Military Psychiatrists Must Determine If Soldiers Can Return to Duty

The Continuity Care Services (CCS) in the department of psychiatry at Walter Reed Army Medical Center determines the occupational outcome of soldiers it has treated from military operations in Iraq and Afghanistan.

Psychiatric residents training at Walter Reed and assigned to the CCS have daily interaction with the soldiers who are receiving intensive outpatient services. One of their responsibilities is to evaluate the soldier's fitness and readiness to return to duty.

Of the 423 soldiers evaluated and treated by the continuity service from March 2003 through November 2004, psychiatrists found that 218 of them were too impaired to return to active duty. The rest were found ready to return to active duty, according to data collected by the CCS.

Those who return to active-duty typically leave Walter Reed after a few weeks stay and return to their home base.

However, soldiers determined by physicians to be too ill or impaired to return to active duty receive ongoing treatment, typically as outpatients. The physicians who made the occupational decision must justify it based on a comprehensive evaluation, diagnosis, compliance, and response to treatment, and other factors.

“An important criterion for psychiatrists to consider is whether the illness can be treated effectively and safely with available medications and/or therapies,” Col. Douglas Waldrep, MC, USA, told Psychiatric News. He was the chief of the CCS for three years until last June (see article above).

“Nearly all soldiers diagnosed with psychosis, bipolar disorder, and schizophrenia, which are complex disorders and often treatment resistant, receive a medical board. By contrast, soldiers with major or severe depression rarely receive a medical board because they can be easily treated with SSRIs,” Waldrep said.

The medical evaluation board process includes a physical evaluation, hearings, and disability reviews. The outcome for most soldiers is retirement with temporary or permanent disability pay and medical benefits. To qualify, the disability must have occurred while on active duty or been directly affected by active-duty responsibilities.

If the soldier had a pre-existing disorder that wasn't directly affected by active duty, the soldier usually receives an administrative separation from the military with disability severance pay, according to military sources.

The entire medical evaluation board process can take up to several months depending on the soldier's diagnosis and need for treatment and whether the soldier agrees with the findings of the evaluation.

The time also varies by service branch. Waldrep noted that the Army medical evaluation board process takes longer than the Air Force's. The Army has the greatest number of troops of any service branch stationed in Iraq and Afghanistan.

Meanwhile, soldiers waiting for their medical or administrative discharge are placed in a medical holding company, and their care is coordinated by their platoon sergeants, case managers, and staff of the holding company.

As of November 2004, more than 1,300 soldiers serving in Iraq or Afghanistan had been transferred to the medical holding company, including approximately 170 soldiers with primary psychiatric diagnoses, according to Lt. Col. Mary Gary-Stephens, NC, USAR. She is a clinical nurse specialist/case manager in the continuity service who also coordinates the psychiatric care for soldiers.

Gary-Stephens told Psychiatric News that once soldiers are transferred to the medical holding company, “the continuity service collaborates with the medical holding case managers and staff. We also assist in triage of their psychiatric needs and facilitate treatment as needed.”

The continuity service also provides medication, group therapy, social work, and recreational services to soldiers in the medical holding company.▪