[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
PERSONALITY DISORDER DISCHARGES:
IMPACT ON VETERANS' BENEFITS
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 15, 2010
__________
Serial No. 111-97
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
BOB FILNER, California, Chairman
CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking
VIC SNYDER, Arkansas CLIFF STEARNS, Florida
MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas
STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, Jr., South
Dakota Carolina
HARRY E. MITCHELL, Arizona JEFF MILLER, Florida
JOHN J. HALL, New York JOHN BOOZMAN, Arkansas
DEBORAH L. HALVORSON, Illinois BRIAN P. BILBRAY, California
THOMAS S.P. PERRIELLO, Virginia DOUG LAMBORN, Colorado
HARRY TEAGUE, New Mexico GUS M. BILIRAKIS, Florida
CIRO D. RODRIGUEZ, Texas VERN BUCHANAN, Florida
JOE DONNELLY, Indiana DAVID P. ROE, Tennessee
JERRY McNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia
Malcom A. Shorter, Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
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C O N T E N T S
__________
September 15, 2010
Page
Personality Disorder Discharges: Impact on Veterans' Benefits.... 1
OPENING STATEMENTS
Chairman Bob Filner.............................................. 1
Prepared statement of Chairman Filner........................ 39
Hon. Steve Buyer................................................. 10
WITNESSES
U.S. Government Accountability Office, Debra A. Draper, Ph.D.,
M.S.H.A., Director, Health Care................................ 20
Prepared statement of Dr. Draper............................. 56
U.S. Department of Defense:
Lernes J. Hebert, Acting Director, Officer and Enlisted
Personnel Management, Office of the Deputy Under Secretary of
Defense (Military Personnel Policy).......................... 22
Prepared statement of Mr. Hebert........................... 61
Major General Gina S. Farrisee, Director, Department of
Military Personnel Management, G-1, Department of the Army... 29
Prepared statement of General Farrisee..................... 63
U.S. Department of Veterans Affairs, Antonette M. Zeiss, Ph.D.,
Acting Deputy Chief Patient Care Services Officer for Mental
Health, Office of Patient Care Services, Veterans Health
Administration................................................. 32
Prepared statement of Dr. Zeiss............................ 65
______
Luther, Sergeant Chuck, Killeen, TX.............................. 4
Prepared statement of Sergeant Luther........................ 47
Kors, Joshua, Investigative Reporter, The Nation. Magazine....... 3
Prepared statement of Mr. Kors............................... 40
Veterans for Common Sense, Paul Sullivan, Executive Director..... 15
Prepared statement of Mr. Sullivan........................... 50
Vietnam Veterans of America, Thomas J. Berger, Ph.D., Executive
Director, Veterans Health Council.............................. 16
Prepared statement of Dr. Berger............................. 54
SUBMISSION FOR THE RECORD
Swords to Plowshares, Amy Fairweather, Policy Director, statement 71
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Follow-up Information:
Clifford L. Stanley, Under Secretary of Defense (Personnel and
Readiness), U.S. Department of Defense, to Secretaries of the
Military Departments, Memorandum Regarding Continued
Compliance Reporting on Personality Disorder (PD)
Separations, dated September 10, 2010........................ 73
Post-Hearing Questions and Responses for the Record:
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Joshua Kors, Reporter, The Nation., letter dated September
21, 2010, and Mr. Kors responses............................. 74
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Thomas J. Berger, Ph.D., Executive Director, Veterans Health
Council, Vietnam Veterans of America, letter dated September
21, 2010, and response memorandum dated, October 29, 2010.... 76
Post-Hearing Questions and Responses for the Record--Continued
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Gene L. Dodaro, Acting Comptroller General, U.S. Government
Accountability Office, letter dated September 21, 2010, and
response from Debra A. Draper, Director, Health Care, letter
dated October 6, 2010........................................ 83
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Hon. John M. McHugh, Secretary, Department of the Army, U.S.
Department of Defense, letter dated September 21, 2010, and
Army responses............................................... 87
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Hon. Robert M. Gates, Secretary, U.S. Department of Defense,
letter dated September 21, 2010, and DoD responses........... 89
Hon. Bob Filner, Chairman, Committee on Veterans' Affairs to
Hon. Eric K. Shinseki, Secretary, U.S. Department of Defense,
letter dated September 21, 2010, and VA responses............ 93
PERSONALITY DISORDER DISCHARGES:
IMPACT ON VETERANS' BENEFITS
----------
WEDNESDAY, SEPTEMBER 15, 2010
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 11:11 a.m., in
Room 334, Cannon House Office Building, Hon. Bob Filner
[Chairman of the Committee] presiding.
Present: Representatives Filner, Donnelly, Buyer, and Roe.
OPENING STATEMENT OF CHAIRMAN FILNER
The Chairman. Good morning. The hearing of the Committee on
Veterans' Affairs will come to order. I apologize for our late
start. As many of you know, we just went through a markup that
took a little longer than expected. I ask unanimous consent
that all Members may have 5 legislative days to revise and
extend their remarks. Hearing no objection, so ordered.
Let me just give some background on the reason for this
hearing. If the first panel would move up to the front, that
would be fine.
In 2007, this Committee held a hearing to explore the
problem of the U.S. Department of Defense (DoD) allegedly,
improperly discharging servicemembers with preexisting
personality disorders rather than mental health conditions
resulting from the stresses of war, such as post-traumatic
stress disorder (PTSD) or traumatic brain injury (TBI). This
means that servicemembers with personality disorder (PDs)
discharges are generally denied key military disability
benefits and the DoD is conveniently relieved from the
responsibility of caring for our servicemembers in the long
term.
These men and women continue to face an uphill battle when
they seek benefits and services at the U.S. Department of
Veterans Affairs (VA) because they must somehow prove that the
so-called preexisting condition was aggravated or worsened by
their military service.
Following our 2007 hearing, the National Defense
Authorization Act for Fiscal Year 2008 included a provision
requiring DoD to submit a report to Congress on this issue. DoD
reported that from 2002 to 2007, the Department discharged
22,600 servicemembers with personality disorders. By the way,
when the DoD has a chance to testify, I would like to see if
they can answer the question, given this large number of
discharges--why were they accepted in the first place?
DoD policy further stated that servicemembers must be
counseled, be given the opportunity to overcome said
deficiencies, and must receive written notification prior to
being involuntarily separated on the basis of a personality
disorder. DoD also added rigor to their guidance by authorizing
such separations only if servicemembers are diagnosed by a
psychiatrist or a Ph.D. level psychologists of the personality
disorder.
It has been over 3 years since we first exposed this issue
at our hearing in 2007. I will add that after it was exposed in
the press, we took it up in the Committee. Mr. Kors, did a lot
of research on this issue and we are glad to have him here
today. We appreciate all of his hard work. Mr. Kors and
Sergeant Luther, could you come up now so that you can be
ready.
It is my understanding that DoD's use of personality
disorder discharges has decreased and that they concluded that
no soldiers have been wrongly discharged. I am rather puzzled
by this conclusion and would like to better understand the
process and the criteria that were used to review the files of
the thousands of servicemembers who were discharged with
personality disorders. I cannot help but suspect that our men
and women are not getting the help that they need and are
struggling with PTSD, TBI, and other stresses of war on their
own because of the wrongful personality disorder discharges.
Stresses of war such as PTSD are debilitating and the
impact can be far reaching. We know of the negative impact that
PTSD and TBI can have on the individual's mental health,
physical health, work, and relationships. We also know that
veterans attempt to self-medicate by using alcohol and drugs.
This means that PTSD and TBI can lead veterans on a downward
spiral towards suicide attempts and homelessness.
Just this past summer, we all heard that the United States
Army reported suicide rates of over 20 per 100,000, which now
exceeds the national suicide rate of about 19 per 100,000 in
the general population. When high risk behaviors such as
drinking and driving and drug overdoses are taken into account,
it is said that more soldiers are dying by their own hand than
in combat. Similarly, we know that homelessness continues to be
a significant problem for our veterans, especially those
suffering with PTSD and TBI.
Now, 3 years later, the Committee continues to hear of
accounts of wrongful personality disorder discharges. This begs
the question of how many soldiers have to commit suicide, go
bankrupt, and end up homeless before real action is taken to
remedy this problem. Clearly, our veterans must not be made to
wait longer and must not be denied the benefits they are
entitled to.
I look forward to hearing from our witnesses today as we
further expose the problem of personality disorder discharges,
better understand the steps that DoD has taken to deal with
this problem, and forge a path forward to help our
servicemembers who were improperly discharged with
personalities disorders.
[The prepared statement of Chairman Filner appears on p.
39.]
The Chairman. When Mr. Buyer returns, I will be happy to
give him time to do an opening statement.
The first panel is made up of Sergeant Chuck Luther, a
veteran who will tell his own story of having personally
experienced this practice. I mentioned Joshua Kors, who is an
investigative reporter for The Nation. Magazine and who has
done some real pioneering research on this subject. We thank
you, Mr. Kors, for your service to the Nation in this regard.
Mr. Kors, you have time before the Committee.
STATEMENTS OF JOSHUA KORS, INVESTIGATIVE REPORTER, THE NATION.
MAGAZINE; AND SERGEANT CHUCK LUTHER, KILLEEN, TX
STATEMENT OF JOSHUA KORS
Mr. Kors. Thank you. Good morning. I have been reporting on
personality disorder for several years, and I am here today to
talk about the thousands of soldiers discharged with that
condition since 2001.
A personality disorder discharge is a contradiction in
terms. Recruits who have a severe preexisting illness like a
personality disorder, do not pass the rigorous screening
process and are not accepted into the Army. In the 3\1/2\ years
I have been reporting on this story, I have interviewed dozen
of soldiers discharged was personality disorder. All of them
passed that original screening and were accepted into the Army.
They were deemed physically and psychologically fit in a second
screening as well, before being deployed to Iraq and
Afghanistan, and served honorably there in combat. In each
case, it was only when they became physically wounded and
sought benefits that their preexisting condition was
discovered.
The consequences of a personality disorder discharge are
severe. Because PD is a preexisting condition, soldiers
discharged with it cannot collect disability benefits. They
cannot receive long-term medical care like other wounded
soldiers. And they have to give back a slice of their signing
bonus. As a result, on the day they are discharged, thousands
of injured vets learn they actually owe the Army several
thousand dollars.
Sergeant Chuck Luther is a disturbing example of how the
Army applies a personality disorder discharge. Luther was
manning a guard tower in the Sunni triangle north of Baghdad
when a mortar blast tossed him to the ground, slamming his head
against the concrete, leaving him with migraine headaches so
severe that vision would shut down in one eye. The other, he
said, felt like someone was stabbing him in the eye with a
knife. When Luther sought medical care, doctors at Camp Taji
told him that his blindness was caused by preexisting
personality disorder.
Luther had served a dozen years, passing eight screenings
and winning 22 honors for his performance. When he rejected
that diagnosis, Luther's doctors ordered him confined to a
closet. The sergeant was held in that closet for over a month,
monitored around the clock by armed guards who enforced sleep
deprivation--keeping the lights on all night, blasting heavy
metal music at him all through the night. When the sergeant
tried to escape, he was pinned down, injected with sleeping
medication, and dragged back to the closet. Finally, after over
a month, Luther was willing to sign anything--and he did,
signing his name to a personality disorder discharge.
The sergeant was then whisked back to Fort Hood, where he
learned the disturbing consequences of a PD discharge--no
disability pay for the rest of his life, no long-term medical
care, and he would now have to pay back a large chunk of his
signing bonus. Luther was given a bill for $1,500 and told that
if he did not pay it, the Army would garnish his wages and
start assessing interest.
Since 2001, the military has pressed 22,600 soldiers into
signing these personality disorder documents at a savings to
the military of over $12.5 billion in disability and medical
benefits. The sergeant's story was part 3 in my series on
personality disorder. In part 2, I interviewed military doctors
who talked about the pressure on them to purposely misdiagnose
wounded soldiers. One told a story of a soldier that came back
with a chunk missing from his leg. His superiors pressed him to
diagnose that as personality disorder.
In 2008, after several Congressmen expressed outrage at
these discharges, President Bush signed a law requiring the
Pentagon to study PD discharges. Five months later, the
Pentagon delivered its report. Its conclusion: Not a single
soldier had been wrongly diagnosed and not a single soldier had
been wrongly discharged. During this 5-month review, Pentagon
officials interviewed no one, not even the soldiers whose cases
they were reviewing.
Three years ago, during a hearing on personality disorder
discharges, military officials sat in these seats and vowed to
this Committee to fix this problem. Three years later, nothing
has happened.
[The prepared statement of Mr. Kors appears on p. 40.]
The Chairman. Thank you, Mr. Kors.
Sergeant Luther, thank you for being here. Thank you for
your service. I know it is not easy to talk about your personal
situation, but we do appreciate it.
STATEMENT OF SERGEANT CHUCK LUTHER
Sergeant Luther. Mr. Chairman, Committee Members, and
guests, thank you for the opportunity to speak and help my
fellow soldiers and veterans by telling my story. I am here
today to say that wearing the uniform for the U.S. Army is what
defined me. I was, and still am, very proud of the service I
gave to my country.
I entered the service on active-duty training status in
February of 1988. I served 5 months on active-duty training
status and then went on to 8 years of honorable Reserve
service. I had a break in service and reentered the Reserves in
2003, and after serving 8 months honorably, I enlisted into the
active-duty Army in October of 2004. I was stationed at Fort
Hood, Texas. I served as an administrative specialist for 3
years and was given several awards for my leadership and
service. I then went to retrain to become a 19D cavalry scout.
Upon finishing school at Fort Knox, Kentucky, I returned to
Fort Hood and was assigned to Comanche Troop, 1-7 CAV, 1st
Brigade, and 1st Cavalry Division. I held the rank of
Specialist ER when we left for Taji, Iraq, for a 15-month
deployment.
We arrived in Iraq in November of 2006. We found ourselves
in a very violent area at the beginning of the surge. On
December 16, 2006, I was working in the company radio area
monitoring the group that we had outside the forward operating
base on an escort mission. I remember that day very clearly.
The call came in from one of our staff sergeants in that patrol
that they had been attacked and one of our vehicles have been
destroyed and we had three killed and one wounded. As we were
receiving the information, we could hear the small arms fire in
the background as they tried to recover the dead and wounded
soldiers.
I served as the training room noncommissioned officer, so I
was asked to translate the combat numbers given over the radio
to my commander and first sergeant for identity. As the
information came over, I realized the truck that had been
destroyed contained one of my close friend, Staff Sergeant
David Staats, and one of the soldiers that I had taken under my
wing, PFC Joseph Baines. I focused on the mission at hand and
that evening, drove the first sergeant and the platoon sergeant
of these soldiers to the mortuary affairs and helped unload
their bodies from the vehicles bringing them home. I pushed
through and the next morning we got word, as we were preparing
to head to Baghdad to see the wounded soldier, that he also
passed away. For the next 2 months, we lost several other
soldiers from our squadron and two Iraqi interpreters.
On February 16, 2007, I was a member of the convoy that
drove out four boats and members of our troop to conduct a
river recon/mosque monitoring mission. After an uneventful
drive out, unload boats, troops, and the soldiers, we headed
back to Forward Operating Base (FOB) Taji. As we pulled back on
the FOB, the call came over the radio that the unit of soldiers
had been ambushed on the river mission. We had to quickly head
to the drop-off location to assist. Upon arriving, we received
small arms and large-scale fire from the enemy. We found one of
our staff sergeants lying in the middle of the beach bleeding
from both legs. One of the lieutenants had been shot in the arm
and two Iraqi police officers had been killed.
We quickly put together two boats of troops and ammo to
retrieve our soldiers. After heading up river, we received fire
on our boat and the boat had capsized and we were stranded on
an island for approximately 14 hours before being picked up. We
have had limited ammunition and no radio communications. We all
thought we were going to die that day.
Fourteen days to the day after that event, I was sent home
for R&R leave. I was very angry, had severe headaches, was
depressed and would cry at times. I have fought with my wife
and family while I was at home. I had an episode where I broke
my hand punching walls. After not being able to cope, I
welcomed the trip back to Iraq. Upon returning to Iraq, I was
promoted to sergeant and received my combat action badge for my
part in the river mission firefights.
After returning from R&R leave, several people in my unit
said that something had changed in me. I tried to pull it
together, but I had trouble sleeping, had anger problems,
severe headaches, nose bleeds, and chronic chest pain. I was
living at the combat post x-ray. While there, I went to see the
medics to get my inhaler for asthma refilled. I was sent back
to the forward operating base, and upon returning to the aid
station, the squadron aid station doctor was not present. I was
told he was busy preparing for his triathlon he would be
competing in after our deployment. I came back the next day and
was seen.
I asked to see the chaplain because I was feeling very
depressed and needed to talk. After talking to the chaplain, I
was sent to the quarters for 2 days and then I was allowed to
go back to the combat outpost. Around the first of April, I was
in guard tower 1 alpha when a mortar landed between the tower
and the wall around the outpost. When it exploded, it threw me
down and I hit my right shoulder and head. I had severe ringing
in my right ear with clear fluid coming from it and had
problems seeing out of my right eye. After a few minutes, I
went to the medics on the outpost and was given ibuprofen and
water and sent back to duty. I started to have worse headaches
and could not sleep.
They sent me back to the forward operating base and I was
seen by the aid station by doctors and medics and then sent to
the mental health center. I spoke with the lieutenant there who
was a licensed clinical social worker. He had a 15-minute talk
with me and gave me Celexia and Ambien. I was sent back to my
quarters. The next 2 days, I began to get angry and hostile due
to the medications, and I was sent back to the lieutenant
colonel. He informed me that if I did not stop acting like
this, that they were going to chapter me out under a 5-13,
personality disorder discharge. I tried and went back to the
aid station.
After several days on suicide watch for making the comment
that if I had to live like this, I would rather be dead, I
asked to be sent somewhere where I could get help and be able
to understand what was wrong with me. I was told I could not go
and demanded I be taken to the inspector general of the forward
operating base. I was told by Captain Dewees that I was not
going anywhere, and he called for all the medics, roughly six
to ten. I was assaulted, held down, and had my pants ripped
from my left thigh and given an injection of something that put
me to sleep. When I awoke, I was strapped down to a combat
litter and had a black eye and cuts on my wrists from the zip
ties.
I eventually was untied and from that point forward for 5
weeks, I was held in a room that was 6 feet by 8 feet that had
bed pans, old blankets and other old supplies. I had to sleep
on a combat litter and had a wool blanket.
I was under guard 24/7, and on several occasions was told I
was not allowed to use the phone or the Internet. I had slept
through chow and asked to be taken to the chow hall or post
exchange to get some food due to my medications. I was told no
and given a fuel-soaked MRE to eat. I was constantly called a
piece of crap, a faker, and other derogatory things. They kept
the lights on and played all sorts of music from rap to heavy
metal all night. The medics worked in shift, therefore, they
didn't sleep. They rotated. These are some of the tactics that
we would use on insurgents that we captured to break them to
get information or confessions.
I went through this for 4 weeks and the HHC (headquarters
and headquarters company) commander told me to sign this
discharge, and if I didn't, they would keep me there for 6 more
months and then kick me out when we got back to Fort Hood
anyway. 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 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. It took 2 more weeks before I was flown out and brought
to Fort Hood. Upon returning, I was told by the rear detachment
acting first sergeant and commander to stay out of trouble and
they would get me out of there. I was sent out to wait on my
wife in the rain with two duffel bags and another carry bag.
This was my welcome home from war.
I went home and I went to sleep, only to be awakened by
three sergeants at my door saying I had to go back to the
mental health due to me being suicidal and they had not had me
checked out yet. I went to the R&R center at Fort Hood, Texas,
and was seen by a lieutenant colonel who was a psychologist. He
asked me why I was brought back from Iraq. I explained they
said I had a personality disorder, and he disagreed. He shook
his head and said that I had severe PTSD and combat exhaustion.
He told me to get to sleep and rest and followup in a week with
him. I was never allowed to go back to see him.
The ironic thing is that in my military records, I held
three Army jobs and had a total of eight mental health
screenings that all found me fit for duty. Also, I had never
had a negative counseling or a negative incident in my 12 years
of Reserve and active-duty career. Two weeks after getting
back, I was discharged from the Army. I had my pay held and
they took my saved up leave from me for repayment of unearned
reenlistment bonus. I received a notice in the mail 3 weeks
after my discharge from the Department of Finance that I owed
the Army $1,501. Three months later, I went to the VA and I was
told they could not see me for the mental health due to my
preexisting disorder. I went back the next week and was seen by
a psychologist.
After an hour with her, she scheduled me an appointment
with a caseworker and then I had several follow-up mental
health appointments. I was given my VA rating a year later in
2008 of 70 percent for post-traumatic stress disorder, knee
injury, headaches, right shoulder, and asthma. Six months
later, after several emergency room visits and neurology
appointments, my rating was upgraded to 90 percent and I was
given service-connection for traumatic brain injury.
In June of this year, after 2 years from the date that I
filed a request with the Military Boards of Correction to have
my discharge changed from a chapter 5-13 to a medical
retirement, I was denied, even after the 3 years of VA medical
documents and evidence from people that know me. I demand my
discharge be changed and I receive the proper discharge for my
service.
I have since founded Disposable Warriors and I have
assisted many veterans and soldiers in a range of issues, from
personality disorder diagnosis to soldiers on Active duty with
diagnosed post-traumatic stress disorder that are not been
treated or being discharged for misconduct other than honorable
or bad conduct discharge, which also does not entitled them to
VA benefits.
I want to say that it has been hell just to get my mind
somewhat back on track and to exist. I have bouts of memory
loss, agitation, flashbacks, paranoia, problems sleeping, and
depression. I get angry every time I look at my DD-214 with the
fraudulent personality disorder discharge. It cost me my
contract jobs for private security after my exit from the Army.
I had to get a job 3 days after I was kicked out of the Army to
feed my wife and three children. I was taught for years in the
Army the definition of integrity, honor, respect, and selfless
service, all of which I gave to the Army but none was given
back to me.
I hold two things very dear to me this day, and it comes
from the noncommissioned officers creed: the accomplishment of
my mission and the welfare of my soldiers. I am on a new
battlefield, with a new mission, and I will, at all cost, take
care of soldiers and their families. I love my country, I love
my Army, but we cannot stand by and watch this to continue to
happen.
At the very same time that this Committee was having
Specialist John Town testify in front of them in 2007, I was
abused, broken, and discharged for the very same thing this he
was testifying about. Please do not let us be here in 3 years
again with another story of shame. The lack of care and
concern, coupled with the stigma of asking for help that we
have allowed to be put on us, has to be totally removed. Then
and only then will we see the veterans homelessness rate drop,
the active duty in veterans suicide rate drop, and the
skyrocketing of divorce decrease. The senior level of the Armed
Forces get it. But they can talk about it, design plans for it,
and make PowerPoints about it, but if it is not being enforced
at the soldiers' level, it is worthless.
In closing, I would like to state that I do not have, nor
have I ever had a personality disorder. I suffer from post-
traumatic stress disorder and traumatic brain injury from my
service to my country while at war in Iraq. I raised my right
hand on several occasions and swore to protect the Constitution
at all cost. I did my part. Now it is time for the military to
keep its part of the agreement that if I were injured, they
would help me get back on my feet. Please help stop these
wrongful discharges and help get our wounded servicemen and
women back to service or back to their families. Thank you.
[The prepared statement of Sergeant Luther appears on p.
47.]
The Chairman. Thank you both for such compelling testimony.
Mr. Kors, the last figure that both you and I had were from
2002 to 2007, stating that DoD discharged 22,600 veterans. Has
that number gone down since we had the first hearing?
Mr. Kors. It was the 22,400. They have added 200 more to
the list. But even that is tremendously outdated. That goes to
2007.
The Chairman. So we don't know what has happened the last 3
years?
Mr. Kors. We don't at all. I think the number of families
who have been purposely cheated out of benefits is just rising
and rising, without stop.
The Chairman. I assume the later panels are here and heard
that question. I hope it is answered. I am sure such an
institution as the Army has more updated figures.
Mr. Kors. I hope so. It is worth mentioning this is not
just the Army. We are seeing personality disorder discharges
across all four branches.
The Chairman. What disorder did they have you down for, Mr.
Luther?
Sergeant Luther. They gave me a personal disorder NOS, not
otherwise specified. They didn't characterize it.
The Chairman. Nothing more specific than that?
Sergeant Luther. No, sir.
Mr. Kors. And that is something you see with all of these
discharges. When you have wounds that clearly don't come from a
personality disorder, a cleaner way to fudge it is to give a
nonpsychological, nonaccurate diagnosis; NOS. You won't find
that in any of the psychological manuals. But it prevents them
from stating specifically what the issue is.
And, of course, these discharges are being used for some of
the most absurd things. Of course, with him, with blindness.
With John Town here 3 years ago after he was wounded by the
rocket and won the Purple Heart, they said he wasn't wounded.
That his deafness came from personality disorder. I think about
Sergeant Jose Rivera. His arms and legs were punctured by
grenade shrapnel. They said those shrapnel wounds were caused
by personality disorder. Sailor Samantha Spitz, her pelvis and
two bones in her ankle were fractured. They said that her
fractured pelvis was caused by personality disorder.
In a case that really touched me of Specialist Bonnie
Moore, she developed an inflamed uterus during service. They
said her profuse vaginal bleeding was caused by personality
disorder. Civilian doctors thought it was something a little
more severe. She went to a hospital in Germany where they
removed her uterus and appendix. But after being given that
personality disorder discharge and denied all benefits, she and
her teenage daughter became homeless. She called me just
because she was concerned that at the homeless shelter her
daughter would be raped.
The Chairman. Sergeant Luther, what you described in the
month or so after they asked you to sign these papers can only
be described as torture, as I listen to it. Did you take any
legal action against the Army for torturing you?
Sergeant Luther. No, sir. At the time, my TDS (Temporary
Duty Station) attorney told me to go ahead and sign it or I
would stay there 6 months. When I got out it took approximately
90 days for me to even get out of my fog to even seek help and
when I went to the VA when they immediately denied me at first
and some psychologist heard me talking and asked me to come
back and then. But I have not been able to take any legal
action. We went through the proper channels to ask the Board of
Corrections to take the evidence and look at it. I just
recently got a copy of that back, and it was pretty astounding.
The Chairman. Maybe Mr. Kors knows this. Does he have any
legal recourse to sue the Army for torture?
Mr. Kors. The Feres doctrine coming out of the Supreme
Court case from 1950, Feres v. U.S., provides a bubble for
military doctors, which regardless of how egregious their
behavior or diagnosis is, they cannot be a sued. A lot of the
doctors I talked to who were pressured to purposely misdiagnose
physical injuries as personality disorder, that was one of the
tactics that their superiors gave them said, look you can go
ahead and do this. You will be promoted for applying the false
diagnosis, and there is no way you can be sued.
The Chairman. Sounds like during this detainment there were
other people besides doctors involved.
Mr. Kors. I think legally it would be a tricky prospect.
The Chairman. All right. Mr. Buyer.
OPENING STATEMENT OF HON. STEVE BUYER
Mr. Buyer. Mr. Chairman, I am going to refer to my opening
statement.
The Department of Defense has the responsibility to ensure
that diagnosis of personality disorders within its ranks are
accurate and the behavior abnormalities are not the consequence
of combat or some other event that might result from post-
traumatic stress. That being said, this Committee does not have
jurisdiction over the military disabilities rating system nor
the discharge procedures. I made this very point 3 years ago
when we held a nearly identical hearing on how the Pentagon
handles the identification and disposition of personality
disorder diagnosis.
Today's hearing takes a slightly different approach as to
how personality disorder discharges impact veterans' benefits,
but the thrust of the discussion is the same. This is primarily
a DoD issue. And if we hope to prompt any effective solutions,
we should have had a joint hearing with the Armed Services
Subcommittee.
As for the topic of today's hearing, I think most
participants can summarize pretty quickly how personality
disorder discharges impacts a veteran's position. Personality
disorders are not considered diseases for VA compensation
purposes and except in cases where they were proximately due to
or aggravated by a service-connected condition. Clearly, if the
VA provides a different diagnosis than the military, then the
condition is considered to have been incurred on active duty.
Service connection may then be established.
So the crux of the problem we are discussing lies with the
accuracy of the diagnosis provided by military physicians. And
if we question whether the misdiagnosis, if there is one, is
due to deliberate actions by some nefarious purpose--that is my
sensing as the testimony--as I listen to the testimony by a
reporter--and they are simply the result maybe even of medical
errors or a line of inquiry that leads back to the DoD. I
expect we are going to hear from DoD and their response to the
issues raised by the 2008 U.S. Governmental Accountability
Office (GAO) report showed that in many instances, DoD was not
following their own procedures and policies regarding
personality disorder discharges. GAO will testify that even
after that, they can still not reasonably say that all the
services are following DoD policies on personality disorders.
Now what is really challenging here for me is--I just want
to be really careful. Number one, Sergeant Luther, let me thank
you for your willingness to serve the country and wear
America's uniform. The United States Army. It is the same
uniform that I have worn for 30 years. So I respect that.
I also have a lot of documents here about you that are
nondiscloseable. And I am not going to discuss them in public.
So when you make statements--you have made public statements--
and I am not going to go into your personal life. I am not
going to discuss your military conditions. But when you make
certain statements and sitting to your left is a reporter that
makes some very exaggerated statements, you disadvantage DoD.
They are going to come up here and, guess what? They can't
specifically talk about your case. They can't come in here and
testify about some of the things that you have said.
You have made some pretty strong statements that are not
supported by what I have. And I am disadvantaged also because,
number one, I am disadvantaged out of respect. I respect you, I
respect your privacy. I also would say this. I would never,
even when I was Chairman of whatever Subcommittee or full
Committee, ever put a reporter on a panel to testify. I would
never do that. Why? Because your testimony is hearsay. It is
hearsay. Everything you say is hearsay. What we are supposed to
do is get to the bottom of things so you can understand that.
You can make whatever allegations you want. You can lead us to
our professional staff and we can find the person. So the
testimony is in first person.
So I would say to the gentleman, you can say whatever you
say and basically you have and you surmised your opinion based
on what you have seen and heard. But I think it is pretty
shocking that you would even come here and provide testimony
with regard to someone's medical condition. You are not a
doctor. If you were a doctor, they would knock you right upside
the head for that. I would be pretty upset if you went and
testified about my medical conditions in a public place, let
alone, where are your sensitivities to talk about a woman and
her health? Wow.
I am pretty shocked that you would do that. So I'm going to
yield back my time, Mr. Chairman. I just want to let you know,
sir, I respect you and I couldn't be more than--gosh, I could
go into this, but sir, my counsel would be is follow the
counsel of some individuals that really have your interests at
heart, and those doctors have your interests at heart. You are
upset with regard to the diagnosis of a personality disorder.
The PTSD has, in fact, been recognized. I have the records with
regard to findings when you attempted to correct the military
records. So I have seen everything that they have seen, and I
have seen the documents with regard to that process.
We want you to get better. We want you get better with
regard to the PTSD, and please, follow the counsel of your
doctors and mental health professionals that take your
interests best at heart, not somebody else that may want to use
you or use your case to write stories or to do other things. If
they truly had your interests at heart, they wouldn't take your
case and what I know about you and put it on public display.
That is Steve Buyer's opinion. I would never do that to a
fellow soldier.
With that, I yield back.
The Chairman. Thank you, Mr. Buyer.
Would either of you like to make a comment? Please feel
free to respond.
Mr. Kors. I would love to address those concerns. Thank
you, Congressman Buyer.
First of all, as to this being hearsay, I hope it is clear
that this is the furthest thing from that. As a reporter, I am
here to summarize the 3\1/2\ years of research I have done on
personality disorders with Sergeant Luther's case,
particularly. I never would have gone into this investigation
if it were a he said/she said story.
In addition to Sergeant Luther's detailed testimony, I have
stacks of medical papers from his doctors at Camp Taji who
documented his confinement. I have an interview with his
commander who was there at the aid station. I have confirmed
every piece of this story. I interviewed Sergeant Byington who
came to visit him while he was confined in the closet. Also,
one of the idiosyncrasies of the story is they did not take
away Sergeant Luther's backpack which had his camera. He was
able to document the closet, take photos of it. Nobody in this
story disputes that this is what happened. The only question
from here is what to do about it.
As for this being an isolated case, I think about Troy
Daniels, a doctor who works extensively with Ft. Hood. He
interviewed or he--sorry, treated Sergeant Luther following his
return to Texas, said in no way did he have a personality
disorder, this was clearly traumatic brain injury and that he
wasn't surprised by this. He had seen a dozen of these
personality disorder cases come out of Ft. Hood, all of them,
he said, did not have personality disorder.
I am simply giving back to you the statements from the
doctors that I have spoken with.
Mr. Buyer. The challenge is, you can't say an emphatic
statement like you just said, all said he does not have. I have
records in front of me.
Mr. Kors. All said what?
Mr. Buyer. I am not going to do this. My integrity as a
gentleman will not permit me to do this.
Dr. Roe, will you take this seat? I am not going to
participate. I'm not going to do it. This is wrong. This is
wrong. Dr. Roe, take over.
The Chairman. Mr. Kors, I apologize for any further
reaction, please, sir? Please.
Mr. Kors. Let me just say further that the Representative
who was upset that I was sharing Specialist Bonnie Moore's
story. These soldiers want their story to be told.
Sergeant Luther, I believe he came here today to represent
those 22,600 families who have been shattered by these false
diagnoses. It is a story that hasn't gotten out to the public
as so many in the military hope it would, and if nobody knows
about this, if these stories don't get out, then this problem
is not going to be fixed. We'll be here, as Sergeant Luther
said, 3 years later with another batch of stories.
The Chairman. I think you have control over your
microphone. There is a button on there.
Sergeant Luther. Just what I would like to say is this. I
am not here just about chuckles. This is larger than I. I
haven't made any statements that were inflammatory or wrong. I
wished I didn't have this story to tell. But what I will tell
you is in the 3 years that I have been treated for post-
traumatic stress disorder and the medications I have been
given, several of my doctors have said to me at different
intervals to make sure I continue to fight to have my
discharged change because it doesn't reflect what my injury is.
I saw a licensed clinical social worker and a pediatrician
in a combat theater for less than 2 hours of face time and was
given the diagnosis of personality disorder. In doing study
over 3 years, that is impossible to diagnose at that interval.
In fact, in the last 3 years, I have been treated--prognosed
and diagnosed for my PTSD and now traumatic brain injury to my
cognitive function disability and if it was a case of a
personality disorder, I think that those licensed psychologists
and psychiatrists would, in fact, have found a personality
disorder and seeing that I have never in my life had any issues
prior to being blown up in Iraq.
