Salon's Coming Home series showed that soldiers who returned from combat duty with symptoms of stress were often ridiculed or otherwise discouraged from seeking help, were overmedicated or misdiagnosed, or chose to self-medicate with drugs and alcohol. Many had been deployed even though they were already displaying signs of combat stress. Additionally, some of the soldiers involved in violence against themselves or others had preexisting conditions that should have disqualified them from service, but were allowed into a military hard-pressed for new recruits via waivers.

The 126-page report issued by the Army Wednesday -- an epidemiological study, or EPICON in military lingo -- focused largely on 14 of the Army post's soldiers allegedly involved in murders since 2005. Ordered by Fort Carson commander Maj. Gen. Mark Graham in the wake of the slayings, it is studded with statistical evidence that buttresses Salon's investigation. The numbers point to a link between violent behavior and substance abuse, repeated deployments, exposure to combat and enlistment waivers. In addition, many of the 14 soldiers allegedly involved in murders witnessed incidents described in the report as War Crimes. Five either heard of or witnessed the "murdering/killing" of non-combatants; three, "detainee abuse;" and, two, "fabricating evidence to justify attacks or criminal acts."

Yet the Army officials presenting the report denied that it established any cause-and-effect relationships. Eric Schoomaker, the Army's surgeon general, waved his hands across his chest under clear blue skies during the outdoor press conference, dismissing the notion that the report proved a tie between soldier-involved killings and the horrors those soldiers experienced in the war.

"While this is probably the most intensive and in-depth investigation on the clustering of violent-on-violent crimes in the Army that we've ever seen or are aware of," said Schoomaker, "it is still in many respects preliminary."

Without causation, there is no way to establish how the murders could've been prevented. "We would all like to look back at the cluster of misconduct and criminal activities," said Schoomaker, "that resulted in devastating human tragedies here in Colorado and be able to say, 'This is the reason they happened and we know exactly what could have been done to prevent them,' but that's rarely the way things work when dealing with human behavior."

Without causation, there is also limited accountability. While commanders were blamed for standing in the way of soldiers receiving mental health and substance-abuse care, Lt. Gen. Michael Rochelle, the Army's director of personnel, said the report "was not a tool that was intended to be used to either fix accountability or to be used for any sort of disciplinary action that may follow."

Schoomaker, Rochelle and Maj. Gen. Graham, who was also on the podium Wednesday, were able to deny cause-and-effect because of caveats in the study. The authors of the report, a 24-member team assembled the Army's Center for Health Promotion and Preventive Medicine, issued recommendations to stop the belittling of soldiers who seek mental health care and to identify units with high exposure to combat. They stopped short, however, of positing causation, saying that ""the cross-sectional nature of the study does not allow for making causal inferences."

Thus Schoomaker could say, truthfully, "It's pointing the finger to levels of causation, but we don't know direct causation yet. ... I'm very reluctant to put cause and effect there. In fact, the authors [of the report] are very careful to say these are correlations ... not necessarily one causing the other."

Yet Schoomaker also seemed to place some blame on the soldiers themselves for failing to seek help. He suggested that units where the soldiers were more willing to get help were less likely to be plagued with violence. The study, he noted, analyzed two brigades at Fort Carson, the 4th and the 3rd. "What did seem to differ between the two was the willingness and ability of those soldiers within the unit where crimes were committed to seek and get effective care for emerging behavioral health problems -- alcohol and drug problems -- and prompt attention to misconduct."

But Schoomaker also claimed that the experiences of the 4th and 3rd Brigades in combat were "similar." That's not what's indicated in the report -- the 4th Brigade, where the murder suspects were clustered, had eight times more combat deaths than the 3rd. Moreover, the report indicated that the Army itself played a role in denying care to the soldiers -- half, some with suicide issues, were sent back to Iraq "early," according to the report.

U.S. Senator Mark Udall, a Colorado Democrat, who met on Tuesday with Schoomaker, issued a statement following the release of the report, noting it raises "serious questions about whether the military is doing enough to help service members transition from battle back into civilian life."

