Pattern of Misconduct
Psychological screeenings prompt call for more reforms

Psychological screenings are supposed to be the last line of defense that protects troops with invisible wounds from being unfairly discharged for misconduct and stripped of benefits. However, a new investigation by The Gazette has found the screenings, which are mandated by Congress, are not working. When informed of the latest findings, a Colorado congressman and a national veterans organization called for even more reforms.

Psychological screenings are supposed to be the last line of defense that protects troops with invisible wounds from being unfairly discharged for misconduct and stripped of benefits. However, a new investigation by The Gazette has found the screenings, which are mandated by Congress, are not working.

The latest findings have caused a Colorado congressman and a national veterans organization to call for reforms.

If troops break the rules and the Army moves to kick them out, psychological screenings are supposed to assess whether the misconduct is a result of war wounds, and refer troops for treatment and medical discharge with benefits if they are. But The Gazette found the screenings, which are given to thousands of soldiers each year, do not look at the connection between soldiers' injuries and their behavior. In addition, the screenings are so easily manipulated and poorly constructed that wounded troops can be diagnosed with combat wounds such as PTSD and still be kicked out and denied a lifetime of benefits.

The Gazette also found that Army psychologists face pressure to clear troubled troops for discharge, regardless of their symptoms, and sometimes underplay diagnoses or alter records when they learn the Army wants a soldier out.

In cases examined by The Gazette, Army psychologists added falsehoods to medical records that cast soldiers as dishonest and even dangerous, making their discharge more likely. Because of this, senior sergeants with multiple combat tours, long lists of honors and documented combat injuries were cleared to be kicked out.

In 2012, more than 10,000 soldiers were given these screenings throughout the Army. Future screenings will likely impact tens of thousands more as the Army downsizes.

After cutting him off from his civilian psychologist, the Army sent the sergeant to a Fort Carson psychologist who said he did not have PTSD and was cleared to be discharged.

A Gazette investigation in May showed the Army is kicking out more soldiers for misconduct than at any time in recent history. The surge in discharges was especially steep at Army posts most affected by combat, including Fort Carson.

The new findings show discharged troops may have been put out without the review intended by Congress.

"It's an issue the Army is not seeing," said Rep. Mike Coffman, an Iraq War veteran who represents a portion of suburban Denver. Prompted by The Gazette's May investigative series "Other Than Honorable," Coffman introduced legislation in June to study the connection between misconduct discharges and combat injuries. He now is pushing for support in the U.S. Senate. He said the new Gazette findings on screenings show the need for action.

"I served in the military for 21 years and have never seen anything like this," said Coffman. "Tossing people out for minor infractions without care for the very issues that might have caused them to act up? It's really disturbing."

Ensuring reliable screenings is critical, he added, because so-called "invisible injuries" such as PTSD are by far the most common wounds from Iraq and Afghanistan, affecting an estimated 500,000 troops, and repeated studies have shown the injuries make it more likely for troops to get in trouble.

It is easier to fix the screenings now than deal with wrongly discharged veterans, said Alex Nicholson, Legislative Director for Iraq and Afghanistan Veterans of America, an organization with more than 200,000 members that is pushing for better mental health screening for troops.

His organization is pushing Congress to have the military reexamine veterans with PTSD or brain injuries to see if they were improperly discharged in the last decade.

"It's time-consuming and expensive, and it takes toll on these veterans," Nicholson said. "It is better to do it right the first time."

Quick tests before exits

Two senior sergeants at Fort Carson, Sgt. First Class Jason Holmer and Staff Sgt. Cedric Coulter, show how the screenings can fail the combat veterans they were designed to protect.

After three combat tours that left him struggling with post-traumatic stress disorder, Holmer was found passed out in his car on the side of the highway south of Colorado Springs in 2012 and arrested for drunken driving.

When Fort Carson learned of his offense, commanders decided to kick him out.

First, though, they sent the sergeant to Army psychologist Ashley Bittle. Psychologists like Bittle can be the deciding factor in soldiers' careers. In a quick evaluation, usually lasting no more than an hour, they determine whether a soldier meets a threshold of service-caused psychological problems that could require a lifetime of benefits including health care and a pension, or whether the soldier is healthy enough to be punished and potentially stripped of all benefits and given an other-than-honorable discharge.

After Bittle met with Holmer, she stated in his medical records that Holmer — who said he had nightmares, flashbacks and paranoia after 39 months in combat — could have PTSD and needed more assessment. But when his unit communicated to the psychologist that he was slated to be kicked out, the psychologist marked on official forms that he was fine, and cleared him to be kicked out.