Mr. Kors. Mr. Chairman, let me also add one misimpression I
want to make sure that folks from this Committee do not come
away with is that there is any kind of connection between PD,
personality disorder, and PTSD. They have similar letters as
Mark Twain said the difference between lightening and the
lightning bug.
It is true that Sergeant Luther did get shell shock from
his service in Iraq, but we are talking about physical injuries
that are being diagnosed as personality disorder. You know,
with PTSD, it is very easy to make this amorphous argument
that, well, you think he was crazy before or after he served in
Iraq, we think he was crazy before. I guess we both have our
own opinion. With blindness, deafness, a mortar fire wound,
fractured pelvises, you can't make that same argument.
The Chairman. Thank you. Mr. Roe, do you have any
questions?
Mr. Roe. Yes, Mr. Chairman. I didn't hear a lot of the
testimony but just as a veteran and as a medical officer in the
Army, when I was in, I never felt any pressure, I never had
anyone--maybe I was immune to it, I don't know, due to
stubbornness, but I never felt pressure to make diagnosis one
way or the other and certainly diagnosis can be right and can
be wrong. I guess Roe's rule is they haven't invented the test
or diagnosis that hasn't been wrong. So people can make
mistakes, honest mistakes, but as a medical doctor in the
military I never had anyone come to my clinic and pressure me
to diagnose someone one way or the other so that an
administrative discharge or whatever could be made. And I am
not saying it did or didn't happen; I am just saying in the
experience of this doctor it didn't happen. So I yield back.
The Chairman. I thank you, Mr. Kors and Sergeant Luther. I
hope you will stay for the next panels. We may want to have you
respond to what happens. I want to thank you for your courage
in being here. I want to thank you for pursuing this. You are
up against a vast machine, some of that you just saw here, and
I think it is extremely important that all the families get the
best possible explanation. By telling your story, Sergeant, you
have tried to do that.
Mr. Kors, there is nobody who has ever testified in front
of this Committee that didn't reference some hearsay. I have
read all of your materials and I have great confidence in both
the ethics and the integrity of what you have said and the way
you go about it. So, I want to thank you both for your courage
and for your integrity for doing this.
Mr. Kors. Thank you. Mr. Chairman, if I could quickly
address two concerns that were raised by Representative Roe.
First to say that you had asked before about the consequences
for these doctors, whether they be subject to lawsuits. Quite
the opposite has been occurring. Those who have provided these
false diagnoses have been rapidly promoted. I think about
Lieutenant Colonel Applewhite, the social worker who diagnosed
personality disorder on Sergeant Luther. He was immediately
given a slot to teach at Fort Sam Houston a course to other
medical professionals on how to properly diagnose mental
illnesses.
With Captain Wehri, who confirmed that Sergeant Luther was
placed in that closet for over a month, he was promoted to
major and those--and in fact, with that doctor I mentioned who
was encouraged to diagnose that chunk of a missing leg as
personality disorder, the superior who applied that pressure
was immediately promoted to one of the top doctors in the
military.
And also to address the concern of Representative Buyer
that this is not--this is an Army issue and not a VA issue.
Nothing could be further from the truth because so many of
these soldiers, they are told you have a personality disorder
discharge; you are not eligible for VA benefits. So these
people don't go to the VA because they don't think they have a
slot there for them. There are very, very few that find out
through other means like maybe the press that they can get an
independent review from the VA. They will go in and in those
cases, you get the most bizarre outcomes. You have VA doctors
who get to examine them in depth and say this soldier doesn't
have a personality disorder. They have a broken arm or
blindness or traumatic brain injury and then you have what you
have in Sergeant Luther's case with traumatic brain injury and
a large disability benefit finally for that injury but yet the
Army is insisting that he has a personality disorder discharge
and doesn't deserve any compensation. One soldier, two vastly
different diagnoses.
Mr. Roe. Mr. Chairman, may I just make a comment. Mr. Kors,
I don't know the details of this and I am just discussing this
in the broader view. If I served in the military that I thought
my promotion was based on me making a diagnosis, it isn't the
Army that I was in. And you may be--maybe an officer got
promoted after they saw someone. I am sure I did. I got
promoted from captain to major when I was in the Army, and I
saw a lot of people during that time. But the military has
criteria that they do, objective criteria, hoops that you jump
through, at least when I was in the Army to get promoted. I
have never heard of any such thing where somebody made a
diagnosis and then you suggest that they got promoted because
of that. That would be outrageous.
Mr. Kors. This is not to say this was the only reason they
were promoted, but in the case of the doctor who was pressed to
diagnose the missing chunk of the leg, he came to me and said I
want to speak out about this but I was not going to do it. He
retired immediately instead of providing that diagnosis.
Mr. Roe. I yield back.
The Chairman. Again, thank you. I hope you will stay
because we may want to recall you after we hear from the
others. If panel two would come forward, please?
Thank you for being here. Paul Sullivan is the Executive
Director of Veterans for Common Sense (VCS). Dr. Thomas Berger
is the Executive Director for the Veterans Health Council for
the Vietnam Veterans of America (VVA). We appreciate you being
here today. The minority has not requested any background
medical conditions on yourself so we will be fine. Mr.
Sullivan.
STATEMENT OF PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR
COMMON SENSE; AND THOMAS J. BERGER, PH.D., EXECUTIVE DIRECTOR,
VETERANS HEALTH COUNCIL, VIETNAM VETERANS OF AMERICA
STATEMENT OF PAUL SULLIVAN
Mr. Sullivan. Mr. Chairman, yes, I brought my glasses. That
is my medical condition. I need to read my testimony.
I thank you, Chairman Filner and Ranking Member Buyer for
inviting Veterans for Common Sense to testify about the impact
of improper military discharges on our veterans. VCS testified
about this issue 3 years ago. We remain alarmed DoD continues
improperly discharging thousands of our servicemembers who had
entered the military in good health and who served with honor
while deployed to the Iraq and Afghanistan Wars.
DoD may have reduced the number of personality disorder
discharges and that should be noted but DoD now improperly uses
adjustment disorder and pattern of misconduct discharges
instead. While we believe the military causes the problems
associated with improper discharges, the solution requires
cooperation between Congress, the military, VA and advocates.
According to an Army Times article, ``Jason Perry, a former
Army judge advocate who helps troops going through medical
retirement said he had seen dozens of such cases, it's very
common and it's completely illegal.''
We agree with Mr. Perry's assessment. VCS urges Congress to
order an immediate stop to DoD's improper personality disorder
adjustment disorder and pattern of misconduct discharges for
those servicemembers deployed to the war zones since 2001. The
main underlying cause of the improper discharges remains the
enormous pressure from Secretary Gates to curb military medical
spending.
VCS estimates between $5 billion and $20 billion in lost
lifetime and other medical benefits for our veterans and
families. DoD's policy improperly shifts costs from the Federal
Government to veterans and private insurance companies as well
as to State and local governments. VCS remains frustrated the
military has not revealed how many of our Iraq and Afghanistan
war servicemembers were administratively discharged since 2001.
We need facts if we are going to stop the improper discharges
and provide VA care and benefits to otherwise deserving
veterans.
VCS used the Freedom of Information Act to try to obtain
this information from DoD, and DoD said they could not obtain
the data due to computer limitations. As advocates we want to
offer solutions, please.
First, VA training. VA should train benefits and health
care staff about DoD discharges to avoid improper VA denials
for health care and benefits.
Two, there should be new DoD regulations. DoD should update
separation rules to provide greater legal protections for
servicemembers.
Three, correct records. DoD should identify and correct as
many as 22,000 previous inappropriate discharges.
Four, enforce accountability. DoD must improve oversight
and accountability. We are troubled that not a single military
officer was fired or reprimanded for apparently or allegedly
violating servicemembers' rights.
Independent review. Congress should create an independent
review of the overall health of our servicemembers; otherwise
the absence of records allows DoD to plead ignorance, just as
they did with exposures to radiation from atomic bomb blasts,
Agent Orange, and Gulf war illness.
Six, conduct universal mandatory medical exams. VCS once
again urges Congress to order the military to implement
mandatory universal pre-deployment and post-deployment physical
exams as required by the 1997 Force Health Protection Act that
will help alleviate some of the fronts with confusing records.
Seven, fill mental health professional vacancies. VCS urges
Congress to order the military to hire more medical
professionals so our soldiers receive the mandatory universal
exams as well as prompt treatment.
Eight, honor medical opinions. VCS urges Congress to
eliminate the ability of line commanders to overrule the
decisions made by medical professionals regarding the ability
of a servicemember to deploy to a war zone.
Nine, expand anti-stigma education. VCS urges DoD and VA to
expand the agency's anti-stigma education program and to
encourage our servicemembers and veterans to seek care when
needed.
In conclusion, DoD is responsible for most of the problems
discussed here today. However, implementing pragmatic solutions
requires cooperation between Congress, the military, VA, and
advocates. This concludes my testimony, Mr. Chairman. I would
be happy to answer any of your questions.
The Chairman. Thank you, Mr. Sullivan.
[The prepared statement of Mr. Sullivan appears on p. 50.]
The Chairman. Dr. Berger.
STATEMENT OF THOMAS J. BERGER, PH.D.
Dr. Berger. Chairman Filner, Ranking Member and
distinguished Members of the Committee who are still around
here.
On behalf of President John Rowan, our board of directors
and our membership, Vietnam Veterans of America thanks you for
the opportunity to present our views on discharges for
personality disorder and their impact on veterans benefits.
We have heard a great deal of pieces and parts about the
history. I think it is important to remember that personality
disorder is a severe mental illness that emerges during
childhood or adolescence and is listed in military regulations
as a preexisting condition, not a result of combat. Personality
disorder contains symptoms that are enduring and play a major
role in most, if not all, aspects of a person's life.
While many disorders vacillate in terms of symptom presence
and intensity, personality disorders typically remain
relatively constant. In other words, according to the
Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV,
to be diagnosed with a disorder in this category, the symptoms
have been present for an extended period of time, inflexible
and pervasive, and are not the result of alcohol or drugs or
another psychiatric disorder, and that history of symptoms can
be traced back to childhood or adolescence.
At the time the issue first arose back in 2007, VVA and
other veterans advocates, some of whom are present in this
room, contended publicly and in meetings with Congress, that
many of the servicemembers were suffering from post-traumatic
stress disorder or traumatic brain injury but that it was
easier and less costly for the military to separate them into
the rubric of personality disorder, leaving some of us to
believe that such a large number of personality disorder
discharges--remember, 22,600 plus--were, in fact, fabricated to
save on the cost of other more appropriate mental health
treatments and disability benefits. We have also heard from the
Chairman himself about some of the history of the hearings that
have gone on since 2007.
I point out a couple of other elements missing from the
history here, and that is in August of 2008, the Department of
Defense, DoD, issued an instruction that took effect--without
public announcement, okay--that revised how they were to apply
the personality disorder discharge.
In addition, that same summer, the Senate also adopted an
amendment to the Defense authorization bill at the time by
then-Senator Obama, Senator Kit Bond and Senator Lieberman from
Connecticut that directed DoD officials to report on the
personality disorder situation. They did so. Subsequently in
October 2008, GAO released its findings based on a review of
service jackets for 312 members separated for personality
disorder from four military installations. It concluded that
the services were not reliably compliant, even with the pre-
August 2008 regulation governing discharge separations. And,
for example, only 40 to 78 percent of enlisted members
separated for personality disorders had documents in their
files showing that a psychiatrist or qualified psychologist
determined that the disorder affected their ability to function
in the service.
Fast forward to 2010. We now hear the Army say that any
soldier--they deny that any soldier that was misdiagnosed
before 2008, all right, if you look at the number of PTSD cases
that jumped between 2008 and 2009. Something happened. And so
we would like to ask, okay, can the Army explain why the number
of the personality disorder discharges doubled between 2006 and
2008 and then shrunk after that by 75 percent? And how many of
those who got those discharge separations were qualified to
retain their benefits?
I would also like to follow-up with Paul's question: Is the
Army now relying on a different designation, referred to as
adjustment disorder, to dismiss soldiers? It is absolutely
clear either through Congressional action or a Presidential
directive that the Army needs to conduct a thorough review of
its personality disorder diagnoses prior to 2008, treat those
who need help and restore disability benefits where
appropriate.
Thank you, Mr. Chairman, Mr. Roe, for holding this meeting.
I'll be glad to answer any questions.
The Chairman. Thank you, Mr. Berger.
[The prepared statement of Dr. Berger appears on p. 54.]
The Chairman. Mr. Roe.
Mr. Roe. I have a meeting I have to go to at noon, but a
couple of quick questions. And Dr. Berger, you may have the
answer to this. I don't and I hadn't studied this issue before
I came here today, but do you know the incidence of personality
disorder in the population in general.
Dr. Berger. No, I can't give you that figure sir, not off
the top of my head.
Mr. Roe. I wondered if--I guess the question I have is what
percent of troops were diagnosed with personality disorder. In
other words, of that 22,600, what percent of our troops that
are in there have been diagnosed, and is that--you see what I
am getting at? Is it higher or is this a diagnosis that all of
a sudden has exploded in the military but it's not out there in
real life. And your description of personality disorder is
correct, at least my familiarity with it is, that it usually
manifests itself in childhood or----
Dr. Berger. In adolescence. The DSM-4 is clear on it, sir.
Mr. Roe. Kids that are acting out, whatever, you have
trouble dealing with them in high school and so on and usually
don't get into the military, but I think that is a couple, just
from demographics that would be very interesting to see what is
the incidence in the population in general, what is the
diagnosis of that, and then what is the--is it higher here that
we use this diagnosis. And I think if you can find out those
two things you'd find out a lot. I think your question about
between 2006 and 2008 where the incidences doubled and then
dropped down, I think that begs an answer also.
Dr. Berger. Thank you, sir. I am skeptical of the Army's
claim that it didn't make any mistakes because the symptoms of
PTSD, anger, irritability, anxiety, depression, all those kinds
of things we have talked about at other hearings, can easily
under certain kinds of circumstances, can easily be confused
with the Army's description of personality disorder.
Mr. Roe. I yield back, Mr. Chairman.
The Chairman. Thank you. The figures that Mr. Berger
referred to, the doubling from 2006 to 2008, you said shrunk by
75 percent but I didn't get the date by which they had shrunk.
Dr. Berger. Two thousand eight, sir.
The Chairman. In 2008, they had shrunk by 75 percent?
Dr. Berger. Yes. Between 2008 and 2009, the annual number
of personality disorder cases dropped by 75 percent. Only 260
soldiers were discharged on those grounds in 2009. At the same
time, the number of PTSD cases soared.
The Chairman. How about the other diagnosis that Mr. Kors
brought up, the adjustment disorder or pattern of conduct? Do
you have those figures?
Dr. Berger. I don't have those figures with me, sir.
The Chairman. Okay. Mr. Sullivan, I want to thank you for
being very specific in your recommendations so that we can try
to deal with these problems. I don't have a doubt, personally,
that something is going on here. It is hard to imagine--maybe I
am too naive--that somebody is ordering a diagnoses or are
changing a diagnoses. Have you seen that happen or do you know
where that happened that these changes in the figures somehow
changed because of a policy change? It doesn't just happen.
Dr. Berger. That is why we are asking the questions, sir.
Mr. Sullivan. Really what we need, Mr. Chairman, is more
transparency from the Department of Defense because when we see
the number of personality disorders drop after the hearing, yet
the number of adjustment and pattern of misconduct discharges
rise after the hearing, it looks as if the DoD is just playing
one of those shell games, and that is what we want to make sure
is not happening. We want to make sure that servicemembers have
their due process rights upheld because we don't want anybody
to be hazed, browbeaten or, as you used the word, tortured into
possibly signing a document that gives up some of their VA
health care and disability benefits.
Dr. Berger. Mr. Chairman, in reference to the question you
asked a few minutes ago, I can't honestly believe that they
reviewed every single one of those 22,600 cases, okay. They
made the statement in public, though, at least spokespersons
for the U.S. Army medical command said that they did but there
weren't any changes made. I find that--I really find that hard
to believe.
The Chairman. Is there a more specific subset of examples
of personality disorder, because when I asked the Sergeant what
was his personality disorder, they just noted NOS. Are there
more?
Dr. Berger. There are four categories.
The Chairman. Can you give me those?
Dr. Berger. Right off the top of my head--it just flew out
of my head. I think there is three or four categories of
personality disorder.
The Chairman. You would have expected these to be noted in
the pre-physical or pre----
Dr. Berger. Prescreening.
The Chairman. Before they enlisted or volunteered for the
service?
Dr. Berger. Yes, sir.
The Chairman. You would think that they would be noted.
Mr. Sullivan. Mr. Chairman, Dr. Roe actually asked a good
question, but it could be phrased a little bit better if I may.
He said, ask the military how many potential recruits were
actually refused the opportunity to enlist because of the
personality disorder, then you would actually get a better
statistic about what is going on because if the military,
suddenly you see an increase or a decrease in rejections for
personality disorder, then you can say, well, what is the
military doing that is different at the military entrance
processing stations, these MEP stations, where they do these
exams.
The Chairman. Have you seen these statistics?
Mr. Sullivan. No, I don't have them, but that is the kind
of questions that should be asked.
The Chairman. Okay, for panel four, it is going to be
asked. Thank you. We may want to talk to you further. I ask
panel three to come forward.
Dr. Berger. Thank you, sir.
The Chairman. Thank you.
Dr. Debra Draper is the Director for Health Care for the
U.S. Government Accountability Office. You have made several
studies on this issue and we thank you for what the GAO does.
We welcome your testimony today.
STATEMENT OF DEBRA DRAPER, DIRECTOR, HEALTH CARE, U.S.
GOVERNMENT ACCOUNTABILITY OFFICE
Ms. Draper. Chairman Filner, thank you for the opportunity
to be here today as you discuss personality disorder
separations and the impact on veterans' benefits.
DoD policy allows enlisted servicemembers with a
personality disorder to be involuntarily separated if the
disorder is severe enough that it makes the servicemember
unsuitable for military service. Those who are separated solely
on the basis of a personality disorder are ineligible to
receive disability compensation benefits because the disorder
is considered to be preexisting and not a service-connected
condition. Prior to separation, DoD requires the services to
comply with three key requirements.
First, the servicemember must be diagnosed with a
personality disorder, which interferes with his or her ability
to function in the military. Second, the servicemember must
receive notification of his or her impending separation, and
third, the servicemember must receive formal counseling.
But the bottom line is that the military services have not
demonstrated full compliance with DoD's requirements. In my
statement today, I plan to first discuss findings and
recommendations from GAO's 2008 report on personality disorder
separations. I will then discuss what actions DoD and the
military services have taken with regard to our
recommendations.
In 2008, we reported that documented compliance with DoD's
requirements varied by specific requirements and by military
installations. For example, in a review of personnel records
from four military installations, we found that documented
compliance with the diagnosis requirement ranged from 40 to 78
percent; and from 40 to 99 percent for the formal counseling
requirement. Based on these and other findings, we recommended
that DoD direct the military services to develop a system to
ensure compliance with the requirements; and that DoD monitor
the services' compliance. In August 2008, after our review was
completed, DoD clarified its existing requirements and added
new requirements, including, for example: requiring that
servicemembers with a personality disorder diagnosis be advised
that this does not qualify as a disability; and requiring
corroboration of the disorder for servicemembers who have
served in imminent danger pay areas.
In response to our 2008 recommendations, DoD instructed
each of the military services to provide compliance reports for
each fiscal year, 2008 and 2009. The fiscal year 2008 reports
indicated that approximately 2000 enlisted servicemembers were
separated that year due to a personality disorder. Three of the
four services did not demonstrate full compliance with any of
the separation requirements, none of the services demonstrated
full compliance with all of the requirements, and neither the
Army nor the Navy reported the number of separations among
servicemembers who had served in imminent danger pay areas in
accordance with DoD instructions.
Although the fiscal year 2009 compliance reports were due
March 31, 2010, we are unable to comment on them because
despite repeated attempts to obtain them, DoD has not yet
provided them to us. In response to our recommendations, DoD
also instructed the military services to provide a plan of
correction if compliance for any personality disorder
separation requirement was less than 90 percent.
According to the 2008 fiscal year reports, each service has
planned or taken corrective actions to improve compliance. For
example, the Army reported that the Army's office of the
Surgeon General will review all personality disorder separation
cases to ensure that each contains the required documentation.
To summarize, the military services have not demonstrated
full compliance with DoD's personality disorder separation
requirements. Consequently, some servicemembers may be at risk
of being inappropriately separated and as a result, denied
benefits for which they may be eligible. We, therefore,
reiterate the importance of DoD fully implementing GAO's 2008
recommendations.
Mr. Chairman, this concludes my opening remarks. I am happy
to answer any questions.
[The prepared statement of Ms. Draper appears on p. 56.]
The Chairman. Thank you, Dr. Draper. Your summary is very
clear. You said--I am not sure I am quoting you exactly--but
the Department of Defense has not provided information post
2008. Is that what you are saying?
Ms. Draper. They had required the military services to
provide compliance reports for each fiscal year, 2008 and 2009.
They provided us with the 2008 reports but we have attempted
repeatedly to obtain the 2009 reports and they have been unable
to produce them or give them to us.
The Chairman. What is your legal standing in regard to
that? Can you subpoena them? Do you request them and have you
notified Congress that they haven't complied?
Ms. Draper. Well, it is unclear whether the reports
actually exist or they just don't know where they are. They
just have been done so----
The Chairman. Did you ask them that?
Ms. Draper. Well, we did, but no one seems to know where
they are.
The Chairman. Do you have any legal authority to compel
them to provide those reports, assuming they exist?
Ms. Draper. We will have to check into that. Up until this
testimony, we were still trying to obtain the reports.
The Chairman. I assume Congress has that subpoena authority
but we need you to tell us whether you are getting the
information or not. You haven't officially said you are having
problems with those reports.
Ms. Draper. Not yet, no.
The Chairman. Okay. We do appreciate the work that you are
doing and we appreciate your testimony. We will hear from the
next panel and see if we need you back here.
Ms. Draper. Okay. Thank you very much.
The Chairman. Thank you, we appreciate it.
Panel three is excused. If panel four will come forward?
Joining us from the Department of Defense is the Acting
Director of Officer/Enlisted Personnel Management, Lernes
Hebert, accompanied by Dr. Jack Smith, who is Deputy Assistant
Secretary of Defense for Clinical and Program Policy.
Major General Gina Farrisee is the Director of Military
Personnel Management of the Office of the Deputy Chief of Staff
for the United States Army, and General Farrisee is accompanied
by Colonel Rebecca Porter, who is the Chief of Behavioral
Health of the Office of the Surgeon General.
From the VA, we have Dr. Antonette Zeiss, who is the Acting
Deputy Chief of Patient Care Services for the Office of Mental
Health. Accompanying her is Tom Murphy, Director of
Compensation and Pension Services.
And I said Mr. Hebert, I meant Hebert. Is that a better
pronunciation? I apologize. You have prepared testimony but I
would like you to submit those for the record and answer some
of the questions that have come up, but I will leave it to your
discretion to how you are going to do that. I would like you to
throw away your prepared testimony and answer some of the
interesting issues that have been raised, but I will leave it
up to you.
Mr. Hebert.
STATEMENTS OF LERNES J. HEBERT, ACTING DIRECTOR, OFFICER AND
ENLISTED PERSONNEL MANAGEMENT, OFFICE OF THE DEPUTY UNDER
SECRETARY OF DEFENSE (MILITARY PERSONNEL POLICY), U.S.
DEPARTMENT OF DEFENSE; ACCOMPANIED BY JACK W. SMITH, M.D.,
DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR CLINICAL AND PROGRAM
POLICY, U.S. DEPARTMENT OF DEFENSE; MAJOR GENERAL GINA S.
FARRISEE, DIRECTOR, DEPARTMENT OF MILITARY PERSONNEL
MANAGEMENT, G-1, DEPARTMENT OF THE ARMY, U.S. DEPARTMENT OF
DEFENSE; ACCOMPANIED BY COLONEL REBECCA PORTER, CHIEF,
BEHAVIORAL HEALTH, OFFICE OF THE SURGEON GENERAL, DEPARTMENT OF
THE ARMY, U.S. DEPARTMENT OF DEFENSE; AND ANTONETTE M. ZEISS,
PH.D., ACTING DEPUTY CHIEF PATIENT CARE SERVICES OFFICER FOR
MENTAL HEALTH, OFFICE OF PATIENT CARE SERVICES, VETERANS HEALTH
ADMINISTRATION (VHA), U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY THOMAS J. MURPHY, DIRECTOR, COMPENSATION AND
PENSION SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF LERNES J. HEBERT
Mr. Hebert. Yes, sir. I will be happy to submit that,
although it really does answer several questions that have come
up. If you will allow me, I will address some of those.
[The prepared statement of Mr. Hebert appears on p. 61.]
The Chairman. Please.
Mr. Hebert. For instance, you asked why individuals are
accepted with personality disorder discharges. Many times the
individuals don't share the information with the session
professionals, and if it is not diagnosed at the time of entry,
naturally there is no determination that such a diagnosis
exists and there is no indication that they----
The Chairman. They may not tell you they have a broken leg,
but you will find it, won't you?
Mr. Hebert. We can test for that.
The Chairman. I hope that you can test for personality
disorder.
Mr. Hebert. I couldn't speak to that but we have someone
who can.
[The DoD subsequently provided the following information:]
L All applicants for military service go through a multi-
step medical screening process:
1. LApplicants are required to complete a medical pre-
screening (DD 2807-2 MEDICAL PRESCREEN OF MEDICAL HISTORY
REPORT) before reporting the Military Enlisted Processing
station. That form is reviewed by Medical Staff at each
Military Entrance Processing Station (MEPS) to identify
individuals who require additional screening. The question on
the form related to mental health issues is:
a. LSeen a psychiatrist, psychologist, counselor or
other professional for any reason (inpatient or outpatient)
including counseling or treatment for school, adjustment,
family, marriage or any other problem, to include depression,
or treatment for alcohol, drug or substance abuse.
2. LFurthermore, all applicants undergo a medical
evaluation that includes a review of medical history and
physical with a licensed physician. Included in the medical
history at the time of the examination are the following
questions:
a. LNervous trouble of any sort (anxiety or panic
attacks)?
b. LReceived counseling of any type?
c. LDepression or excessive worry?
d. LBeen evaluated or treated for a mental condition?
e. LAttempted suicide?
L All positive responses are addressed by the examining
physician at the time of the physical examination.
The Chairman. You discharge people for it so you must have
a test for it.
Mr. Hebert. Well, we rely on medical professionals who----
The Chairman. Well, why don't you do it before they enlist?
Mr. Hebert. We potentially could create some sort of
scenario where they would.
The Chairman. But you don't now?
Mr. Hebert. Well, sir, would you have them serve for some
period of time? Many times----
The Chairman. I don't want them in if they have a
personality disorder since you are discharging them. Why don't
you figure it out before then? Since it is a preexisting
condition, you can find out about it.
Mr. Hebert. Sir, it is a behavioral condition that is
tested----
The Chairman. Do you know how many people are diagnosed
with personality disorder and are rejected for enlistment or
volunteer service?
Mr. Hebert. I do not, sir.
The Chairman. Do we have those records?
Mr. Hebert. I suspect we do not, sir, but I will look into
it.
[The DoD subsequently provided the following information:]
L FY 2009 data show 1,018 potential recruits were rejected
for personality disorders and a total of 9,698 potential
recruits were rejected for various mental health conditions.
Preliminary data for FY 2010 show 1,161and 8,248, respectively.
Subsequent to these disqualifications an applicant may be
considered for a waiver of their condition. In FY 2009, 182
waivers were granted to applicants originally disqualified for
personality disorders. Data for FY 2010 are still being
tabulated.
The Chairman. You mean to say you can't tell me? Can you
tell me how many people have applied for volunteer or have
volunteered for service in a given year and how many people
were rejected? Can you tell me that?
Mr. Hebert. Yes, sir, I can tell you that.
The Chairman. Well then you must be able to tell me why
they were rejected.
Mr. Hebert. You asked whether or not we had the records. We
do not presently have the records. We will take that question
for the record and go back and research it and provide the
Committee----
The Chairman. I assume you have this information, not that
you have it here, but you must have that information.
Mr. Hebert. We do have the information on a number of
individuals who were rejected from enlistment, yes, sir.
The Chairman. All right. Continue.
Mr. Hebert. Yes, sir. The question was raised with regard
to how many personality disorder discharges have occurred since
2007. In 2008, we record 2,903. In 2009, 1,426.
The Chairman. The first one was 2,903?
Mr. Hebert. Yes, sir.
The Chairman. Of those, 2008?
Mr. Hebert. Yes, sir.
The Chairman. Two thousand nine, was what?
Mr. Hebert. Two thousand nine was 1,426, and year to date,
2010, is 650.
The Chairman. Is that more or less than 2000 to 2007?
Mr. Hebert. It is less. It is a continuing declining trend,
and we see that declining trend across all four services.
The Chairman. Do you know why? Have you accounted for that?
Mr. Hebert. We have no direct correlation, sir but we would
attribute the more rigorous screening process that we are doing
for PTSD and TBI as contributing to that trend.
The Chairman. Do you have any problem with the figures that
I think either Dr. Draper or Mr. Sullivan said was shrinking by
75 percent in 2009 from the previous years? Is that accurate?
Mr. Hebert. I am not--there was a shrinkage, it wasn't 75
percent. I am not sure whether that was specific to the Army
or----
The Chairman. We will check that.
Mr. Hebert. All right.
The Chairman. It appears to me that if you have 3,000 in
those 3 years and 23,000 in 7 years, it is a big, big drop.
Okay.
Mr. Hebert. Yes, sir.
The Chairman. Go ahead.
Mr. Hebert. And additionally, I believe you asked what were
the incidence of personality disorder in the population versus
the Department of Defense. We don't have that information with
us. We will be glad to provide that for you.
[The DoD Subsequently provided the following information:]
L Most epidemiologic studies on personality disorders
derive an estimated prevalence (disease burden in the
population) using survey data. Incidence rates (new cases of a
disease or disorder diagnosed) of diagnosed personality
disorders are not as easily estimated.
L In the general population, prevalence of Personality
Disorders is generally estimated to be 14.8 percent.\1\ The
estimated prevalence within the military care system is much
lower; 0.03 percent for hospitalizations and 1.1 percent for
ambulatory care.\2\ Methods used to collect and report
personality disorder data do not permit us to report aggregate
prevalence rate statistics to compare the two groups. In
addition, it is very difficult to have an accurate assessment
because most people with Personality Disorders do not present
to medical on their own accord since they do not think that
their beliefs and behaviors are abnormal. Also, as indicated in
the following discussion, there is no single diagnostic entity
of ``Personality Disorder;'' each sub-type carries with it
separate diagnostic criteria and occurs at different estimated
prevalence rates.
---------------------------------------------------------------------------
\1\ http://www.sciencedaily.com/releases/2004/08/040803095121.htm.
\2\ Those hospitalized may also be included in the denominator for
those receiving ambulatory care.
The Chairman. Who did the report? Which one of you is
responsible for the report--of the review that was required of
the previous 23,600? Who should I ask about that when it is
their turn?
Mr. Hebert. Yes, sir. I believe that was--I am not sure,
sir.
The Chairman. You didn't do that?
Mr. Hebert. No, sir.
[The DoD subsequently provided the following information:]
L The Office of the Under Secretary of Defense for
Personnel and Readiness submitted the report to Congress, which
reported 22,656 Personality Disorder discharges from FY 2002
through FY 2007. The report was prepared by the Officer and
Enlisted Personnel Management Directorate and Mr. Hebert is the
witness representing that office.
The Chairman. Does it sound reasonable to you that out of
23,600 of anything that not one mistake was made by anybody? I
don't care if it is two plus two is four, somebody's going to
make a mistake somewhere. Do you find that a little bit
uncredible--even incredible?
Mr. Hebert. Without the information with regard to the
review----
The Chairman. Does anybody here have responsibility for
that, please?
Colonel Porter. Sir, if I may, I am from the Army's Surgeon
General office, and my understanding is that rather than the
20-some thousand records that is being quoted here, what, in
fact, was reviewed in the Army's Surgeon General's Office
amounted to approximately 600 records, and those were
individuals who were separated with a personality disorder
diagnosis who had been deployed to an imminent danger pay area,
and in those years that the review was conducted, it was less
than 600 people. The review was conducted by psychiatrists and
psychologists in the Army who were brought to the Surgeon
General's Office to do the review, and their findings were that
they did not see any evidence that a misdiagnosis had occurred.
The Chairman. They didn't interview any of the 600 people?
Colonel Porter. No, sir, they did not.
The Chairman. It doesn't sound like a good review to me.
Mr. Buyer complained about hearsay. This is see-say. Somebody
reads a report and somebody's written reports, somebody else
sees it, somebody reviews it. That doesn't sound like a real
investigation to me. Is there a word like see-say? We have
hearsay. I guess you can have see-say. I invented a new word,
actually.
I am sorry, this doesn't sound appropriate to me. I am just
a layman. What do I know? How do you know there is no evidence?
Because the guy wrote the diagnosis? Did the doctor give a
reason for the diagnosis? Was that reason reviewed? Did the guy
check with the actual soldier who was reviewed in this way?
This doesn't sound reasonable to me.
Colonel Porter. I think the corrective action that we have
taken and that we continue to take right now is that when we
review those records, and they are sent to the Surgeon
General's Office before they are endorsed, we ensure that not
only is there a diagnosis written down, but that the
documentation for that and the rationale that the provider used
to come to the diagnosis are very clear in the record, and if
we don't see that, then we ask for more information.
The Chairman. Are you telling me that wasn't done with the
23,000, that they weren't required to do that or that they
didn't do it?
Colonel Porter. I think, sir, that before the recordkeeping
was not as clear as it could have been and now we----
The Chairman. That just begs the question then, if you were
directed to investigate whether they were sound or not and you
found out that there was no real rationale, it seems to me you
should go back and ask the doctor what was the rationale and
then check that with the patient. It just looks like you
reviewed it and you found that there was no rationale. I would
check the records of all 23,600 and say, hey, soldier, we
didn't find any rationale, we better look at you again. Why
didn't you do that?
Colonel Porter. I am not sure I understand the question,
sir. Why didn't we go and find----
The Chairman. If you are saying that based on your review
of those 600 files, your forward-looking process is that you
now require a far more specific rationale for that diagnosis,
it leads me to think that didn't happen on the first 600 or the
22,600. If that didn't happen and if you were required to
review the accuracy, it would seem to me that would force you
to go back to the doctor and the patient and ask what was the
specific rationale on which you based this diagnosis.