"This is a matter of life and death, for our service members – and civilians," Udall stated. "We must do everything in our power to ensure that the military is providing all necessary treatment and support to protect our service members, their families, and our communities."

That could be a long road. The report indicated that "overall staffing" for behavioral health at Fort Carson's Evans Army Community Hospital between 2006 and 2008 was just 65 percent of authorized positions.

Instead of receiving proper care, however, these soldiers were ridiculed, discouraged from seeking care, misdiagnosed and given handfuls of medication and not much else for their symptoms. Others self-medicated with alcohol or drugs. Salon also found that some soldiers had troubled pasts and probably should never have been in the Army in the first place.

A new Army investigation of homicides at Fort Carson, released at a press conference at the Colorado Army post today, confirms these findings. According to the 126-page report, researchers found "higher levels of combat intensity" among soldiers who later ended up in trouble (p. 8). They also found "a strong theme of soldiers using alcohol or drugs to self medicate" after returning from war (p. 13). The troops reported problems getting proper healthcare, ridicule for trying, and complained about "an over-reliance on pharmacotherapy" when they did access healthcare (p. 16). A significant number of the soldiers being studied also witnessed incidents described by the report as "War Crimes."

Excerpts from the report follow, beginning with the introduction to the executive summary, which describes how the study was commissioned after "8 [alleged] homicides in the previous 12 months."

The only bright spot in the new suicide data is some evidence that Army efforts to improve suicide prevention -- among other things, implementing "chain teaching" among troops on suicide risk, hiring more mental health workers and releasing suicide prevention videos -- seem to be taking hold. While 31 soldiers committed suicide in January, that number dropped to 28 in February, then 22 in March and then to 10 in April. (The month-by-month chart of suicides that the Army released to Salon is reproduced in its original form on Pages 2 and 3 of this story.)

Previous reporting by Salon has established the connection between combat stress and suicide. According to the new data, among the active-duty troops who have committed suicide so far in 2009, 48 committed suicide after or during a deployment, while only 16 killed themselves without having gone to war. Two of the active-duty soldiers who killed themselves did so after deploying to war four times. Among National Guard and Army Reserve troops, 11 died during or after deployments while 16 killed themselves having never deployed. The figures for the National Guard and Army Reserve include an unexplained bubble of seven suicides among never-deployed troops that occurred in February.

The Army data does not show whether those Guard troops killed themselves after receiving an alert that they would be deployed. Paul Sullivan, executive director of the advocacy group Veterans for Common Sense, says his organization is investigating what appears to be a pattern of suicides following notices to deploy or redeploy.

Salon obtained the data from the Army one day after a soldier at Camp Liberty in Iraq allegedly stormed into a combat stress clinic and gunned down five comrades. Sgt. John Russell, a patient at the clinic, stands accused of killing an Army officer and a Navy officer working on staff at the clinic, as well as three other enlisted soldiers. Russell, 44, was on his third deployment to Iraq and had also served in Bosnia and Kosovo. He is a communications specialist from Sherman, Texas, serving with the 54th Engineering Battalion, based out of Bamberg, Germany.

Army officials confirmed for Salon Tuesday that despite some early rumors, Russell was not wounded by anyone else during the shooting spree, nor did he wound himself. Those officials would not discuss details of the events and would not comment on reports that Russell had argued with clinic staff just prior to the shooting.

The new suicide data obtained by Salon alarmed some veterans' advocates. "There is still a suicide epidemic," worried Sullivan of Veterans for Common Sense. "The Department of Defense failed our soldiers by not conducting pre- and post-deployment medical exams -- not paper screenings -- as required by law."

"This data," he said, "should set off an alarm to initiate medical exams, stop deploying unfit soldiers, launch an anti-stigma campaign and train our soldiers on how to spot mental health conditions."

Noting the shooting at Camp Liberty, and the rash of murders among troops coming back from Iraq and Afghanistan, Sullivan added that, "We may be verging on a suicide-homicide epidemic."

