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.
Dr. Harry Croft, a San Antonio, Texas, psychiatrist who has diagnosed 7,000 veterans with PTSD for the Veterans Affairs Department and written the book "I Always Sit With My Back to The Wall" about PTSD said the case has set back years of work to erase the perception that veterans are walking time bombs who can go off without warning. Veteran advocates point to one tabloid headline labeling the then-unidentified suspect "Sergeant Psycho."
That stereotype, they say, has caused employers to shy away from hiring veterans returning from war and steered singles away from getting involved in relationships with them.
"Even the most severe cases of PTSD alone would not have caused such a heinous act like this," Croft said. "Something else was definitely going on, most probably severe depression, psychosis, substance abuse or he received some terrible news from home that pushed him over the edge."