I am just a layman here, but it seems to me that you are
concerned with your soldiers. I am concerned with your
soldiers. If you are really concerned with them, find out why
they are being diagnosed this way, and then you will find out
that we didn't have any real accurate diagnosis. So, wouldn't
you want to go back and try to correct the record?
Mr. Hebert. Sir, if I may, what we are doing is reaching
out to our veterans who have separated since 9/11 who have been
characterized for separation of personality disorder, who had
previously deployed as part of their service, and we are
reaching out to them to inform them of what options are
available to them if they consider their discharge
mischaracterized and how to access VA benefits with respect to
getting screening for PTSD?
The Chairman. You have notified or tried to notify all
22,600 plus?
Mr. Hebert. That is not my number, sir, but we are
notifying every veteran who separated since 9/11 who had been a
separation characterized as personality disorder who had
previously deployed to make sure that they have access----
The Chairman. You are not asking them to come back to re-
examine them to see if you made the correct diagnosis, are you?
Mr. Hebert. No, sir. We are asking them if they believe
they have their separation was mischaracterized or if they
believe that they have symptoms of PTSD or traumatic brain
injury, that they seek help and that we are giving them the
instructions, if you will.
The Chairman. Could you give me a copy of the outreach
letter or whatever you are doing?
Mr. Hebert. Yes, sir.
[The DoD subsequently provided the following information:]
L On September 10, 2010, the Under Secretary of Defense
for Personnel and Readiness directed the Military Departments
to report by March 31, 2011, actions taken to: (1) identify
servicemembers who have deployed in support of a contingency
operation since September 11, 2001, and were later
administratively separated for a personality disorder,
regardless of years of service, without completing the enhanced
screening requirements for post-traumatic stress disorder
(PTSD) and traumatic brain injury (TBI); (2) inform them of the
correction of discharge characterization process; (3) inform
them on how to obtain a mental health assessment through the
Department of Veterans Affairs; and (4) identify these
individuals to the Department of Veterans Affairs. A copy of
that letter appears on p. 73.
The Chairman. Are you able to get in touch with everybody?
Are letters coming back ``no sufficient address?''
Mr. Hebert. As a result of the inputs from the services
with respect to the report that the GAO brought up, that is
what is driving this outreach, and we are just in the initial
stages of it?
The Chairman. Now, you are in initial stages? When you
started, you said you are notifying everybody. So how many have
you notified?
Mr. Hebert. We will notify everybody.
The Chairman. How many have you notified?
Mr. Hebert. We have notified no one.
The Chairman. No one?
Mr. Hebert. Sir, the report came in----
The Chairman. Look, you led me to believe--I could ask the
reporter to read back your words--that you already notified
everybody. Anybody else have that sense? That is what I heard,
that you have notified everybody. Now you are saying you
haven't even started the notification process. So you haven't
started it?
Mr. Hebert. No, sir.
The Chairman. When will you do this?
Mr. Hebert. We are in the process of----
The Chairman. How long does that process take? Since you
are making me ask these stupid questions because, I don't know
whether you go to school to learn this or it is part of your
personality disorder or--oh, excuse me, I couldn't diagnose
that so quickly. You are not telling me anything--I have to ask
what your words mean. When are you going to do this?
Mr. Hebert. We are doing it now, sir.
The Chairman. When will you notify all 22,600 plus 903,
plus 1,426, plus 650?
Mr. Hebert. Over the upcoming months we will notify
everyone that we have contact information on.
The Chairman. I think all the civilians should be examined
for personality disorder. I would discharge half of you. We are
supposed to be talking English to each other. We are trying to
get some answers and you are not helping me very much. It
sounds to me that you don't want to help me, and you are
playing with words because you don't have the records. You knew
what we were going to ask. It has all been published and the
information has all been published. You just don't have the
information. You got any other nuggets for me?
Mr. Hebert. Mr. Chairman, we are committed to our veterans
who are serving and our former members, and as a Department,
you are looking at a team here that represents a much larger
team that works together on a daily basis to try and make sure
that after a diagnosis occurs that accurate separation
characterizations occur and that our members, most importantly,
are taken care of with the respect they deserve.
The Chairman. Given the fact that you have 23,600
discharges in 7 years wouldn't that lead you to believe that
your intake interview has to be better? Have you changed that?
If you are taking people that have a personality disorder and
you find out about them after they have gone through combat,
had severe injuries, and blast compressions, and then you find
out they have personality disorders, doesn't that lead to some
conclusion? Why would you take them in? I can't figure that
out.
Dr. Smith. Sir, if I could comment, the screening process
is certainly one that presents some difficulties. It does rely
upon self-volunteered information. In many cases, people with
personality disorders may never have been diagnosed. There have
been additions of additional mental health questions to the
screening questionnaire, but again, that hasn't identified a
great number of people, and it is usually in the performance of
duties that problems come to light and then can be more
thoroughly evaluated by medical personnel after they been
accessioned.
The Chairman. After they get clumps of shrapnel in their
leg, then you will figure out they have a personality disorder?
You are not giving me a lot of confidence that you know what
you are doing. I can't figure out how you screen in the
beginning and then all of the sudden, these people have a
personality disorder. Mr. Kors wrote about this, that it is
designed to save money. You haven't given me any a reason not
to accept that conclusion.
Dr. Smith. The people who are eventually diagnosed with
personality disorder ordinarily are brought to light through
difficulties adjusting to military life. And most of those will
occur early in their service and have difficulties adjusting to
the requirements.
The Chairman. How many of those have you found since 2001?
Dr. Smith. I believe the numbers Mr. Hebert quoted were
inconclusive of those who were early in service. I think the
percentages of people who have served in an imminent danger pay
area are a small percentage of those totals, if I am correct
about that.
The Chairman. So it is a small percentage of the total, is
what you just said.
Dr. Smith. The number of people who have served in an
imminent danger pay zone who are subsequently diagnosed with
personality disorder are a small percentage.
The Chairman. You said you find out about them early in
their military service. So what is the percentage of the
discharges that you find within a year, versus those that occur
after they have been in combat. Did this 23,600 figure include
those earlier discharges?
Dr. Smith. I believe that is correct.
The Chairman. So what percentage is which? Do you know?
Mr. Hebert. We can provide those numbers for you.
[The DoD subsequently provided the following information:]
L Eleven thousand sixty-nine (49 percent) of the 22,656
Personality Disorder discharges that took place from FY 2002
through FY 2007, involved servicemembers who were in their
first year of service. Also, 3,372 (15 percent) of those 22,656
personnel had deployed in support of Operation Iraqi Freedom or
Operation Enduring Freedom.
The Chairman. Apparently I don't hear very well because
your words seem to mean something else after you say them. You
were trying to justify the fact that you did not find them
earlier by saying you will find them during boot camp or in the
first year. It sounds to me that you are saying, we find them
before they become a real problem for our combat. I just wanted
to know the percentage.
Dr. Smith. No, sir, I didn't say that we find them before--
at any particular time. I think that people who are having
difficulties adjusting to military life are oftentimes referred
for evaluation. And that may occur very early in their time. It
may be at some later point in their service. That is rather
hard to predict.
The Chairman. All right. The next person on the panel,
please.
STATEMENT OF MAJOR GENERAL GINA S. FARRISEE
General Farrisee. Mr. Chairman, I will submit my comments
for the record and attempt to answer any questions you have.
[The prepared statement of General Farrisee appears on p.
63.]
The Chairman. Tell me how your sphere is different from
their sphere so I know what kind of questions to ask.
General Farrisee. Sir, I am from the Deputy Chief of Staff
for Personnel in the Army. And I am working in the policy area.
The Chairman. Okay. You are aware of the review that was
done of the 600 now?
General Farrisee. Yes, Mr. Chairman. I knew that they did
do a review of those records. I did not know the conclusion
until this week.
The Chairman. I am sorry?
General Farrisee. I did not know the conclusion of the
review until this week.
The Chairman. When was that done?
Colonel Porter. Mr. Chairman, that review was done in 2007
and 2008.
The Chairman. Takes a while for the Army to figure out what
is going on. You just found out about it 3 years later. And
this is your sphere of responsibility?
General Farrisee. No, sir, not the results of the record
review.
The Chairman. That is not your sphere of responsibility?
General Farrisee. No, sir.
The Chairman. So you didn't care what they found out but
you knew this was taking place.
General Farrisee. Sir, I do care. I knew it was taking
place. I did not hear the results. I probably should have heard
the results, yes, sir.
The Chairman. Did my layman's critique of the way it was
done have any validity, in your view? You didn't talk to the
soldiers. You found out that there was no specific rationale so
you didn't go back to the doctors. You only had a small sample
to begin with. Is any of that valid?
General Farrisee. Mr. Chairman, as far as the small sample,
the only sample that we took was going to be soldiers who had
been deployed or who had gone to an imminent danger pay area.
So it was specifically for only those soldiers who had
deployed; that they would do a relook of those records. I did
not know that they did not speak to anyone until this week. I
was not told how they were going to do the review. I believe
that the certain General's office would, in fact, do that
review again of those records.
The Chairman. You heard some of the testimony, which talked
about physical injury and that it was somehow related to
personality disorder. Could that happen?
General Farrisee. Mr. Chairman, I can't answer that
question. The first time I have ever heard that was when I saw
Mr. Kors' article. I had never heard that before.
Dr. Smith. Sir, if I can comment on that. I think that it
is possible for someone who has a personality disorder to have
other diagnoses. So someone who has broken a leg may also have
a personality disorder. But there is certainly not a connection
between those two diagnoses, or causality, which I think was
suggested in panel 1.
The Chairman. So all 600 that you are looking at for their
personality disorder seem to come to light after a major fiscal
injury or major psychological injury.
Dr. Smith. I am not sure that it did come to light. I think
the review the Army conducted was of people who were diagnosed
with personality disorder and had been separated
administratively----
The Chairman. But I asked you what percentage of that was
based on their time in combat versus some officer saw
something. I asked you and you said you didn't know the
percentage of that. It sounds to me that when these people had
physical injury that it may have led to their discharge and
that is when you found out about the ``personality disorder.''
Dr. Smith. No, sir, I don't believe that is correct. I
think the 600 cases reviewed by the Army were all people who
had been deployed to an imminent danger pay zone. They may not
have had any other physical diagnosis or injuries. There may
have been some.
The Chairman. Do you know how many of each?
Dr. Smith. I do not know.
The Chairman. I asked you for figures. You don't have them,
but you are making judgments based on your sense of the
figures.
Dr. Smith. The review of the record was for people
separated for personality disorder.
The Chairman. But you can't tell me, because I just asked
you, how many had physical injury, which brought that diagnosis
to light and you said not very many. But you are not giving me
any numbers.
Dr. Smith. Personality disorders would not ordinarily come
to light as a result of a physical injury.
The Chairman. But that is the whole reason that we are
having this hearing. They get discharged not for PTSD or TBI or
shrapnel in their thigh--they get discharged for personality
disorder. So they were only diagnosed because they were getting
treatment for these other things, it sounds to me.
Dr. Smith. I am not sure that I can say that that is
accurate.
The Chairman. But you can only say it is not if you give me
the figures. Until you give them to me----
Dr. Smith. We would have to take that question for the
record.
[The DoD subsequently provided the following information:]
L According to the Department of Defense (DoD) report to
Congress required by Section 597 of the National Defense
Authorization Act for Fiscal Year 2008, an analysis of
separation data showed that only 3,400 (15 percent) of the
22,600 servicemembers with personality disorder coded
separations had deployed in support of the Global War on
Terror. Additionally, the data indicate that the majority,
19,200 (85 percent) of the 22,600 servicemembers with
personality disorder coded separations, had two or fewer years
in the service.
L It is DoD policy that any servicemember with an illness
or injury that makes her or him unfit for retention must be
referred to the Physical Evaluation Board for a disability
determination. If a servicemember has both a potentially
unfitting injury or illness and another condition (e.g.
personality disorder or sleepwalking) that could be a possible
cause for administrative separation, referral for disability
evaluation (and medical separation or retirement, if
appropriate) would be required prior to any consideration for
administrative separation.
The Chairman. Well, I would like you to do that.
Who would be responsible, General? Sergeant Luther's report
of what I call torture, could that happen in the Army? Was it
ever investigated and did the people who are accused of doing
this--there were pictures and witnesses--was that ever
investigated?
General Farrisee. Mr. Chairman, to my knowledge, it was
not. When it first came out in the media, it was referred to
Fort Hood. I have will have to followup with them to find out
if there is any investigation.
The Chairman. If I were you, I would have jumped. We can't
let that happen in the Army. If it is true, somebody has got to
be punished and if it is not true, that has to be known, too.
Some people are making these charges in public session here
where they are sworn to tell the truth. They have been in the
newspaper. Surely, you would be concerned if the Army was
accused of torturing its own soldiers, wouldn't you?
General Farrisee. Yes, Mr. Chairman.
The Chairman. Would you find out if there was any
investigation for me?
General Farrisee. We will take that question for the
record, yes, Mr. Chairman.
[The DoD subsequently provided the following information:]
L Sergeant Luther's battalion and company commanders were
interviewed regarding the allegations. Sergeant Luther
indicated suicidal ideations to his chain of command and
doctors; in response, his chain of command placed him on a
suicide watch. The chain of command stated that they acted out
of genuine concern to protect Sergeant Luther and possibly
other soldiers. Once placed on suicide watch, (which included
continuous line-of-sight observation) Sergeant Luther spent
days and nights in the squadron aid station, so that he would
be close to medical care, if required, and so that he could be
continuously monitored. Every day, Sergeant Luther was escorted
to the life support area (about 1 mile away) so that he could
take a shower. He was also afforded opportunities to visit the
internet cafes and dining facility. During the day, Sergeant
Luther sat in the waiting room of the squadron aid station. The
description of the small sleeping quarters in the aid station
is accurate. However, the small sleeping quarters was not set
up specifically for Sergeant Luther. It was a sleeping quarters
used by medics during the night as they remained on duty 24/7
for possible casualties. Neither Sergeant Luther nor any other
soldier complained to the chain of command about his living
conditions. It has been confirmed by the chain of command and
the U.S. Army Inspector General Offices that no investigations
have been initiated as a result of any allegations being
reported to the chain of command, inspector general, or through
the criminal investigative channels.
The Chairman. Who is next?
STATEMENT OF ANTONETTE M. ZEISS, PH.D.
Dr. Zeiss. Well, I will go next. I represent VA. So I am
happy to make just a couple of points since the issues for VA
have not been as much in focus. So I won't go through my full
written testimony or oral testimony, but will just want to make
a couple of points and then happy to answer whatever questions
you have.
[The prepared statement of Dr. Zeiss appears on p. 65.]
The Chairman. Thank you.
Dr. Zeiss. First of all, we would just like to say that my
oral testimony did go over the diagnostic criteria for
personality disorders. There are three clusters with 10
different personality diagnosis. Dr. Berger has really gone
through the basics of that so we need not----
The Chairman. You didn't have any problem with his
testimony.
Dr. Zeiss. No.
The Chairman. When I read your testimony--it is, again,
underlined from Dr. Draper it is enduring. Manifested in both
cognition, affects impulse control. Would you expect that all
to be diagnosed by the military's intake testing of these guys?
Dr. Zeiss. I can't comment on how thorough the intake
testing would be and whether they could reach a diagnosis. The
second point I would like to make that is eligible veterans can
get the health care they need from VA, whatever their mental
health or physical health diagnosis and whatever their
diagnosis when they leave the military, assuming that they are
eligible, and that is based on two factors--the character of
the discharge and the completion of service. If they enter VA
care, they will be routinely screened on an early visit to
primary care for PTSD, for depression, for problem drinking,
for TBI, for military sexual trauma. And if any of those
screens are positive, there will be a full evaluation and a
full diagnostic process to guide health care decisions. In
addition, veterans who seek compensation and benefits can do so
on the basis of whatever diagnosis they choose to present.
While information from prior experiences may be part of the C-
file that comes to the VHA clinical examiner, they will do a
full clinical examination based on DSM-IV-TR criteria to
determine whether or not that is an appropriate diagnosis.
The fact that someone may have been separated for
personality disorder diagnosis would not be compelling
information. The information would really come from the
clinical exam that would be done by the VHA doctor level
psychologist or psychiatrist.
So we are committed to providing care to eligible veterans.
We are eager for veterans, whatever their diagnosis, when they
are discharged, to know about their ability to access VA care.
We have tried to get that word out. We have contacted all
Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
veterans who have not sought care to let them know about their
eligibility and how to do so. So we are eager----
The Chairman. You have contacted or in the process?
Dr. Zeiss. We have contacted. That was done a couple of
years ago.
The Chairman. It can be done.
Dr. Zeiss. We certainly want to cooperate and look forward
to potentially receiving some additional veterans who seek care
with us after the outreach that the Department of Defense
plans.
The Chairman. Are you aware of the situation that this is a
hearing of people that were discharged for personality disorder
and feel it was wrong and want to get health care for their
service-connected disability? Is that common? Do you know how
many people that would be? I don't know if your diagnosis would
be counter to that, but it is a different situation, I guess.
Are there people who have come in diagnosed with personality
disorder that you haven't found had personality disorder, or
you didn't diagnose in that way?
Dr. Zeiss. We know that of OEF/OIF veterans who have sought
VA care, at this point cumulatively since 2002, 7,348 have
received a personality disorder diagnosis. They may have
additional diagnoses. But that is about 1.3 percent of those
veterans who have come to seek VA care. And that is a diagnosis
given by a VA clinician.
The Chairman. Do you know how many people came in with a
personality diagnosis from the military and didn't receive that
diagnosis from the VA?
Dr. Zeiss. I don't have those numbers.
The Chairman. Do we know that? Would we keep such
information?
Dr. Zeiss. We can certainly go back to Public Health and
Environmental Hazards, who get the separation files from the
Department of Defense, and see whether there is information in
that file about what the discharge diagnoses were. Again, we
seek to establish our own diagnosis, but we can--I can
certainly try to get that information.
[The VA subsequently provided the following information:]
L The Office of Public Health and Environmental Hazards
does not receive complete data on military separation codes
from Department of Defense DoD Manpower Data Center (DMDC) for
the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/
OIF) Veteran population. Of the 1,168,953 OEF/OIF Veterans with
final out-of-country dates through February 2010, only 625,660
(53.5 percent) had complete information related to their
military separation, and of these Veterans, less than 1 percent
were coded as having separated due to ``character or behavior
disorder''. Therefore, we cannot provide accurate information
on the number of personality disorder discharges among OEF/OIF
Veterans from military separation codes as provided to us by
DMDC.
L We can, however, provide the total number of OEF/OIF
Veterans who have been diagnosed at a VA health care facility
with personality disorders (ICD-9CM 301). Through the second
quarter of FY 2010 (March 30, 2010), of all OEF/OIF Veterans
who sought medical care at VA since October 2001 (n=565,024),
7,988 (1.4 percent) unique OEF/OIF Veterans were diagnosed at
least once with personality disorders (ICD-9CM 301).
L VHA program office: 13-Doug Dembling
The Chairman. The 1 percent or 1 percent-plus figure was 1
percent of what, of all the people that come to see you from
VA?
Dr. Zeiss. I would add--Of those OEF/OIF veterans who have
sought care in VA----
The Chairman. Only 1 percent had a diagnoses with
personality disorder.
Dr. Zeiss [continuing]. One point 3 percent. The other
thing that we are very aware of is that Congress has given Vet
Centers the legal authority to work with veterans who want
guidance to appeal their discharge status. And they certainly
take that charge seriously and do work with veterans who want
to return to the Department of Defense with additional
information and attempt to see whether the discharge status can
be changed.
The Chairman. Do we know how many have done that yet?
Dr. Zeiss. Vet Centers, we work very collaboratively with
them, but they don't enter data in the electronic medical
records, as you know, and they take very seriously their
confidentiality. So we won't get specific data.
The Chairman. The military should know who has appealed
their case and how many of those come to VA specifically for
personality disorder?
Mr. Hebert. We will take that question.
The Chairman. You don't have that either.
Does anybody want to correct anything I have said? You have
a chance to say anything you want before I let you go about
this issue. How should we be looking at it? What would help us
and help you do your job better?
Dr. Zeiss. The only thing I would add from the VA
perspective is that PTSD, in particular, is a diagnosis that we
know can have late onset. So we don't assume in VA if we make a
different diagnosis than the diagnosis that was made in the
Department of Defense that it was necessarily an incorrect
diagnosis. They were working with whatever information they had
at the time. And people are dynamic. They all change. And PTSD
can have late onset. That would not be as true, obviously, for
TBI and for some other disorders. So we want to be clear that
while we want to do our own diagnosis, we are working with the
veteran as they are when they appear to us at VA.
The Chairman. I understand that. If something like 98
percent of what you worked with you differed with the military,
it would tell us something. Not that they were wrong, but you
found out in every case that they seemed to make the wrong
diagnosis or a different diagnosis.
Anybody from the Army or Defense Department care to
comment?
Colonel Porter. Mr. Chairman, I want to express that we
sincerely appreciate the concern that you have for both the
serving members and the veterans. I think to speak to some of
the GAO observations that perhaps the Army wasn't complying
with the directives that had gone out, what I would say is that
in the Army we have started within the OTFG or the Surgeon
General's Office we have started an inspection program where we
go out and we pull records and we look at what is happening at
the ground treatment facilities just to make sure that they are
not ignoring the directives. The other thing that we have in
the works--it is not done yet, but it is being done, and it is
on its way to the Surgeon General for approval--is stricter
guidelines for any kind of separation--administrative
separation that has a mental health diagnosis in it.
So whether it is a personality disorder, an adjustment
disorder, PTSD, any of those will have to come to the Surgeon
General's Office for review so that we can have an oversight of
any of those. And we are requiring the regional medical
commanders to acknowledge receipt of that guidance so there
isn't any more people saying we didn't know. That is all I
have, sir.
The Chairman. I think Dr. Draper mentioned that she was
having trouble getting a document for 2009. Do you know
anything about that?
Colonel Porter. I don't know anything about it, but we will
certainly get what we can.
The Chairman. You will be glad to help us find the right
documents?
Colonel Porter. Yes.
The Chairman. Thank you. Department of Defense, anybody
want to say something? I will give you the last word.
Mr. Hebert. Sir, Mr. Chairman, if your question to the
Department is whether or not we are satisfied with the progress
we have made, the answer is no. Can we do more? Yes. Will we do
more? Absolutely. Admittedly, the amount of time we have had
since 2007 to develop a full body of knowledge about the
complexities of this issue. I mean before you see the medical
community, you see the human resource community, and I will
tell you our legal communities have been arm-and-arm with us as
well. And together we have forged a very structured, very
rigorous screening process to ensure that no veteran leaves
from active service without having been properly screened and
diagnosed, to the extent that it is possible. Beyond that, we
are working with our partners in the VA to make sure that
anyone who hasn't passed through those screening process will
be identified and will get the proper care. And we will
continue to do that. While we have not begun that fight, we
will continue to endeavor.
The Chairman. When you heard the story of Sergeant Luther
about this closet, does anybody in the Department of Defense
have authority or responsibility to investigate that type of
charge?
Mr. Hebert. Allegations of misconduct are generally
referred to the Inspector General's Office, yes, sir.
The Chairman. You just heard that charge. Would you refer
it or do I have to do it?
Mr. Hebert. We will look into it, sir.
The Chairman. Thank you. All right. I appreciate your
testimony. I sound a little frustrated and upset only because I
am. But it just seems to me we have some pretty significant
allegations here and it just doesn't sound like we have the
information or testimony to allay my fears or my sense that
they are right. If you could give me the answers to the
questions you said you would, I would get a better
understanding. I appreciate that. Thank you for your testimony.
Panel four is excused.
I would like, Mr. Kors, if you could, return for a second.
I see you as not a person of hearsay, as was alleged, but
as somebody who really understands this issue and is trying to
do the best for our soldiers. What questions--do you have any
response to some of the testimony you heard since you testified
this morning or what questions we should ask these panels?
Mr. Kors. I do. About the hearsay, I think they would make
me return my Military Reporters and Editors Award if that were
the case.
The Chairman. Right. Thank you.
Mr. Kors. First of all, about the VA looking at cases in
which a soldier clearly did not have personality disorder but
were discharged with that, finding that out would take about 30
seconds. When the soldier was called in for VA medical
screening, they would say hey, bring your discharge papers.
Every soldier has them. On the discharge paper it would say:
Discharged for personality disorder. Now they would know who
they have there.
The Chairman. Is Dr. Zeiss still back there?
I had asked you how many people who were discharged for
PTSD--I mean, personality disorder that you didn't find that. I
don't think you answered me. Can we figure that out? Do we have
that information?
Dr. Zeiss. I will go back and check with our office that
gets the separation information and find out what we can
abstract from it. I am happy to do that.
The Chairman. Thank you.
Mr. Kors. And then, of course, in those cases the
Department of Defense remains firm in its decision with
Sergeant Luther. The VA came to a radically different
conclusion. It said severe traumatic brain injury. Yet a few
weeks ago he got a letter for his appeal for his discharge. And
they said, Yeah, the VA came to that conclusion, but we are
sticking with ours. And you see that over and over in the rare
few soldiers who were discharged were personality disorder and
know that they can attend VA. So many of the soldiers we are
talking about here are soldiers who don't even know they can
enter VA's doors because of this discharge.
I think it goes well beyond money. That is another
important factor here. So many of these soldiers come to me,
they say, This discharge is like a scarlet letter they just
can't wash off. In today's job economy, can you imagine going
into a potential employer and handing them a paper saying you
are mentally ill? You are not going to get that job. And so
that is how you end up with so many of these soldiers not just
with without any benefits, but also then broke and then
homeless.
The Chairman. The issue you raise, of course, with all the
witnesses we have had since your panel, talk about the law or
the regulations. But you are saying that if somebody is told
they get no benefits, they don't distinguish between the VA,
DoD or----
Mr. Kors. Exactly. They are told they can get no benefits.
They don't realize they can get a fresh review at the VA.
The Chairman. I notice that will be clear in the letter
that is now going to go out to those 23,000 veterans. Right?
Mr. Hebert. Yes, sir.
Mr. Kors. This idea of, Well, how do you find out whether
those 22,600 soldiers had preexisting conditions, well, that is
where not interviewing anybody comes into play. If they made a
single phone call to a single one of those families or their
doctors, all of them would say this is ridiculous; this soldier
has been perfectly healthy, that is why he won 22 honors and
was able to serve a dozen years. So by just dealing with the
papers they had produced, they are just recycling their same
information over and over.
I think about the earlier review done by the Army Surgeon
General Gail Pollock. She said that they had done a 5-month
thoughtful and thorough review. But with a touch more
reporting, I found that in that case, again, they did not
interview a single person. All they did was go back to one of
the doctors who created the false diagnosis and said hey, did
you get it right the first time? The doctor said yep, I did.
And they shut down the review at that point. They even--you
have to have a dark sense of comedy to report on this stuff--
they sent a letter----
The Chairman. You have come to the right Committee.
Mr. Kors. They sent a letter out saying that they had
additionally reviewed a stack of hundreds of cases out of Fort
Carson the last 4 years of personality disorder discharges and
realized that--and came to the conclusion that all of those
soldiers were also properly diagnosed. But accidentally one of
the Surgeon General's staff sent out an e-mail to a fellow
military reporter of mine saying hey, we couldn't even find
those cases. And the internal reply was okay, just say that
they were properly diagnosed even if we couldn't locate them.
Ten minutes later, the e-mail to that reporter came and said,
oops, we shouldn't have sent that to you. Please ignore. She
went ahead and forwarded it to me so that I could see what was
going on. But I contacted the Surgeon General's Office at that
point and said how did you know that those 4 years of cases
were properly diagnosed when you couldn't even locate them? And
the reply came that they could not answer that question.
The Chairman. Well, again, I want to thank you and many of
the soldiers you have interviewed who have gone on the record
with very painful things to share especially in public. You
have opened up something that we need to know about. As you
saw, I am not convinced by the testimony we have heard that
there is not an issue there. We have to figure out exactly how
to get to it.
Mr. Kors. This is not an example of soldiers slipping
through the cracks. When you have soldiers who are wounded and
discharged with this, the purpose of this discharge is to get
them out the side door. Again, it is not just money. Think
about the PR factor as well. Everyone knows about the 5,670 who
are dead from Iraq and Afghanistan and the 91,000 who are
officially wounded. But the Rand Corporation, an independent
agency, looked at that and found that over 400,000 soldiers
from these wars were suffering from traumatic brain injury. By
giving those soldiers personality disorder discharges, you are
essentially sliding them out the side door and keeping them off
the books and records of the wounded.
The Chairman. I will give you another statistic. You have
the official casualty count that you recited there. My sense--
and I may not have the exact figures--but it is certainly
close--that almost a million veterans of these wars have come
to the VA for help. A million versus 45,000 reported wounded.
It is not a rounding error. This is a deliberate attempt not to
let us know what is going on in the battles.
Mr. Kors. And these aren't just number. They are not 1
percent. We are talking about 22,000 shattered families who,
first, they have to deal with the wounds from the war, and now
they have to deal with the devastation of no benefits, no long-
term medical care. The demand that they give back a chunk of
their signing bonus just immediately drives so many of these
families into debt, if they already weren't there.
The Chairman. Well, again, I appreciate the service you are
rendering to our country and look forward to trying to see if
we can help all these folks. Thank you so much.
This hearing is adjourned.
[Whereupon, at 1:05 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Bob Filner, Chairman,
Full Committee on Veterans' Affairs
Good morning. The Committee on Veterans' Affairs will now come to
order.
In 2007, this Committee held a hearing to explore the problem of
the Department of Defense (DoD) improperly discharging servicemembers
with pre-existing personality disorders rather than mental health
conditions resulting from the stresses of war such as Post-Traumatic
Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).
This means that servicemembers with personality disorder discharges
are generally denied key military disability benefits and DoD is
conveniently relieved from the responsibility of caring for our
servicemembers in the long-term. These men and women continue to face
an uphill battle when they seek benefits and services at the Department
of Veterans Affairs (VA) because they must somehow prove that the so
called pre-existing condition was aggravated or worsened by their
military service.
Following the 2007 hearing on personality disorder discharges, the
National Defense Authorization Act for Fiscal Year 2008 included a
provision requiring DoD to submit a report to Congress on this issue.
DoD reported that from 2002 to 2007, the Department discharged 22,600
servicemembers with personality disorders.
DoD policy further stated that servicemembers must be counseled, be
given the opportunity to overcome said deficiencies, and must receive
written notification prior to being involuntarily separated on the
basis of a personality disorder. DoD also added rigor to their policy
guidance by authorizing such separations only if servicemembers are
diagnosed by a psychiatrist or Ph.D. level psychologists of the
personality disorder.
It has been over 3 years since we first exposed this issue at our
hearing in 2007. It is my understanding that DoD's use of personality
disorder discharges has decreased and that they concluded that no
soldiers have been wrongly discharged.
I am deeply puzzled by this conclusion and would like to better
understand the process and the criteria that were used to review the
files of the thousands of servicemembers who were discharged with
personality disorders. I cannot help but suspect that our men and women
are not getting the help that they need and are struggling with PTSD,
TBI, and other stresses of war on their own because of wrongful
personality disorder discharges.
Stresses of war such as PTSD and TBI are debilitating and its
impact can be far-reaching. We know of the negative impact that PTSD
and TBI can have on the individual's mental health, physical health,
work, and relationships. We also know that veterans attempt to self-
medicate using alcohol and drugs. This means that PTSD and TBI can lead
veterans on a downward spiral towards suicide attempts and
homelessness.
Just this past summer, we all heard the United States Army
reporting suicide rates of 20.2 per 100,000 which now exceeds the
national suicide rate of 19.2 per 100,000 in the general population.
And, when high-risk behaviors such as drinking and driving and drug
overdoses are taken into account, it is said that more soldiers are
dying by their own hand than in combat. Similarly, we know that
homelessness continues to be a significant problem for our veterans,
especially those suffering with PTSD and TBI.
Three years later, the Committee continues to hear of accounts of
wrongful personality disorder discharges. This begs the question of how
many soldiers have to commit suicide, go bankrupt, and end up homeless
before real action is taken to remedy this problem? Clearly, our
veterans must not be made to wait longer and must not be denied the
benefits that they are entitled to. ELIMINATE BAD BREAK deg.
I look forward to hearing from our witnesses today as we further
expose the problem of personality disorder discharges, better
understand the steps that DoD has taken to deal with this problem, and
forge a path forward to help our servicemembers who were improperly
discharged with personality disorders.
Prepared Statement of Joshua Kors, Investigative Reporter,
The Nation. Magazine
Good morning. I've been reporting on personality disorder for
several years, and I'm here today to talk about the thousands of
soldiers discharged with that condition since 2001.
A personality disorder discharge is a contradiction in terms.
Recruits who have a severe, pre-existing illness like a personality
disorder do not pass the rigorous screening process and are not
accepted into the Army.
In the 3\1/2\ years I've been reporting on this story, I've
interviewed dozens of soldiers discharged with personality disorder.
All of them passed that original screening and were accepted into the
Army. They were deemed physically and psychologically fit in a second
screening as well, before being deployed to Iraq and Afghanistan, and
served honorably there in combat. In each case, it was only when they
became physically wounded and sought benefits that their pre-existing
condition was discovered.
The consequences of a personality disorder discharge are severe.
Because PD is a pre-existing condition, soldiers discharged with it
cannot collect disability benefits. They cannot receive long-term
medical care like other wounded soldiers. And they have to give back a
slice of their signing bonus. As a result, on the day of their
discharge, thousands of injured vets learn they actually owe the Army
several thousand dollars.
Sergeant Chuck Luther is a disturbing example of a how the Army
applies a personality disorder discharge. Luther was manning a guard
tower in the Sunni Triangle, north of Baghdad, when a mortar blast
tossed him to the ground, slamming his head against the concrete,
leaving him with migraine headaches so severe that vision would shut
down in one eye. The other, he said, felt like someone was stabbing him
in the eye with a knife. When Luther sought medical care, doctors at
Camp Taji told him his blindness was caused by pre-existing personality
disorder.
Luther had served a dozen years, passing eight screenings and
winning 22 honors for his performance. When he rejected that diagnosis,
Luther's doctors ordered him confined to a closet. The sergeant was
held in that closet for over a month, monitored around the clock by
armed guards who enforced sleep deprivation: keeping the lights on all
night, blasting heavy metal music at him all through the night. When
the sergeant tried to escape, he was pinned down, injected with
sleeping medication and dragged back to the closet. Finally, after over
a month, Luther was willing to sign anything--and he did, signing his
name to a personality disorder discharge.
The sergeant was then whisked back to Fort Hood, where the he
learned the disturbing consequences of a PD discharge: no disability
pay for the rest of his life, no long-term medical care, and he would
now have to pay back a large chunk of his signing bonus. Luther was
given a bill for $1,500 and told that if he did not pay it, the Army
would garnish his wages and start assessing interest.