Despite his symptoms, however, the Army diagnosed the first lieutenant with anxiety disorder instead of PTSD. He was also diagnosed with depression and given antidepressants. The Army then "stop-lossed" Marino, to prevent him from leaving the Army although his time was up. He was shipped back to Afghanistan for a second tour in 2006. A diagnosis of PTSD might have kept him from being redeployed and sent back into combat; a diagnosis of anxiety disorder did not.

In two stories published this week, Salon has described how a soldier secretly taped an Army psychologist named Douglas McNinch saying that the Army was exerting pressure on him not to diagnose soldiers with post-traumatic stress disorder. According to McNinch, the Army preferred that he diagnose soldiers with anxiety disorder instead -- the same diagnosis Marino received. Marino's experience is a case study in what happens when Army medical care is influenced by the need to keep soldiers on the battlefield and the need to hold down the cost of long-term disability payments.

Marino returned to the States from his second tour in Afghanistan at the beginning of 2007 with symptoms nearly identical to those he'd experienced after his first tour. But the Army processed him out by Feb. 10, 2007 without a real medical examination. Marino recalls filling out a written questionnaire and then being discharged. "They didn't spend any time checking me when I went out the door."

When Marino left the Army, all he had were his anti-depression pills and a vague diagnosis from the Army. The diagnosis said, essentially, that Marino was anxious and depressed, but that neither his anxiety nor his depression were necessarily caused by the war. His condition worsened. "My wife was pushing me to go to therapy over and over again," he said.

And he did. This time, however, Marino went to a facility in Boston run by the Department of Veterans Affairs, the government agency responsible for pay and benefits for service members after they leave the military. There, doctors diagnosed him with PTSD from the war. This means he can receive therapy tailored to help ameliorate the symptoms of combat stress. He also now receives financial benefits from the VA for his mental wounds.

There is no way of knowing for certain whether the Army misdiagnosed Marino with anxiety disorder instead of PTSD after his initial deployment in Afghanistan. His symptoms, however, suggest that that's exactly what happened. "If you want my opinion," says Marino, "I believe that I did have PTSD after the first tour." Marino thinks the Army misdiagnosed him with anxiety disorder, but "I can't say whether it was by intent or negligence that it was misdiagnosed."

If Marino had not gone to the VA clinic in Boston and asked for help, who knows how long he would have gone on with the wrong diagnosis and without proper benefits. "There are probably plenty of people walking around with the same thing," he said. "PTSD has caused me a lot of hardship. If I can help anyone else with my story I'm happy to do it."

But neither the U.S. Senate nor the Army apparently agrees with McNinch's assessment of the treatment that returning soldiers are receiving. By early July, news of the tape recording had made its way to both the Senate Armed Services Committee and the upper reaches of the Pentagon. Despite prodding from Sen. Kit Bond, the Senate Armed Services Committee declined to investigate the tape's implications. A veterans' advocacy group then had a combative July 14 meeting at the Pentagon with the Army's vice chief of staff, at which the vice chief was reportedly dismissive. Two weeks later, the Army issued the results of an internal investigation and absolved itself of any wrongdoing.

Today's article describes the contentious meeting at the Pentagon, how the tape got to the Senate and the secretary of the Army in the first place, and which Senate aide determined it was not worth investigating. It also details how the individuals assigned by the Army to investigate the tape were connected both to the individual who had allegedly pressured McNinch not to diagnose soldiers as having PTSD and to earlier questionable in-house investigations of Army medical care.

Salon dubbed the soldier who made the tape "Sgt. X" because he is still in the process of being put out of the Army and he fears that if he is identified, it might affect the process meant to gauge his disability. He made the tape during a visit to McNinch's office in June so he could remember what the psychologist told him -- a traumatic brain injury suffered in Iraq has affected his short-term memory. When she heard what McNinch said about PTSD diagnoses on the tape, Sgt. X's wife handed the tape over to Georg-Andreas Pogany, an investigator with a group called the National Veterans Legal Services Program. The NVLSP is a group of lawyers who take on difficult medical entitlement cases for soldiers, free of charge.

