Lieutenant General Patricia Horoho, the Army surgeon general, initiated the review in response to the discovery that hundreds of soldiers being treated for post-traumatic stress disorder had their diagnoses reversed after being seen by psychiatrists at the Madigan Army Medical Center in Washington State.

The medical center is located at Joint Base Lewis McChord, the home base of Staff Sergeant Robert Bales, who is suspected of killing 16 people, including nine children, in a shooting rampage in Afghanistan this month.

Bales was on his fourth deployment to a war zone in the past 10 years. His civilian lawyer told Reuters last week that PTSD would likely be part of the defense.

PTSD is a huge issue for the Defense Department. A recent Army study estimated as many as 20 percent of the more than two million U.S. troops who served in Iraq and Afghanistan could suffer from post-traumatic stress disorder. Cost of care could range between $4 billion and $6.2 billion, it said.

The Army is looking at whether doctors at the medical center were influenced by the cost of PTSD diagnosis in terms of pensions and other benefits. One psychiatrist said the cost to taxpayers was $1.5 million over the lifetime of a soldier on medical retirement, the Seattle Times reported.

The review being carried out by the Army inspector general aims to ensure that standardized diagnostic procedures are followed by all psychiatrists “and equally important that fiscal considerations are not in any way a part of the evaluations," McHugh said. “It's simply unacceptable."

Referring to Bales, Representative Bill Pascrell, founder of a U.S. congressional task force on brain injuries, told reporters he wanted to “cradle this soldier in our arms" while condemning his actions until it could be determined what happened to him and whether he was properly tested and treated.

Bales had received a traumatic head injury and lost part of a foot during previous deployments in Iraq. The incident raised questions about the stress of repeated deployments, but McHugh said four was not uncommon.

“We have in the military writ large over 50,000 folks in uniform who have had at least four deployments," McHugh told members of the defense panel of the Senate Appropriations Committee.

'VERY CONCERNING'

Patty Murray, a U.S. senator from Washington State, told McHugh it was “very concerning" that 40 percent of the service members with PTSD who were seen by psychiatrists at Madigan “had their diagnosis changed to something else or overturned entirely."

“What it says is that over four in 10 of our service members -- many of whom were already being treated for PTSD -- and were due the benefits and care that comes with that diagnosis had it taken away by this unit," she said. “They were then sent back into the force or the local community."

General Ray Odierno, the Army chief of staff, said the Army wanted doctors and psychiatrists to have the attitude they were “patient advocates."

“That's the mindset that we're going to work on changing -- to make sure that everybody understands that," Odierno said. “We are patient advocates. We are trying to get the best for what is right for our soldiers."

But Murray said senior military leaders had been saying that since the start of the war a decade ago.

“It's really disconcerting after 10 years to find now that that has not been the case," she said.

Murray said it was important to focus on the issue system-wide to make clear that “it isn't the cost of PTSD or any mental health evaluation that is of concern to the Army... It is making sure that those men and women get the care."

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