An army hospital in Tacoma, Wash. is under fire for reneging on mental health care for troops diagnosed with post-traumatic stress disorder.
Since 2007, more than 300 soldiers under consideration for medical retirement because of PTSD had their diagnoses reversed by a screening team at Madigan Army Medical Center -- a move criticized for putting costs before care.
"Over 40 percent of those service members who walked in the door with a PTSD diagnosis had their diagnosis changed to something else or overturned entirely," Sen. Patty Murray said at a Defense Appropriations Subcommittee hearing Wednesday. "In light of all the tragedies we have seen that stem from the untreated, invisible wounds of war, I'm sure that you would agree that this is very concerning."
PTSD is an anxiety disorder brought on by a traumatic event. The symptoms -- from anger and hypervigilance to numbness and avoidance, not to mention recurrent nightmares and terrifying flashbacks -- can wreak havoc on a person's personal and professional life.
A 2010 study by Walter Reed Army Institute of Research found up to 30 percent of Iraq war veterans have symptoms of PTSD. The diagnosis can cost taxpayers as much as $1.5 million per soldier, according to an Army Medical Command memo obtained by the Seattle Times.
"The challenges of PTSD and mental health care are real. And no one -- no one -- should be denying any service member purely because of a question of cost," said Murray. "That is something the tax payers of this country bear the burden of providing. We will provide it."
Madigan is currently under investigation by the U.S. Army Medical Command for the reversed diagnoses. But Murray argued the investigation should be military-wide.
"I want to make sure that we are really looking not just at Madigan… but system-wide," she said, adding that cost should not stand in the way of soldiers getting "the care that they have earned and they deserve and that this country expects them to have."
Army Secretary John McHugh said the problem appears to be isolated to Madigan.
"To this point, we don't see any evidence of this being systemic," he responded, during Wednesday's hearing, adding that all military providers have been reminded to leave fiscal considerations out of the diagnostic process.
The controversy highlights the high costs of treating PTSD -- a once unrecognized consequence of combat. It also underscores the unspoken costs of leaving PTSD undiagnosed and untreated.
"People with PTSD are twice as likely to lose their job or be unemployed," said Dr. Joseph Calabrese, a psychiatrist at University Hospitals Case Medical Center in Cleveland. "They're also twice as likely to separate from their spouse or get divorced. And of those who aren't married are much less likely to get married. It's hard to maintain a stable relationship when you're having all these symptoms. Your social life becomes chaotic as well."
Untreated PTSD also raises the risk of suicide. In 2007 and 2008, 255 active duty soldiers committed suicide. That number is up 80 percent from 2004, according to a March 2012 study.
Without a diagnosis, soldiers go without the proper care -- a combination of psychotherapy and medication -- and the financial benefits they need to be able to cope. Some soldiers diagnosed with PTSD were receiving treatment for months and even years prior to having their diagnoses reversed.
"They received treatment for those conditions. But then when they entered the [Military Disability] process, they had those diagnoses changed," said Murray.
Some soldiers were even accused of faking PTSD symptoms to qualify for medical retirement, the Seattle Times reported. But Calabrese said PTSD is "not difficult" to accurately diagnose and the symptoms are hard to fake.
Both Calabrese and Murray worried that the Madigan controversy might dissuade soldiers from seeking treatment for PTSD.
"Not only is it damaging for these soldiers, but it also furthers the stigma for others that are deciding whether to seek help for behavioral health problems," said Murray.