across the Army, officials said. For example, a task force on behavioral health is developing a corrective-action plan to ensure diagnosis and evaluation best practices are in place across the Army. The results of those efforts are expected in December.

Officials acknowledged the congressional role in bringing problems with the evaluation process to the Army’s attention.

“The fact that Senator Murray’s constituents brought their concerns to her regarding our evaluation process provided the impetus to look at our entire system,” Austin said in his statement.

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Army: Forensic Psychiatry No Longer Used for PTSD Disability Evaluations

Diagnoses Reversed

The problems at Madigan began when some soldiers contended that their initial diagnoses of PTSD were reversed during disability evaluations and suggested that cost might have been a factor.

In May, the Army began a review of mental-health diagnoses and evaluations made at all its medical facilities. That review was followed by one ordered across the military services by Defense Secretary Leon Panetta.

Sen. Patty Murray (D-WA), who had been instrumental in pushing for these investigations, suggested that the reversal of PTSD diagnoses could be widespread and pressed DoD officials during congressional hearings to get to the bottom of the matter.

“I do continue to have a number of concerns, not only about the situation at Madigan but the implication for our soldiers across the Army who may have also struggled to get a proper diagnosis, adequate care and an honest evaluation during the integrated disability system process,” she told Army Surgeon General Lt. Gen. Patricia Horoho, RN, at a hearing in March.

At a separate hearing in June, she told Panetta that “at Madigan to date, over 100 soldiers and counting have had their correct PTSD diagnosis restored after being told they were exaggerating their symptoms, lying and accused of shirking their duties. So, understandably, a lot of our servicemembers’ trust and confidence in the disability evaluation system has been seriously shaken in the wake of these events.”

In speaking about the military-wide review, Panetta acknowledged the seriousness of the matter.

“We’ve got to do everything we can to make sure that the system itself is working to help soldiers, not to hide this issue, not to make the wrong judgments about this issue, but to face facts and deal with the problems up front and make sure that we provide the right diagnosis and that we follow up on that kind of diagnosis,” he said at a DoD suicide conference in June.

Forensic Psychiatry

According to the Army statement, MAMC developed the forensic psychiatry service to perform a variety of functions, “including completing behavioral health evaluations on soldiers in the disability evaluation system to make the most accurate diagnosis possible.” The review found that the forensic psychiatry service applied “a strict interpretation of the diagnostic criteria found in the Diagnostic and Statistical Manual.”

At a press conference recently at MAMC, Commanding General of Western Regional Medical Command Maj. Gen. Richard Thomas explained that forensic psychiatry is a “valuable tool” that can be used for several specialized areas. However, it was found to be inappropriate for evaluating PTSD cases in the disability evaluation system. Rather, this review is better completed by general behavioral health practitioners.


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