At the same time, she emailed Holmer's commander privately and said the Army should get him out quickly. The email, accidently sent to Holmer, said that while the soldier "may have a significant (behavioral health) condition ... I'll be able to clear him, I'll have the (mental status evaluation form) for legal ready as I believe it would be in our best interest to assist in expediting the process..... thank you! :)"

Privacy laws prevent Bittle from commenting.

When Holmer, who has seven medals for heroism, read the email, he asked to see his medical records. The psychologist refused. When the sergeant kept requesting the records, the psychologist had him arrested for harassment. The charge was later dismissed in court.

"These people are supposed to be helping you. They're doctors. You are supposed to trust them," said Holmer, 33. "I gave the Army my life, almost literally, then to be betrayed? I don't know what to say."

Staff Sgt. Coulter, another decorated three-tour soldier at Fort Carson, had a spotless record until he transferred to the 3rd Squadron, 61st Cavalry Regiment. The regiment began writing him up for minor infractions, sometimes several times a day, including showing up without gloves and being late to formation.

The unit used the list of infractions to charge Coulter with "a pattern of misconduct" and moved to kick him out of the Army.

Coulter walks with a limp from injuries related to three combat tours, and has been diagnosed with traumatic brain injury and has PTSD flashbacks that can make it hard for him to drive. But this spring when his battalion announced it would kick him out for his list of misconduct write-ups, medical records show that doctors said his injuries were not longer an issue and he did not have PTSD.

"It's a miracle. They say I have all these problems," Coulter said. "Then as soon as they want me out, there is nothing wrong."

When the battalion slated Coulter for discharge, it stopped him from seeing his civilian psychologist, then said it was not the Army but the civilian psychologist who canceled his treatment.

Contacted by The Gazette, the civilian psychologist, Judith Ray, said the statement was "absolutely untrue."

"I would never do such a thing," she said. "It goes against the ethics of our profession."

Asked why she thought Fort Carson officials stopped Coulter's treatment, she said, "Everybody knows they don't like to diagnose PTSD."

In May, after meeting with Coulter once for less than an hour, his Army psychologist, Kelly Moss, said the sergeant did not have PTSD or a TBI, he had "adjustment disorder,"a diagnosis with symptoms similar to PSTD that does not require the Army to provide benefits upon discharge — and he was cleared for discharge.

"It's just crazy, man," Coulter said. "But if they want you out, they're gonna get you out."

Privacy laws keep Moss from commenting.

In response to a request for interviews with 12 Army commanders and medical providers involved in the sergeants' cases, Fort Carson issued a short statement saying: "The Army does not and will never discharge soldiers to avoid providing the needed medical care and benefits."

Required screenings not working

Congress started requiring the military to screen troops for PTSD before discharging them in 2010 to assess whether their injuries may have caused their misconduct.

The Army complied, but documenting a connection between injuries and conduct creates problems for the military.

Soldiers who are injured are required to go through a lengthy evaluation for medical discharge with benefits. Combat units cannot get healthy replacements until the wounded complete the evaluation, which can take two years.

In comparison, sources say, discharging soldiers for misconduct is quick and easy.

This creates incentive for commanders to choose misconduct and pressure for psychologists to allow it.

Medical staff at Fort Carson, who talked to The Gazette about the issue on condition of anonymity because they fear retribution from their superiors, said while most of the behavioral health staff at Fort Carson behaves ethically, there is constant pressure to minimize soldiers' diagnoses in order to discharge troubled troops quickly, and some psychologists play along.

"The commanders can call and tell them how they want things, let them know if they want a guy out," said a hospital employee who works with troubled soldiers. "Then the doctors say, 'Oh, you don't have PTSD. You have adjustment disorder. You're fine."

An analysis of discharge records by The Gazette shows 96 percent of soldiers screened for a misconduct discharge at Fort Carson in 2012 were deemed fit to be dismissed.

"It's wrong," said an Army psychiatrist with more than 20 years' experience. "A lot of these guys are damaged from combat."

Fort Carson began moving psychologists out of the central hospital and embedding them in combat units in 2008 to make therapy more accessible. The practice has been adopted at many other Army posts. While the move was intended to encourage soldiers to seek help for PTSD, Army medical workers say it also has given unit commanders more influence over psychologists.

The practice creates a fundamental conflict of interest for behavioral health providers, the psychiatrist said. "Their loyalties begin to go toward the commanders. And they can start struggling over whether their primary responsibility is to the good of the patient or the good of the unit. That is a serious breach of medical ethics."

A Fort Carson psychologist told The Gazette that the forms commanders use to request a separation screening include an area where commanders can add their impression of the soldier.

