Madigan memo on PTSD costs sparked Army review
A memo about a psychiatrist's remarks about costs of treating post-traumatic stress disorder has helped spark what the Army Regional Medical Command calls a "top-to-bottom" review of a Madigan Army Medical Center forensic psychiatric team charged with screening soldiers under consideration for medical retirement.
By Hal Bernton
Seattle Times staff reporter
Western Regional Medical Command's statement about memo
"The U.S. Army Medical Command and the Western Regional Medical Command 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. However, while the investigation is being conducted, it would be inappropriate for us to comment further on the details of any inquiry until it is completed."
"If a Soldier receives a disability rating based on a PTSD diagnosis, under the National Defense Authorization Act of 2008, the Soldier receives at least a rating of 50 percent. This may not be permanent, however, as the Soldier will be placed on the Temporary Disabled Retired List and periodically re-evaluated. During this re-evaluation period, the Soldier's level of benefit may be adjusted depending on the stability of his mental health condition."
Source: U.S. Army Medical Command and Western Regional Medical Command
In a lecture to colleagues, a Madigan Army Medical Center psychiatrist said a soldier who retires with a post-traumatic-stress-disorder diagnosis could eventually receive $1.5 million in government payments, according to a memo by a Western Regional Medical Command ombudsman who attended the September presentation.
The psychiatrist went on to claim the rate of such diagnoses eventually could cause the Army and Department of Veterans Affairs to go broke.
"He (the psychiatrist) stated that we have to be good stewards of the tax payers dollars, and we have to ensure that we are just not 'rubber stamping' a soldier with the diagnoses of PTSD," stated the ombudsman's memo.
That memo has helped spark what the Army Medical Command calls a "top-to-bottom" review of a Madigan forensic psychiatric team charged with screening soldiers under consideration for medical retirement.
The name of the psychiatrist who made the remarks is removed from the copy of the memorandum obtained by The Seattle Times, and the name of the author of the "memorandum for record" also is removed.
Several sources identified the memo's author as an Army Medical Command ombudsman. And, in a statement Monday, officials of 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."
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.
The Army Medical Command's investigation is being monitored by Sen. Patty Murray, who chairs the Senate Committee on Veterans Affairs. She said that doctors should not be taking financial considerations into account as they make a mental-health diagnosis.
"This is the opposite of everything that we are working for," Murray said of the statements detailed in the memorandum. "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 U.S. Department of Veterans Affairs.
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.
According to the memorandum, the Madigan speaker said a soldier retiring with a PTSD diagnosis might receive $1.5 million in benefits during a lifetime. But there is no mention of the details about how the Army or VA benefits were calculated.
After the comments about the financial cost, the meeting room "was exceptionally quiet," the ombudsman wrote. "Not sure if it was because people didn't know how much a diagnoses of PTSD equated to or why we are talking about dollars in relation to our soldiers."
Under the VA system, a 25-year-old veteran with a 100 percent PTSD disability currently can receive $2,769 per month, and at that rate of compensation would tally more than $1.5 million in payments over 46 years.
In its written statement, the Western Regional Medical Command said that a soldier with a PTSD diagnosis gets at least a 50 percent Army disability rating. However, the statement said that rating might not be permanent and that the diagnosis is periodically reviewed.
The memorandum also detailed another controversy at the meeting, when one participant asked whether the forensic team could be subject to a second opinion. At that point, another participant mentioned the name of a patient, declaring he does not have PTSD and there would be no second review.
"Those in the audience who knew about the case were flabbergasted" that the soldier's case was "inappropriately introduced," the memorandum stated.
Very uncool.
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