Since 2001, the military has pressed 22,600 soldiers into signing
these personality disorder documents, at a savings to the military of
over $12.5 billion in disability and medical benefits. The sergeant's
story was Part 3 in my series on personality disorder. In Part 2, I
interviewed military doctors who talked about the pressure on them to
purposely misdiagnose wounded soldiers. One told the story of a soldier
that came back with a chunk missing from his leg. His superiors
pressured him to diagnose that as personality disorder.
In 2008, after several congressmen expressed outrage at these
discharges, President Bush signed a law requiring the Pentagon to study
PD discharges. Five months later the Pentagon delivered its report. Its
conclusion: not a single soldier had been wrongly diagnosed, and not a
single soldier had been wrongly discharged. During this 5-month review,
Pentagon officials interviewed no one, not even the soldiers whose
cases they were reviewing.
Three years ago, during a hearing on personality disorder
discharges, military officials sat in these seats and vowed to this
committee to fix this problem. Three years later nothing has changed.
Key Links
Personality Disorder series: www.joshuakors.com/military
Sergeant Luther article: www.joshuakors.com/part3
Luther on BBC: http://bit.ly/BBC1interview
ABC News on Personality Disorder: www.joshuakors.com/abcnews.mov
Personality Disorder discharge stats: www.joshuakors.com/statistics
Personality Disorder legislation: www.joshuakors.com/legislation
__________
The Nation.
April 26, 2010
``Disposable Soldiers: How the Pentagon is Cheating Wounded Vets''
By Joshua Kors
The mortar shell that wrecked Chuck Luther's life exploded at the
base of the guard tower. Luther heard the brief whistling, followed by
a flash of fire, a plume of smoke and a deafening bang that shook the
tower and threw him to the floor. The Army sergeant's head slammed
against the concrete, and he lay there in the Iraqi heat, his nose
leaking clear fluid.
``I remember laying there in a daze, looking around, trying to
figure out where I was at,'' he says. ``I was nauseous. My teeth hurt.
My shoulder hurt. And my right ear was killing me.'' Luther picked
himself up and finished his shift, then took some ibuprofen to dull the
pain. The sergeant was 7 months into his deployment at Camp Taji, in
the volatile Sunni Triangle, twenty miles north of Baghdad. He was
determined, he says, to complete his mission. But the short, muscular
frame that had guided him to twenty-two honors--including three Army
Achievement Medals and a Combat Action Badge--was basically broken. The
shoulder pain persisted, and the hearing in his right ear, which
evaporated on impact, never returned, replaced by the maddening hum of
tinnitus.
Then came the headaches. ``They'd start with a speckling in the
corner of my vision, then grow worse and worse until finally the right
eye would just shut down and go blank,'' he says. ``The left one felt
like someone was stabbing me over and over in the eye.''
Doctors at Camp Taji's aid station told Luther he was faking his
symptoms. When he insisted he wasn't, they presented a new diagnosis
for his blindness: personality disorder.
``To be told that I was lying, that was a real smack in the face,''
says Luther. ``Then when they said `personality disorder,' I was really
confused. I didn't understand how a problem with my personality could
cause deafness or blindness or shoulder pain.''
For 3 years The Nation has been reporting on military doctors'
fraudulent use of personality disorder to discharge wounded soldiers.
PD is a severe mental illness that emerges during childhood and is
listed in military regulations as a pre-existing condition, not a
result of combat. Thus those who are discharged with PD are denied a
lifetime of disability benefits, which the military is required to
provide to soldiers wounded during service. Soldiers discharged with PD
are also denied long-term medical care. And they have to give back a
slice of their re-enlistment bonus. That amount is often larger than
the soldier's final paycheck. As a result, on the day of their
discharge, many injured vets learn that they owe the Army several
thousand dollars.
According to figures from the Pentagon and a Harvard University
study, the military is saving billions by discharging soldiers from
Iraq and Afghanistan with personality disorder.
In July 2007 the House Committee on Veterans' Affairs called a
hearing to investigate PD discharges. Barack Obama, then a senator, put
forward a bill to halt all PD discharges. And before leaving office,
President Bush signed a law requiring the defense secretary to conduct
his own investigation of the PD discharge system. But Obama's bill did
not pass, and the Defense Department concluded that no soldiers had
been wrongly discharged. The PD dismissals have continued. Since 2001
more than 22,600 soldiers have been discharged with personality
disorder. That number includes soldiers who have served two and three
tours in Iraq and Afghanistan.
``This should have been resolved during the Bush administration.
And it should have been stopped now by the Obama administration,'' says
Paul Sullivan, executive director of Veterans for Common Sense. ``The
fact that it hasn't is a national disgrace.''
On Capitol Hill, the fight is not over. In October four senators
wrote a letter to President Obama to underline their continuing concern
over PD discharges. The president, almost 3 years after presenting his
personality disorder bill, says he remains concerned as well.
Veterans' leaders say they're particularly disturbed by Luther's
case because it highlights the severe consequences a soldier can face
if he questions his diagnosis and opposes his PD discharge.
Luther insisted to doctors at Camp Taji that he did not have
personality disorder, that the idea of developing a childhood mental
illness at the age of 36, after passing eight psychological screenings,
was ridiculous. The sergeant used a vivid expression to convey how much
pain he was in. ``I told them that some days, the pain was so bad, I
felt like dying.'' Doctors declared him a suicide risk. They collected
his shoelaces, his belt and his rifle and ordered him confined to an
isolation chamber.
Extensive medical records written by Luther's doctors document his
confinement in the aid station for more than a month. The sergeant was
kept under twenty-four-hour guard. Most nights, he says, guards
enforced sleep deprivation, keeping the lights on and blasting heavy
metal music. When Luther rebelled, he was pinned down and injected with
sleeping medication.
Eventually Luther was brought to his commander, who told him he had
a choice: he could sign papers saying his medical problems stemmed from
personality disorder or face more time in isolation.
`Every Night It Was Megadeth'
Luther entered the Army in 1988, following in the footsteps of his
grandfathers, both decorated World War II veterans. In 2005, after
Hurricane Katrina, he and his unit were deployed to New Orleans, where
he helped evacuate residents and dispose of bodies left in the street.
In 2006 he was deployed from Fort Hood in Texas to Camp Taji, where he
performed reconnaissance with the First Squadron, Seventh Cavalry
Regiment, led by Major Christopher Wehri. ``Luther was older and more
mature than most of the soldiers. He was forthcoming, very polite,''
says Wehri. ``He seemed to have a good head on his shoulders.''
Doctors at the aid station didn't see him that way. Following the
May 2007 mortar attack, Luther entered the base's clinic and described
his concussion symptoms to Captain Aaron Dewees. Dewees, a pediatrician
charged with caring for soldiers in the 1-7 Cavalry, grew suspicious of
Luther's self-report. ``It is my professional opinion,'' Dewees wrote
in his medical records, ``that Sergeant Charles F. Luther Jr. has been
misrepresenting himself and his self-described medical conditions for
secondary gain.'' The doctor suggested that Luther was faking his
ailments to avoid reconnaissance duty. He called the sergeant
``narcissistic'' and said Luther's descriptions of his injuries were a
mixture of ``exaggeration and flat-out fabrication.''
Luther's medical records document severe nosebleeds and ``sharp and
burning'' pain. Still, the sergeant says he could sense that his
doctors didn't believe him. It was at that point--frustrated, plagued
by blinding migraines--that he spoke of pain so severe he wished he
were dead. ``I made clear that I was not going to kill myself, that it
was just a colorful expression to explain how much pain I was in.''
Dewees agreed. In their records, Luther's doctors note a ``suicide
gesture'' and ``'off-handed' comments'' that the sergeant was going to
kill himself, but Dewees said those gestures were ``unlikely to have
been a serious attempt'' at self-harm. Nonetheless, Dewees wrote, such
statements ``must be taken seriously and treated as such,'' that Luther
``remains a threat to himself and others given his need for attention,
narcissistic tendencies and impulsive behavior.''
Luther was taken to an isolation chamber and told this was his new
sleeping quarters. The room, which Luther captured on his digital
camera, served as a walk-in closet. It was slightly larger than an Army
cot and was crammed with cardboard boxes, a desk and a bedpan. Through
a small, cracked window, he could look out onto the base. Through the
open doorway, the sergeant was monitored by armed guards.
Both Dewees and Lieutenant Colonel Larry Applewhite, an aid station
social worker, declared Luther mentally ill, suffering from a
personality disorder. The next step was to remove him from the military
as fast as possible. ``It is strongly recommended that Sergeant Luther
be administratively separated via Chapter 5-13,'' wrote Applewhite,
citing the official discharge code for personality disorder. In a
separate statement, Dewees endorsed the 5-13 discharge and urged that
it be handled rapidly. ``I feel the safest course of action,'' he
wrote, ``is to expedite his departure from theater.''
That didn't happen. For more than a month Luther remained in his
six-by-eight-foot isolation chamber, weeks he describes as ``the
hardest of my life.'' He says the guards would ridicule him and most
nights enforced sleep deprivation, keeping the lights on all night and
using a nearby Xbox and TV speakers to blast heavy metal into his room.
``Every night it was Megadeth, Saliva, Disturbed.'' The sergeant pulled
a blanket over his head to block out the noise and the light, but it
was no use.
``They told me I wasn't a real soldier, that I was a piece of crap.
All I wanted was to be treated for my injuries. Now suddenly I'm not a
soldier. I'm a prisoner, by my own people,'' says Luther, his voice
tightening. ``I felt like a caged animal in that room. That's when I
started to lose it.''
Isolated, exhausted, the sergeant who had been confined for being
mentally ill says he began feeling exactly that. Finally Luther
snapped. He stepped out of his room and was walking toward a senior
official's office when an altercation broke out. In the ensuing
scuffle, Luther bit one of his guards, then spit in the face of the aid
station chaplain. The sergeant was pinned to the floor and injected
with five milligrams of Haldol, an antipsychotic medication. Sedated,
Luther was returned to isolation.
Staff Sergeant James Byington, who was serving at Camp Taji with
the 1-7 Cavalry, walked the half-mile to the aid station to visit his
fellow soldier. Byington says that off the battlefield, Sergeant Luther
was ``animated and peppy,'' the comedian of the chow hall. During
combat, he says, Luther was focused and prepared, a key component in a
farmland raid just outside Taji that discovered a cache of weapons and
money. The man he found in the isolation chamber was neither the
soldier nor the comedian, he says, but something altogether odd and
decrepit. ``He wasn't energetic like he used to be. He wasn't cutting
jokes. Chuck's one of those guys that talks with his hands. You go into
a room with twenty guys, and you're going to hear Chuck Luther,'' says
Byington. ``Now he seemed half-asleep. He looked worn out.''
A few hours after Byington's visit, Luther was called to his
commander's office. Major Wehri was frank. He held the personality
disorder discharge papers in his hand. ``And he said, `Sign this
paperwork, and we'll get you out.' I said, `I don't have a personality
disorder.' But it was like that didn't matter,'' says Luther. ``He
said, `If you don't sign this, you're going to be here a lot longer.'
''
The sergeant signed. ``They had me broke down,'' he says. ``At that
point, I just wanted to get home.'' Luther's voice grows quiet as he
recounts that final meeting. ``I still remember Wehri's face,'' he
says. ``He was smiling.''
Wehri confirms his statements to Luther. He says he pressed the
sergeant to sign because he felt it was in Luther's best interest and
in the best interest of the Army. The sergeant, he says, ``had gotten
so belligerent. If we had returned him to his unit, he would have been
a danger to himself and to others. His behavior was not suitable to
military service. And he wanted to get home. So I told him, `If your
goal is to get home, and we've diagnosed you with personality disorder,
your fastest way is to sign the papers. If you don't sign, you're just
subjecting yourself to further anguish and discomfort.' ''
Wehri insists that his comments to Luther were not pivotal to the
sergeant's discharge. Even without a soldier's signature, a PD
dismissal can proceed. But the papers would then move to an Army
lawyer, and the process would be delayed. ``You can't force anyone to
sign,'' he says. ``But if you're going to be stubborn and not sign, try
to play hardball, you run the risk of a dishonorable discharge. With
Luther's biting and spitting, I could have court-martialed him out
right there for failure to perform in a military manner.''
The major says Luther's real story is that of a good soldier who
came home for leave, saw his wife's new haircut and slimmed figure and
was driven mad by fears of her infidelity. ``When he came back to Iraq,
something had changed. He had a negative attitude. He wouldn't respond
to direct orders. His head wasn't in the game.'' Wehri says it became
clear to him that Luther was intent on returning home right away, a
realization that left him disappointed but not shocked. ``Soldiers are
conniving,'' he says. ``They are manipulative. If they get in their
minds they want to do something for personal gain, including going
home, they'll go to any lengths to get it.''
Wehri rejects the idea that the mortar attack and subsequent
concussion could have triggered Luther's woes. ``That mortar attack was
nothing,'' he says. ``Insignificant. Maybe he fell down. Sure. I've
fallen down lots of times.'' The major wonders aloud whether Luther is
using that injury to justify his instability. He says if he thought the
attack was significant, he would have investigated it fully and gotten
the ball rolling for a Purple Heart.
The major confirms that Luther was confined to the aid station for
several weeks and that his room was minuscule. But he says those
circumstances were unavoidable. ``Discharging a soldier with
personality disorder is a very long and drawn-out process,'' he says.
``And Luther was a danger to himself and others. He needed to be
watched. The aid station, that's where they had 24-7 supervision.''
Wehri says he marvels at the idea that Luther could be a poster
child for false personality disorder discharges. He has seen seven
personality disorder cases in his career, he says. ``And Chuck Luther
was by far the clearest one.'' The major says that when Luther's
troubles began, the sergeant's behavior confounded him. Then, says
Wehri, he heard from a commander who said Luther's family had spoken
with him and revealed that Luther had suffered from psychiatric
problems before entering the military and had been treated with
medication. ``Then suddenly it made sense to me,'' says Wehri. ``This
was not new. His symptoms were just popping up now, after he'd kept a
lid on them for many years. It all clicked into place.''
But Luther's wife and his mother say that story is flatly false.
Both say they never had such a conversation with an Army commander and
are emphatic that the sergeant never faced any psychiatric problems
before entering the military. ``Hearing that makes me really angry,''
says Luther's mother, Barbara Guignard. ``Chuck was an all-American
boy. He never took any medication, and he never had a problem.''
How Dewees and Applewhite came to the conclusion that Luther was
suffering from a pre-existing mental illness remains unclear. They
declined to elaborate on their notes or discuss the diagnosis of
personality disorder in general. What is clear is that neither Dewees
nor Applewhite spoke with Luther's family before determining that his
problems existed before his military service. The sergeant's wife and
his mother say that had they been asked, both could have provided key
information demonstrating Luther's stability and health before the
mortar attack.
Specialist Angel Sandoval says he could have helped as well.
Sandoval, who was stationed at Camp Taji and served under Luther in the
1-7 Cavalry, laughs at the idea that the sergeant was mentally ill.
``Chuck was a lot more than `not mentally ill,' '' he says. ``He saved
my life.'' Sandoval describes heading into combat under Luther's
command. The specialist was ready to dump his side-SAPIs, large ceramic
plates that strap to the side of a bulletproof vest, protecting the
kidneys from machine-gun fire. ``They're bulky and kinda heavy, but he
said, `No way, you have to wear them,' '' says Sandoval. ``Two days
later I got shot right there, under my arm. It could have killed me.''
Luther, he says, was ``one of the greatest leaders I had. He never
steered me wrong. If they thought he was ill and needed medical help,
they should have given it to him instead of kicking him out of the
Army.''
But it was Wehri and Applewhite's view that mattered. Soon after
signing the personality disorder papers, Luther was placed in a DC-10
and whisked back to Fort Hood. There he would learn about Chapter 5-
13's fine print: he was ineligible for disability benefits, since his
condition was pre-existing. He would not be receiving the lifetime of
medical care given to severely wounded soldiers. And because he did not
complete his contract, he would have to return a slice of his signing
bonus.
At the base, a Fort Hood discharge specialist laid out the details.
``He said I now owed the Army $1,500. And if I did not pay, they'd
garnish my wages and assess interest on my debt,'' Luther says.
Luther was then released into a pelting Texas rain. He called his
wife, Nicki, to pick him up. ``When I got to Fort Hood he was in the
parking lot, alone, wet, sitting on his duffel bag,'' Nicki recalls.
``He had lost a lot of weight. He looked like. . .a little boy. I
remember thinking, My God, what have they done to my husband?''
The President `Continues to Be Concerned'
Luther's case is not an isolated incident. In the past 3 years, The
Nation has uncovered more than two dozen cases like his from bases
across the country. All the soldiers were examined, deemed physically
and psychologically fit, then welcomed into the military. All performed
honorably before being wounded during service. None had a documented
history of psychological problems. Yet after seeking treatment for
their wounds, each soldier was diagnosed with a pre-existing
personality disorder, then discharged and denied benefits.
That group includes Sergeant Jose Rivera, whose hands and legs were
punctured by grenade shrapnel during his second tour in Iraq. Army
doctors said his wounds were caused by personality disorder. Sailor
Samantha Stitz fractured her pelvis and two bones in her ankle. Navy
doctors cited personality disorder as the cause. Specialist Bonnie
Moore developed an inflamed uterus during her service. Army doctors
said her profuse vaginal bleeding was caused by personality disorder.
Civilian doctors disagreed: they performed emergency surgery to remove
her uterus and appendix. After being discharged and denied benefits,
Moore and her teenage daughter became homeless.
``The military is exacerbating an already bad situation,'' says
Sullivan of Veterans for Common Sense. ``This is more than neglect.
It's malice.'' Sullivan's organization has spent the past few years
pressing officials in Washington to take action on the personality
disorder issue. In July 2007 he testified before the House Committee on
Veterans' Affairs. Sullivan told the Committee that PD discharges
needed to be halted immediately.
That month Obama put forward his bill to do just that. The bill was
matched in the House by legislation from Representative Phil Hare, and
it had passionate support on both sides of the aisle, from prominent
Democrats like Senator Barbara Boxer to high-ranking Republicans like
Senator Kit Bond. Sullivan and other veterans' leaders say they were
hopeful that Obama would use the spotlight of the presidential campaign
to generate further momentum for his bill.
That didn't happen. In the twenty-one months of his presidential
run, the Illinois senator never spoke publicly about PD discharges or
his bill to halt them. Eventually, without widespread public knowledge
or support, and facing opposition from senators who had never heard of
personality disorder and worried the bill would open a floodgate of
expensive benefits, Obama and Bond, the bill's co-author, were forced
to reshape it into an amendment and water down its contents. Their
amendment did not halt PD discharges. Instead, it required the Pentagon
to investigate PD dismissals and report back to Congress. The
amendment, part of the Defense Authorization Act, was signed by
President Bush in January 2008.
Five months later the report landed on Obama's and Bond's desks.
The Pentagon's conclusion: no soldiers had been improperly diagnosed,
and none had been wrongly discharged. The report praises the military's
doctors as ``competent professionals'' and endorses continued use of
pre-existing personality disorder to discharge soldiers whose ``ability
to function effectively'' is impaired. The report's author, former
Under Secretary of Defense David Chu, further notes that though the
Navy's official label for the discharge is ``Separation by Reason of
Convenience of the Government,'' soldiers ``are not wantonly discharged
at the convenience of the Military.''
It is unclear how Chu came to these conclusions. The report does
not cite any interviews with soldiers discharged with personality
disorder, or their families, doctors or commanders. That fact
infuriated many military families, as it triggered memories of a 2007
study by former Army Surgeon General Gale Pollock. Pollock had been
asked to examine a stack of PD cases. Five months later she released
her report, saying her office had ``thoughtfully and thoroughly''
reviewed them. Like Chu, she commended the soldiers' doctors and
determined that they all had been properly diagnosed. The Nation later
revealed that Pollock's office did not interview anyone, not even the
soldiers whose cases she was reviewing.
``He doesn't talk to soldiers, and he doesn't talk to their
families?'' says Nicki Luther, the sergeant's wife, her eyes welling
with tears. ``I heard the same thing from that surgeon general, and I
thought, You haven't been in my house. You don't know what I've dealt
with. How dare you sit there and say you've investigated thoroughly and
found nothing. That's a crock.''
The Chu report does recommend several changes to the PD discharge
system, alterations, it says, that will protect soldiers from being
wrongly discharged. Those protections include requiring that a doctor
diagnose the soldier's personality disorder and a lawyer counsel him on
the ramifications of the discharge. The report also recommends that the
surgeon general review each soldier's case and endorse the PD discharge
before releasing the soldier from the military.
Chu, a Bush appointee, left office in 2008 with the president. But
his findings remain as the Defense Department's position on PD
discharges. In early April the Pentagon released a statement saying
that Clifford Stanley, the current under secretary, is implementing
Chu's recommendations and fully embraces his findings.
That fact left many on Capitol Hill enraged. ``This study, with the
new requirement to have the upper-ups approve discharges--all it
basically did was set up one more hurdle. As far as we can tell, the
impact has been somewhere between zero and less,'' says Senator Bond.
Bond says the Pentagon still hasn't explained the fundamental
contradiction of a PD discharge: recruits who have a severe pre-
existing mental illness could not pass the rigorous screening process
and would not be accepted into the military in the first place. Yet he
says his office is looking at several cases, like Luther's, in which
the soldiers have been deemed physically and psychologically fit in
several screenings before their personality disorder is diagnosed.
``These men and women who have put their lives on the line, we owe
them,'' says Bond. ``We have a responsibility. Discharging them with
personality disorder--it's just an easy way to duck that
responsibility.''
The Republican from Missouri says he's hopeful that Obama, his
partner on the PD bill, will take action from the White House. ``He has
a unique chance now to change the whole operation, to alter the system
from the inside.'' In October Bond gathered a small coalition of
senators and wrote a letter to the president, asking him to confront
the issue once again. ``In 2007 we were partners in the fight against
the military's misuse of personality disorder discharges,'' wrote the
senators. ``Today, we urge you to renew your commitment to address this
critical issue.''
The next week Senator Boxer, a co-sponsor of the original bill,
submitted a statement of her own. ``It is simply appalling that any
combat veteran with a Traumatic Brain Injury [TBI] or Post-traumatic
Stress Disorder would be denied medical care for injuries sustained
during combat,'' Boxer wrote. Even with the reforms that followed the
Chu report, ``we must make sure that the new discharge process. . .is
working.''
The White House responded quickly, assuring the senators that the
president still has his eye on personality disorder. President Obama
``is determined to fulfill America's responsibility to our Armed
Forces,'' says White House spokesman Nicholas Shapiro. ``The president
was concerned with personality disorder discharges as a senator, and he
drafted a bill. He continues to be concerned as commander in chief.''
Disposable Warriors
Luther hopes that concern will translate into action. The sergeant
stands in his backyard, 1,500 miles from Washington, five miles from
Fort Hood, talking about Obama's bill and watching his 7-year-old
daughter floating high above the family's oversize trampoline, her face
wild with joy. Luther looks on with sullen eyes. ``Right now I can't
worry about Washington, or even about fixing my discharge papers,'' he
says. ``First thing, I got to fix myself.'' He gestures to his
daughter, a mop of blond hair leaping to and fro. ``I used to be like
that: a goofball, all this energy. Now. . . I don't know.''
Some nights he doesn't sleep. Others he's back in Iraq, in the aid
station, in endless isolation. The blinding headaches and piercing
shoulder pain still plague him, he says, along with panic attacks and
bursts of post-traumatic stress-fueled rage. Luther broke four bones in
his hand punching a hole in his bedroom wall. His family's hallway is
pocked with holes from similar incidents.
``He's not the man I married,'' says Nicki Luther. ``And when I'm
honest with myself, I don't think I'll ever have that man again. He
wakes up screaming in the middle of the night, sweating, swearing.''
Nicki says he tries to be a good dad to their kids. ``He used to
wrestle around with them. But his body's like an old man's now. And
he's so quick to anger. The kids say, `We want our dad back.' I don't
know what to tell them.''
Three years after the mortar blast, Luther's life is still on shaky
ground. Some days he's posting love notes on his wife's Facebook page
and hand-delivering her favorite salad to her office at lunchtime.
Another day, in the midst of an argument, he knocked down a family
photo, then ripped the furniture out of the living room and dumped it
in the garage, scaring his children. Soon after the birth of their
fourth child, Marlee Grace, Luther and his wife separated. They
reunited a few months later, in time for their eighteenth anniversary.
Luther knew he needed help. This time he sought it outside the
military. He began seeing Troy Daniels, a psychologist, once a week.
One fact was clear immediately, says Daniels. ``He did not have
personality disorder. The symptoms we were looking at looked more like
traumatic brain injury and post-traumatic stress disorder. To take a
soldier having problems with vision, hearing and so forth--and to say
he has personality disorder--that's a bogus kind of statement. I don't
even think a master's student would make that kind of mistake.''
While Daniels dismisses the Army doctors' diagnosis as a ``gross
error,'' he says he was not surprised by it. ``I've treated hundreds of
soldiers over the years, and I've seen a dozen personality disorder
diagnoses. None of them,'' says the psychologist, ``actually had
personality disorder.''
Yet all of those soldiers, he says, faced serious repercussions
because of their discharge. ``Many of the soldiers can't get hired
anymore. Every time they go for a job, they'll have this paper that
says they've been diagnosed with a personality disorder. Employers take
one look at that and think, `This guy's crazy. We can't hire him.' For
most of the soldiers,'' says Daniels, ``it becomes a lifetime label.''
Luther luckily has secured a job, as a truck driver for Frito-Lay.
Securing benefits has proved a bit tougher. Since being released from
the Army, the sergeant has been locked in battle with the VA, fighting
to prove that despite his PD discharge, his wounds are war related and
thus worthy of disability and medical benefits.
Those efforts stumbled at first. In May 2008 the VA declared Luther
``incompetent'' and demanded that a fiduciary collect any disability
benefits he may receive. Eventually, following a slew of paperwork and
medical exams, the sergeant re-established his full standing. This past
December--after VA doctors found Luther to be suffering from migraine
headaches, vision problems, dizziness, nausea, difficulty hearing,
numbness, anxiety and irritability--the VA cited traumatic brain injury
and post-traumatic stress disorder and declared Luther 80 percent
disabled. ``PTSD, a consequence of the TBI,'' wrote one VA doctor, ``is
a clear diagnosis.''
The VA rating cleared the way for the sergeant to receive
disability benefits and a lifetime of medical care. But it hasn't
changed the Army's view--or altered Luther's discharge papers, which
still list the sergeant as suffering from personality disorder. The
sergeant, in return, has refused to pay back the $1,500 of his signing
bonus that the Army says he owes, despite threats to garnish his wages.
``I told them, Let me put it this way: as long as I'm breathing of my
own free will, I'm not paying you a dime.''
Luther says what really boils his blood is having to accept that
his military career is over while the careers of those who devised his
discharge are flourishing. After Luther's dismissal, Wehri, a captain
at the time, was promoted to major and selected to be an executive
officer with NATO. Dr. Dewees returned to Kentucky, where he continues
to serve with the National Guard. Social worker Applewhite is now an
instructor at Fort Sam Houston, where he teaches a class on how to
identify mental disorders.
With or without the Army, Luther says he will continue to serve.
With his health gradually improving and the bulk of his battle over,
the sergeant is taking on a new mission: fighting the military on
behalf of other soldiers like himself. Luther is now the founder and
executive director of Disposable Warriors, a one-man operation that
assists soldiers who are fighting their discharge and veterans who are
appealing their disability rating.
Luther's organization did not receive a hero's welcome. Soon after
founding the group, he discovered a threatening note on his windshield.
``Back off or you and your family will pay!!'' it read, in careful,
black ink cursive. Weeks later, thieves broke into the home of a
veterans' organizer who worked closely with Luther, taking nothing but
the files of the soldiers they were assisting.
The sergeant, characteristically, is undaunted. ``This is the right
path for me,'' he says, his voice resolute. ``I got to be there for
these other soldiers. I'm not the only one who needs help.''
Prepared Statement of Sergeant Chuck Luther, Killeen, TX
Mr. Chairman, Committee Members, and guests, thank you for the
opportunity to speak and help my fellow soldiers and veterans by
telling my story.
I am here to day to say that wearing the uniform for the U.S. Army
is what defined me. I was and still am very proud of the service that I
gave to my country. I entered the service on active duty training
status in February of 1988. I served 5 months and then went on to 8
years of Honorable Reserve service. I had a break in service and
reentered the Reserves in 2003, and after serving 8 months honorably, I
enlisted into the active duty Army in October 2004. I was stationed at
Fort Hood Texas. I served as an admin specialist for 3 years and was
given several awards for my leadership and service. I then went to
retrain to become a 19D cavalry scout, upon finishing school at Fort
Knox, KY. I returned to Fort Hood and was assigned to Comanche Troop,
1-7 CAV, 1st Brigade, and 1st Cavalry Division. I held the rank of
specialist (E4) when we left for Taji, Iraq, for a 15 month combat
deployment.
We arrived in Iraq in November of 2006. We found ourselves in a
very violent area at the beginning of the surge. On December 16, 2006,
I was working in the company radio area monitoring the group that we
had outside the FOB on an escort mission. I remember that day very
clearly. The call came in from one of our Staff sergeants in that
patrol that they had been attacked and one of our vehicles had been
destroyed and that we had three killed-in-action and one wounded-in-
action. As we were receiving the information we could hear the small
arms fire in the background as they tried to recover the dead and
wounded soldiers. I served as the training room noncommissioned
officer, so I was asked to translate the combat numbers given over the
radio to my commander and first sergeant for identity. As the
information came over, I instantly realized that the truck that had
been destroyed contained one of my closest friends, SSG David Staats,
and one of the soldiers that I had taken under my wing, PFC Joe Baines.
I focused on the mission at hand and that evening drove the first
sergeant and the platoon sergeant of these soldiers, to the mortuary
affairs and helped unload their bodies from the vehicles bringing them
home. I pushed through and the next morning we got word. as we were
preparing to head to Baghdad to see the wounded soldier that he had
died. For the next 2 months, we lost several other soldiers from our
squadron and two Iraq interpreters.
On February 16, 2007, I was a member of a convoy that drove out 4
boats and members of our troop to conduct a river recon/mosque
monitoring mission. After an uneventful drive out, unload boats, troops
and soldiers, we headed back to FOB Taji. As we pulled back on FOB
Taji, the call came over the radio that the unit of soldiers had been
ambushed mission. We had to quickly gather up troops and head back to
the drop off location to assist. Upon arriving, we received small arms
and large scale fire from the enemy, we found one of our SSG's (SSG
Thompson) lying in the middle of the beach bleeding from the legs, one
of our Lieutenants had been shot in the arm, and two Iraq police
officers had been killed. We quickly put together two boats of troops
and ammo to retrieve our soldiers. After heading up river we had
received fire and our boat had capsized and we were stranded on an
island for approximately 14 hours before being picked up. We had
limited ammunition and no radio communications. We all thought that we
were going to die that day.
Fourteen days to the day after that event, I was sent home for R
and R leave. I was very angry, had severe headaches, was depressed and
would cry at times. I fought with my wife and family while I was home.
I had an episode where I broke my hand punching walls. After not being
able to cope, I welcomed the trip back to Iraq. Upon returning to Iraq,
I was promoted to SGT and received my Combat Action Badge for my part
in the river mission firefights. After returning from R and R leave,
several people in my unit said that something had changed in me. I
tried to pull it together but had trouble sleeping, had anger problems,
severe headaches, nose bleeds and chronic chest pain. I was living at
the combat outpost x-ray. While there I went to see the medics to get
my inhaler for asthma filled. I was sent back to the FOB, upon
returning to the FOB aid station, the squadron aide station doctor, CPT
Aaron Dewees was not present. I was told he was busy preparing for his
triathlon that he was going to be in after deployment. I came back the
next day and was seen. I asked to see the chaplain because I was
feeling very depressed and needed to talk. After talking to the
chaplain, I was sent to quarters for 2 days and then I was allowed to
go back to the combat outpost. Around the first of April I was in guard
tower 1 alpha when a mortar landed between the tower and the wall
around the combat outpost. When it exploded it threw me down and I hit
my right shoulder and head. I had severe ringing in my right ear with
clear fluid coming from it and had problems seeing out of my right eye.
After a few minutes, I went to the medics on the outpost and was given
ibuprofen and water and sent back to duty.
I started to have worse headaches and could not sleep. They sent me
back to the FOB and I was seen by the aid station doctors and medics
and then sent to the mental health center. I spoke with a LTC there who
was a licensed clinical social worker. He had a 15-minute talk with me
and they gave me celexia and ambien. I was sent back to my quarters.
The next 2 days I began to get angry and hostile (due to the meds) and
was sent back to the LTC. He informed me that if I did not stop acting
like this that they were going to chapter me out under a 5-13. I tried
and went back to the aid station. After several days on suicide watch
for making the comment that ``if I had to live like this I would rather
be dead,'' I asked to be sent somewhere where I could get help and to
be able to understand what was wrong with me. I was told I could not go
and I then demanded that I be taken to the Inspector General of the
FOB. I was told by CPT Dewees that I was not going anywhere and he
called for all the medics, roughly 6 to 10. I was assaulted, held down,
and had my pants ripped off my left thigh and given an injection of
something that put me to sleep. When I awoke, I was strapped down to a
combat litter and had a black eye and cuts on my wrists from the zip
ties. I eventually was untied and from that point forward for 5 weeks I
was held in a room that was 6 feet by 8 feet that had bed pans, old
blankets and other old supplies. I had to sleep on a combat litter and
had a wool blanket. I was under guard 24/7 and on several occasions was
told I was not allowed to use the phone or internet, and when I would
take my meds and fall asleep I was not awakened to get food. On one
occasion, I had slept through chow and asked to be taken to the chow
hall or PX to get some food. I was told no and given a fuel soaked MRE
to eat. I was constantly called a piece of crap, a faker, and other
derogatory things. They kept the lights on and played all sorts of
music from rap to heavy metal very loud all night, the medics worked in
shifts, therefore, they didn't sleep; they rotated. These are some of
the same tactics that we would use on insurgents that we captured to
break them to get information or confessions. I went through this for 4
weeks and the HHC Commander, CPT Wehri told me to sign this discharge
and that if I didn't that they would keep me there for 6 more months
and then kick me out when we got back to Fort Hood anyway, I said I
didn't have a personality disorder and he told me that 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.