Pogany told Salon that he found the tape shocking. On July 2, he handed it over to the Fort Carson's post commander, Maj. Gen. Mark Graham.

In a telephone interview, Graham refused to name Pogany as the man who gave him the tape, but confirmed that he had received it and that it set off alarms. "Anytime anyone brings me information regarding the health and welfare of our soldiers, I take it very seriously, as I did this," Graham said, adding that he has not yet seen the results of Army's internal investigation.

After receiving the tape, Graham forwarded it up the Army chain of command, where it ultimately wound up in the hands of Gen. Richard Cody, then the Army's vice chief of staff.

At about this same time, Sen. Kit Bond, R-Mo., a longtime champion of veterans' issues, also became aware of the tape. Bond's staff attempted to prod the Senate Armed Services Committee into an independent investigation of the implications of the tape, but were ignored.

Salon has learned that Gerald Leeling, a majority counsel to the Senate Armed Services Committee, was informed of the tape and its contents. Leeling reports to Sen. Carl Levin, D-Mich., the chairman of the committee. However, there is no evidence that Levin's committee ever launched an investigation or did anything to check whether the Army's investigation was thorough and unbiased.

Leeling did not respond to a request for an interview. A committee spokeswoman released a statement, essentially deferring to the official Army line: "The Army conducted an investigation into whether mental health providers at Fort Carson were being pressured by the Command to change diagnoses from PTSD to Anxiety Disorder. The investigation found that that there was no command pressure to influence diagnoses."

While the Senate was declining to act last July, there was building pressure within the Army to do something about the tape. (Heat would come from the outside as well -- though the timing of the contact is unclear, a spokeswoman for Sen. Bond confirms that the senator personally contacted Army Secretary Pete Geren to express alarm about the implications of the recording.)

On July 10, the Army initiated an investigation. In addition, Gen. Cody, the Army's second-most-powerful officer, contacted the NVLSP to arrange a meeting at the Pentagon.

The Pentagon's sprawling parking lot shimmered with heat as Bart Stichman, a co-executive director for the NVLSP, arrived for a face-to-face meeting with Cody last July 14, flanked by fellow co-executive director Ron Abrams and investigator Andreas Pogany.

It was already halfway through a year that would mark the highest suicide rate in Army history. And Stichman, Abrams and Pogany were aware of the Army's apparent pattern of misdiagnosing troops, often leaving them without access to the best care for their war-related mental injuries and possibly no care at all. "We have seen other cases like this, where diagnoses are changing over a short time frame," Stichman's investigator, Pogany, said in a recent telephone interview. "We are seeing what is described on the tape."

The three were hopeful, however. If anybody had the power to recognize the real problems and start fixing things, it would be Cody.

The three entered a conference room deep inside the Pentagon to meet with Cody and an A-list of Army power players: Lt. Gen. David Huntoon, director of the Army staff; Maj. Gen. Bernard Champoux, chief legislative liaison; Brig. Gen. Gary Cheek, director of the Army's wounded warrior transition program; Cheek's chief of staff, Col. Jimmie Keenan; Lt. Gen. Scott Black, the Army's top lawyer; Brig. Gen. Jeffrey Phillips, deputy chief of public affairs; and Col. James Polo, assistant deputy for health policy.

Stichman and his colleagues felt somewhat optimistic simply because Cody was the one who had called the meeting. But in person, Cody set a cold, browbeating tone early. "Are we tape-recording this meeting?" Cody joked icily. "Do you advise your clients to tape-record meetings?" To Stichman, it seemed Cody was trying to imply that Sgt. X and his tape were part of a setup and that the NVLSP was involved.

Stichman started with a discussion of some of the problems identified by his organization. "We were going to go over what the problems we saw were and what could be done about it," Stichman recalled to Salon. He hoped the tape might spur the Army to launch an independent probe to see whether Army doctors elsewhere also felt pressured to issue misdiagnoses for combat veterans.

