Late Breaking News
Legislators, Military, and Veterans Advocates Clash Over Discharges
WASHINGTON, DC—“I said I didn’t have a personality disorder, and he told me if I signed the paperwork that I would get back home and get help and I would have all my benefits. After the endless nights of sleep deprivation, harassment, and abuse, I finally signed just to get out of there. I was broken.” This is how Spc Chuck Luther described his last few months serving with the First Squadron, Seventh Cavalry Regiment of the US Army to members of the House Veterans Affairs Committee last month.
Luther deployed from Fort Hood to Camp Tajo in 2006. He described an April 2007 mortar attack that occurred very near him. Shortly after, he went to the base’s clinic complaining of severe headaches and problems seeing. While there, he was diagnosed with a personality disorder (PD)—a condition physicians said was preexisting to his having entered the Army. Luther went on to describe a tortuous scenario where he was kept in solitary confinement, abused by medics, and essentially forced to accept being removed from the military with a discharge stating that he had PD.
Two weeks later, he was flown out of Iraq and back to Fort Hood. Two weeks after that, he was discharged. A few months later, Luther went to a VA hospital where he was eventually diagnosed with PTSD, he told legislators. “In June of this year, after two years from the date that I filed a request with the Military Board of Corrections to have my discharge changed from a Chapter 5-13 to medical retirement, I was denied.”
A Continually Contentious Issue
The possibility that servicemembers suffering from service-connected ailments were being falsely diagnosed with PD first arose three years ago. Accusations that first surfaced in the media eventually made their way to Congress, resulting in a contentious hearing of the House Committee on Veterans’ Affairs in July 2007. Soldiers were coming forward and saying that they had been misdiagnosed with PD when they really had symptoms of combat trauma.
A servicemember discharged for a pre-existing personality disorder is not eligible for military benefits. It also makes it more difficult for them to enter the VA healthcare system, since one of the ways a veteran will show up at VA’s doorstep is through the military’s disability assessment process.
In 2007, veterans’ advocates pointed to what they described as a trend by military physicians to misdiagnose service-connected mental health problems as PD and suggested that it was intentional. These misdiagnoses, advocates said, were a way for the military to escape paying benefits and to downplay the rising numbers of PTSD in returning servicemembers.
That hearing three years ago was a contentious one, with Rep Bob Filner, D-CA, committee chair, aggressively questioning VA and DoD officials while ranking Republican Rep Steve Buyer, R-IN, objected to the committee’s jurisdiction over the issue. The hearing last month was, in many ways, a replay of events in 2007.
“This committee doesn’t have jurisdiction over military benefits or discharges,” Buyer declared last month. “I made that point at the hearing three years ago. If progress is going to be made, a joint hearing with the House Armed Services Committee is needed.”
Buyer also objected to the inclusion of Joshua Kors, an investigative reporter for The Nation magazine, who has written a series of articles on PD discharges in the military for that publication. “I would never put a reporter on a panel,” Buyer exclaimed. “Everything you say is hearsay.”
Finally, Buyer revealed that he had possession of Luther’s records, including the records from his attempt to have his military discharge changed. He intimated that the records could be used to contradict what Luther had told the committee regarding the events leading up to his discharge. But Buyer explained that those records were nondisclosable and could not be used by himself or DoD to contradict Luther.
“When you make certain statements, and sitting to your left is a reporter who has made some very exaggerated statements, you disadvantage DoD,” Buyer declared. “Please follow the counsel of your doctors and the mental health professionals who have your best interests at heart [and] not someone who’d use your story to write articles.”
With that, Buyer abruptly exited the hearing, giving his seat over to another Republican committee member.
Reviewing the Numbers
DoD data shows that, from November 2001 through June 2007, there were 26,000 enlisted servicemembers separated from the military because of personality disorders.
In 2008, Congress asked GAO to investigate these discharges across all four services. A survey of four installations—Fort Carson, Fort Hood, Davis-Monthan Air Force Base, and Camp Pendleton—found that discharge paperwork was frequently incomplete and that DoD had no way of ensuring that key personality disorder separation requirements had been followed by the military services.
DoD responded by taking two actions. A January 2009 memo from the under secretary of defense directed military services to provide reports on their compliance with DoD’s PD separation requirements for FY 2008 and FY 2009; and DoD required the services to provide a plan for correcting compliance deficiencies.
GAO was informed that the DoD Office of Inspector General has collected the FY 2008 compliance reports and found noncompliance across the board. DoD OIG has yet to receive the 2009 compliance reports, which were due last March.