It took 2 more weeks before I was flown out and brought to Fort
Hood. Upon returning I was told by the rear detachment acting 1SG and
Commander to stay out of trouble and they would get me out of there. I
was sent out to wait on my wife in the rain with 2 duffle bags and
another carry bag. This was my welcome home from war. I went home and
went to sleep only to be awakened by three sergeants at my door saying
I had to go back to mental health due to me being suicidal and they
hadn't had me checked out. I went to the R and R center at Fort Hood
and was seen by LTC Baker, who was a psychologist. He asked why I was
brought back from Iraq, I explained they said I had a personality
disorder and he disagreed, he shook his head and said that I had severe
PTSD and combat exhaustion. He told me to get some sleep and rest and
follow up in a week with him. I was never allowed to go back to see
him. The ironic thing is that in my military records I held 3 Army jobs
and had a total of 8 mental health screenings that all found me fit for
duty. Also, I had never had a negative counseling or negative incident
in my 12 years of Reserve and active duty career. Two weeks after
getting back, I was discharged from the Army, I had my pay held and
they took my saved up leave from me for repayment of my unearned
reenlistment bonus. I received a notice in the mail 3 week after my
discharge from the department of finance that I owed the Army $1501.
Three months later, I went to the VA and was told they could not see me
for mental health due to my preexisting disorder. I went back the next
week and was seen by a psychologist, after an hour with her she
scheduled me an appointment with a caseworker and then I had several
follow-up mental health appointments. I was given my VA rating a year
later in 2008 of 70 percent for PTSD, knee injury, headaches, right
shoulder and asthma. Six months later after several emergency room
visits and neurology appointments, my rating was upgraded to 90 percent
and I was given service-connection for Traumatic Brian Injury. In June
of this year, after 2 years from the date that I filed a request with
the Military Boards of Correction to have my discharge changed from a
Chapter 5-13 to a medical retirement, i was denied, even after the 3
years of VA medical documents and evidence from people who know me. I
demand that my discharge be changed and that I receive the proper
discharge for my service.
I have since founded Disposable Warriors and have assisted many
veterans and soldiers in a range of issues from Personality Disorder
diagnosis to soldiers on active duty with diagnosed PTSD that are not
being treated or being discharged for misconduct under other than
honorable or bad conduct discharge (which does not entitle them to VA
benefits either). I want to say that it has been hell to just get my
mind somewhat back on track and to exist; I have bouts of memory loss,
agitation, flashbacks, paranoia, problems sleeping and depression. I
get angry every time I look at my DD-214 with the fraudulent
personality disorder discharge. It cost me contract jobs for private
security after my exit from the Army. I had to get a job 3 days after I
was kicked out of the Army to feed my wife and three children. I was
taught for years in the Army the definition of Integrity, Honor,
Respect and Selfless Service, all of which I did I have given to the
Army, but did not get in return.
I hold two things very dear to me to this day. It comes from the
NCO Creed, the accomplishment of my mission and the welfare of my
soldiers. I am on a new battlefield, with a new mission, and I will at
all cost take care of soldiers and their families. I love my country, I
love my Army but we cannot stand by and watch this continue to happen.
At the very same time that this Committee was having SPC Jon Town
testify in front of them in July of 2007, I was abused, broken and
discharged for the very same thing that he testified about. Please do
not let us be here in 3 years again with another story of shame. The
lack of care and concern, coupled with the stigma of weakness for
asking for help that we have allowed to be put on us, has to be totally
removed. Then, and only then, will we see the veterans homelessness
rate drop, the active duty and veteran suicide rate drop, and the
skyrocketing rate of divorce decrease. The senior level of the armed
forces gets it, but they can talk about it, design plans for it, make
PowerPoints of it, but if it is not being enforced at the soldier's
level, it is worthless.
In closing I would like to state that I do not have, nor have I
ever had, a personality disorder. I suffer from PTSD and Traumatic
Brian Injury from my service to my country while at war in Iraq. I
raised my right hand on several occasions and swore to protect the
Constitution at all cost. I did my part and now it is time for the
military to keep its part of the agreement that if I were injured they
would help me get back on my feet. Please help stop these wrongful
discharges and help get our wounded servicemen and women back to
service or back home to their families.
Thank you for your time.
Prepared Statement of Paul Sullivan, Executive Director,
Veterans for Common Sense
Veterans for Common Sense (VCS) thanks Committee Chairman Filner,
Ranking Member Buyer, and Members of the Committee for inviting us to
testify about the impact of improper Department of Defense (DoD)
``personality disorder'' discharges on our veterans seeking benefits
from the Department of Veterans Affairs (VA).
VCS is here today because we remain alarmed DoD continues
improperly discharging our servicemembers who had entered the military
in good health and served with honor while deployed to the Iraq and
Afghanistan Wars, only to be administratively discharged, often without
access to medical care or benefits from DoD or VA.
We begin our testimony with an urgent request that Congress put an
immediate stop to DoD's improper ``personality disorder,'' ``adjustment
disorder,'' and ``pattern of misconduct'' discharges for servicemembers
deployed to war since 2001.
The main underlying cause of the improper discharge remains the
enormous pressure from top Pentagon officials, including Secretary
Robert Gates himself, to curb military spending. A recent news article
by Noel Brinkerhoff at www.AllGov.com is a recent example of
significant pressure to reduce military medical spending: ``With the
Department of Defense staring at enormous cost increases for its health
care program, Defense Secretary Robert Gates is proposing raising
premiums for the first time ever since the creation of the TRICARE
system in 1996.''
VCS believes the military's improper discharges will continue so
long as there is pressure to reduce medical costs and so long as
military recruitment standards remain artificially low due to strong
public opposition to the current wars.
Our testimony today focuses on three areas. First, how many of our
Iraq and Afghanistan war veterans were improperly released by the
military? Second, what are the financial incentives for our military to
continue the policy, and what does it cost our veterans in terms of
lost benefits? And, third, what are the solutions Congress can
implement to repair the damage, and how do we prevent this from
happening again?
First, How Many Veterans are Impacted?
According to Army Times and U.S. Senator Christopher ``Kit'' Bond,
discharges for ``other designated physical or mental conditions not
amounting to disability''--which includes adjustment disorder--have
shot from 1,453 in 2006 to 3,844 in 2009 (``Adjustment disorder
discharges soar; Military boots PTSD troops with no benefits, vets
advocates say,'' Army Times, Kelly Kennedy, August 16, 2010, is
included in testimony).
The increase in personality disorder discharges skyrocketed 165
percent in 3 years without any plausible explanation from the military.
Now, Army Times observed, ``Over the same time, personality disorder
discharges dropped from a peak of 1,072 in 2006 to just 260 last
year.'' In 2007, one estimate of the total number of improper
discharges was as high as 20,000 based on an investigation by The
Nation. Magazine.
Congress and advocates need additional accurate and consistent
information in order to understand the full scope of this issue. VCS
urges Congress to demand the military produce statistics on the number
of ``personality disorder,'' ``adjustment disorder,'' and ``pattern of
misconduct'' discharges, every year since 2001, sorted by deployment
status and military branch. DoD's refusal to release all of the data to
Senators speaks volumes about DoD's intent to conceal this problem from
Congress, continue the improper discharges, and otherwise avoid a
proper resolution.
Based on the limited statistics available, VCS believes the
military switched from ``personality disorder'' discharges to
``adjustment disorder discharges'' after this Committee exposed
``personality disorder'' discharges during a July 2007 hearing.
Again, quoting Army Times, ``Jason Perry, a former Army judge
advocate who helps troops going through medical retirement, said he has
seen dozens of such cases. `It's very common. And it's completely
illegal.' '' In our view, the military was caught by investigative
reporter Joshua Kors at The Nation. Magazine. In response to his
investigation, and subsequent Congressional hearings featuring veterans
and advocates, the military did change the rules. Shortly thereafter,
the military went back the department's old ways, simply changing a few
words on servicemembers' discharge forms and continuing the same
shameful, outrageous, and improper practice.
From our 2007 testimony, VCS restates the obvious. Using the
``personality disorder,'' ``adjustment disorder,'' or ``pattern of
misconduct'' discharges to remove servicemembers who served honorably
during war is wrong and a violation of military regulations. Our
servicemembers need medical exams and medical care, not improper
discharges creating a cloud over their military service and access to
VA care.
Second, Who Wins and Who Loses?
The answer is obvious. The military wins while our veterans and
local governments lose. The military's illegal activity means DoD
spends less on health care and benefits during a time of tight budgets.
Our veterans and families lose because some won't receive urgently
needed health care, disability payments, and other VA benefits. When VA
does not provide care, then state and local governments pick up the
tab.
The losses to our veterans are staggering. The average cost for VA
care and benefits, over a period of 40 years, is between $500,000 to
$1,000,000 per veteran. To date, DoD stands to illegally deny between
$5 billion to $20 billion in lifetime health care and benefits to the
estimated 10,000 to 20,000 veterans improperly kicked out by the
military. This estimate is based on the academic research found in the
book, The Three Trillion Dollar War, by Linda Bilmes and Joseph
Stiglitz, published in 2008. The authors estimate the lifetime medical
and benefit costs for our deployed Iraq and Afghanistan war veterans
may be $500 billion or higher for nearly one million patients and
claims.
Based on our conversations with veterans, those with ``personality
disorder'' discharges frequently believe they are not entitled to full
VA benefits. In many cases, that's partly true. VA is supposed to
provide 5 years of free medical care for veterans who deployed to a war
zone after November 11, 1998 (except those with a dishonorable
discharge). There are plenty of examples of veterans diagnosed with
post-traumatic stress disorder (PTSD) and/or Traumatic Brain Injury
(TBI) who urgently need VA care and benefits for those conditions.
However, they either do not seek VA care, they are unreasonably delayed
in obtaining care due to VA paperwork nightmares, or they are denied
care by VA.
Some non-medical VA benefits may be lost by veterans with improper
``personality disorder'' discharges. For example, an early release from
active duty may block access to VA's home loan guaranty and education
benefits.
PTSD symptoms may mimic ``personality disorder'' discharges with
anger, self-medicating, and minor infractions. A proper diagnosis by a
psychologist or psychiatrist is imperative, rather than DoD's current
process of rushing veterans through a non-medical administrative
discharge. According to DoD and VA policy, if PTSD symptoms last longer
than 6 months, then the veteran's diagnosis should be changed to PTSD.
With a PTSD diagnosis, a veteran may be medically retired with an
honorable discharge, a disability rating of at least 50 percent, and
free medical care.
In the worst case examples of lost benefits among veterans, VA has
improperly denied veterans' PTSD disability compensation claim because
the veterans' DD-214 listed ``personality disorder,'' even when the
veterans had deployed to a war zone, were diagnosed with PTSD, and were
clearly given an improper military discharge.
Third, what are the solutions?
VCS urges Congress to take several steps toward resolving the
crisis of improper military discharges often preventing access to VA
services for our Iraq and Afghanistan war veterans. These steps include
modernizing military separation regulations, identifying and righting
past inappropriate discharges, and dramatically improving oversight and
accountability of military health surveillance. VCS encourages veterans
to seek care and benefits at VA, without fear of discrimination or
stigma. An improper discharge by the military may unfairly stigmatize a
veteran and impede access to health care, benefits, and employment that
are often vital for a smooth transition from combat to community.
Improve VA Training. VCS recommends that VA train staff to identify
potential veterans at risk of falling in the cracks. While some
veterans may have a properly issued ``personality disorder,''
``adjustment disorder,'' or ``pattern of misconduct'' discharge, VA
needs to look beyond that frequently incorrect DoD label. VA medical
staff should be sure to welcome home deployed veterans with 5 years of
free medical care. Similarly, VA claims adjudication staff should look
beyond DoD's discharge documents and carefully review each veteran's
mental health symptoms and diagnoses, especially those cases where the
veteran deployed to a war zone.
Update DoD's Discharge Regulations. VCS recommends DoD modernize
military separation regulations to provide protection against abuse of
mental health related administrative discharges. Although the governing
Department of Defense Instruction, DoDI 1332.14, was updated, the
language fails to guarantee protection from abuses and retains
loopholes which continue to contribute to this problem. Specifically,
Enclosure 3, paragraph 3(8)(a) still permits the individual services to
authorize administrative separation for ``other designated physical or
mental conditions, not amounting to disability, that interfere with
assignment to or performance of duty,'' without providing any new
protections against abuse of this authority, except for the recent
protections for ``personality disorder.''
Joshua Kors' article on this subject in The Nation. contributed
greatly to the political pressure that led the Senate to submit
amendments to the 2008 National Defense Authorization Act preventing
DoD from discharging returning veterans with a ``personality
disorder.'' While these strong protections against abuse were
appropriate and beneficial, they have been effectively sidestepped
merely by characterizing the early manifestations of mental health
problems, such as PTSD, as ``other . . . mental conditions, not
amounting to disability.'' DoD has simply shifted from ``personality
disorder'' discharges to ``adjustment disorder'' and ``pattern of
misconduct'' discharges.
All mental health-related administrative separations under this
section should be subject to the same rigid review and validation
process as those for ``personality disorder'' discharges under
subparagraphs (8)(a) through (d). VCS recommends that no servicemember
previously deemed fit to deploy be processed for administrative
separation for a mental condition unless such condition has been
centrally reviewed and validated by the principal advisor for mental
health issues of the component service.
Review All Administrative Discharges Since 2001. To ensure no
veteran is left behind, VCS recommends Congress legislate a mandatory
review of all administrative separations for mental health conditions
made since the start of combat operations in 2001. DoD was supposed to
contact the 22,000 personality disorder discharges to determine if the
discharges were correct. Congress should mandate that DoD retroactively
correct and properly characterize all such discharges in accordance
with these new recommended revised guidelines. In cases where the DoD
made an error, DoD would upgrade the veteran's discharge.
Unfortunately, in the 3 years since the hearing, the military did not
contact the veterans or conduct a review.
Enforce Stronger Oversight. VCS emphasizes how these episodes
underscore the critical need to dramatically improve oversight and
accountability for military health surveillance. Time and time again,
DoD has proven itself a poor steward of military health information,
failing to proactively identify disturbing and incriminating trends in
patterns of administrative discharges, failing to release important
information to Congress and the public, and as at least one recent
episode suggests, engaging in outright lies in defense of its actions.
For example, when the issue of improper discharges was first raised by
Senator Kit Bond and then-Senator Barack Obama in 2007, DoD
investigated itself. DoD fabricated a ghost-written review and claimed
the Department had done nothing wrong. After Acting Surgeon General
Gale Pollack released the report to Congress, advocates Steve Robinson
and Andrew Pogany revealed the Pentagon report was falsified. To the
best of our knowledge, no military officials were held accountable.
Independent Review. Congress needs to create a method for an
independent review of the overall health of our servicemembers. As VCS
has argued on numerous occasions, the lack of timely and accurate
health data has a chilling effect on the ability of Congress to perform
effective oversight in the best interests of our servicemembers. On
numerous occasions DoD has deeply troubling patterns of misconduct in
relation to its sole ownership of this information: Delaying the
release of information; feigning confusion as to the meaning or
accuracy of information; and claiming requested analyses are not
possible. Most often this happens with toxic exposures. This also
happens with PTSD, TBI, and the improper discharges discussed at this
hearing. DoD's actions serve to protect DoD's interests at the expense
of servicemembers, and are conducted in many instances with the purpose
of stalling Congressional investigations and reform.
Conduct Universal, Mandatory Medical Exams. VCS urges Congress to
order the military to implement mandatory, universal pre-deployment and
post-deployment medical exams as required by the 1997 Force Health
Protection Act. This means every soldier sits down, face-to-face, with
a medical care provider before and after going to a war zone to
identify--and then treat--identified medical conditions when care is
more effective and less expensive. We support DoD's continued use of
medical assessments 6 months after veterans return. This upholds our
military's need to field a fit fighting force while protecting the
health of our individual servicemembers.
Fill Mental Health Professional Vacancies. VCS urges Congress to
order the military to hire more medical professionals so our soldiers
receive mandatory, universal exams. The creation of lifetime electronic
records remains a superb and urgently needed reform for our
servicemembers and veterans. However, the new electronic records will
be rendered useless if the military fails to include examination,
exposure, and other salient medical information in the new records.
Secretary Shinseki must make it very clear to Defense Secretary Gates
that VA expects DoD to perform pre-deployment and post-deployment
medical exams as well as record toxic exposures. This military medical
history, currently missing for many veterans, remains absolutely
essential so VA may provide veterans with accurate claims decisions and
health care.
Honor Medical Opinions. VCS urges Congress to eliminate the ability
of line commanders to overrule the decisions made by medical
professionals regarding the ability of a servicemember to deploy to a
war zone or to remain in the military. In too many cases commanders
override medical opinions and send unfit soldiers back into combat,
recklessly endangering the servicemember, the unit, and the mission.
Expand Training and Anti-Stigma Education. VCS urges DoD and VA to
expand the agencies' anti-stigma education program encouraging our
servicemembers with PTSD and/or TBI to seek care, beyond what has
already been established. VCS also supports mandatory reintegration
training for every servicemember, regardless of discharge, except for
dishonorable discharges.
In conclusion, the problem of improper discharges is caused by the
military, yet the solution requires cooperation between Congress, the
military, and VA.
News Articles Cited:
1. Defense Secretary Gates Suggests Raising Health Care Premiums for
Employed Veterans
by Noel Brinkerhoff, www.AllGov.com
September 08, 2010--With the Department of Defense staring at
enormous cost increases for its health care program, Defense Secretary
Robert Gates is proposing raising premiums for the first time ever
since the creation of the TRICARE system in 1996.
Health care costs for the Pentagon have ballooned from $19 billion
in 2000 to an estimated $50 billion for next year, and $65 billion by
2015. Gates wants to avoid increasing premiums for active-duty
personnel and their families. Instead, he's suggesting charging higher
premiums and co-pay fees for retired veterans using TRICARE who have
access to private health care plans through their current employers.
Gates' idea is likely to have a tough time gaining approval in
Congress, where both Democrats and Republicans have been reluctant to
lift TRICARE premiums for any military personnel.
2. `Adjustment disorder' discharges soar; Military boots PTSD troops
with no benefits, vets advocates say
By Kelly Kennedy, Army Times
August 16, 2010--Two years ago, Congress enacted rules to curb the
military's practice of separating troops with combat stress for pre-
existing personality disorders--an administrative discharge that left
those veterans without medical care or other benefits. Now, veterans
advocates say, the military is using a new means to the same end:
giving stressed troops administrative discharges for ``adjustment
disorders,'' which also carry no benefits. And just as before, Congress
appears poised to wade in. Senator Christopher ``Kit'' Bond, R-Mo.,
plans to ask President Obama to have the Pentagon provide details on
discharges for adjustment disorder in recent years. In the meantime,
Bond's office has been gathering more general data that show discharges
for ``other designated physical or mental conditions not amounting to
disability''--which includes adjustment disorder--have shot from 1,453
in 2006 to 3,844 in 2009. Over the same time, personality disorder
discharges dropped from a peak of 1,072 in 2006 to just 260 last year.
Shana Marchio, an aide to Bond, said the issue was brought to the
Senator's attention by Steve Robinson, a former Army Ranger who is now
a veterans advocate. ``The good news is that the Pentagon has moved
away from personality disorders, but we feel [adjustment disorder]
could be another piece of the same problem,'' Marchio said. At press
time, Pentagon officials had not responded to a request for comment
about the recent rise in administrative discharges. According to the
DSM-IV, the psychiatric manual for mental health issues, adjustment
disorder may occur when someone has difficulty dealing with a life
event, such as a new job or a divorce--or basic training. It also may
occur after exposure to a traumatic event. The symptoms can be the same
as for post-traumatic stress disorder: flashbacks, nightmares, anger,
sleeplessness, irritability and avoidance. According to military and
Veterans Affairs Department rules, if symptoms last longer than 6
months, the diagnosis should change to PTSD. Under the law enacted in
2008, that means medical retirement, an honorable discharge, a 50
percent disability rating and medical care. That is not always
happening, Robinson said. ``This is a case of inappropriate discharges.
There are hundreds of cases.''
`I could barely function' During a deployment to Iraq with the 4th
Infantry Division in 2008, former Army Pfc. Michael Nahas, 22, said he
survived 2 roadside bomb explosions and 1 rocket-propelled grenade
attack, and watched people die in another explosion in Mosul. Two
months after returning to Fort Carson, Colo., he began feeling anxious
and guilty about people he believed had died needlessly. He went to the
post mental health clinic. Over 3 weeks, he said he had 3
appointments--and a lot of medication, including 14 milligrams of Xanax
a day. ``I was drooling on myself,'' he said. ``I could barely
function.'' His mother and veterans advocates verified his doses. As
enlisted supervisors in his unit chain found out he was going to
behavioral health, Nahas said some made fun of him, calling him
``crazy'' and telling him to kill himself so he would not be a problem.
Veterans advocates who worked on Nahas' case verified his information,
citing police and medical records as well as conversations with
commanders. Army Lieutenant Colonel Steve Wollman, spokesman for the
4th Infantry Division, declined to comment on Nahas' specific charges.
``The allegations . . . were thoroughly investigated,'' he said. ``Some
. . . were unsubstantiated and some of them were substantiated.
Appropriate corrective actions were made, and the investigation is
closed.'' In February, Nahas said he had a reaction to his medication
that, coupled with the stress he was under, led him to try to commit
suicide by sticking IV needles in his arms to bleed out. In a photo of
the aftermath provided by Nahas' family, blood fills the bathtub and a
red smiley face gazes from the tiles above. His wife found him and
called for help, and Nahas survived. After his suicide attempt, he said
he spent time in an inpatient clinic where he was diagnosed with PTSD,
then went back to his unit. But rather than beginning the medical
retirement process for PTSD, in late April his unit gave him an
administrative discharge for adjustment disorder and sent him back to
civilian life. ``I was told I had PTSD, and then I was told I didn't,''
he said. His situation is not unique, according to people familiar with
the military disability system. Jason Perry, a former Army judge
advocate who helps troops going through medical retirement, said he has
seen dozens of such cases. ``It's very common,'' Perry said. ``And it's
completely illegal.''
Prepared Statement of Thomas J. Berger, Ph.D., Executive Director,
Veterans Health Council, Vietnam Veterans of America
Chairman Filner, Ranking Member Buyer, and distinguished Members of
the House Veterans' Affairs Committee, on behalf of President John
Rowan, our Board of Directors, and our membership, Vietnam Veterans of
America (VVA) thanks you for the opportunity to present our views on
discharges for personality disorders and their impact on veterans'
benefits.
Some in this room may well remember that the issue of personality
order discharges first surfaced publicly back in the spring of 2007
because of an article in ``The Nation'' by Joshua Kors and a subsequent
CBS Evening News special. They reported that since the attacks of 9/11,
more than 22,600 servicemembers had been discharged for a ``personality
disorder''. Nearly 3,400 of them, or 15 percent, had served in combat
or imminent danger zones. Those numbers include personnel who had
served multiple tours.
Now, please remember that a personality disorder is a severe mental
illness that emerges during childhood and is listed in military
regulations as a pre-existing condition, not a result of combat.
Personality disorder contains symptoms that are enduring and play a
major role in most, if not all, aspects of the person's life. While
many disorders vacillate in terms of symptom presence and intensity,
personality disorders typically remain relatively constant. In other
words, according to the DSM-IV, to be diagnosed with a disorder in this
category, the symptoms have been present for an extended period of
time, are inflexible and pervasive, and are not a result of alcohol or
drugs or another psychiatric disorder, and the history of symptoms can
be traced back to childhood or adolescence. Thus, those who are
discharged with a personality disorder are denied a lifetime of
disability benefits. Soldiers discharged with a personality disorder
are also denied long-term medical care, and they may have to give back
a portion of their re-enlistment bonus.
At the time, VVA and other veterans' advocates contended that many
of these servicemembers were suffering from Post-traumatic Stress
Disorder (PTSD) or traumatic brain injury (TBI), but that it was easier
and less costly for the military to separate them under the rubric of
``personality disorder'', leading some to believe that such a large
number of personality disorder discharges were in fact fabricated to
save on the cost of other, more appropriate mental health treatments
and disability benefits.
Then, after several Congressional hearings--including one before
this committee--and criticism from VVA and other veterans' advocates on
the overuse of personality disorder separation, a revised Department of
Defense (DoD) instruction (No. 1332.14) took effect without public
announcement on August 28, 2008. This revision only allows separation
for personality disorder for members currently or formerly deployed to
imminent danger areas if: (1) the diagnosis by a psychiatrist or a
Ph.D.-level psychologist is corroborated by a peer or higher-level
mental health professional; (2) if the diagnosis is endorsed by the
surgeon general of the service; and (3) if the diagnosis took into
account a possible tie or ``co-morbidity'' with symptoms of PTSD or
war-related mental injury or illness. The DoD director of officer and
enlisted personnel management noted that ``rigor and discipline'' is
``very important'' when separating deployed members for personality,
considering what is at stake for the servicemember.
In addition, the Senate also adopted an amendment to the fiscal
2008 defense authorization bill introduced by then-Senator Obama (D-
Ill.), Senator Kit Bond (R-Mo.), and Senator Joseph Lieberman (ID-Ct.)
that directed DoD officials to report on service use of personality
disorder separations, and the Government Accountability Office (GAO) to
study how well the services follow DoD's own rules for processing such
separations.
The Army, meanwhile, reviewed its own use of personality disorder
separations for more than 800 soldiers who had wartime deployments.
That review quickly found some ``appalling'' lapses, said an official,
including incomplete files and missing counseling statements. In the
following months, the Army claimed to have tightened its own rules for
using personality disorder separations.
DoD then reported to Congress that it would add ``rigor'' to its
personality disorder separation policy, previewing the changes
implemented in late August. The Navy had strongly opposed the changes
because it frequently uses personality disorder separations to remove
sailors found too immature or undisciplined to cope with life at sea.
Requiring their surgeon general to review every personality disorder
separation from ships deployed in combat theaters would be too
burdensome, the Navy argued. But DoD officials insisted on the changes.
DoD's report showed the Navy led all services in personality
disorder separations. For fiscal years 2002 through 2007, the Navy
total was 7,554 versus 5,923 for the Air Force, 5,652 for the Army, and
3,527 for the Marine Corps. The Army led in personality disorder
separations of members who had wartime deployments, with a total of
1,480 over 6 years. The Navy total was 1,155, the Marine Corps 455 and
the Air Force 282. But DoD said it found ``no indication'' that
personality disorder diagnoses of deployed members ``were prone to
systematic or widespread error.'' Nor did internal studies show ``a
strong correlation'' between personality disorder separations and PTSD,
brain injury or other mental disorders. ``Still, the Department shares
Congress' concern regarding the possible use of personality disorder as
the basis for administratively separating this class of
servicemember,'' the report said.
In late October 2008, the GAO released its findings based on a
review of service jackets for 312 members separated for personality
disorder from four military installations. It concluded that the
services were not reliably compliant even with the pre-August
regulation governing separations. For example, only 40-78 percent of
enlisted member separated for personality disorder had documents in
their files showing that a psychiatrist or qualified psychologist
determined that their disorder affected their ability to function in
service.
After all that, the annual number of personality disorder cases
dropped by 75 percent. Only 260 soldiers were discharged on those
grounds in 2009. At the same time, the number of PTSD cases has soared.
By 2008, more than 14,000 soldiers had been diagnosed with PTSD--twice
as many as 2 years before.
Fast-forward to August 2010: the Army denies that any soldier was
misdiagnosed before 2008, when it drastically cut the number of
discharges due to personality disorders and diagnoses of PTSD
skyrocketed. The Army attributes the sudden and sharp reduction in
personality disorders to its policy change. Yet Army officials deny
that soldiers was discharged unfairly, saying they reviewed the
paperwork of all deployed soldiers dismissed with a personality
disorder between 2001 and 2006. According to an AP report, ``We did not
find evidence that soldiers with PTSD had been inappropriately
discharged with personality disorder,'' said Maria Tolleson, a
spokeswoman at the U.S. Army Medical Command.
But with the problem apparently solved, the Army is still refusing
to treat those discharged before 2008, insisting that their diagnoses
of these personnel were correct. Army officials ``reviewed the
paperwork of all deployed soldiers dismissed with a personality
disorder between 2001 and 2006, and said they ``did not find evidence
that soldiers with PTSD had been inappropriately discharged with
personality disorder.'' What does this mean? It means that thousands of
soldiers, misdiagnosed as having a personality disorder, are still
suffering without treatment in the wake of the U.S. military's mental
health reform in 2008.
We at VVA are skeptical of the Army's claim that it didn't make any
mistakes because symptoms of PTSD--anger, irritability, anxiety and
depression--can easily be confused for the Army's description of a
personality disorder. There is no reason to believe the number of
personality discharges would decrease so quickly unless the Army had
misdiagnosed hundreds of soldiers each year in the first place. That
leaves us to ask this Committee to ascertain the following:
During its review of previous cases, did the Army
interview soldiers' families, who can often provide evidence of a shift
in behavior that occurred after the soldier was sent into a war zone?
Can the Army explain why the number of the personality
disorder discharges doubled between 2006 and 2009 and how many of those
qualified to retain their benefits?
Is the Army now relying on a different designation--
referred to as ``adjustment disorder''--to dismiss soldiers?
It is absolutely clear, either through Congressional action or a
Presidential directive, that the Army needs to conduct a thorough
review of its personality disorder diagnoses prior to 2008, treat those
who need help, and restore disability benefits where appropriate.
VVA thanks you, Mr. Chairman, for holding this hearing. And we
thank you and the Members of this Committee for the opportunity to
present our views on this very troubling mental health care issue. I
shall be glad to answer any questions you might have.
Prepared Statement of Debra A. Draper, Ph.D., M.S.H.A., Director,
Health Care, U.S. Government Accountability Office
Defense Health Care: Status of Efforts to Address Lack of Compliance
with Personality Disorder Separation Requirements
Mr. Chairman and Members of the Committee:
I am pleased to be here today to discuss the Department of
Defense's (DoD) separation requirements for enlisted servicemembers
diagnosed with personality disorders and the military services'
compliance with these requirements. DoD requires that all enlisted
servicemembers, including those serving in support of Operation
Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), be physically
and psychologically suitable for military service.\1\ Enlisted
servicemembers who fail to meet this standard may be involuntarily
separated from the military.\2\ One psychological condition that can
render an enlisted servicemember unsuitable for military service is a
personality disorder, which is defined as a long-standing, inflexible
pattern of behavior that deviates markedly from expected behavior, has
an onset in adolescence or early adulthood, and leads to distress or
impairment.\3\ Although a personality disorder by itself does not make
enlisted servicemembers unsuitable for military service, DoD policy
allows for involuntary separation from the military if a
servicemember's disorder is severe enough that it interferes with his
or her ability to function in the military.\4\ DoD data show that from
November 1, 2001, through June 30, 2007, about 26,000 enlisted
servicemembers were separated from the military because of a
personality disorder. Of these 26,000 servicemembers, about 2,800 had
deployed at least once in support of OEF/OIF.
---------------------------------------------------------------------------
\1\ Operation Enduring Freedom, which began in October 2001,
supports combat operations in Afghanistan and other locations, and
Operation Iraqi Freedom, which began in March 2003, supports combat
operations in Iraq and other locations. In September 2010, Operation
Iraqi Freedom became known as Operation New Dawn.
\2\ We discuss only enlisted servicemembers in this testimony
because officers are generally able to resign at any time rather than
be involuntarily separated.
\3\ Diagnostic and Statistical Manual of Mental Disorders, 4th ed.,
Text Revision (Washington, D.C.: American Psychiatric Association,
2000).
\4\ Department of Defense Instruction 1332.14, Enlisted
Administrative Separations (Mar. 29, 2010).
---------------------------------------------------------------------------
In 2007, your Committee held a hearing on how a personality
disorder separation may affect a veteran's ability to receive support
from the Department of Veterans Affairs (VA). Specifically, enlisted
servicemembers who receive only a diagnosis of personality disorder are
ineligible to receive disability compensation benefits from VA after
their military service because a personality disorder is not considered
a service-connected mental health condition.\5\ At the hearing, a
representative from Veterans for America, a veterans' advocacy group,
expressed concern that some enlisted servicemembers may have been
incorrectly diagnosed with a personality disorder, resulting in unfair
denial of disability compensation.
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\5\ Enlisted servicemembers who are separated because of a
personality disorder may receive other support, such as medical
services, from VA if they have other illnesses or injuries possibly
related to their service.
---------------------------------------------------------------------------
Accurately diagnosing enlisted servicemembers who have served in
combat with a personality disorder can be challenging. Specifically,
some personality disorder symptoms--irritability, feelings of
detachment or estrangement from others, and aggressiveness--are similar
to the symptoms of post-traumatic stress disorder (PTSD), a condition
for which OEF/OIF enlisted servicemembers may also be at risk.
According to mental health experts and military mental health
providers, one important difference between a personality disorder and
PTSD is that a personality disorder is a long-standing condition,
whereas PTSD is a condition that follows exposure to a traumatic event.
According to the American Psychiatric Association and the American
Psychological Association, the only way to distinguish a personality
disorder from a combat-related mental health condition, such as PTSD,
is by obtaining an in-depth medical and personal history from the
enlisted servicemember that is corroborated, if possible, by others
such as family members and friends.
DoD has three key requirements that the military services--Army,
Air Force, Marine Corps, and Navy--must follow when separating enlisted
servicemembers because of a personality disorder. Specifically, before
they are separated because of a personality disorder, enlisted
servicemembers
1. must receive notification of their impending separation because
of a personality disorder;
2. must receive, prior to the notification, a diagnosis of
personality disorder by a psychiatrist or psychologist \6\ who
determines that the personality disorder interferes with the enlisted
servicemember's ability to function in the military; and
---------------------------------------------------------------------------
\6\ According to a DoD official, DoD does not hire psychologists
who are not doctoral-level psychologists.
---------------------------------------------------------------------------
3. must receive formal counseling about their problem with
functioning in the military.\7\
---------------------------------------------------------------------------
\7\ Although DoD separation policy does not specify who needs to
conduct the formal counseling session, according to a DoD separation
policy official, the counseling should be conducted by the enlisted
servicemember's supervisor. The counseling can occur at any time up
until the enlisted servicemember is notified of the separation.
The separation process is typically initiated by an enlisted
servicemember's commander, who must then follow the requirements
established by DoD when separating an enlisted servicemember because of
a personality disorder. Once an enlisted servicemember has been
separated from military service, he or she receives a certificate of
release from the military, which includes information on the reason for
separation and an official characterization of his or her time in the
service.\8\
---------------------------------------------------------------------------
\8\ Enlisted servicemembers who are separated because of a
personality disorder receive either an ``honorable'' or ``general under
honorable'' characterization, or description, of service that is given
at the time of separation.
---------------------------------------------------------------------------
In my statement today, I will provide information from a report we
issued in 2008 on our review of personality disorder separations in the
military services.\9\ I will also update you on the actions DoD has
taken since August 2008 related to the recommendations we made in that
report.
