By Stephen Spotswood
WASHINGTON — The U.S. military continues to use improper processes to diagnose significant numbers of servicemembers with pre-existing personality disorders (PD) and then discharge them, according to government documents obtained by an advocacy group.
The Vietnam Veterans of America (VVA) cited new documents released from DoD under the Freedom of Information Act to show the problem is continuing and may be increasing. Personality disorders are considered pre-existing conditions, and servicemembers discharged with those diagnoses are ineligible for financial or medical benefits.
VVA and other veterans’ advocates have spent years advocating reform of DoD’s procedure for identifying and diagnosing PD, contending the disorder can be confused with service-connected mental-health conditions. They also maintain that improper diagnosis of PD has cut hundreds, perhaps thousands, of servicemembers off from the benefits and healthcare services they are owed.
According to a report released by VVA that breaks down information the organization obtained from DoD, the number of PD discharges may be going up, and many of those discharges are still being conducted improperly.
Recruits go on patrol during basic training at Fort Jackson, SC, earlier this year.
Even if recruits meet the physical rigors, they could be forced out of the military
because of improper diagnoses of personality disorders. Photo by Air Force Staff
Sgt. Shawn Weismiller
Personality disorders are a class of mental-health disorder characterized by individuals’ inflexible, socially inappropriate behaviors across diverse situations. It cannot be caused by any other major psychiatric disorder, medical disorder or substance abuse. Neither is it necessarily incompatible with military service but deemed that only when it interferes with the proper execution of a servicemember’s duties.
In 2008, after a series of reports in the media about the inappropriate use of PD discharges by DoD physicians, including allegations that the diagnoses were made to cut down on benefit costs, Congress asked DoD to establish a moratorium on PD discharges.
According to DoD documents, 31,000 servicemembers were separated from the military with a PD diagnosis between FY 2001 and FY 2010. Records obtained by VVA and investigations conducted by the Government Accountability Office (GAO) indicate that hundreds of these discharges were done in violation of DoD instructions establishing protections against wrongful discharge.
According to VVA’s report, those wrongful — or at least poorly conducted — discharges are continuing. One Navy report on 2008-2009 PD discharges states only that only 8.9% of PD discharges were properly processed.
A 2008 GAO investigation had looked at a sample of soldiers discharged for PD and found that between 22% and 60% of those had not actually been diagnosed by a psychologist or psychiatrist as having a PD that interfered with their duties. Additionally, 60% of them never received counseling about their PD before leaving the service.
The report concluded that the military had no way of confirming that military commanders were meeting DoD separation requirements.Servicemembers Lose Benefits after Improper Discharges for Alleged Personality Disorders Cont
As of August 2008, a legal PD separation must meet eight requirements — five general and three specific to servicemembers who have served in a designated imminent danger pay (IDP) area. The first five are: formal counseling of a PD diagnosis and a chance to improve behavior; a diagnosis by a psychiatrist or PhD-level psychologist; a written statement from that mental-health provider that the disorder keeps the servicemember from functioning in the military; written notification to the servicemember of his or her impending separation; advising the servicemember that the diagnosis does not qualify as a disability.
The latter requirement exists because of reports from discharged servicemembers that they were told by military physicians or superior officers that the PD discharge was, in fact, a disability and would allow them to receive benefits and healthcare. The servicemember would then not protest the discharge and, only after leaving the military, would they discover they were ineligible for benefits.
The three additional IDP requirements are: evidence that PD diagnosis was corroborated by a peer psychiatrist; addressing PTSD or other mental-illness comorbidity; the endorsement of the Surgeon General of the military department concerned prior to discharge.
In FY 2008, a 0% compliance rating on some of these requirements by the different services was not unusual. By FY 2010, compliance rates had risen dramatically, with several services showing 100% compliance. As the VVA report makes a point of mentioning, however, the compliance ratings are self-reported by the services.
Substituting AD for PD
From FY 2008 to FY 2010, the number of PD discharges dropped, and PD compliance improved throughout DoD, according to the documents obtained by VVA. During that same time, however, discharges increased for adjustment disorder (AD), defined as a response to a life stress that is out of proportion to the intensity of the event. It manifests as significant emotional or behavioral symptoms that do not meet the criteria for PTSD or anxiety disorder.
VVA has expressed concern that the services are simply substituting AD discharges for PD discharges.
The most complete data VVA received concerning AD discharges was from the Air Force. Between FY 2008 and FY 2010, PD discharges in the Air Force dropped from 840 to 77 — an 87% decrease.
During a similar time period, AD discharges in the Air Force rose from 102 in FY 2007 to 668 in FY 2010 — a 555% increase.
From FY 2008 to FY 2010, the Army routinely discharged more than 2,000 soldiers annually for AD. During those years, the number of those soldiers who had served in imminent-danger areas rose dramatically, from 346 in FY 2008 to 767 in FY 2010, when they made up 37% of all Army AD discharges.
The only other data VVA received through its FOIA request on AD discharges was from the Coast Guard, whose AD discharges rose from 57 in FY 2009 to 109 in FY 2010.
“Unlike personality-disorder discharges, adjustment-disorder procedures were neither the subject of the 2008 GAO investigation nor the centerpiece of congressional hearings that year,” the VVA report states. “To date there has been no examination of the use of AD discharges, and it is unclear whether AD has simply replaced PD as a tool for illegally separating servicemembers.”
VVA recommends DoD revise its regulations so that the requirements for meeting an AD discharge mirror the requirements for PD discharges.
Addressing The Discharged
VVA and other VSOs are concerned about the continuing practice of wrongfully discharging soldiers for personality or adjustment disorders, but they are also concerned about the thousands of servicemembers discharged improperly over the last 10 years who might be due benefits and healthcare and have been unable to receive them.
The report states several times that, to date, DoD has “taken no meaningful steps to redress the wrongful discharges of these thousands of servicemembers.”
“Shame on the Department of Defense,” said Thomas Berger, MD, VVA executive director for the Veterans Health Council. “It acknowledges the widespread illegality of these discharges and changed its rules going forward but has left 31,000 wounded warriors alone to fend for themselves, denied even basic medical care for their injuries.”
DoD has not commented on the report.
At a recent House Veterans Affairs Committee hearing on an unrelated topic, legislators waded into the issue, asking DoD and VA officials how these discharged servicemembers can address what could have been an illegal discharge from the military.
Philip Burdette, principal director of DoD’s Wounded Warrior Care and Transition Policy admitted that, as more attention has been paid to behavioral health issues and diagnoses have skyrocketed, training of behavioral health professionals has lagged.
As for the recourse left to discharged servicemembers, Burdette said, “The ability of a servicemember to challenge and reopen these cases has not been abridged. They’ve been extended. VA has done fantastic work of making those avenues for veterans available.”
Of the VVA report, Burdette said, “I think the role of VSOs is critical. I consider them our conscience.”
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