By Sandra Basu
WASHINGTON – A new Army report suggests that doctors made changes to PTSD diagnoses during the Medical Evaluation Board (MEB) process at similar rates to other behavioral health diagnoses, “suggesting that PTSD is not handled differently than other diagnoses.”
The finding came from the Army Task Force on Behavioral Health’s Corrective Action Plan (CAP) recently released to the public. The task force’s Armywide review was conducted after allegations were made by soldiers at Madigan Army Medical Center, Tacoma, WA, who felt their PTSD diagnoses were downgraded, potentially impacting their medical discharge and reducing their benefits.
After members of Congress also began pushing the issue, the Secretary of the Army ordered an Armywide review to identify systemic breakdowns or concerns in the Integrated Disability Evaluation System (IDES) as they affect the diagnosis and evaluation of behavioral health (BH) conditions.
The report noted that MEDCOM’s review of more than 146,000 MEB records found that greater than 6,400 soldiers had BH diagnoses adjusted during the MEB process. It also pointed out that about the same number of soldiers had a PTSD diagnosis added as had changed or downgraded during the MEB process.
The task force found that only two MEB locations, Fort Polk, LA, and Fort Irwin, CA, had slightly higher rates of BH diagnostic variance from the Army’s aggregate variance, which ranged from 11-22%.
Army Surgeon General Lt. Gen. Patricia Horoho, RN, said during a press briefing last month that there was “no systemic issue of soldiers being disadvantaged in our disability process.”
As for Madigan Army Medical Center, where allegations first surfaced about the changed diagnoses, Horoho said variance in diagnoses was related to the participation within the MEB process of forensic psychiatrists, who were not being used elsewhere.
“There was no intentional malice, nor was there wrongdoing that was seen by the way they were doing the evaluation at Madigan. It was just a difference in capability,” Horoho said.
While the CAP report did not find a bias against giving a PTSD diagnosis, it did provide 24 findings and 47 recommendations to improve behavioral health diagnosis and evaluation in the IDES.
Among the problems identified was inadequate staffing. Though the Army has increased its military and civilian behavioral health work force by more than 100% in the past five years, some MTFs still cannot meet the need for behavioral health, the report found.
“Several MTFs, especially those in remote locations, are challenged with filling vacant behavioral health provider positions. The Army must review the effectiveness of expedited hiring authority, requesting direct hiring authority and fully implementing telebehavioral health capabilities,” the report stated.
The report also cited issues with management and tracking of soldiers in the IDES “due to information gaps between multiple, uncoordinated IT systems.”
“The DoD has multiple IDES data tracking systems, none of which interfaces directly with Veteran Tracking Application, the VA’s system for tracking IDES cases. The eMEB and the ePEB are DoD data systems which track a soldier in the respective IDES phase. The lack of interface between these systems inhibits the ability of all stakeholders in the IDES to provide accurate, consistent data and metrics,” report stated.
The CAP Task Force also recommended that the Army “establish a Behavioral Health Clinical Coordinator on each installation to advise the senior mission commander on the key BH-related program level issues facing soldiers and families as they navigate through the IDES.”
“The complexity of multilevel BH activities which exist on Army installations requires one BH leader with the ability to represent all BH issues to the senior commander,” the report stated. “Issues of suicide, alcohol and drug abuse, and child and spouse abuse represent just a few of many BH issues which extend across unit structures. In addition, soldiers and families going through the IDES often require support from personnel assigned to multiple agencies simultaneously.”
Other recommendations included:
- That the Secretary of the Army designate the Deputy Chief of Staff, (G-1) as the Army’s lead agent for the IDES
- That both IDES policy dissemination and training be standardized and coordinated to reduce systemic variance across the Army.
- That measures be taken to ensure that treating provider conducting the impartial medical review is not directly involved during the Medical Evaluation Board (MEB) process or care of the soldier.
- That a communications plan be implemented to educate soldiers and families about the continuity of care across the DoD, VA and other agencies.
“This action plan marks a major step forward in our ongoing commitment to seek new and better ways to care, support and protect the nation’s most valuable asset — our soldiers” Secretary of the Army John McHugh said in a memo attached with the report.