---------------------------------------------------------------------------
\9\ GAO, Defense Heath Care: Additional Efforts Needed to Ensure
Compliance with Personality Disorder Separation Requirements, GAO-09-31
(Washington, D.C.: Oct. 31, 2008).
---------------------------------------------------------------------------
To do the work for our 2008 report, we analyzed DoD data and
identified installations that had the highest or second highest
incidence of enlisted OEF/OIF servicemembers separated because of a
personality disorder from November 1, 2007, through June 30, 2007. We
then selected four of these installations to visit--Fort Carson (Army),
Fort Hood (Army), Davis-Monthan Air Force Base (Air Force), and Camp
Pendleton (Marine Corps). We also reviewed the personnel records, which
contain the separation packet--the documents necessary to separate a
servicemember--for selected servicemembers from the four installations
we visited. In our review, we determined whether the packets contained
documentation demonstrating that DoD's personality disorder separation
requirements had been met. Our findings from the four installations
that we visited can be generalized to each of these installations, but
not to the military services. In addition to the four military
installations from the Army, Air Force, and Marine Corps, we also
visited Naval Base San Diego and reviewed the personnel records from
servicemembers who were identified to have been separated because of a
personality disorder from this installation. Due to the structure of
the Navy, we cannot attribute our findings to the particular
installation we visited, and so we reported these results separately
from the findings of the other four military installations.\10\ In
total, we examined 371 enlisted servicemembers' personnel records for
compliance with personality disorder requirements--312 for
servicemembers from the Army, Air Force, and Marine Corps installations
we visited and 59 records for enlisted servicemembers from the Navy. We
also reviewed DoD and the military services' separation regulations and
instructions and interviewed relevant officials to determine how DoD
ensures the military services' compliance with its personality disorder
separation requirements.
---------------------------------------------------------------------------
\10\ We were told that the separation process for enlisted Navy
servicemembers may occur at various locations, such as on a ship or in
a transition center at a naval base. Because of this, we could not
attribute our findings to the particular installation we visited.
Additionally, we could not generalize these findings to the Navy.
---------------------------------------------------------------------------
To obtain updated information on the actions DoD has taken related
to the recommendations in our 2008 report, we reviewed documentation
provided by DoD's Office of Inspector General (OIG)--the DoD office
responsible for following up and tracking the status of GAO
recommendations. We also contacted DoD officials to clarify information
in the documentation we reviewed. We conducted this performance audit
from July 2010 through September 2010 in accordance with generally
accepted government auditing standards. Those standards require that we
plan and perform the audit to obtain sufficient, appropriate evidence
to provide a reasonable basis for our findings and conclusions based on
our audit objectives. We believe that the evidence obtained provides a
reasonable basis for our findings and conclusions based on our audit
objectives.
In summary, our 2008 review found that the documented compliance
with DoD's requirements for personality disorder separations varied by
requirement and by military installation. Additionally, we found that
DoD did not have reasonable assurance that its key personality disorder
separation requirements had been followed by the military services.
Since our 2008 review, DoD has taken some action to implement our
recommendations. However, we have not verified whether the actions the
services planned or reported to DoD to increase compliance were
actually realized. Because the military services have not demonstrated
full compliance with DoD's personality disorder separation
requirements, we reiterate the importance of DoD implementing our 2008
recommendations.
In 2008, we found that, while compliance with DoD's requirement
that servicemembers be notified of an impending personality disorder
separation was high among the four installations, it varied
considerably for the other two requirements. (See table 1.)
Specifically, at the four installations, we found that
compliance with the notification requirement was at or
above 98 percent,
compliance with the requirement related to the
personality disorder diagnosis by a psychiatrist or psychologist ranged
from 40 to 78 percent, and
compliance with the requirement for formal counseling
ranged from 40 to 99 percent.
Table 1: Rate of Documented Compliance at Selected Military
Installations
with Three Key Personality Disorder Separation Requirements, for
Separations Completed from November 1, 2001, through June 30, 2007
------------------------------------------------------------------------
Diagnosis- Formal
Installation Notification related counseling
requirement \a\ requirement \b\ requirement \c\
------------------------------------------------------------------------
Fort Carson (Army) 99% 73% 92%
------------------------------------------------------------------------
Fort Hood (Army) 98% 57% 76%
------------------------------------------------------------------------
Davis-Monthan Air 100% 40% \d\ 40%
Force Base (Air
Force)
------------------------------------------------------------------------
Camp Pendleton 99% 78% 99%
(Marine Corps)
------------------------------------------------------------------------
Source: GAO analysis of enlisted servicemembers' personnel records
obtained from the military services.
Note: We determined whether servicemembers' records demonstrated
compliance with the requirements that servicemembers be diagnosed with
a personality disorder by a psychiatrist or psychologist who
determines that the personality disorder interferes with the
servicemember's ability to function in the military and that the
servicemembers receive formal counseling only if the servicemembers'
records had documentation that the servicemembers were notified of
their impending separation because of a personality disorder. In
total, four records did not indicate that the servicemembers were
notified of their separation as required.
a The Department of Defense (DoD) requires that before enlisted
servicemembers are separated because of a personality disorder they
must receive notification of their impending separation because of a
personality disorder.
b DoD requires that before enlisted servicemembers are separated
because of a personality disorder they must receive, prior to the
notification, a diagnosis of personality disorder by a psychiatrist or
psychologist who determines that the personality disorder interferes
with the enlisted servicemember's ability to function in the military.
c DoD requires that before enlisted servicemembers are separated
because of a personality disorder they must receive formal counseling
about their problem with functioning in the military.
d Air Force officials acknowledged that prior to October 2006 some
enlisted servicemembers with a mental health diagnosis other than a
personality disorder, such as an adjustment disorder, were erroneously
separated under the reason of a personality disorder. However in
October 2006, Air Force officials stated that they took steps to
correct this error. Some of the servicemembers separated from the Air
Force installation we visited may have been affected by this error.
We also found variation in the enlisted Navy servicemembers'
personnel records we reviewed. Ninety-five percent of these records
demonstrated compliance with the notification requirement, 82 percent
demonstrated compliance with the requirement related to the personality
disorder diagnosis, and 77 percent demonstrated compliance with the
requirement for formal counseling.\11\
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\11\ If the psychiatrist or psychologist determines that
servicemembers are a threat to themselves or others, the Navy waives
the requirement that servicemembers must receive formal counseling. We
considered enlisted servicemembers' separation packets that included
documentation of this waiver to indicate compliance with DoD's
counseling requirement.
---------------------------------------------------------------------------
Moreover, we found in our prior work that DoD did not have
reasonable assurance that its key personality disorder separation
requirements had been followed by the military services. To address
this issue, we recommended that DoD (1) direct the military services to
develop a system to ensure that personality disorder separations are
conducted in accordance with DoD's requirements, and (2) monitor the
military services' compliance with DoD's personality disorder
separation requirements.
In August 2008, after our review was completed, DoD updated its
requirements for personality disorder separations to clarify its three
key requirements and include additional requirements to help ensure
that servicemembers are not incorrectly separated because of a
personality disorder. DoD's revised requirements for personality
disorder separations required that enlisted servicemembers be advised
that the diagnosis of a personality disorder does not qualify as a
disability. Additionally, the revised policy specified additional
requirements for enlisted servicemembers who have or are currently
serving in imminent danger pay areas.\12\ Specifically, for
servicemembers serving in these pay areas, their diagnosis of
personality disorder must be corroborated by a psychiatrist or PhD-
level psychologist, or a higher level mental health professional,\13\
and the diagnosis must be endorsed by the Surgeon General of the
respective military service prior to the separation. In addition, for
these enlisted servicemembers, the diagnosis of personality disorder
must also discuss whether or not PTSD or other mental health conditions
are present.
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\12\ An imminent danger pay area is defined by DoD as an area in
which enlisted servicemembers were in imminent danger of being exposed
to hostile fire or explosion of hostile mines and in which, during the
period they were on duty in that area, other members of the uniformed
services were subject to hostile fire or explosion of hostile mines. A
foreign area in which enlisted servicemembers were subject to the
threat of physical harm or imminent danger on the basis of civil
insurrection, civil war, terrorism, or wartime conditions is also
considered an imminent danger pay area.
\13\ A higher level mental health professional generally refers to
a mental health professional who is of higher rank than the diagnosing
official.
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DoD has taken two actions in response to our 2008 recommendations.
First, in a January 2009 memo, the Under Secretary of Defense directed
each of the military services to provide reports on their compliance
with DoD's personality disorder separation requirements for fiscal
years 2008 and 2009. Regarding these reports, the memo specified the
following.
The first report, for fiscal year 2008, was due on June
30, 2009. The second report, for fiscal year 2009, was due on March 31,
2010.
Both compliance reports were to include a random sample
of at least 10 percent of all personality disorder separations in the
fiscal year and were to document compliance with the three key
requirements listed in our 2008 report as well as the requirements DoD
added in August 2008.
The military services were to report the total number of
personality disorder separations for that fiscal year, as well as the
total number of these separations that were for enlisted servicemembers
who had served in imminent danger pay areas at any time since September
11, 2001.
The DoD OIG has collected the services' fiscal year 2008 compliance
reports, which were due June 30, 2009. Overall, these reports showed
that in fiscal year 2008, three out of the four services were not in
compliance with any of the personality disorder separation
requirements. (See table 2.) Each military service reported their
findings of compliance based on their review of a sample of personality
disorder separations; the sample size for each service ranged from 10
to 35 percent of the respective service's total personality disorder
separations for fiscal year 2008. In addition, in a summary of the
services' compliance reports, the Office of the Under Secretary of
Defense stated that the military services' compliance with the
additional personality disorder separation requirements that DoD added
in 2008 was generally well below 90 percent. The Office of the Under
Secretary attributed this level of compliance to the services not
revising their own requirements to reflect DoD's changes until after
fiscal year 2008 was complete.\14\
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\14\ DoD's revisions to its personality disorder separation
requirements became effective August 28, 2008.
Table 2: Number of Separations Because of a Personality Disorder and
Compliance with Key Personality Disorder Separation Requirements, by
Military Service, for Fiscal Year 2008
------------------------------------------------------------------------
Army Air Force Marine Corps Navy
------------------------------------------------------------------------
Total number of 567 86 409 946
enlisted
servicemembers
separated because of
a personality
disorder
------------------------------------------------------------------------
Number of enlisted Not 15 60 Not
servicemembers reported \ reported
separated because of b\ \c\
a personality
disorder who served
in imminent danger
pay areas \a\
------------------------------------------------------------------------
Compliance with 8 8 8
requirement that
enlisted
servicemembers
receive notification
of impending
separation
------------------------------------------------------------------------
Compliance with 8 8 8
requirement that
enlisted
servicemembers
receive a diagnosis
by an appropriate
professional \d\
------------------------------------------------------------------------
Compliance with 8 8 8 8 \e\
requirement that
enlisted
servicemembers
receive formal
counseling
------------------------------------------------------------------------
Source: GAO analysis of Department of Defense documents.
a An imminent danger pay area is defined by the Department of Defense
(DoD) as an area in which enlisted servicemembers were in imminent
danger of being exposed to hostile fire or explosion of hostile mines
and in which, during the period they were on duty in that area, other
members of the uniformed services were subject to hostile fire or
explosion of hostile mines. A foreign area in which enlisted
servicemembers were subject to the threat of physical harm or imminent
danger on the basis of civil insurrection, civil war, terrorism, or
wartime conditions is also considered an imminent danger pay area.
b The Army's report did not include the total number of servicemembers
separated for a personality disorder during fiscal year 2008 who had
served in imminent danger pay areas. The report did note that of the
60 records reviewed for the compliance report, 21 servicemembers (35
percent) had served in imminent danger pay areas.
c According to the Navy's report, the office performing the compliance
analysis did not have the capability to screen records to see which
individuals separated for a personality disorder served in an imminent
danger pay area.
d According to DoD policy, an appropriate professional to diagnose a
personality disorder is a psychiatrist or PhD-level psychologist. This
professional must determine that the personality disorder interferes
with the enlisted servicemember's ability to function in the military.
e The Navy attributes its noncompliance with this requirement to an
error in its personality disorder separation regulations. The Navy
regulation allowed for an exemption to the counseling requirement if
servicemembers were deemed a danger to themselves or others.
Key:
= Military service met DoD's 90 percent compliance threshold for
the personnel records reviewed of enlisted servicemembers who were
separated because of a personality disorder. The services' compliance
rates were based on their review of a sample of personality disorder
separations. The sample size for each service ranged from 10 to 35
percent of the respective service's total personality disorder
separations for fiscal year 2008.
8 = Military service did not meet DoD's 90 percent compliance threshold
for the personnel records reviewed of enlisted servicemembers who were
separated because of a personality disorder. The services' compliance
rates were based on their review of a sample of personality disorder
separations. The sample size for each service ranged from 10 to 35
percent of the respective service's total personality disorder
separations for fiscal year 2008.
According to DoD OIG officials with whom we spoke, as of August 31,
2010, the DoD OIG had not received copies of the military services'
fiscal year 2009 compliance reports, which were due March 31, 2010. It
is unclear if DoD will require the military services to report
compliance beyond fiscal years 2008 and 2009.
Regarding DoD's second action to address our recommendations, in
the January 2009 memo, DoD also required the military services to
provide a plan for correcting compliance deficiencies if the services
found that their compliance with any DoD personality disorder
separation requirement was less than 90 percent. According to their
fiscal year 2008 reports, each service has planned or taken corrective
actions to improve compliance. For example, the Army's report stated
that as of March 13, 2009, the Army's Office of the Surgeon General
will review all personality disorder separation cases to ensure that
each contains the required documentation. Similarly, the Marine Corps
will require the General Court Martial Convening Authority \15\ to
certify that the requirements have been met. The military services also
reported actions they will take to implement DoD's revised personality
disorder separation requirements. For example, the Marine Corps will
incorporate a checklist of the new requirements to be used with all
personality disorder separations. We did not verify whether the actions
the services planned or reported as of March 2009 were actually
realized.
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\15\ In the Marine Corps, the General Court Martial Convening
Authority, typically a high ranking commanding officer, is designated
as the official who approves personality disorder separations.
---------------------------------------------------------------------------
Since the military services have not demonstrated full compliance
with DoD's personality disorder separation requirements, we reiterate
the importance of DoD implementing our 2008 recommendations.
Mr. Chairman, this concludes my prepared remarks. I will be pleased
to respond to any questions you or other Members of the Committee may
have.
Contacts and Acknowledgments
For further information about this testimony, please contact Debra
Draper at (202) 512-7114 or [email protected]. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this testimony. GAO staff who made key contributions
to this testimony include Randall B. Williamson, Director, Health Care;
Mary Ann Curran, Assistant Director; Susannah Bloch; Rebecca
Hendrickson; Lisa Motley; and Rebecca Rust.
Prepared Statement of Lernes J. Hebert, Acting Director, Officer and
Enlisted Personnel Management, Office of the Deputy Under Secretary of
Defense (Military Personnel Policy), U.S. Department of Defense
Mr. Chairman, Mr. Ranking Member, and Members of the Committee,
thank you for the opportunity to testify on Personality Disorder
discharges and the Department's progress in implementing
recommendations made by the Government Accountability Office (GAO) to
improve oversight of the Personality Disorder discharge process. In
response to the October 2008, GAO audit, the Department implemented
policy changes and established a reporting process to maintain
oversight of the Military Departments' progress in carrying out these
requirements. Today, I will report on those policy changes and how the
Military Departments' compliance with those policy changes has
progressed.
Separation Policy
Through the Department's separation policies, individuals are
provided an orderly transition after service to the Nation and the
Department can properly husband the forces under arms to meet national
security needs. As the requirements for service are often physically
demanding, fitness for duty is a key element of these policies.
Medical fitness determination is an area where great care must be
taken to ensure accuracy and fairness. In that regard, the nature of
the signature injuries sustained in Operations Iraqi Freedom and
Enduring Freedom (OIF/OEF) of Traumatic Brain Injuries (TBI) and Post-
Traumatic Stress Disorder (PTSD) has challenged the Department's
understanding and treatment of those injuries. As the body of knowledge
of PTSD and TBI has matured, personnel policies have also evolved to
provide Servicemembers a thorough evaluation prior to consideration of
a discharge from military service. The Department's separation and
transition policies offer multiple levels of oversight to tender the
appropriate characterization of each servicemember's separation. This
critical review by medical professionals is especially important in
ensuring the proper diagnosis and treatment of wounded warriors with
PTSD, TBI, or other physical and psychological conditions and initiate
an appropriate, compensable, physical disability discharge when
warranted.
Leadership awareness and understanding of PTSD and TBI, and
accurate diagnosis of mental health conditions, as they relate to
Personality Disorder separations, are Department priorities. On August
28, 2008, the Department issued new policy on personality disorders
separations, which added greater rigor and oversight. The revised
policy only permits a personality disorder separation if diagnosed by a
psychiatrist or PhD-level psychologist. Implementation of this change
has increased the Department's confidence in our ability to accurately
diagnose personality disorders, which by themselves are not
compensable. This change serves to help ensure accurate diagnoses of
mental health conditions and improve the identification of any co-
morbidity of PTSD or TBI, which are compensable disabilities.
In addition, members who have served in an imminent danger pay area
must have their diagnosis corroborated by a peer psychiatrist, PhD-
level psychologist, or higher level mental health professional and
endorsed by The Surgeon General of the Military Service concerned. This
change specifically addresses concerns early in the War that members
suffering PTSD or TBI might be separated without proper treatment under
the non-compensable, exclusive diagnosis of a personality disorder. To
ensure continued monitoring of this critical process, the Department
implemented oversight mechanisms to include an annual personality
disorder report and periodic reviews of personality disorder separation
data by the Department's Medical and Personnel (MedPers) Council.
By adding new requirements for personality disorder separations to
the requirements that were already contained in Department of Defense
Instruction 1332.14, Enlisted Administrative Separations, there are now
eight requirements that must be met prior to separating a Servicemember
for personality disorder.
Personality Disorder Separations Oversight and Compliance
On January 14, 2009, the Under Secretary of Defense for Personnel
and Readiness directed the Secretaries of the Military Departments to
report their compliance with the personality disorder separation
requirements in DoDI 1332.14, for two fiscal years beginning with
fiscal year 2008. The Services were directed to review, at a minimum, a
random sampling of at least 10 percent of all personality disorder
separations for compliance with the eight DoD personality disorder
separation requirements and report the total number of personality
disorder separations for Servicemembers who had served in an imminent
danger pay area since September 11, 2001.
Of note is that fact that the early reports were impacted by the
delay between when the Department issued new personality disorder
separation policy and the incorporation of that new guidance into
Military Service regulations. The Military Departments made
considerable progress between FY 2008 and FY 2009 to fully comply with
the personality disorder separation requirements in DoDI 1332.14. To
ensure this progress is not lost, the Under Secretary of Defense for
Personnel and Readiness has extended the requirement for the Military
Departments to report their compliance until FY 2012.
The number of personality disorder separations across the
Department by more than a third since 2008 when the more rigorous
processes were implemented. Each of the Military Services has similarly
experienced decreases in personality disorder separations. While other
factors may have contributed to this decrease, the increased oversight
and awareness clearly supported this trend.
PTSD Disability Evaluation System (DES) Case Disposition Trends
The Military Departments combined reported 979 more PTSD DES case
dispositions (a 47 percent increase) in FY 2009 versus FY 2008. There
were 3,063 PTSD DES case dispositions in FY 2009 versus 2,084 PTSD DES
case dispositions in FY 2008. The Army accounted for 81 percent of all
PTSD DES case dispositions.
The Military Departments reported they complied with requirements
in the Veterans Affairs Schedule for Rating Disabilities (VASRD) when
rating mental illness due to traumatic events. Conditions classified as
mental disorders by the VASRD existed in 5,141 (27 percent) of 19,215
FY 2009 DES case dispositions.
PTSD DES case dispositions comprised 16 percent of the total 19,215
DES case dispositions in FY 2009. In FY 2008, PTSD DES case
dispositions comprised 11 percent of the total 19,583 DES case
dispositions.
In FY 2009, 119 (3.9 percent) of the PTSD DES case dispositions
resulted in the Servicemember being placed on the Permanent Disability
Retirement List (PDRL). 2,936 (95.8 percent) of the FY 2009 PTSD DES
case dispositions resulted in the Servicemember being placed on the
Temporary Disability Retirement List (TDRL). This represents 42 percent
of the total of 6,965 Servicemembers placed on the TDRL in FY 2009. Six
(.2 percent) case dispositions resulted in Separation with Severance
Pay and three (.1 percent) case dispositions resulted in Separation
without benefits.
In FY 2008, 233 (11.2 percent) of the PTSD case dispositions
resulted in the Servicemember being placed on the PDRL. 1,352 (64.9
percent) of the FY 2008 PTSD DES case dispositions resulted in the
Servicemember being placed on the TDRL. 489 (23.5 percent) case
dispositions resulted in Separation with Severance Pay and two (.1
percent) case dispositions resulted in Separation without Benefits.
Mental Health Assessments
A Mental health assessment is a bio-psycho-social evaluation
examining every aspect of the patient's life. A psychiatric diagnosis
is made if the patient demonstrates symptoms that meet clinical
criteria as defined by the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR).
Symptoms that may be present in PTSD represent a challenge in the
differential diagnosis and treatment of the disorder. Moreover, chronic
PTSD is frequently complicated by co-morbid (dual diagnosis)
psychiatric disorders including depression and other mood disorders,
substance abuse, dissociative disorders, other anxiety disorders, and
psychotic symptoms or disorders. These co-morbidities offer a further
challenge in the diagnosis and management of PTSD. Concurrent (pre-
existing) character pathology (personality disorders) is important to
diagnose since it may affect the course, severity, and prognosis of
PTSD. When personality changes (newly) emerge and persist after an
individual has been exposed to extreme stress, a diagnosis of Post-
Traumatic Stress Disorder should be considered.
Policy issuances currently require an examination and multiple
reviews by medical professionals prior to administrative separation for
a Personality Disorder. Servicemembers diagnosed with or reasonably
asserting post-traumatic stress disorder (PTSD) or traumatic brain
injury (TBI) fall under guidance provisions for psychiatric and/or
medical disorders, respectively (DoDI 1332.38). If a Servicemember is
diagnosed with PTSD or TBI at the time of their separation examination,
it is policy that a Medical Evaluation Board should be initiated. If a
Personality Disorder is diagnosed after all other medical and mental
health disorders have been ruled out, and the patient is considered to
be a hazard to themselves or others and unable to function in the
military setting, one of the criteria for an administrative separation
would be met. Ultimately, it is the Servicemember's commander, with the
advice of medical professionals, who makes the final decision as
whether the Servicemember should be processed for Administrative
Separation.
PTSD and TBI Related Discharge Review Board and BCMR Request
The Department realizes that the new policies and body of knowledge
of PTSD and TBI evolved too late to benefit many Servicemembers. In
that regard, the Department continues to encourage veterans who are
later diagnosed with PTSD or other mitigating disorders to request
review of their separations through their respective Military
Department Discharge Review Board (DRB) and Board for Correction of
Military Records (BCMR). As expected, the number of DRB and BCMR
appeals related PTSD or TBI has increased. This process has worked
well, and we continue to work with the Military Departments and the
Department of Veterans Affairs to identify those with PTSD and TBI who
may have transitioned prior to our current understanding of these
conditions.
Conclusion
The Department is confident that given the positive trends
Servicemembers who experience or assert PTSD or TBI are being diagnosed
and that those diagnoses are being considered prior to separation.
Rigorous execution and oversight of the Department's separation
policies is crucial to ensuring the proper transition of our veterans
and the readiness of the military forces. The Department is committed
to continue efforts to improve the accuracy and efficacy of these
policies. I will be happy to answer any questions you might have at
this time.
Prepared Statement of Major General Gina S. Farrisee, Director,
Department of Military Personnel Management, G-1, Department of the
Army, U.S. Department of Defense
Introduction
Chairman Filner, Representative Buyer, Distinguished Members of
this Committee, thank you for the opportunity to appear before you on
behalf of America's Army. Our greatest heroes are America's most
precious resource--our Soldiers and Veterans. These Soldiers and
Veterans represent the very best of America's values and ideals and
faithfully shoulder the load that our Nation asks of them. Their
dedicated service and sacrifice are deserving of the very best
services, programs, equipment, training, benefits, lifestyle, and
leadership available.
Personality Disorder
The Army is dedicated to ensuring that all Soldiers with physical
and mental conditions caused by wartime service receive the care they
deserve. The Army remains committed to tracking personality disorder
separations for our Soldiers. Our culture is shifting away from the
stigma associated with having post-traumatic stress disorder (PTSD) or
traumatic brain injury (TBI) and ensuring Soldiers know that it is
expected that they seek help for these hidden wounds to restore and
maintain their health and readiness.
A personality disorder is a deeply ingrained maladaptive pattern of
behavior of long duration that interferes with a Soldier's ability to
perform duty. The onset of a personality disorder is frequently
manifested in the early adult years and may reflect an inability to
adapt to the military environment as opposed to an inability to perform
the requirements of specific jobs or tasks. As such, observed behavior
of specific deficiencies are documented in appropriate military
counseling records to include history from sources such as supervisors,
peers, and others, as necessary to establish that the behavior is
persistent, interferes with assignment to or performance of duty, and
has continued after the Servicemember has been counseled and afforded
the opportunity to overcome the deficiencies.
In 2006 and 2007, public concern arose that some Soldiers returning
from combat tours who were also suffering from PTSD or TBI as a result
of their combat experiences had been discharged from the military for
personality disorder. To address these concerns, the Army's Office of
the Surgeon General issued policies in August 2007 and May 2008
requiring higher-level review of recommendations to administratively
separate Soldiers for personality disorder and requiring screening for
PTSD and TBI for administrative separation for personality disorder and
other types of administrative separation. In August 2008, the
Department of Defense (DoD) mandated similar requirements across DoD
including the requirement that the diagnosis of personality disorder
for Servicemembers who had served or were serving in imminent danger
pay areas must be endorsed by the Military Department's Surgeon
General.
Army administrative separations policy was subsequently updated
implementing the recommendations of the Government Accountability
Office, the requirements of Department of Defense Instruction 1332.14
and the National Defense Authorization Act for Fiscal Year 2010.
Included were the requirements that a psychiatrist or PhD-level
psychologist be the mental health professional diagnosing the
personality disorder, that a Personality Disorder diagnosis be
corroborated by a peer or higher-level mental health professional
(Medical Treatment Facility Chief of Behavioral Health or equivalent
official), that the Personality Disorder diagnosis be endorsed by the
Director, Proponency of Behavioral Health, Office of The Surgeon
General, and that the diagnosis address PTSD or other co-morbid mental
illness, if present. The Army also provided for the distinction between
Soldiers who were separated for Personality Disorder who had less than
2 years time in service (Chapter 5-13/Personality Disorder) with
Soldiers with 2 or more years of service (Chapter 5-17/Other Designated
Physical or Mental Conditions).
Commanders make maximum use of counseling and rehabilitation before
determining that a Soldier has limited potential for further military
service and, therefore, should be separated. When a Soldier's conduct
or performance becomes unacceptable, the commander will ensure that the
Soldier is formally counseled on his or her deficiencies and given a
reasonable opportunity to overcome or correct them. If the commander
believes a medical issue may be the basis of the misconduct or poor
performance, the commander refers the Soldier for a medical evaluation.
Separation for personality disorder is authorized only if the diagnosis
concludes that the disorder is so severe that the Soldier's ability to
function effectively in the military environment is significantly
impaired. The Soldier is counseled that the diagnosis of a personality
disorder does not qualify as a disability. When it is determined that
separation for personality disorder is appropriate, the unit commander
takes action to notify the Soldier. Separation authority for
personality disorder for Soldiers who are or have been deployed to an
area designated as an imminent danger pay area is the General Court
Martial Convening Authority (General Officer-level commander). In all
other cases, the separation authority is the Special Court Martial
Convening Authority (Colonel-level commander).
Separated Soldiers may request review and change of their discharge
by petitioning the Army Review Boards Agency (ARBA). ARBA's case
management division screening team hand carries these cases to the Army
Discharge Review Board (ADRB), which prioritizes review and boarding of
applications for upgrades or changes in discharges where either PTSD or
TBI is diagnosed. ARBA's Medical Advisor serves as a voting board
member when PTSD/TBI cases are boarded by the ADRB.
Army Career and Alumni Program
Soldiers who are separated from Active Duty prior to their actual
separation date, also known as unanticipated losses, are fully eligible
for all transition services provided by the Army Career and Alumni
Program (ACAP). Programs available for Soldiers within ACAP include
pre-separation counseling, employment assistance, Veterans Benefits
Briefing, and the Disabled Transition Assistance Program (DTAP).
Pre-separation counseling provides Soldiers information about
services and benefits they have earned while on active duty. The
following areas are covered in this counseling: effects of a career
change, employment assistance, relocation assistance, education and
training, health and life Insurance, finances, Reserve affiliation,
Veterans benefits, Disabled Veterans benefits, post government service
employment restriction and an Individual Transition Plan. Each of these
areas have several items that support the specific area. This pre-
separation counseling is mandatory for all separating Soldiers who have
at least 180 days of active duty upon time of separation.
Employment assistance consists of individual one-on-one counseling,
attending a Department of Labor two-and-a-half day long employment
workshop, finalizing a resume, practice employment interviews, using
various automated employment tools and using the internet to access job
data banks. This is strictly voluntary; Soldiers do not have to
participate.
The Veterans Benefits Briefing is a 4-hour long briefing provided
by Veterans Affairs (VA) counselors covering all VA-controlled services
and benefits that a Soldier can receive or may be eligible for after
separation. Transition counselors strongly encourage separating
Soldiers to attend.
The Disabled Transition Assistance Program (DTAP) is a 2-hour long
briefing provided by VA counselors. Soldiers who are separated due to
medical or physical injuries, as well as Soldiers who believe that they
will file a VA Disability Claim, are highly encouraged to attend this
briefing.
Soldiers out-processing as an unanticipated loss normally have
limited time remaining on active duty and will in almost all cases have
insufficient time to take advantage of the above programs except for
the legally-mandated pre-separation counseling. However, these Soldiers
are fully eligible to receive these services for up to 180 days after
separation. Additionally, they are referred by the transition counselor
to go to the nearest Department of Labor Career One Stop after
separation for assistance in obtaining employment and are instructed to
use the VA E-benefits Web site to obtain information concerning their
eligibility for VA benefits.
Congressional Assistance
The Army remains dedicated to making sure that all Soldiers with
physical and mental conditions caused by wartime service receive the
care they deserve. The Army is grateful for the continued support of
Congress for providing for the well-being of the best Army in the
world.
Conclusion
The Army leadership has confidence in our behavioral health
providers and the policies in place to ensure proper treatment for our
Soldiers. We continue to monitor these processes to ensure the accurate
diagnosis of PTSD and TBI and to further corroborate each diagnosis of
personality disorder. Veterans who feel that they were discharged
inappropriately are encouraged to seek a remedy through the Army Review
Boards Agency (ARBA).
The mental and physical well-being of our Soldiers and Veterans
depends on your tremendous support. We must continue to maintain an
appropriate level of oversight on PTSD and TBI, wounds all too
frequently associated with the signature weapon of this war, the
improvised explosive device. The men and women of our Army deserve
this; we owe this to them. The Army is committed to continuing to
improve the accuracy and efficiency of these policies and their
implementation. Thank you for the opportunity to appear before you this
morning. I look forward to answering any questions you may have.
Prepared Statement of Antonette M. Zeiss, Ph.D., Acting Deputy Chief
Patient Care Services Officer for Mental Health, Office of Patient
Care Services, Veterans Health Administration,
U.S. Department of Veterans Affairs
Good morning Chairman Filner, Ranking Member Buyer, and Members of
the Committee. Thank you for inviting me to discuss the mental health
services the Department of Veterans Affairs (VA) provides our Veterans,
and how a Veteran's discharge for a personality disorder affects his or
her access to key VA benefits. I am accompanied today by Mr. Tom
Murphy, Director of the Compensation &Pension Service (VBA).
A personality disorder is defined by the Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition (Text Revision, or DSM-IV-TR)
as an enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individual's culture, manifested
in cognition (ways of perceiving or interpreting events and others'
behavior), affect (including the range, intensity, ability to manifest,
or appropriateness of emotional responses), interpersonal functioning,
and impulse control. Essentially, this means that a person with a
personality disorder displays behavior and attitude that is a
consistent, long-term characteristic of the individual and that differs
from cultural norms in problematic ways.
In DSM-IV-TR, personality disorders differ fundamentally from other
types of mental health disorders. DSM-IV-TR requires that a new
diagnosis of a personality disorder should only be made after
considering the possibility that there may be other causes of the
behavioral change, such as another mental disorder, the physiological
effect of a substance (such as medication), or a general medical
condition like head trauma. Primarily, these requirements exist because
many of the problems exhibited by individuals with personality
disorders can also be symptoms of other mental health disorders or
other health problems, and without a prior personality disorder
diagnosis, the clinician cannot assume that these symptoms represent
long-standing, enduring characteristics of the individual. For example,
traumatic brain injuries (TBI) and Post-Traumatic Stress Disorder
(PTSD) can have effects similar to the symptoms of some personality
disorders.
Given the complexity associated with personality disorders and
other cognitive and behavioral issues, VA has developed a comprehensive
system involving outreach, screening and treatment for Veterans to
determine if they have mental health disorders or TBI. Our intensive
programs ensure that any problems are recognized, diagnosed, and
treated, and our benefits programs provide compensation and support for
Veterans whose conditions were the result of service in the military.
My testimony today will begin by discussing Veterans' eligibility for
benefits from VBA and health care. I will then describe the process by
which Veterans are screened for cognitive and behavioral problems and
discuss three conditions: personality disorders, TBI and PTSD. Finally,
I will cover the health care benefits and services available to
Veterans in VA health care facilities and Vet Centers.
Veteran Benefits Administration
Veterans' eligibility for benefits under title 38 is generally
conditioned on two factors: 1) the character of discharge, and 2) the
completion of an enlistment or period to which called. Title 38 U.S.C.
Sec. 101(2) and 38 CFR Sec. 3.1(d) define a Veteran ``as a person who
served in the active military, naval, or air service, and who was
discharged or released under conditions other than dishonorable.'' The
uniformed services, when separating a Servicemember, characterize his
or her service as one of the following: honorable; general, under
honorable conditions; under other than honorable conditions; bad
conduct; dishonorable; or, uncharacterized.
