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Military officials insist that Bales had been properly screened and declared fit for combat.

Army officials say soldiers sent to war may be checked up to five times, including before being deployed, during combat, once they return home, and six months and a year later. The Army screens soldiers for depression and PTSD, asking questions to find out about any social stressors, sleep disruption and other problems. Those who are detected as having problems go on to a second phase of screening.

Officials say, however, that no test is considered diagnostically definitive for mental illness in general or PTSD in particular.

Critics say the Army has a history of bandaging the problem and rushing troops back into combat by loading them up on prescription drugs. Military courts also do not recognize PTSD as a legitimate defense, said attorney Geoffrey Nathan, who has represented a number of court-martialed troops.

“They’re still in a state of denial as to what combat soldiers go through in the field of battle,” Nathan said.

The Army says it’s committed to the health of the force, pointing out it has invested $710 million in behavioral health care and doubled the number of mental health workers since 2007.

“The Army has a robust policy to return soldiers who are fit for duty to combat units as soon as possible,” said Army spokesman George Wright. “If a soldier has a broken leg, and he is healed, and fully capable of conducting the mission, he’s eligible to return to duty. It’s the same when qualified medical doctors, psychologists or psychiatrists determine a soldier suffering from a behavioral health disorder is healed. If he displays the signs that he’s fully capable of accomplishing the mission as a solider, he’ll be returned to duty.”

Treatment can result in cure for some patients with PTSD, but more often results in improvement in symptoms and functioning, not a complete cure, according to the Army. PTSD can recur after treatment on exposure to other traumatic events or stressors. According to some studies, up to 80 percent of people with PTSD also suffer from another psychiatric disorder, making it challenging to make an accurate diagnosis.

The Army says its doctors look at a soldier’s current clinical condition and rely heavily on the soldier telling the provider whether symptoms have subsided. The Army says it recognizes that deploying a soldier who is not medically ready puts both the individual and unit at risk.

PTSD is a condition that results from experiencing or seeing a traumatic event, whether it’s being in a car crash or witnessing a battlefield casualty.

Browne said a fellow soldier’s leg had been blown off days before the rampage and Bales had seen the wounds. A U.S. defense official said it is likely that a soldier from Bales‘ unit suffered a leg wound a day or two before the March 11 shootings, but military officials have no evidence that this has any connection to the massacre.

Bales also remembers very little or nothing from the time the military believes he went on the rampage, according to his attorney.

Not remembering a traumatic event or avoiding the memory is a classic symptom of PTSD, along with recurrent nightmares, flashbacks, irritability and feeling distant from other people.

But mental health experts believe other factors were at play. Bales‘ personal history shows he had a past assault case involving a casino bouncer that required anger management classes. Another assault allegation involved a woman and her boyfriend outside a bowling alley but ultimately didn’t result in charges. He also had financial troubles.

Those who suffer from PTSD are prone to acting out, according to the Department of Veterans Affairs National Center for PTSD. But the violent behavior is usually against family members or fellow troops, not strangers, mental health professionals say.

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