In 2007, the Army Surgeon General ordered a review of all of the soldiers who been deployed in imminent danger zones and subsequently discharged with PD—approximately 600 soldiers. Col Rebecca Porter, behavioral health chief for the Army Surgeon General, testified that the review found no improper discharges among those soldiers. “We ensured that not only is there a diagnosis, but the documentation and the rationale [for the discharge] is very clear in the record.”
However, she admitted that prior to the spotlight being put on this issue, record keeping was not “as clear as it could have been.” She also revealed that the review did not involve any interviews with soldiers or their families, who may or may not be able to testify as to pre-existing personality problems.
Porter noted that the Army has started an inspection program where officials will go to treatment facilities and pull records to make sure proper documentation is being kept and the regulations are being followed. Also, the Army will soon require that all discharges for mental health issues of any kind undergo review by the Army Surgeon General’s Office .
Filner pressed DoD officials to justify why a more thorough review of the discharges was not made and expressed disbelief that there was not a single improper discharge found during the review. “Don’t you find it incredible that no mistakes were found?” he asked.
He was also skeptical that so many soldiers with preexisting personality disorders—26,000 between 2001 and 2007—could have made it through the military’s intake screening processes. Jack Smith, deputy assistant secretary of defense for clinical and program policy, explained to Filner that there are inherent limitations in the screening process.
“The screening process is certainly one that presents difficulties,” Smith declared. “It relies on self-reported information. In many cases, people with PD might never have been diagnosed. It’s usually in the performance of duties that problems come to light.”
Such difficulties adjusting to military life usually present early during a servicemember’s career, sometimes during basic training. It is rare, Smith noted, that someone with a personality disorder stays in the military long enough to be stationed in danger zone. “The number of people who served in a danger zone and [are later] discharged with PD is a very small percentage of total PD discharges,” Smith said.
PTSD Rises as PD Falls
The number of military disability evaluation system (DES) cases for PTSD saw a 47% increase in FY 2009 versus FY 2008. In FY 2008, PTSD accounted for 11% of the total DES case dispositions; in FY 2009 they rose to 16% of the total.
At the same time, the number of personality disorder separations across DoD decreased by more than a third since 2008—something that DoD officials attribute to more rigorous separation policies, increased oversight, and a heightened awareness of PTSD.
While not admitting that the two trends are directly linked, or that DoD discharged servicemembers with PD when they were suffering from PTSD, officials did recognize that the military has missed recognizing PTSD before discharging servicemembers. According to Lernes Hebert, DoD acting director of officer and enlisted personnel management, told legislators that DoD was in the process of reaching out to servicemembers discharged with PD and explaining to them that they are still able to seek care at VA if they believe they have symptoms of PTSD.
As long as a servicemember’s discharge is not a dishonorable one, they can come to VA for care. When there, they will be screened for PTSD, TBI, and a number of other conditions. The label of PD on their discharge form would have no impact on their evaluation. “The fact that a servicemember is separated due to PD would not be compelling information when diagnosed by VA,” declared Antonette Zeiss, PhD, VA’s acting deputy mental health chief. “We seek to establish our own diagnoses.”
To date, 7,348 servicemembers who have received PD discharges have sought care at VA—1.3% of all OIF/OEF veterans receiving care. Zeiss noted that a diagnosis of PTSD in a veteran whom the military did not recognize as having PTSD does not necessarily mean the military diagnosis was incorrect. PTSD is a diagnosis that can have very late onset, she explained. “That the diagnosis is different from that made by the military does not mean the military is wrong. They were working with the information they had.”
We Want to Hear From You
Do you believe that the military has misdiagnosed some service-connected conditions as personality disorders in order to escape paying benefits or to downplay the rising numbers of PTSD in returning servicemembers? Click to participate in our poll
Related Psychiatry Articles
- Multiple TBIs, Chronic Pain Linked to Increased Risk of Military Suicides
- Improved Mental Healthcare Demanded After Four Deaths at Atlanta VAMC
- DoD Mobile App Helps Healthcare Providers Track Own Resilience
- New VA Study Takes Issue with FDA's Warnings about Citalopram
- TBI, PTSD Research Will Go On Despite DoD Budget Crunch
- Who Are Most Likely Military Suicide Victims? Guard Study Offers Some Valuable Clues
- Army Seeks to Improve Troop Resilience as Suicides Increase
- Alpha Blockers Tested as Potential Treatment for PTSD Symptoms
- Free Mobile App Offers Tools to Enhance PTSD Treatment
- Enlistment Waivers for Mental Health Tougher to Get with Reduction in Forces