VA accepts discharges that are characterized as honorable or
general, under honorable conditions, as ``other than dishonorable'' for
VA purposes. Such discharges generally do not disqualify a Veteran for
health care, disability compensation and pension, educational
assistance, vocational rehabilitation and employment services, home
loan guaranty, and burial and memorial benefits offered by VA as long
as the Veteran meets the minimum active duty requirement of 2 years of
service or ``the period called'' to service if activated for less than
2 years. Service ``for the period called'' would be applicable in the
situation of a Reservist or National Guard member called to active duty
by a Federal Order (for other than training purposes) and completing
the full call-up period. If VA determines that a Veteran has a service-
connected disability the minimum active duty requirement does not
apply. In addition, for purposes of the Montgomery GI Bill and the
Post-9/11 GI Bill, a Veteran must have received an honorable discharge.
VA uses the process outlined in 38 CFR Sec. 3.12 to determine
whether other than honorable and bad conduct discharges may be
considered ``other than dishonorable'' for VA purposes. Dishonorable
discharges are all disqualifying. A separation resulting from a
reported personality disorder is of potential significance to VA only
if it results in a separation that is less than honorable or if it
results in a separation before completion of the minimum active duty
requirement.
Personality disorders are considered constitutional or
developmental abnormalities and thus are not service-connected.
Therefore the law does not permit payment of compensation for a
personality disorder. However, Veterans who are eligible to enroll for
VA health care can be examined by VA clinicians, who may diagnose other
mental health disorders. Veterans are not bound by any diagnosis from
the Department of Defense (DoD) when seeking treatment from VA or when
submitting a claim for service connection.
Veterans Health Administration
Eligible Veterans may enroll in the VA health care
system. Once enrolled, they are provided all needed care set forth in
the medical benefits package. VA's enrollment system manages the
enrollment of Veterans in accordance with priority categories.
Currently, the following Veterans are eligible to enroll:
The Veteran was a former Prisoner of War;
The Veteran received a Purple Heart Medal;
The Veteran is determined to have a compensable
service-connected disability;
The Veteran receives a VA pension;
The Veteran received a Medal of Honor;
The Veteran is determined to be catastrophically
disabled;
The Veteran has an annual household income below
applicable income thresholds.
In addition, Operation Enduring Freedom and Operation Iraqi Freedom
(OEF/OIF) combat Veterans may enroll and receive free VA medical care
for any condition related to their service. Under the ``Combat
Veteran'' authority, VA provides cost-free health care services and
nursing home care for conditions possibly related to military service
to:
Combat Veterans who were discharged or released from
active service on or after January 28, 2003, for 5 years from the date
of discharge or release if they enroll for VA health care during this
period.
Combat Veterans who were discharged from active duty
before January 28, 2003, but who did not enroll in VA health care
system now have until January 27, 2011 to enroll and receive care as
combat veterans. Veterans who enroll with VA under this authority will
continue to be enrolled even after their combat-Veteran eligibility
period ends but may be required to make applicable copayments.
Screening for Cognitive and Behavioral Conditions
VA clinicians routinely and systematically screen enrolled Veterans
for a range of health concerns. Every Veteran who visits a VA health
care facility is screened initially and periodically for PTSD, problem
drinking, and depression, and all Veterans receive a one-time screening
for Military Sexual Trauma (MST). Veterans from OEF/OIF are screened
for possible TBI as well. Any Veteran who screens positive for any of
these conditions is referred for further assessment and care. With the
widespread integration of mental health into primary care settings,
this process has become easier for Veterans, and the potential stigma
of being referred to an exclusively mental health environment has been
reduced.
VA's universal screens are primarily health assessments meant to
ensure that appropriate care is delivered, but such assessments may be
relevant to service connection claims as well. VA clinicians, including
psychologists or psychiatrists, conduct detailed assessments when
Veterans apply for disability benefits for a mental health condition
connected to their military service. These experts review medical
records, including screening and further test results, as part of this
assessment.
Compensation and pension (C&P) examinations for mental health
disorders follow established guidelines and cover psychosocial
functioning, as well as self-reports of symptoms of mental disorders
that manifested before, during, or after military service. VA
clinicians also assess the Veteran's individual military experience,
including exposure to traumatic events or other stressful experiences
that could trigger a mental health problem, and compare this
information with the timing of symptoms to determine if the condition
is likely to be connected to military service. If the Veteran exhibited
a pattern of maladaptive behavior prior to military service, VA must
determine whether there has been a change in behavior connected to and
a result of military service. All VA clinicians, including those
responsible for completing C&P evaluations, adhere to the DSM-IV-TR,
which is widely recognized as the most current and authoritative source
for mental health conditions.
Personality Disorders, TBI, and PTSD
As I stated earlier, some personality disorders, TBI, and PTSD can
share common symptoms. Behavioral changes may be the result of physical
or psychological injuries, or both, and it is our responsibility to
properly identify which condition a Veteran has to ensure an accurate
record for benefits administration and effective treatment planning.
For this reason, I will spend some time describing the similarities and
differences of these conditions.
Personality Disorders
At the beginning of my testimony, I provided an overview of the
DSM-IV-TR definition of a personality disorder. For a VA clinician to
make a diagnosis that a Veteran meets criteria for a personality
disorder, the clinician must use the full definition and establish each
component. Generally speaking, this means that a personality disorder
is not situational, temporary, or recently acquired, and that the
person's behavior has been adversely affected and cannot be explained
by other disorders.
Events characterized by repeated exposure to traumatic stress can
result in symptoms and behaviors that appear, on the surface, to
resemble some of these personality disorders. In addition to a
comprehensive psychological assessment of the individual, VA advises
clinicians to consult with family members or others with knowledge of
the individual prior to his or her military service when considering
whether a Veteran should be diagnosed with a personality disorder.
Traumatic Brain Injury
Traumatic brain injury is the result of a severe or moderate force
to the head, where physical portions of the brain are damaged and
functioning is impaired. Depending upon where the injury is sustained
and its severity, the effects of a TBI on a person's behavior will
vary. A mild TBI, which is also commonly called a concussion, may
simply require some time to recover. Short term effects might include
dizziness, nausea, memory lapses, or other conditions, and in many
cases, there are no long term effects. Moderate and severe TBI can have
more lasting effects and may impact a person's behavior. For example, a
person may be more irritable or aggressive as a result of a brain
injury.
Due to the severity and complexity of their injuries,
Servicemembers and Veterans with moderate to severe TBI require an
extraordinary level of coordination and integration of clinical and
other support services. Veterans who screen positive for TBI are
referred for a comprehensive evaluation at one of 22 Polytrauma Network
Sites or one of 83 Polytrauma Support Clinic Teams. This comprehensive
evaluation assesses the Veteran's current physical, behavioral,
emotional, and cognitive status. The evaluation includes a 22-item
Neurobehavioral Symptom Inventory, which allows for systematic
assessment of a wide array of potential current problems. This
diagnostic tool allows VA to develop an appropriate diagnosis of
current TBI-related symptoms and problems and to contribute to
developing an interdisciplinary plan for care.
PTSD
According to the DSM-IV-TR clinical criteria, PTSD can follow
exposure to a severely traumatic stressor that involves personal
experience of an event involving actual or threatened death or serious
injury. It can also be triggered by witnessing an event that involves
death, injury, or a threat to the physical integrity of another. The
person's response to the event must involve intense fear, helplessness
or horror. The symptoms characteristic of PTSD include persistent re-
experiencing of the traumatic event, persistent avoidance of stimuli
associated with the trauma, numbing of general responsiveness, and
persistent symptoms of increased arousal. It is extremely rare that an
individual would display all of these symptoms, and a diagnosis
requires a combination of a sufficient number of symptoms, while
recognizing that individual patterns will vary.
PTSD can be experienced in many ways. Symptoms must last for more
than 1 month, and the disturbance must cause clinically significant
distress or impairment in social, occupational, or other important
areas of functioning. Military combat certainly can create situations
that fit the DSM-IV-TR description of a severe stressor event that can
result in PTSD, and VA recognizes that being stationed in a combat area
where there is constant danger and inability to predict or control the
threat of danger also can meet the description of a severe stressor
event. The likelihood of developing PTSD is known to increase as the
proximity to, intensity of, and number of exposures to such stressors
increase. In addition, PTSD can be a result of many other experiences
besides combat exposure, such as sexual assault, life-threatening
accidents, or natural disasters.
PTSD is associated with increased rates of other mental health
conditions, including Major Depressive Disorder, Substance-Related
Disorders, Generalized Anxiety Disorder, and others. PTSD can directly
or indirectly contribute to other medical conditions. Duration and
intensity of symptoms can vary across individuals and within
individuals over time. Symptoms may be brief or persistent; the course
of PTSD may ebb and return over time, and PTSD can have a delayed
onset. Clinicians use these criteria and discussions with patients to
identify cases of PTSD, sometimes in combination with additional
psychological testing.
Comparing and Contrasting Personality Disorders, TBI, and PTSD
The significance of an accurate diagnosis cannot be underestimated,
as the diagnosis will inform our approach to treatment and care, and a
person can meet criteria for more than one problem at a time. For
example, a Veteran could have experienced events that led to both PTSD
and TBI. A person previously able to function in spite of a long-
standing mild-to moderate personality disorder can develop PTSD after
trauma. Such a person could also have sustained a TBI, which could
contribute to aggression, poor impulse control, or suspiciousness.
Since the onset of personality disorders by definition occurs by
late adolescence or early adulthood, there typically should be evidence
of the behavior pattern prior to adulthood. A history of solid
adjustment and good psychosocial functioning prior to adulthood would
not be expected in an individual with a personality disorder. Following
an extended event characterized by traumatic stressors, it is
particularly important to determine if problematic behaviors are due to
PTSD. The DSM-IV-TR explicitly states, ``When personality changes
emerge and persist after an individual has been exposed to extreme
stress, a diagnosis of Post-Traumatic Stress Disorder should be
considered'' (p. 632). PTSD can induce irritability or outbursts of
anger, feelings of detachment or estrangement from others, and
restricted range of affect (unable to experience feelings such as
love). In addition, PTSD may increase the risk of self-destructive and
impulsive behavior, social withdrawal, hyper-vigilance, and impaired
relationships with others.
Many Veterans who screen positive for possible TBI and who are seen
for a comprehensive evaluation have co-occurring conditions, including
PTSD. A Veteran may exhibit significant interpersonal difficulties that
were not present prior to the TBI. Inability to control anger, trouble
with social tact, and other interpersonal difficulties are examples,
and these occur more frequently in those with moderate to severe TBI.
Clinicians are able to distinguish a TBI-related interpersonal change
by taking a thorough history and obtaining collateral interview data.
Pinpointing the onset of interpersonal and personality change to the
time of sustaining a TBI provides evidence of acquired interpersonal
dysfunction and rules out a longstanding personality disorder.
The symptoms and problems related to TBI and PTSD can be
particularly challenging to differentiate for several reasons, most
notably because the same event may have resulted in TBI and led to the
development of PTSD. However, specific criteria in the DSM-IV-TR guide
clinicians in distinguishing between the two conditions by looking for
symptoms that are specific to one or the other disorder, such as
persistent re-experiencing of a traumatic event and avoidance of
stimuli associated with the trauma, which would only be related to
PTSD.
To address this, VA uses interdisciplinary polytrauma
rehabilitation teams and neuropsychologists and rehabilitation
psychologists to determine if a Veteran with TBI also has PTSD.
Standardized questionnaires such as the PTSD Checklist--Military
Version (PCL-M) and structured interviews such as the Clinically
Administered PTSD Scale (CAPS) also aid VA clinicians in determining
whether a Veteran meets criteria for PTSD, with or without TBI. VA
clinicians consider factors such as symptom presentation and a
psychosocial history from the Veteran that creates a timeline of
symptom development. Clinicians also conduct a medical record review, a
psychological and neuropsychological assessment, and interviews.
Following a thorough evaluation, the polytrauma rehabilitation team,
often in concert with mental health providers, collaborates to develop
and execute a comprehensive treatment plan.
According to the DSM-IV-TR classification system, these clinical
scenarios involving personality change after a TBI are diagnostically
distinct from Personality Disorders and are coded as such. Most
frequently, they fall under the category of Mental Disorders Due to a
General Medical Condition (i.e., diagnostic code 310.1--Personality
Disorder Due to General Medical Condition) or Relational Problem
Related to a General Medical Condition (code V61.9). When these
diagnostic codes are used, TBI also must be coded as the relevant
medical condition.
Treatment
VA offers mental health services to Veterans through medical
facilities, community-based outpatient clinics (CBOC), and in VA's Vet
Centers, discussed later in my testimony. VA has been making
significant enhancements to its mental health services since 2005,
through the VA Comprehensive Mental Health Strategic Plan and special
purpose funds available through the Mental Health Enhancement
Initiative from fiscal years 2005 to 2009. In 2007, VA approved the
Handbook on Uniform Mental Health Services in VA Medical Centers and
Clinics to define what mental health services should be available to
all enrolled Veterans who need them, no matter where they receive care,
and to sustain the enhancements made in recent years.
VA's enhanced mental health activities include outreach to help
those in need to access services, a comprehensive program of treatment
and rehabilitation for those with mental health conditions, and
programs established specifically to care for those at high risk of
suicide. To reduce the stigma of seeking care and to improve access, VA
has integrated mental health into primary care settings to provide much
of the care that is needed for those with the most common mental health
conditions. In parallel with the implementation of these programs, VA
has been modifying its specialty mental health care services to
emphasize psychosocial as well as pharmacological treatments and to
focus on principles of rehabilitation and recovery. VA is ensuring that
treatment of mental health conditions includes attention to the
benefits as well as the risks of the full range of effective
interventions. Making these treatments available responds to the
principle that when there is evidence for the effectiveness of a number
of different treatment strategies, the choice of treatment should be
based on the Veteran's values and preferences, as well as the clinical
judgment of the provider.
Veterans with TBI seen in VA receive some of the best care
available. The VA Polytrauma System of Care, which is composed of 4
regional Polytrauma/TBI Rehabilitation Centers, 22 Polytrauma Network
Sites, and 83 Polytrauma Support Clinic Teams, currently provides
specialty rehabilitation care. Veterans with TBI can also be seen at
other VA facilities for treatment, including via telehealth.
Vet Center Services
In addition to the clinical care and diagnostic services discussed
previously, VA's Vet Centers offer an important complement that assists
Veterans with readjustment issues. Vet Centers provide quality outreach
and readjustment counseling services to returning war Veterans of all
eras and their family members in confidential, easy to access
community-based sites. The Vet Centers' mission goes beyond medical
care in providing a holistic mix of services designed to treat the
Veteran as a whole person in his or her community setting. Vet Centers
provide an alternative to receiving treatment in traditional mental
health care settings that helps many combat Veterans overcome the
stigma and fear related to accessing professional assistance for
military-related problems. Vet Centers are staffed by interdisciplinary
teams that include psychologists, nurses and social workers, many of
whom are Veterans themselves.
Vet Center care consists of a continuum of social and psychological
services including community outreach to special populations,
professional readjustment counseling to Veterans and families, and
brokering of services with community agencies that provides a key
access link between the Veteran and other needed services both in and
outside of the VA. Readjustment counseling offered at Vet Centers may
address problems such as war-related psychological readjustment, PTSD
counseling, family or relationship problems, lack of adequate
employment or career goals, lack of educational achievement, social
isolation, homelessness and lack of adequate resources, and other
psychological problems such as depression or substance use disorders.
Vet Centers also provide military-related sexual trauma counseling,
bereavement counseling, employment counseling and job referrals,
preventive health care information, and referrals to other VA and non-
VA medical and benefits facilities.
The Vet Center program promotes early intervention and ease of
access to services by helping combat Veterans and families overcome all
barriers of care. To facilitate access to services for Veterans in hard
to reach outlying areas, 50 mobile Vet Centers have been deployed
across the country to provide assistance to Veterans, military service
personnel, and family members. There are currently 267 operational Vet
Centers nationwide, with another 33 expected to open in 2011, for a
total of 300.
In addition to the wide range of services and increased
accessibility for Veterans to access these services, Vet Centers
provide assistance and support for combat Veterans through referrals to
other agencies. Section 402 of the Caregivers and Veterans Omnibus
Health Services Act of 2010 (Public Law 111-163) provides VA the
authority to assist Veterans with problematic discharges through
referral to services outside VA or referral for assistance with
discharge upgrades when appropriate. Until 1996, VA had specific
statutory authority to refer ineligible Veterans to non-VA resources
and to advise such individuals of the right to apply for review of the
individual's discharge or release. With this renewal, the Vet Centers
have the authority to help combat Veterans with problem discharges that
may be related to traumatic war-time stress. We appreciate the renewal
of this provision, and VA has advised its readjustment counselors that
they should provide such help to Veterans when needed.
Conclusion
Thank you again for this opportunity to speak about VA's role in
providing care for all our Veterans, including those with personality
disorders, PTSD, or TBI. VA recognizes the sacrifice all of our
Veterans have made, and we seek to ensure we offer the right diagnosis
in all clinical settings, whether for a compensation and pension
examination or as part of a standard mental health assessment and
treatment plan. Once a Veteran is enrolled in the VA health care
system, it does not matter when or where the condition developed; we
will deliver appropriate, Veteran-centered care as set forth in the
medical benefits package. We are prepared to answer your questions at
this time.
Statement of Amy Fairweather, Policy Director, Swords to Plowshares
Thank you Chairman Filner, Congressman Buyer and the members of the
House Veterans Affairs Committee for the opportunity to submit
testimony on this important topic; Personality Disorder discharges and
their impact on our veterans.
Founded in 1974, Swords to Plowshares is a community-based not-for-
profit organization that provides counseling and case management,
employment and training, housing and legal assistance to homeless and
low-income veterans in the San Francisco Bay Area. We promote and
protect the rights of veterans through advocacy, public education, and
partnerships with local, state and national entities. Swords to
Plowshares is a Congressionally recognized Veteran Service Organization
which represents veterans in VA Compensation and Pension claims as well
as discharge review matters. As such we have represented many veterans
who have unjustly received inappropriate personality disorder (PD),
adjustment disorder (AD) and pattern of misconduct discharges and been
denied treatment for their PTSD.
The purpose of this testimony is to emphasize how the inappropriate
use of personality disorder, adjustment disorder and pattern of
misconduct impact our veteran clients on the ground. Such discharges
have a tremendously negative impact on our veteran clients. We will not
go into data on a broader scale as our colleagues at Veterans for
Common Sense have done an excellent job framing the issues. Instead, we
can tell you that client after client with PTSD and traumatic brain
injury and inappropriate PD discharges come to us feeling that they
have been branded as damaged goods, their combat service has been
invalidated, and their identity and self worth as once proud warriors
destroyed. The fallout can be tragic, this practice exacerbates PTSD,
depression, homelessness and suicidally, and creates obstacles to
employment, and access to health care and benefits.
At Swords to Plowshares we have 35 years experience in picking up
the pieces and pulling our Vietnam era clients out of poverty, and
chronic homelessness, mental health need and substance abuse stemming
from their military service. We hope that we have learned lessons and
may be proactive, prevent future homelessness and suffering by ensuring
that this generation of combat veterans are afforded the honor, care
and support they need for successful outcomes.
The following are some of our observations regarding personality
disorder, adjustment disorder and pattern of misconduct discharges for
veterans with PTSD, TBI and other mental health needs.
The Impact of Misdiagnosis
Many of our clients served honorably and without any disciplinary
or mental health concerns for several years prior to receiving a
personality disorder or adjustment disorder discharge. Unlike PTSD,
schizophrenia and psychosis, personality disorder does not develop
following a traumatic stressor or deployment. It does not manifest
suddenly. Instead it is a pre-existing condition and was allegedly
present at the time the servicemember joined the military. If the
servicemember had a pre-existing personality disorder which led to such
a discharge it should have been identifiable in the preceding years of
service. Indeed, it should be identified in boot camp or A school. We
are seeing and hearing from veterans who have been diagnosed with
personality disorder after multiple deployments. The military is simply
not following the diagnostic criteria set forth in the DSM-IV, and its
failure to do so should not forever punish former servicemembers.
The DoD is shirking their responsibility to treat PTSD to the VA
and the community-based system of care. If these servicemembers were
properly and legally discharged they should receive medical retirement,
an honorable discharge, a 50 percent disability rating and medical
care. Instead they are kicked out of the military with a less than
honorable discharge status with no readily available means of support
or health care. Veterans come to Swords to Plowshares in financial and
psychological crisis, many believe that they are not eligible for VA
care and benefits because personality disorder, as a pre-existing
condition is not service connectable. Even with the help of our legal
and social services staff, this status causes significant delays in
care, causing unnecessary exacerbation of their symptoms. The cost of
care should never have been externalized to our communities. Further
the cost in suffering, poverty, and the shame inflicted on warriors is
immeasurable.
The DoD is taking advantage of vulnerable disabled servicemembers.
Many of our clients have signed away their right to a just and proper
discharge because they are suffering from PTSD or TBI and cannot bear
remaining in the military environment. Some because their PTSD and
depression are too acute, others because of the stigma and mistreatment
they receive in seeking care. In other cases, their symptoms have led
to some diminished capacity which interferes with performance or have
engaged in some degree of misconduct symptomatic of their true
diagnosis and are being met with discipline rather than care. These
servicemembers will sign anything to escape a hostile environment and
do not have the capacity for informed consent in signing away their
right to a proper medical discharge.
Personality, adjustment and pattern of misconduct discharges can
unjustly strip veterans of their GI Bill benefits. A personality
disorder discharge in itself is not a bar to benefits however, in our
experience; they often arise in the context of a pattern of misconduct
and disciplinary action. If the veteran received an other than
honorable discharge they are barred from the GI Bill benefits. This
unjustly throws more obstacles in their path to healing, employment,
housing and economic stability.
To assign a PD, AD or BCD discharge to a mentally ill warrior is a
devastating betrayal. It is a cruel injustice to servicemembers who
have served their country for some years, deployed to combat, been
exposed to trauma and injury, witnessed the deaths of friends, and
struggled with the demons of PTSD. Rather than honoring their service
and healing their wounds, the military with which they have identified
and sacrificed for has labeled them `crazy' and sent them packing. This
overwhelming psychic blow to our clients cannot be overstated. The
military is a not just a job, it is an all-encompassing culture of its
own, and these injured veterans are in essence banished from society.
There is virtually no access to justice for disabled veterans who
have illegally and unjustly received PD, AD and BCD discharge. There
are very very few attorneys who specialize in discharge upgrades and
corrections. And only a handful in the country that provide this
service free of charge. Our own funding for discharge review has been
cut back and we have had to severely restrict our client representation
in these matters. Without competent affordable representation too many
combat veterans will fall into a life of chronic mental illness,
poverty and homelessness due to the military's illegal and inexcusable
mistreatment of wounded servicemembers.
In closing, we urge the HVAC committee will ensure that
servicemembers with mental health needs receive appropriate discharges
and streamlined access to all the benefits and care they have earned.
To that end, we fully concur with the recommendations of Veterans for
Common Sense.
MATERIAL SUBMITTED FOR THE RECORD
U.S. Department of Defense
Under Secretary of Defense
Personnel and Readiness
Washington, DC.
September 10, 2010
MEMORANDUM FOR SECRETARIES OF THE MILITARY DEPARTMENTS
SUBJECT: Continued Compliance Reporting on Personality Disorder (PD)
Separations
Reference: USD (P&R) Memorandum, dated January 14, 2009
In October 2008, the Government Accountability Office released a
report titled, Additional Efforts Needed to Ensure Compliance with
Personality Disorder Separation Requirements, which found that the
Military Departments were not wholly compliant with DoD personality
disorder separation guidance contained in DoD Instruction 1332.14,
Enlisted Administrative Separations. The Department endorsed the
subsequent recommendation that DoD review compliance on a regular
basis.
In January 2009, the Military Departments were directed (reference)
to provide a report on compliance with DoD PD separation guidance
contained in DoDI 1332.14 for PD separations during fiscal year (FY)
2008 and FY 2009. While improvement has occurred, it is clear that
compliance reporting should continue through FY 2012. Your report is
due by March 31 of the year following the close of the FY.
The report provided shall be based, at a minimum, on a random
sampling of at least 10 percent of all PD separations for your
respective Military Department for the designated FY. Each case file
sampled shall be checked for compliance with the DoD requirements
listed in the attached document titled, ``DoD Personality Disorder
Separation Requirements.'' Additionally, the report shall include the
total number of PD separations for the applicable FY and the total
number of PD separations of Servicemembers who had served in imminent
danger pay areas since September 11, 2001.
If a Military Department finds that compliance with any DoD PD
separation requirement is less than 90 percent, then the report shall
also contain the Military Department's plan for correcting compliance
deficiencies.
We owe special care to those Servicemembers who have deployed in
support of a contingency operation since September 11, 2001, and were
later administratively separated for a personality disorder, regardless
of years of service, without completing the enhanced screening
requirements for Post-Traumatic Stress Disorder (PTSD) and Traumatic
Brain Injury (TBI). Our knowledge in these areas has evolved
significantly and we need to make every effort to ensure our veterans
are advantaged by the latest medical knowledge in this area.
Accordingly, I am directing that your FY 2010 Compliance Report on
Personality Disorder Separations include actions taken to: (1) identify
these discharged Servicemembers; (2) inform them of the correction of
discharge characterization process; (3) inform them on how to obtain a
mental health assessment through the Department of Veterans Affairs;
and (4) identify these individuals to the Department of Veterans
Affairs
If you should have any questions regarding this matter, please
contact my action officer, Michael Pachuta, at (703) 695-6461 or
[email protected].
Clifford L. Stanley
Attachment:
As stated
cc:
ASA (M&RA)
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DoD Personality Disorder (PD) Separation Requirements
All references listed refer to DoD Instruction 1332.14, Enlisted
Administrative Separations, August 28, 2008.
Member received formal counseling and was afforded
adequate opportunity to improve his or her behavior prior to being
separated on the basis of PD (Ref: Paragraph 3.a.(8)(a)).
Member's PD diagnosis was made by a psychiatrist or
Ph.D.-level psychologist (Ref: Paragraph 3.a.(8)(c)).
The PD diagnosis included a statement or judgment from
the psychiatrist or Ph.D.-level psychologist that the Servicemember's
disorder was so severe that the member's ability to function
effectively in the military environment was significantly impaired
(Ref: Paragraph 3.a.(8)(c)).
Member received written notification of his or her
impending separation based on PD diagnoses (Ref: Paragraph 3.a.(8)(f)
and Enclosure 6, Paragraph 2.a).
Member was advised that the diagnosis of a personality
disorder does not qualify as a disability (ref: Paragraph 3.a.(8)(a))--
(only required for PD separations after August 28, 2008).
For Servicemembers separated on the basis of PD who
served in imminent danger pay areas (only required for PD separations
after August 28, 2008).
Member's PD diagnosis was corroborated by a peer
psychiatrist or Ph.D.-level psychologist or higher level mental
health professional (Ref: Paragraph 3.a.(8)(c)).
Member's PD diagnosis addressed Post-Traumatic
Stress Disorder (PTSD) or other mental illness co-morbidity
(Ref: paragraph 3.a.(8)(c)). (NOTE: According to paragraph
3.a.(8)(d), unless found fit for duty by the disability
evaluation system, a separation for PD is not authorized if
Service-related PTSD is also diagnosed.)
Member's PD diagnosis was endorsed by The Surgeon
General of the Military Department concerned prior to discharge
(Ref: Paragraph 3.a.(8)(c)).
Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
Joshua Kors
Reporter
The Nation.
190 E. 7th Street, Suite 503
New York, NY 10009
Dear Joshua:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
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Responses from Joshua Kors
Question 1: Of the 22,600 servicemembers who have been discharged
with personality disorder, how many do you believe are due to improper
diagnosis?
Response: All of them. A personality disorder discharge is a
contradiction in terms. Applicants with a severe mental illness like a
personality disorder do not pass the military's rigorous screening and
are not accepted into the Army. . . . My years of reporting on this
problem further indicate how the diagnosis/discharge are being used,
applied to thousands of soldiers only after they suffer physical
injuries from combat. These are soldiers deemed perfectly healthy in
multiple screenings, many of whom even served in multiple combat tours.
Worth mentioning that the recent hearing revealed that the current
count of fraudulent PD discharges since 2001 is now over 25,500
soldiers. The 22,600 figure went through 2007. In his testimony, the
Army's acting director of Officer/Enlisted Personnel Management, Lernes
Hebert, provided the numbers for recent discharges. (Note: I'll have to
go back and look at the tape, but I'm curious to see whether Hebert
just gave the number of post-2007 Army PD discharges. In which case, he
was really giving one-quarter of the true PD discharge figure, as the
fraudulent discharges are spread equally through all four branches.)
For further info on PD discharge stats: www.joshuakors.com/
statistics.
Question 2: What recommendations do you have for DoD in correcting
the wrongful diagnosis of personality disorders? Do you believe that
DoD should eliminate personality disorder discharges altogether or find
alternative, rigorous means of validating personality disorders? Please
explain.
Response: The ``personality disorder discharge'' should certainly
be eliminated altogether. It has no honest purpose, existing solely to
rapidly discharge wounded soldiers and deny them benefits. Even the
staunchest defenders of PD discharges--and I have met very few in my
3.5 years of speaking with military personnel on this topic--would say
that after a soldier has been deployed and suffers a clear physical
wound (broken bones, aural damage, Traumatic Brain Injury) or notable
psychological injury (like shell shock/PTSD) and can no longer serve,
the honest thing to do is chapter them out for those injuries. In each
case I've looked at, the military then claims this pre-existing mental
illness, on soldiers who had been perfectly healthy, with no proof
presented that a mental illness did indeed exist before the soldier
joined the Armed Forces.
Question 3: When speaking with military doctors, how prevalent do
you believe the pressure is to purposely misdiagnose wounded soldiers
with personality disorders?
Response: It's a great question, and it's very hard to say, since
military doctors are so afraid to speak out. As Sergeant Luther learned
this week, speaking out has severe consequences for them and their
family.
Of course, you have obvious examples of that pressure, like the
Perez memo (www.joshuakors.com/perezmemo), in which Norma Perez, former
coordinator of the PTSD program at the VA hospital in Temple, Texas,
urged the doctors under her command to guard against ``compensation
seeking veterans'' by diagnosing pre-existing conditions. And the Knorr
memo (www.joshuakors.com/part2#knorrmemo), in which Colonel Steven
Knorr, chief of Fort Carson's Behavioral Health unit, posted a memo to
his doctors urging them not to ``believe everything Soldiers tell us''
about their injuries and instead move to a rapid discharge, like a PD
discharge. In the words of his memo: ``Get rid of dead wood.''
An indication of how ``mainstream'' those views are within the
military is the fact that for the first PD discharge review, former
Army Surgeon General Gale Pollock tapped Knorr--and only Knorr--to do
the review: www.joshuakors.com/part2#
SGreview. Further reporting revealed that in the Knorr/Surgeon General
5-month ``thoughtful and thorough'' review, to determine that all the
soldiers were suffering from severe, pre-existing mental illness, they
interviewed no one, not even the soldiers whose cases they were
reviewing. As with the Pentagon review 3 years later, the Knorr/Surgeon
General review determined that all soldiers had been properly diagnosed
and all had been properly discharged, even the soldiers' whose cases
they couldn't even find (www.joshuakors.com/part2#lostcases).
Then again, the doctors who spoke with me about being pressured to
misdiagnose wounded soldiers weren't even at these two facilities. I
think of the military doctor who worked far from Colorado (Fort Carson)
and Texas (Perez's VA facility) and was pressured to diagnose the
soldier with a chunk missing from his leg as suffering from a
personality disorder--an indication of how widespread this is, a reason
why the fraudulent discharge figures are so high.
Finally I would say that my sense is, after reporting on this for
several years, that this pressure on doctors is simply part of the
military culture. I think of the VA's manual for its doctors, which
advises doctors not to trust soldiers' reports of their own wounds
because injuries like shell shock are ``relatively easy to fabricate.''
When you're instructing doctors to begin with that mindset, suspecting
dishonesty from wounded soldiers, it's not too far from there to arrive
at ``personality disorder'' as the diagnosis.
Question 4: Beyond personality disorder discharges, have you
observed a problem with DoD wrongfully using ``adjustment disorder''
and ``pattern of misconduct'' discharges?
Response: Yes. As Paul Sullivan, director of Veterans for Common
Sense, testified at the hearing, from the cases he's seeing,
``adjustment disorder'' is becoming the new PD. Of course, adjustment
disorder is just another phony pre-existing condition that prevents
benefits, so we're talking about the same trick with only a small
change in the language. (The Perez memo actually uses the term
``Adjustment Disorder.'') Needless to say, yes, I've seen pre-existing
``adjustment disorder'' diagnoses too, and yes, they do screen for that
mental condition as well before applicants are accepted into the
military.
As for ``pattern of misconduct,'' so many of these soldiers fall
into immediate trouble when they're faced with these fraudulent
discharges, get stressed, and smoke some marijuana or lose their temper
and punch someone. You'll recall Major Wehri, Luther's commander, in my
recent article speaking about Luther's attempted escape from his closet
and how, in the ensuing ruckus, Luther bit one of his guards and spit
in the face of the aid station chaplain. Wehri said his pushing Luther
to sign the PD discharge papers was truly an act of kindness. ``With
Luther's biting and spiting,'' he said, ``I could have court-martialed
him out right there for failure to perform in a military manner.''
If Luther, like so many others in his shoes, did end up receiving
that dishonorable discharge, it would have meant a whole new batch of
devastating consequences.
Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
Thomas J. Berger, Ph.D.
Executive Director, Veterans Health Council
Vietnam Veterans of America
8719 Colesville Road
Silver Spring, MD 20910
Dear Tom:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax your responses at 202-225-2034. If you have any
questions, please call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
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Veterans Health Council
Improving Veterans Health through Information and Education
To: The Honorable Bob Filner, Chair, U.S.
House of Representatives Committee
on Veterans' Affairs
From: Thomas J. Berger, Ph.D., Executive
Director, Veterans Health Council
Vietnam Veterans of America
Date: October 29, 2010
Question 1: What recommendations do you have for DoD in correcting
the wrongful diagnosis of personality disorder? Do you believe that DoD
should eliminate personality disorder discharges altogether or find
another alternative rigorous means of validating personality disorder
discharges?
Response: First, we at Vietnam Veterans of America remain skeptical
of the claims by both DoD and the individual military services that
each of the 22,600 personality disorder discharges reported back in
2007 were, in fact, reviewed appropriately to determine the possibility
of a misdiagnosis. Our skepticism was bolstered by the October 2008 GAO
report and the testimony presented by GAO Director Dr. Draper before
the HVAC on September 15, 2010 that ``only 40 to 78 percent'' of the
reviews of service jackets for ``312 members separated for personality
disorder from four military installations'' were not compliant with the
regulations governing such separations. In addition, after the GAO
report was issued in 2008, the number of personality disorder
discharges dropped by 75 percent, while the number of PTSD diagnoses
soared. Thus, there is no reason to believe the number of personality
disorder discharges would decrease so quickly unless hundreds of
military personnel had been misdiagnosed in the first place.