But when the discussion came to the subject of the tape, Cody cut Stichman off. The tape should stay private, Cody argued, citing a "moral obligation to protect this soldier." Cody then suggested that the psychologist, McNinch, might have felt "pressure" to make timely disability payment decisions for soldiers, rather than pressure to misdiagnose soldiers, although on the tape the psychologist clearly stated he was pressured "to not diagnose PTSD and diagnose anxiety disorder."

Stichman was stunned. "Look, we can understand English," Stichman said to Cody. "I don't know if you heard the same thing we heard, but the guy clearly says he's pressured not to give diagnoses of PTSD."

Cody seemed unconcerned, Stichman recalled. "To our surprise, when we came into that meeting, he no longer seemed to be disturbed by that tape. He said there was going to be an investigation, but that he didn't see anything wrong and felt that the Army is doing well by soldiers. It was clear that they weren't taking it seriously. It was very disheartening. I was in disbelief."

Stichman's NVLSP counterpart, Abrams, recalled that Cody avoided talking about the specifics of the tape or discussing how a thorough investigation of the tape might ultimately improve Army mental health care. Instead, Abrams remembered Cody describing Army initiatives to improve mental health care, including efforts to deal proactively with suicide risk through "chain teaching" -- commanders supporting commanders to get soldiers help. In other words, Abrams said, Cody seemed reluctant to explore whether the tape was a representation of specific abuse and possibly wider problems. Instead, Cody merely spoke in broad terms about how the Army's existing healthcare system operates. Cody's tone, Abrams said, was "insulting."

Cody told Stichman and his associates that an internal investigation of the tape would be conducted. To Stichman's surprise, Cody then suggested what the not-yet-completed investigation would reveal.

Cody denied that the Army was pressuring doctors not to diagnose PTSD in soldiers. "There is no one in leadership telling doctors to do this," stated Cody. "This is not Army policy." Cody called the evidence on the tape "anecdotal."

After the meeting was concluded, Stichman never heard from Cody again. None of the other officers in the room contacted Stichman, either. Just three weeks after the meeting, Cody retired from the Army. Last September, the former general joined L-3 Communications, a defense contractor, as corporate vice president. Salon described this article to an L-3 spokeswoman and requested an interview with Cody, but was told Cody was "not interested" in talking. "He has retired and moved on," the spokeswoman said.

On July 28, a week before Cody's retirement, the Army completed its internal investigation, an informal review known as an "AR 15-6."

Salon requested a copy of the investigation in November through the Freedom of Information Act. The Army finally produced a copy in March, after it became apparent that Salon had obtained the recording and planned to write about it. Large portions of the report are blacked out, including several entire pages of the "analysis of evidence" and the explanation of the conclusions. The Army even blacked out some references to "PTSD."

What is not blacked out is that the Army Medical Command, which investigated itself, determined that none of the medical workers under its watch did anything wrong. "This investigation," it states, "does not find that any level of [the Army Medical Command] staff and leadership have attempted to coerce or otherwise influence the outcome of clinical evaluations."

What also escaped the black pen was the name of the man who presided over the review: Brig. Gen. James Gilman, who commands Great Plains Regional Medical Command, which oversees several Army hospitals, including the one under scrutiny at Fort Carson. Gilman assigned Col. Bruce Crow, the clinical psychology consultant to the Army surgeon general, to supervise the actual investigation.

Almost the entire investigation consists of questionnaires handed out to a handful of healthcare providers. There is no interview of Sgt. X, the soldier who made the tape, or any review of his case.

The copy of the investigation ultimately obtained by Salon shows that the Army reached almost exactly those conclusions that Cody had predicted it would reach: "This investigation does not find that any level of [the Army Medical Command] staff and leadership have attempted to coerce or otherwise influence the outcome of clinical evaluations."

Yet the investigation found "potential systemic pressures" that could cause a misdiagnosis. Those pressures "may lead providers to avoid making a diagnosis of PTSD ... contrary to their clinical judgment." The Army says it fixed those problems last December by removing a requirement that soldiers produce "credible supporting evidence" that they faced trauma in war in order to receive benefits.

