Guidebook to Protecting DoD Budget by ‘Un-Diagnosing’ PTSD in Soldiers at Fort Lewis Madigan Army Medical Center

MIND FIELD: PTSD & the Military

Can the Armed Forces afford to accurately diagnose soldiers and their families with psychological issues stemming from war?

by Keegan Hamilton
Seattle Weekly Aug. 08, 2012

Nature calls, even in a war zone.

And so, in April 2008, when John Byron Etterlee was stationed at an American military base in Baghdad, working the night shift at an Army tactical operations center, he carried his rifle as he stepped outside to use the outhouse.

Suddenly, just as he began to relieve himself, he heard an ominous buzz in the sky above.

Spc. John Etterlee (SW)

Etterlee, a stout Georgia native with a blond crew cut and thick spectacles, hustled out of the portable toilet and gazed up into the darkness. The buzz sounded like a small airplane approaching, but Etterlee, already midway through his second tour of duty in Iraq, realized the white streak tearing through the night was an incoming rocket.

“For a split second I thought, ‘Oh my God, am I going to die?’ ” the 35-year-old soldier recalls matter-of-factly in his slow Southern cadence. “I thought it was coming toward me. Fifteen seconds later I heard a loud explosion that shook the buildings. The rocket hit maybe 50 yards outside the gate.”

Nobody was injured in the attack, and Etterlee’s desert outpost incurred no serious damage. In hindsight, he says, it was just another close call during a span when he and his unit became accustomed to mortar fire, IED detonations, and other random explosions.

But for some reason, perhaps because of the embarrassing circumstances, this particular brush with death has stuck with him.

“I almost pissed in my pants,” Etterlee says with a halfhearted chuckle. “It wasn’t funny when it happened, but it’s kinda funny now.”

A chemical-weapons specialist tasked mainly with keeping records and maintaining equipment, Etterlee had limited combat experience during his time in Iraq.

Nevertheless, his vehicle was once nearly struck by a roadside bomb, and one of his closest friends was killed in action in a separate incident.

When he returned home to Joint Base Lewis-McChord (JBLM) in late 2008, the chemical weapons specialist was clearly rattled.

His wife forced him to spend nights on the couch because he punched, kicked, and thrashed in his sleep. He was prone to outbursts of anger. He tried to avoid conversations about the war, and, when co-workers inevitably swapped battle stories, his heart pounded and his mind raced.

He says he tried to seek help, but to no avail.

“I went to chaplains more times than I can count,” Etterlee says. “I went to my chain of command, and basically got the runaround. Nobody put me on any kind of formal treatment program.”

On top of his mental issues, Etterlee was struggling financially. He and his wife divorced. And then, during a training exercise at Fort Lewis, he suffered herniated discs in his back while dragging a fellow soldier in a simulated rescue situation.

View detailed medical report prepared by Madigan’s forensic psychiatric team member, Thomas M. Danner PhD., who ‘un-diagnosed’ Spc. John Etterlee’s PTSD after conducting a paper review of Etterle’s prior PTSD exams performed by VA psychiatrist Lawrence Smith, PhD. Danner changed Etterlee’s PTSD diagnosis to a lesser condition known in medical lingo as ‘adjustment disorder.’ By doing so, Danner in effect, denied Etterlee from receiving medical benefits that the Army would have had to pay him under federal law.

Despite the painful back injury, he was briefly redeployed to the Middle East. Back at the base again in 2010, Etterlee was at the end of his rope.

Finally, on July 15, 2011, a Veterans Affairs (VA) psychiatrist interviewed Etterlee and diagnosed him with Post-Traumatic Stress Disorder (PTSD).

But five months later the diagnosis was abruptly changed to “adjustment disorder”—a lesser condition—by a forensic psychiatrist at Madigan Army Medical Center in Tacoma.

The switch was made even though the clinician merely reviewed paperwork and never spoke with Etterlee or met him face-to-face. Only later did Etterlee learn that he was one of several hundred Fort Lewis soldiers who’d had their PTSD diagnoses downgraded by Madigan doctors.

A controversy erupted after several servicemen stationed at JBLM complained about the PTSD screening team—the only one of its kind in the military—at Madigan that overturned their original diagnoses.

Internal memos emerged revealing that the military psychiatrists had been told by higher-ups to consider the long-term cost of a PTSD diagnosis, which qualifies a soldier for a lifetime of increased disability payments. In some cases, the memos noted, the total taxpayer burden could be as much as $1.5 million for a single soldier over the course of his or her lifetime.

“By downgrading me to adjustment disorder,” Etterlee came to realize, “they’re eliminating the medical retirement [benefits] and compensation. I was pretty angry.”

Col Dallas Homas

Both the Madigan commander, Col. Dallas Homas, and the leader of the forensic psychiatry team were relieved of their duties earlier this year, and an investigation into the PTSD diagnosis reversals is ongoing. Army leaders ordered a system-wide review of their behavioral health-care practices, and announced last week that they would end the use of forensic psychiatry for disability evaluations.

Col. Homas was reinstated as commander of the hospital. 

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