WASHINGTON — Nearly four in five military personnel returning from the wars in Iraq and Afghanistan who were found to be at risk for posttraumatic stress disorder were never referred by government clinicians for further help, according to a government report.

The report says Defense Department officials were unable to explain why some service members were referred for further help but most were not. Many veterans groups have accused the government of downplaying the risk of posttraumatic stress disorder because of concerns over skyrocketing costs.

The report by the Government Accountability Office, the investigative agency of Congress, is due to be released today.

Posttraumatic stress disorder is a serious psychiatric disorder characterized by disruptive memories and anxieties following traumatic episodes. Soldiers were determined to be at risk for posttraumatic stress disorder if they gave three or more positive answers on a screening questionnaire asking whether they had nightmares about frightening experiences, had avoided situations that reminded them of such events, were constantly on guard, or felt numb or detached from everyday life.

In all, 9,145 service members were found to be at risk out of 178,664 who took the screening test. Of those at risk, 22 percent were referred for further help. The Army referred 23 percent of those at risk, the Marines about 15 percent, the Navy 18 percent and the Air Force 23 percent, according to a draft of the report obtained by The Washington Post.

UNSPECIFIED FACTORS

The final report to be issued today will have the formal responses of the departments of Defense and Veterans Affairs. In the draft report, Pentagon officials are quoted as saying that not all service members who give positive responses to the screening test needed further help, but the report said the officials could not specify what factors are involved in referring some people but not others.

Asked for comment late yesterday, the Defense Department said only that it had "several comprehensive and proactive programs to deal with PTSD." Spokeswoman Cynthia Smith said the most knowledgeable officials were unavailable so late in the day.

"You would think that (referrals for treatment) would be the point of the whole screening tool," said Veterans Affairs spokesman Jim Benson. Benson said that the Defense Department was solely responsible for administering the screening test and making referral decisions.

HEALTH ASSESSMENT

The screening questionnaire is given to returning service members as part of a post-deployment health assessment. VA and Defense Department experts jointly determined that three or more positive answers indicated a risk of posttraumatic stress disorder, according to the report.

After service members complete the screening questionnaire, the responses are reviewed by a Defense Department healthcare provider, who interviews the service member and decides whether to make a referral for a thorough mental health evaluation, the report said. Providers range from physicians to medical technicians.

'SYSTEM IS NOT WORKING'

Deciding whether to refer service members for further help involves judgment, the GAO report said, but the Defense Department "cannot provide reasonable assurance that all (Iraq and Afghanistan) service members who need referrals for further mental health or combat stress evaluations receive such help."

Maine Rep. Mike Michaud, the ranking Democrat on the House Veterans' Affairs subcommittee on health, said screening service members for posttraumatic stress disorder was the right thing to do, but questioned the utility of the screening if people at risk were not given help.

"When 78 percent of the service members who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working," he said in a statement. "Early assessment can prevent tragedy. Untreated PTSD can lead to substance abuse, severe depression and even suicide."