In addition to relying almost exclusively on questionnaires to a handful of Army healthcare officials and failing to interview Sgt. X or scrutinize his medical records, the Army also did not interview the NVLSP's Pogany, who has documented several cases that support what was said on Sgt. X's tape. And there is no evidence the Army went back to see how many soldiers might have been refused benefits to which they were entitled during the years since the nation began its wars in Iraq and Afghanistan.

Gilman, the general who ordered the Army's investigation, defended the Army's response to the tape. "We were very, very concerned about what we heard on the tape," he said in an interview. "We felt that an investigation was warranted and we moved out on that as expeditiously as we could." He also supported the idea of limiting the investigation mostly to questionnaires sent to healthcare providers. "The thing that concerned me was that internal to the hospital … somehow people were getting the word that people should use something other than good clinical practice and clinical judgment to assign diagnoses," Gilman said. To investigate that, he added, "you go talk to the people who are involved in those processes."

It appears, however, that investigators did not question the Army officer who Douglas McNinch said had pressured him not to diagnose PTSD. In an interview with Salon, McNinch said the pressure to misdiagnose soldiers came from the psychiatrist who used to head the Department of Behavioral Health at Fort Carson. "His name was Steve Knorr," McNinch said. When asked if he told Army investigators this information, McNinch responded, "Yes, I did." Though the extensive redaction makes it difficult to say for certain, there is no sign in the report that Knorr was contacted or interviewed by Army investigators.

McNinch also said he was afraid to talk. He himself suffers from medical issues and, as a civilian employee of the Army, is going through the process of getting government benefits. "I am going through a disability process right now," he said, "and quite frankly, I would not put it past the Army to, you know, fuck me over, to be blunt."

McNinch's naming of Knorr is particularly intriguing, given that Knorr's name has come up before in connection with internal investigations of possibly questionable Army medical care. In a 2007 article for the Nation, journalist Joshua Kors documented a shocking coverup of Army misdiagnoses. The Army was apparently diagnosing soldiers as having "personality disorders" instead of combat-related stress. Since "personality disorders" supposedly preexist military service, they cannot be attributed to combat, meaning veterans are potentially ineligible for proper benefits. Kors reported that Knorr conducted a review of cases on behalf of the Army's acting surgeon general and determined that no one in the Army had done anything wrong. Within a year, in response to the Nation article, the Government Accountability Office, the investigative arm of Congress, released a report questioning why 2,800 war veterans had been diagnosed as having "personality disorders."

Contacted by Salon, Knorr said, "I don't talk with media. Good day," and hung up.

Salon has learned that one of the officers conducting the investigation of the tape is a junior officer to Knorr at their shared Army post. Lt. Col. Kris Peterson, chief psychiatrist at Madigan Army Medical Center at Fort Lewis, Wash., assisted Col. Bruce Crow in the investigation of the tape. Knorr is now a health consultant at Madigan.

Crow, meanwhile, was also implicated in the "personality disorder" scandal. As Knorr was writing up his review back in 2007, the Army dispatched Crow to Congress to "set the record straight," as he told the House Committee on Veterans' Affairs on July 25, 2007. Crow said the Army would study soldiers dismissed with personality disorders but suggested the Army was doing nothing wrong. He said soldiers with a diagnosis of personality disorder only "feel" they have been wrongly separated from the Army. "I want to assure the Congress that the Army Medical Department's highest priority is caring for our warriors and their families," he told the panel.

In a statement to Salon, Col. Catherine Abbott, an Army spokeswoman, reiterated Gilman's defense of the Army's internal investigation of Sgt. X's tape. "They did do an investigation into it," said Abbott in a phone interview. "There was indeed no pressure and no coercion to make any diagnosis other than the correct ones,."

"This story," Abbott said, "is over and done with."

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Tomorrow: Salon explores the possible motivations for the Army to avoid recognizing the size and scope of psychiatric injuries among American ground troops, and examines the case of one soldier the Army seems to have misdiagnosed.