"The command definitely tries to work the system," said the psychologist. "We have guys with serious problems who are not showing up, using drugs, causing problems, and the command will call and say, 'Just clear this guy so we can get him out.'"

In practice, the screenings are not used to see if misconduct is connected to invisible injuries, as the Pentagon claims. While many types of misconduct can be tied to PTSD and other combat-related injuries, psychologists are instructed not to consider the connection during screenings, she said. The goal is to determine one thing: If soldiers are psychologically fit for duty. If soldiers are unfit for duty, they are required to go through the long medical discharge process that could lead to retirement and benefits. If they are fit, whether their misconduct is tied to injuries or not, they are cleared to be disciplined and potentially stripped of benefits.

"These guys may be having issues. They may have PTSD, but that doesn't mean they can't be kicked out. We just look at if they can do their job," the psychologist said.

The conflict between the good of the soldier and good of the unit is so strong that she and other psychologists often won't screen their own patients, because, she said, "in the evaluations we're really representing the Army's interests, not the soldiers'."

Commanders are in a tough position because wounded troops strain the resources of fighting units, the psychologist said, adding, "The Army is not a social welfare organization. We have to focus on the guys who fight wars, not the guys who are done. That's what the VA is for."

Applying for Veterans Affairs benefits, though, can take years. And many soldiers discharged for misconduct are barred from VA benefits as punishment.

The Army refused to make the chief of Fort Carson's behavioral health department, Lt. Col. Charles Weber, available for an interview. In an email statement, Fort Carson's Medical Command said psychologists are independent of the units they work with and commanders have "no influence on diagnosis."

Diagnoses face scrutiny

Army mental health diagnoses have been used for years to discharge combat veterans quickly and without benefits.

From 2004 to 2008 the Army discharged more than 1,000 soldiers per year because psychologists said the troops had pre-existing personality disorders, according to government records obtained by the group Vietnam Veterans of America. After media coverage suggesting many of the soldiers actually had PTSD, Congress issued stringent restrictions on the use of personality disorder discharges, and the number plunged to 17 in 2010.

As discharges for personality disorder dried up, discharges for adjustment disorder almost tripled. Behavioral health staff also routinely downgraded existing diagnoses of PTSD. At Madigan Army Medical Center in Washington, psychiatry staff reversed the PTSD diagnoses of 40 percent of soldiers between 2007 and 2012, according to a report by Sen. Patty Murray of Washington. Hundreds were rediagnosed with PTSD after the practice was exposed.

At Fort Carson, former nurse Billy Gray told The Gazette she came across an email in 2008 in which an Army psychiatrist told an Army psychologist to change a soldier's PTSD diagnosis "or we'll be paying for it the rest of his life."

A current hospital employee who also saw the email confirmed Gray's account.

The nurse reported the email to hospital authorities. While the psychiatrist and psychologist still work for Fort Carson, Gray said she was fired without explanation three weeks after reporting the email.

"It's a dirty business," she told The Gazette. "The Army has been struggling with this issue for a long time."

Concerns about system

Both Coulter and Holmer were spared at the last minute, but not because Army mental health safeguards worked as intended.

Holmer was discharged in June. He canceled a surgery his wife had scheduled, moved out of his rental house, scheduled a moving truck and was ready to move back to his parents in Florida. Then, after multiple appeals by his Army defense lawyer, Fort Carson's commander, Maj. Gen. Paul LaCamera, canceled the discharge and recommended Holmer for further medical evaluation.

Army doctors now say Holmer has PTSD, TBI and physical problems from his deployments that qualify him for a medical discharge.

When asked if he thought it was evidence that the system works, Holmer looked stunned.

"The system works?" he said. "It took a year and a half of fighting to get what was right. I was put in jail. No one in my command would listen to me. A doctor lied to get me out. Just because finally someone listened, I wouldn't say the system works."

Coulter was spared, too.

After months of fighting his battalion for access to doctors and due process, in May, Coulter filed a complaint with the Army's Inspector General and told his congressman and senator how he had been treated. With investigations pending in June, he was moved to another brigade.

He was scheduled to be kicked out July 11. That day he got a text message from his new brigade saying his "separation was revoked."

"No explanation, no going to someone's office to talk, no accounting for everything the old unit did. Just, you are still in the Army," he said. "I feel abused."

He finished his enlistment commitment Sunday and left the Army. He said he still struggles with issues from combat, but after his experiences with Fort Carson, he was wary of staying in the Army another year or two to go through an evaluation for medical discharge with benefits.

"After what I've been through," he said, "I just had to get out."