Aaron Ostrum and his wife thought they got a blessing early last year when the Army reconsidered the former soldier's mental health records and changed his diagnosis to post-traumatic stress disorder.
The couple believed the adjusted diagnosis more accurately reflected the psychological toll of his experiences inspecting mass graves in Bosnia and serving on security details in Baghdad. They expected the PTSD diagnosis would get him better care and more money in monthly disability benefits to support his family.
A year and a half later, they have the PTSD diagnosis in hand, but they're still struggling to get the Army to follow through with changes to his service records and retirement benefits.
"What else do they want? I don't understand," the former Washington National Guard specialist said in an interview at his Pierce County house.
Ostrum, 35, was one of more than 400 military service members and veterans called back to Madigan Army Medical Center in early 2012 amid concerns that doctors there had improperly diagnosed PTSD in such a way that soldiers received fewer benefits than they deserved. Patients met with doctors from other hospitals in what the Army called a fusion cell at Madigan.
Of that group, 158 left the process with new diagnoses for service-connected PTSD. The Army says 13 of them still have unresolved cases in terms of diagnoses or final adjustments to their retirement benefits.
If they were still in uniform, the Army was able to get patients immediate care and make adjustments to their service records, a spokesman for the Western Regional Medical Command said.
But veterans such as Ostrum who had retired before going to the hospital for their reviews had more trouble. They were given a memorandum on how to have the Army update their service records and then left to figure out the next steps on their own.
HELP FROM D.C.
Ostrum, who left the military in 2010, got a rejection letter early last month from the Army office that corrects medical records. The letter ignores the updated diagnosis he received at Madigan last year.
"What a slap in the face," his wife said.
(Both of the Ostrums had civilian careers in law enforcement, and she did not want to be identified in the newspaper or disclose personal details about their family.)
About 40 former Madigan patients, including Ostrum, have sought help with their benefits from Democrat Sen. Patty Murray's office, her spokesman said. Her staffers are still working on some of the cases.
"Sen. Murray was adamant with Army officials from the first moment these misdiagnoses came to light that the Army had to make this right with the soldiers and their families," Murray spokesman Matt McAlvanaugh said. "And that absolutely includes soldiers who were discharged before going through the fusion cell process."
Ostrum had high expectations for the system the Army developed to review Madigan diagnoses.
At the time, Madigan seemed to have the nation's attention, particularly when a hospital ombudsman obtained a PowerPoint presentation that implied Madigan forensic psychiatrists were purposely being critical of PTSD diagnoses to save taxpayers' money in long-term benefits that would be owed to service members.
Murray held a Senate Veterans Affairs Committee field hearing in Tacoma in April 2012. She prodded the Defense Department to reform its mental health programs in every service branch.
In the end, Army investigations concluded that Madigan doctors were doing their jobs correctly, but that the Army needed to update its policies regarding how PTSD is diagnosed. The changes were made in the interest of getting help to more soldiers.
The Army no longer uses forensic psychiatrists at Madigan as extensively as it did before the inquiries.
Once the investigations wrapped up, some former Madigan patients felt frustrated when they could not get answers about their cases from the Army.
"The biggest disappointment for me was the complete lack of communication and lack of understanding of the process," said John Millan, an Iraq veteran and former Washington National Guard soldier who testified at Murray's field hearing.
After the hearing, Millan received a flood of support from officials across the country. He said he went back to Madigan to meet with doctors that spring, and he learned he had a PTSD diagnosis that would enable him to receive a medical retirement.
But when he asked for updates, he'd hear from polite Army staffers who could only tell him, "We don't know," he said.
In April, the Bonney Lake resident received an email out of the blue from the Washington National Guard telling him the Army had approved his medical retirement four months earlier. Its arrival was as mysterious to him as the poor communication he faced in the preceding months.
Ostrum's path through the system began in late 2008 when he returned from a deployment in Iraq with an injured wrist. He wound up in the Warrior Transition Battalion at Madigan, where he received care for his physical injuries and for PTSD.
The Army gave him a medical retirement in the fall of 2010 based on his injuries and a diagnosis he received for an anxiety disorder. He believed he had PTSD based on his treatment plan at the Warrior Transition Battalion, but did not question the anxiety disorder diagnosis. A PTSD diagnosis likely would have given him a higher disability rating, and more money in monthly pay.
REVIEWING THE DIAGNOSIS
As the months wore on, Ostrum remained troubled by nightmares in which he heard the sound of gunfire while he was cornered in a Baghdad alley. He also experienced paranoia, irritability and a strong desire to be away from crowds.
When he got the call to return to Madigan in early 2012, "We thought, 'yes, someone's finally going to advocate for us'," his wife said.
Ostrum's review resulted in a psychologist writing an 18-page report diagnosing him with PTSD. He let a News Tribune reporter read it.
It says Ostrum has nightmares, headaches and paranoia. It cites traumatic scenes he witnessed in Bosnia in 1997, such as observing the excavation of mass graves. His unit on that assignment was charged with disabling landmines.
"I saw lots and lots and lots of dead people, babies," he said.
The report further discusses the stress he felt during his 2008 tour in Iraq, his wrist injury and the fears he had about not coming home from that mission.
"I was 10 feet tall and bulletproof in Bosnia," Ostrum said. "I was no longer 10 feet tall and bulletproof in Iraq. I was a father and a husband. My fear was not being able to see my kids again."
FIGHTING FOR A CORRECTION
The family stayed in touch with Murray's office for guidance on how to adjust his disability benefits, and it submitted the new diagnosis to the Army Board for Correction of Military Records.
On July 29, board acting director Gerard Schwartz signed a memo rejecting Ostrum's request to change his medical records. The document does not mention the April 2012 diagnosis. It's based on his 2010 anxiety disorder diagnosis.
Ostrum said he has submitted an appeal to Schwartz's letter. He's confident it ultimately will be successful. After all, he has his PTSD diagnosis in writing.
"I know it's going to get fixed, but the process shouldn't be so hard," he said. "This whole process has completely rearranged my life. I had to go through everything I dealt with all over again."