Secondly, VVA believes that the military services, with the Army in
particular, may now be using different administrative designations--
``adjustment disorder'' and/or ``readjustment disorder''--to
erroneously discharge members of the Armed Forces who are experiencing
symptoms of Post-traumatic Stress Disorder (PTSD) or Traumatic Brain
Injury (TBI), instead of making sure they can receive the mental health
medical care worthy of their service and sacrifice.
Because of these concerns, VVA and the Jerome N. Frank Legal
Services Organization at the Yale School of Law have filed a FOIA
request with DoD and each military service (including National Guard)
to provide the records and demographic details of all personality
disorder discharges, adjustment disorder discharges and readjustment
disorder discharges from October 2001 through October 2010 (see
attached letter to the Air Force). This FOIA request is a more detailed
complement to the October 15, 2010 request from Senators Bond,
Brownback, Grassley, and Leahy to Secretary Gates for information about
the use of personality disorder discharges (see attached letter from
U.S. Senate).
As a result, As a result, VVA suggests that a review of the FOIA
information should take place before making a recommendation to keep or
eliminate the personality disorder discharge altogether.
Question 2: In your view, does VA do a good job of ensuring that
veterans who have been inappropriately discharged with a personality
disorder discharge are correctly diagnosed and provided the appropriate
care and benefits?
Response: According to the statement of the VA's Acting Deputy
Chief of Patient Care Services, Dr. Antoinette Zeiss, at the September
15, 2010 HVAC hearing, ``A separation resulting from a reported
personality disorder is of potential significance to VA only if it
results in a separation that is less than honorable or if it results in
a separation before completion of the minimum active duty requirement.
Veterans are not bound by any diagnosis from the Department of Defense
(DoD) when seeking treatment from VA or when submitting a claim for
service connection.'' However, VVA does not know how many ``veterans
who have been inappropriately discharged with a personality disorder''
have been subsequently ``correctly diagnosed and provided the
appropriate care and benefits''. So VVA and the Jerome N. Frank Legal
Services Organization at the Yale School of Law have also filed a FOIA
request with the VA to provide the records and demographic details of
inappropriate personality disorder discharges handled by VA's mental
health services.
__________
The Jerome N. Frank Legal Services Organization
Yale Law School
New Haven, CT.
October 22, 2010
U.S. Air Force
HAF/ICIOD
1000 Air Force Pentagon
Washington, DC 20330-1000
Re: Freedom of Information Act Request
Dear FOIA Officer:
Pursuant to the Federal Freedom of Information Act, 5 U.S.C.
Sec. 552, we request access to and copies of records \1\ in possession
of the Air Force (and all its component offices). These records are
requested by the Veterans Legal Services Clinic at the Jerome N. Frank
Legal Services Organization on behalf of Vietnam Veterans of America
and Connecticut Greater Hartford Chapter 120 of Vietnam Veterans of
America (``Requesters''). This letter requests all records related to
the use by the United States Air Force (``Air Force'') \2\ of
personality disorder discharges and adjustment disorder or readjustment
disorder discharges to separate members of the Air Force \3\ from
service since October 1, 2001.
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\1\ The term ``records'' as used herein, includes all records or
communications preserved in electronic or written form, including but
not limited to correspondence, documents, data, videotapes, audio
tapes, emails, faxes, files, guidance, guidelines, evaluations,
instructions, analyses, memoranda, agreements, notes, orders, policies,
procedures, protocols, reports, rules, technical manuals, technical
specifications, training manuals, or studies.
\2\ The terms ``United States Air Force'' or ``Air Force,'' as
used in this letter, refers to the Air Force and any subcomponents of
that branch of service including, but not limited to, the Reserves.
\3\ The terms ``servicemembers'' or ``members of the Air Force,''
as used in this letter, refer to officers and enlisted members of the
Air Force, and includes both active duty members and reservists.
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These records include, but are not limited to:
1. Any records containing information indicating the total number
of servicemembers of the Air Force from October 1, 2001, through the
present time who have been separated from the Air Force on the basis of
a personality disorder, adjustment disorder, or readjustment disorder,
including information indicating the number of these servicemembers who
were deployed as part of Operation Iraqi Freedom, Operation Enduring
Freedom, and/or Operation New Dawn; information indicating the number
of these servicemembers who served multiple tours in Operation Iraqi
Freedom, Operation Enduring Freedom, and/or Operation New Dawn;
information indicating the number of these servicemembers who served on
aircraft carriers deployed in support of Operation Iraqi Freedom,
Operation Enduring Freedom, and/or Operation New Dawn. Where possible,
records breaking down this information into the following categories
should also be provided:
Indicating the number of such discharges given to
active duty servicemembers and reservist servicemembers
respectively.
By number of enlisted servicemembers and number of
officers.
By year, whether by fiscal year or calendar year.
By gender.
By whether or not servicemembers served multiple
tours in Operation Iraqi Freedom, Operation Enduring Freedom,
and/or Operation New Dawn.
2. Any records containing information indicating the total number
of members of the Air Force, broken down by year and rank, if
available, or combined if not available, from October 1, 2001, through
the present time, who have been separated from the Air Force on the
basis of an administrative discharge for the convenience of the
government.
3. Any record identifying which types of personality disorder,
adjustment disorder, and/or readjustment disorder have been used as the
basis for personality disorder, adjustment disorder, or readjustment
disorder separations of members of the Air Force from October 1, 2001,
to the present.
4. Any reports, documents, memoranda, or the like prepared,
issued, submitted, or otherwise produced by the Air Force from January
1,2008 to the present regarding compliance with the Department of
Defense personality disorder separation requirements \4\ and any record
containing information regarding these reports.
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\4\ See Department of Defense, Instruction No. 1332.14
Sec. (3)(a)(8)(b) (Aug. 28, 2008).
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5. All records relating to claims made by the Air Force or any of
its component parts regarding the accuracy of the personality disorder
discharges made before 2008, including, but not limited to all records
(e.g., interviews with family members) relied on by the Air Force in
reaching these conclusions and all records regarding the methodology
used.
6. Any and all memoranda, manuals, guidance or other record, in
effect at any time from October 1, 2001, to the present, containing
information regarding the policies governing the administrative
separation of members of the Air Force based on personality disorder,
adjustment disorder, or readjustment disorder.
7. Any record containing information regarding measures
implemented from October 1, 2001, to the present to ensure that members
of the Air Force who should be evaluated for disability separation or
retirement due to mental health conditions are not processed for
separation from the Air Force on the basis of a personality disorder,
an adjustment disorder, or a readjustment disorder.
8. Any record containing information regarding whether members of
the Air Force who were discharged on the basis of a personality
disorder, an adjustment disorder, or a readjustment disorder since
October 1, 2001, have been allowed access to service-connected
disability compensation, pension benefits, and health care; and an
identification of the various forms of personality, adjustment, or
readjustment disorders forming the basis for such separations.
9. Any record containing information regarding any evaluation,
review, or other assessment since October 1, 2001 of the adequacy of
policies controlling administrative separations of members of the Air
Force for ensuring that covered members of the Air Force who may be
eligible for disability evaluation due to other mental health
conditions are not separated from the Air Force on the basis of
personality disorder, adjustment disorder, or readjustment disorder.
10. Any record containing information regarding measures
implemented since October 1, 2001, to ensure that members of the Air
Force who should be evaluated for disability separation or retirement
due to other mental health conditions are not processed for separation
from the Air Force on the basis of a personality disorder, an
adjustment disorder, or a readjustment disorder.
11. Records relating to any application for a discharge upgrade or
record correction submitted by any former servicemember who received a
personality disorder, adjustment disorder, or readjustment disorder
discharge after October 1, 2001, including but not limited to the total
number of servicemembers who have submitted such petitions to the Air
Force Review Board, or to the Board of Correction of Military Records
of any service branch; the number of petitions that have been granted;
the number that have been appealed, whether appealed to the Board of
Correction of Military Records or to a U.S. District Court, after their
initial application for a discharge upgrade was denied; the judicial
districts in which such appeals were brought; and the city and state
where any veteran seeking such a discharge upgrade resides.
Requesters request that any records that exist in electronic form
be provided in electronic format on a compact disc. If this information
is not available in a succinct format, we request the opportunity to
view the records in your offices.
Requesters agree to pay search, duplication, and review fees up to
$100. If the fees amount to more than $100, requesters request a fee
waiver pursuant to \5\ U.S.C. Sec. 552(a)(4)(A)(ii)(II) and
(a)(4)(A)(iii), as the information is not sought for commercial uses
and its disclosure is in the public interest, because it is likely to
contribute significantly to public understanding of the operations and
activities of the government and is not in the commercial interest of
the requester. If the request is denied in whole or in part, please
justify all deletions by reference to the specific exemptions of the
Act. In addition, please release all segregable portions of otherwise
exempt material. We reserve the right to appeal your decision to
withhold any information or to deny a waiver of fees.
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\5\ The Department of Defense's regulations related to the Freedom
of Information Act ``take[ ] precedence over all DoD Component
publications that supplement and implement the DoD FOIA Program.'' 32
CFR Sec. 286.1 (b).
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FOIA's legislative history makes clear that the ``fee waiver
provision . . . is to be liberally construed in favor of waivers for
non-commercial requesters.'' Fed. Cure v. Lappin, 602 F. Supp. 2d
197,201 (D.D.C. 2009) (internal quotation marks omitted). Department of
Defense (DoD) FOIA regulations (which apply to all DoD Components
explain that a fee waiver will be granted where ``disclosure of the
information is in the public interest because it is likely to
contribute significantly to public understanding of the operations or
activities of the Government,'' and ``is not primarily in the
commercial interest of the requester.'' 32 CFR Sec. 286.28(d)(3)(i),
(ii).
To determine whether disclosure is in the public interest because
it is likely to contribute significantly to public understanding of the
operations or activities of the Government, DoD regulations look to:
(i) The subject of the request; (ii) The informative value of the
information to be disclosed; (iii) The contribution to an understanding
of the subject by the public likely to result from disclosure; and (iv)
The significance of the contribution to public understanding. 32 CFR
Sec. 286.28(d)(3)(i)(A-D).
The subject of requesters' request certainly ``involves issues that
will significantly contribute to the public understanding of the
operations or activities of the Department of Defense.'' 32 CFR
Sec. 286.28(d)(3)(i)(A). The records requested concern how (and how
often) DoD and its Components determine that a soldier merits a
personality disorder, adjustment disorder, or readjustment disorder
discharge; the methodology by which DoD determined that only two of . .
. the nearly 30,000 soldiers discharged since 2001 with personality
disorder were designated incorrectly; and how DoD responds to requests
for personality disorder or adjustment or readjustment disorder
discharge upgrades. All these issues are integral to public
understanding of governmental operations and activities.
The information which requesters seek has significant informative
value because it is ``meaningful'' and ``shall inform the public on the
operations or activities of the Department of Defense.'' 32 CFR
Sec. 286.28(d)(3)(i)(B). DoD has refused to fully explain, on a case-
by-case basis, the methodology by which it determined that nearly
30,000 soldiers had a ``personality disorder,'' and the methodology by
which it later determined that only two of these soldiers were
diagnosed incorrectly. DoD's decision to release the number of soldiers
who were discharged with personality disorder between 2001 and 2007 and
to discuss its official policies related to these discharges did not
provide the public with the meaningful information necessary to
understand the way in which DoD determined, on a case-by-case basis,
whether soldiers had personality disorder.\6\ The disclosure of the
requested records will enable the public to verify DoD's
unsubstantiated statements that nearly all personality disorder
discharges between 2001 and 2006 were appropriate.\7\ Disclosure is
particularly meaningful because the public remains unaware of whether
DoD has misused personality disorder discharges, how DoD polices its
own discharge policies in practice, and whether disabled veterans
continue to be unjustly denied the benefits they are due by virtue of
their service to the Nation while in uniform. In addition, the public
does not know whether adjustment disorder or readjustment disorder
discharges have increased in the past few years, let alone whether DoD
and its Components have been using adjustment or readjustment disorder
discharges inappropriately.
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\6\ See Office of the Under Secretary of Defense, Report to
Congress on Administrative Separations Based on Personality Disorder
(2008) [hereinafter DoD, 2008 Report].
\7\ Anne Flaherty, Advocates See Trouble for Misdiagnosed
Soldiers, Associated Press, Aug. 15, 2010, available at http://
abcnews.go.com/Politics/wireStory?id=11404572.
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Disclosure of the requested records will contribute to an
understanding of the subject by the general public, rather than simply
informing ``the individual requester or small segment of interested
persons.'' 32 CFR Sec. 286.28(d)(3)(i)(C). Vietnam Veterans of America
(VVA) is a highly respected 32-year-old nonprofit organization with
60,000 members and 635 chapters nationwide.\8\ VVA's legislative
efforts have led to the establishment of the Vet Center system and the
passage of legislation assisting veterans with job training and job
placement, assisting Agent Orange victims, and permitting veterans to
challenge adverse VA decisions in court.\9\ Connecticut Greater
Hartford Chapter 120 is a 27-year-old chapter of VVA.\10\
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\8\ A Short History of VVA, Vietnam Veterans of America, http://
www.vva.orglhistory.html (last visited Sept. 29, 2010).
\9\ Id.
\10\ VVA Connecticut Chapter 120, http://www.vvaI20.org/ (last
visited Sept. 29, 2010).
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Requesters' research will involve determining, on a case-by-case
basis, why and how DoD discharged soldiers on the basis of personality
disorder, adjustment disorder, and readjustment disorder; whether these
diagnoses were inaccurate and improper; and the methodology by which
DoD determined that all but two of these discharges had been
appropriate. This information will be used to inform the public whether
DoD has unjustly denied disabled veterans the benefits they deserve,
and to enable the public to prevent DoD from misusing personality
disorder and adjustment or readjustment disorder discharges in the
future. The general public is highly interested in this issue. The
Nation \11\ and The Associated Press \12\ have recently published
articles on personality disorder and adjustment disorder discharges for
popular consumption. In addition, Congress has responded to public
discontent by holding a hearing on personality disorder discharges.\13\
VVA is immensely capable of disseminating its findings to the public.
VVA continuously produces publications related to veterans' health and
government affairs, and disseminates these publications via mail and on
its Web site.\14\ In addition, VVA has a long history of working with
the media and testifying at Congressional hearings in order to
publicize information and issues.\15\ VVA plans to disseminate its
research on personality disorder and adjustment disorder discharges via
publications, work with the media, and attendance at Congressional
hearings.
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\11\ Joshua Kors, Disposable Soldiers: How the Pentagon Is
Mistreating Wounded Vets, NATION, Apr. 26, 2010, at 11.
\12\ Flaherty, supra note 7.
\13\ Personality Disorder Discharges: Impact on Veterans'
Benefits, House Committee on Veterans' Affairs, http://
veterans.house.govihearingsihearing.aspx?newsid=622 (last visited Sept.
29, 2010).
\14\ VVA Publications, Vietnam Veterans of America, http://
www.vva.orglbrochures.html (last visited Sept. 29, 2010).
\15\ A Short History of VVA, supra note 8.
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Disclosure of the requested records will ``lead to a significant
understanding of the issue'' of personality disorder and adjustment
disorder discharges, and will ``be unique in contributing unknown
facts, thereby enhancing public knowledge.'' 32 CFR
Sec. 286.28(d)(3)(i)(D). DoD's use of adjustment disorder discharges is
completely unknown to the public. And DoD has kept the public in the
dark about how, in practice and on a case-by-case basis, it determined
that nearly 30,000 soldiers should be discharged with personality
disorder. The public knowledge of the number of personality disorder
discharges between 2001 and 2007 and of DoD's official policies related
to personality disorder discharges is worthless unless the public gets
to look at the ways in which DoD actually dealt with real soldiers on a
case-by-case basis.\16\ Yet DoD continues to conceal the procedures and
processes by which it determined that soldiers had personality disorder
and the methodology by which it determined that all but two of these
discharges were appropriate.
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\16\ DoD, 2008 Report, supra note 6.
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DoD's refusal to admit that the overwhelming number of the
discharges were inappropriate is shocking in light of the fact that the
number of personality disorder discharges has dramatically decreased
since DoD released its report at the behest of Congress in 2008.\17\
The public has a right to know whether DoD is unjustly preventing the
disabled veterans who defended their country from receiving veterans
benefits. Only if the public fully understands how DoD uses personality
disorder and adjustment or readjustment disorder discharges will it be
able to prevent misuse of these discharges in the future and to help
improperly discharged soldiers access the benefits they deserve.
---------------------------------------------------------------------------
\17\ Flaherty, supra note 7.
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In determining whether disclosure of information is primarily in
the commercial interest of the requester, DoD and its Components will
consider ``[t]Nhe existence and magnitude of a commercial interest,''
and, if a commercial interest exists, whether the requester's primary
interest in disclosure is commercial. 32 CFR Sec. 286.28(d)(3)(ii)(A-
B).
Requesters have no commercial interest in gaining access to the
requested records. Requesters are both nonprofit organizations whose
primary goal is to assist veterans. Because no commercial interest
exists, the requesters' primary interest in disclosure is not
commercial.
Finally, pursuant to 5 U.S.C. Sec. 552(a)(6)(A)(i), we expect a
response within the twenty (20)-day statutory time limit.
Should you have any questions in processing this request, we can be
contacted by mail at the address below or by telephone at (203) 432-
4800.
Please furnish all applicable records to:
Tasha Brown, Law Student Intern
Melissa Ader, Law Student Intern
Michael Wishnie, Supervising Attorney
Veterans Legal Services Clinic
Jerome N. Frank Legal Services Organization
P.O. Box 209090 New Haven, CT 06520
Thank you for your assistance and prompt attention to this matter.
Sincerely,
Tasha N. Brown
Law Student Intern
Melissa S. Ader
Law Student Intern
Michael J. Wishnie
Supervising Attorney
Veterans Legal Services Clinic
Jerome N. Frank Legal Services Organization
CC: Representative Robert Filner
Chairman, United States House Committee on Veterans' Affairs
__________
U.S. Congress
Washington, DC.
October 15, 2010
The Honorable Dr. Robert Gates
Secretary of Defense
The Pentagon
Washington, D.C. 20301
Mr. Secretary
In 2007, several members of the Senate formed a bipartisan
coalition to identify and combat the misuse of personality disorder
(PO) discharges in the Armed Forces, and as a result, improved mental
health care and services for combat veterans. Today, we request your
assistance to ensure that a new loophole has not been created that
abuses the administrative discharge system by erroneously discharging
members of the Armed Forces who are experiencing symptoms of Post-
Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI) rather
than providing them with medical care worthy of their service and
sacrifice.
While it is a good thing that the Pentagon has moved away from
unfairly discharging combat troops by erroneously claiming a
servicemember had a PO rather than addressing the harmful effects of
combat stress, we need to ensure a new method is not being used to deny
combat veterans the care and benefits they deserve. Unfortunately, the
recent drop in discharges for PDs has been accompanied by a disturbing
rise in discharges for the ``convenience of the government'' for
``other physical or mental conditions not amounting to disability.''
According to Pentagon data, while PO discharges have decreased from
1,072 in Fiscal Year 2006 to just 64 through March, 20 I0, discharges
for ``other physical or mental conditions'' have more than doubled from
1,453 in Fiscal Year 2006 to 3,844 in Fiscal Year 2009. We fear the
rise in this category of discharges could reflect a failure to identify
and treat troops for whom a deployment related disability board would
be more appropriate.
Under a discharge for the ``convenience of the government,'' troops
may be separated from the Army for mental or physical conditions
``manifesting . . . behavior sufficiently severe that the Soldier's
ability to effectively perform military duties is significantly
impaired''. We are concerned that many of these discharges are
occurring among Soldiers in whom the diagnosis reflected in the
discharge may actually represent a deployment-related mental health
condition which might-had the Soldier continued on active duty--
otherwise have progressed towards a diagnosis eligible for a disability
evaluation. Specifically, we are aware of numerous discharges for
``adjustment disorder'', a mental health condition which, according to
U.S. Army documents, exists along a spectrum of deployment-related
stress occurring in progressive severity, from acute stress reaction to
PTSD. We are particularly concerned that troops who display symptoms of
combat stress are being expeditiously chaptered out of the military by
the medical bureaucracy prior to their condition meeting formal
diagnostic criteria for PTSD or other conditions that would constitute
disability.
This problem appears to be most acute in the U.S. Army, which is
why in early August of this year we asked the Army to provide
information on the number of soldiers discharged with an ``adjustment
disorder'' or similar mental health diagnosis under the provisions of
Army Regulation 600-235 (Enlisted Separations), chapter 5-17, and the
number of troops who served in combat. Army officials assured us they
would provide the information in 30 days, but as the due date arrived,
announced their data search would take 6 months to complete and even at
that late date would only include soldiers discharged in fiscal year
2009. As a result of this disappointing response and our ongoing
concern for the treatment of our combat troops, we request your
assistance in obtaining information on the use of the adjustment
disorder discharge by the Army.
In order to identify discharge trends and ensure our combat troops
are receiving proper care it is critical Congress be provided figures
on the number of active duty Army servicemembers discharged from 2008
through 2010 for Personality Disorders (Chapter 5-13) and for ``other
designated physical or mental conditions'' (Chapter 5-17).
Specifically, we request the following information by fiscal year:
1. The total number of soldiers discharged each under provisions
of Chapter 5-13 and 5-17; and
2. Among (1), the number of those each who had served in an
imminent danger pay area.
As members of the United States Senate, we have an obligation to
ensure that our troops receive the benefits and care they have earned
on the battlefield. We are eager to work with you the Administration on
these issues to ensure no soldier who has served their nation honorably
in combat is unfairly discharged from the military or denied the care
needed to heal their wounds, whether physical or mental.
Sincerely,
Kit Bond
Sam Brownback
Chuck Grassley
Patrick Leahy
Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
Gene L. Dodaro
Acting Comptroller General
U.S. Government Accountability Office
441 G Street, NW
Washington, DC 20548
Dear Gene:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
CW:ds
__________
United States Government Accountability Office
Washington, DC.
October 6, 2010
The Honorable Bob Filner
Chairman
Committee on Veterans' Affairs
House of Representatives
Subject: Responses to Questions for the Record; Hearing Entitled
Personality Disorder Discharges: Impact on Veteran's Benefits
Dear Mr. Chairman,
This letter responds to your September 21, 2010, request that we
address several questions for the record related to the Committee's
September 15, 2010, hearing on the impact of personality disorder
discharges on veteran's benefits. Our responses to the questions, which
are in the enclosure, are based on our previous work and updates on the
actions DoD has taken since August 2008 related to the recommendations
we made in our 2008 report.
If you have any questions about the letter or need additional
information, please contact me on (202) 512-7114 or at [email protected]
or contact Mary Ann Curran on 202-512-4048 or at [email protected].
Sincerely yours,
Debra A. Draper
Director, Health Care
Enclosure
__________
Enclosure 1
Responses to Post-Hearing Questions for the Record, Personality
Disorder Discharges: Impact on Veterans' Benefits, Committee on
Veterans' Affairs, U.S. House of Representatives, September 15, 2010,
Questions for Debra A. Draper, Ph.D., M.S.H.A., Director,
Health Care U.S. Government Accountability Office
Questions for the Record Submitted by the Honorable Bob Filner
Question 1: Has DoD taken sufficient action to implement GAO's 2008
recommendations?
Response: In our 2008 report--Defense Health Care: Additional
Efforts Needed to Ensure Compliance with Personality Disorder
Separation Requirements, GAO-09-31 (Washington, D.C.: October 31,
2008)--we recommended that DoD (1) direct the military services to
develop a system to ensure that personality disorder separations are
conducted in accordance with DoD's requirements, and (2) monitor the
military services' compliance with DoD's personality disorder
separation requirements. Although DoD strengthened its personality
disorder separation policy and has taken some action in response to our
recommendations, at this time, we do not believe that DoD has taken
sufficient action to implement our recommendations. In August 2008,
after our review was completed, DoD updated its requirements for
personality disorder separations and included additional requirements
to help ensure that servicemembers, especially those serving in
imminent danger pay areas, are not inappropriately separated because of
a personality disorder. Additionally, in January 2009, DoD required the
military services to submit compliance reports on their fiscal year
2008 and 2009 personality disorder separations. The fiscal year 2008
compliance reports from the military services showed a high rate of
noncompliance with the requirements we reviewed in our report.
Specifically, three out of four of the military services were not in
compliance with any of the personality disorder separation
requirements. As of August 31, 2010, DoD did not have the services'
fiscal year 2009 compliance reports available for our review. Because
the military services have not demonstrated full compliance with DoD's
personality disorder separation requirements, we reiterate the
importance of DoD implementing our 2008 recommendations.
Question 2: Do you know why the military services have not provided
the fiscal year 2009 compliance reports?
Response: At this point, we are unsure of the reason we have not
been provided the military services' compliance reports for fiscal year
2009, as the services were required to submit them to DoD by March 31,
2010. Based on DoD's response to us, it is unclear to us if these
fiscal year 2009 compliance reports actually exist, or if DoD simply
does not know where the reports are.
Question 3: Of the requirements GAO reviewed, what requirement had
the worst compliance rate among the military services?
Response: In our 2008 review, which covers the period November 1,
2001, through June 30, 2007, we found that for each of the four
installations whose records we reviewed, the requirement that all
enlisted servicemembers receive a diagnosis of personality disorder by
a psychiatrist or psychologist who determines that the personality
disorder interferes with the enlisted servicemembers' ability to
function in the military had the lowest rate of documented compliance
when compared with the other personality disorder separation
requirements that GAO reviewed. Specifically, for these four
installations, we found that the documented compliance rate for this
requirement ranged from 40 to 78 percent. At one of these
installations, compliance with the requirement that servicemembers
receive formal counseling prior to their separation was equally low.
For Navy servicemembers whose records we reviewed, the requirement that
servicemembers receive formal counseling had the lowest rate of
documented compliance (77 percent) of the personality disorder
requirements that we reviewed.
In our review of the military services' compliance reports that
covered fiscal year 2008, the requirement that all enlisted
servicemembers receive formal counseling prior to their separation had
the worst rate of compliance for all of the services; none of the
services met DoD's 90 percent compliance threshold for this
requirement. In particular, the Navy's policy allowed enlisted
servicemembers to be separated without formal counseling if they were
deemed a danger to themselves or others, which did not mirror DoD's
policy.
Question 4: Why is formal counseling important?
Response: Formal counseling is an important requirement for a
personality disorder separation because it is intended to inform the
enlisted servicemember that his or her behavior is unacceptable in the
military; it is also intended to provide the servicemember with an
opportunity to change his or her behavior.
Question 5: Has DoD required any actions of the military services
because of their reported noncompliance?
Response: Yes. In January 2009, DoD required the military services
to submit, along with their compliance reports for fiscal years 2008
and 2009, corrective action plans for any requirements that did not
achieve a 90 percent compliance rate.
Question 6: Can you provide an example or two of the types of
corrective actions the services submitted?
Response: Each of the military services did not demonstrate
compliance with all of DoD's personality disorder separation
requirements for fiscal year 2008, and all of the services submitted
corrective action plans for how each respective service planned to
correct any deficiency in compliance. The Army, for example, stated in
its fiscal year 2008 compliance report that its corrective action was
to have the Army's Office of the Surgeon General review all personality
disorder separation cases to ensure that each contains the required
documentation. Each case that is found to not be in compliance with
these requirements is to be returned for corrective action. This plan
was to become effective as of March 13, 2009. The Marine Corps stated
in its fiscal year 2008 compliance report that it would educate its
personnel on the requirements for a personality disorder separation and
provide a checklist of DoD's additional requirements to ensure these
are followed during enlisted servicemembers' separations.
Question 7: DoD's additional requirements cover enlisted
servicemembers who were separated as of August 28, 2008. What is DoD
doing about servicemembers who were separated prior to August 28, 2008?
Response: Servicemembers who feel that their separations from the
military were inappropriate can request adjudication through their
respective service's Discharge Review Board. If a servicemember does
not agree with the decision made by his or her service's Discharge
Review Board, he or she may appeal this decision by applying to the
respective service's Board for the Correction of Military Records.
Question 8: Do you know if any servicemembers have gone before this
discharge board to request adjudication of their separation?
Response: Of the 371 servicemembers' records that we reviewed for
our 2008 report, we found that 3 servicemembers applied to their
respective Discharge Review Board to challenge the reason for their
separation. One of these servicemembers received a change to the reason
for separation because the review board found the separation because of
a personality disorder was unjust. This servicemember's reason for
separation was changed to secretarial authority of the military
service, meaning that the Secretary of the military service decided it
was in the best interest of the service to separate the servicemember.
The other two servicemembers did not receive a change to their
separation reason because the Discharge Review Board found that the
documentation in the personnel records supported the personality
disorder separation.
Question 9: How long do servicemembers have to utilize the
Discharge Review Board?
Response: The Discharge Review Board process has to be utilized
within 15 years after a servicemember's separation. After 15 years,
servicemembers may apply directly to their service's Board for the
Correction of Military Records to have the reason for separation
reviewed.
Question 10: Do enlisted servicemembers have any protections when
going through the separation process?
Response: Yes, enlisted servicemembers going through a personality
disorder separation have several protections that they can utilize when
going through the separation process. Enlisted servicemembers can
submit statements on their own behalf to the commander with separation
authority, consult with legal counsel prior to separation, and obtain
copies of the separation packet--the documents necessary to separate a
servicemember--that is sent to the commander with the authority to
separate the servicemember. Those enlisted servicemembers with 6 or
more years of service are eligible to request a hearing before an
administrative board. The Navy allows enlisted servicemembers with less
than 6 years of service to request this hearing. The administrative
board hearing allows servicemembers to have legal representation, call
witnesses, and speak on their own behalf in defending against the
separation.
Question 11: Did any of the servicemembers' records that GAO
reviewed show that the servicemember selected any of the protections?
Response: In our 2008 review, we found that enlisted servicemembers
utilized the protections available to them to a varying degree. For
example, 41 of the 371 servicemembers whose records we reviewed--or 11
percent--submitted statements on their own behalf. Of the 41
servicemembers that submitted a statement, 8 of these servicemembers
(20 percent) questioned the accuracy of the diagnosis or requested not
to be separated. All were eventually separated. We also found that 120
of the 371 servicemembers' records (32 percent) indicated that the
servicemembers wanted to consult with legal counsel prior to their
separation. We could not verify if they met with legal counsel.
Additionally, 328 of the 371 records that we reviewed (88 percent) had
documentation that the servicemember requested a copy of their
separation packet. For the 36 enlisted servicemembers in our review who
were eligible to request an administrative hearing, we found that none
of these servicemembers requested to do so.
ELIMINATE BAD BREAK deg.Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
The Honorable John M. McHugh
The Secretary
U.S. Department of the Army
The Pentagon, Room 3E700
Washington, DC 20310
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
CW:ds
__________
Army Questions for the Record
Hearing Date: September 15, 2010, Committee: HVA,
Member: Congressman Filner, Witness: Major General Farrisee
Response to Sergeant Luther
Question 1: Sergeant Luther was ordered confined to a closet and
subjected to sleep deprivation so that he would sign his name to a
personality disorder discharge. What is your response to this story?
Answer: This is a mischaracterization of the chain of command's
actions to prevent Sergeant Luther from endangering his life or the
lives of his fellow soldiers. Sergeant Luther indicated suicidal
ideations to his chain of command and doctors; in response, his chain
of command placed him on a suicide watch. Sergeant Luther's battalion
and company commanders were interviewed by officials within the
Department of the Army's Deputy Chief of Staff for Personnel about
Sergeant Luther's suicide watch. The chain of command stated that they
acted out of genuine concern to protect Sergeant Luther and possibly
other soldiers. Once placed on suicide watch, Sergeant Luther spent
days and nights in the squadron aid station, so he would be close to
medical care, if required, and so that he could be continuously
monitored. Every day, Sergeant Luther was escorted to the life support
area (about 1 mile away) so he could take a shower. He was also
afforded opportunities to visit the internet cafes and dining facility.
During the day, Sergeant Luther sat in the waiting room of the squadron
aid station. The description of the small sleeping quarters in the aid
station is accurate. However, the small sleeping quarters was not set
up specifically for Sergeant Luther. It was a sleeping quarters used by
medics during the night as they remained on duty 24/7 for possible
casualties. Sergeant Luther used the sleeping quarters at night
following his suicidal ideations that led the chain of command to place
him on a suicide watch.
The claim that sleep deprivation was used against Sergeant Luther
to obtain his signature on his separation documentation is false.
Sergeant Luther's signature was not required in order to process his
separation packet. More importantly, the chain of command ensured
Sergeant Luther's individual rights were protected and due process
followed. Sergeant Luther was provided legal counsel throughout the
separation proceeding; he was provided the opportunity to have his
separation heard before an administrative separation board (he elected
not to); he was provided the opportunity to submit matters to include
supporting witness statement on his behalf (he elected not to).
Personality Disorder Separation
Question 2: Please explain how the Army reached the conclusion that
no soldier was dismissed improperly with personality disorder.
Answer: In 2006 and 2007, the Office of The Surgeon General
conducted two reviews of all separations, under Army Regulation (AR)
635-200, Enlisted Separations, Chapter 5-13 (Personality Disorder) for
Soldiers who had deployed to an imminent danger pay area. The results
of these two investigations indicated that there was no evidence of
inappropriate discharges of enlisted personnel for Personality
Disorders. Recently, the Office of The Surgeon General conducted a
record by record review of all cases of enlisted Soldiers who have
deployed and were administratively separated under the provisions of AR
635-200, Chapter 5-13 (Personality Disorder) or Chapter 5-17
(categorized as behavioral health) since 2009, and found that no
enlisted Soldier was dismissed improperly during this time.
Investigation with Soldiers' Families
Question 3: During its review of previous cases, did the Army
interview soldiers' families, who can often provide evidence of a shift
in behavior that occurred after the soldier was sent into a war zone?
Answer: During its review of cases, the Army did not interview
Soldiers' Families. While interviewing Family members could indeed
yield helpful collateral information, in accordance with the Diagnostic
and Statistical Manual of Mental Disorders, 4th Edition, a diagnosis of
Personality Disorder is not contingent on collateral information being
provided. Instead, it is based on the presence of an enduring,
inflexible, and pervasive pattern of behavior that can typically be
traced back to an individual's adolescence, and causes significant
distress in different areas of the individual's life. Our review showed
that in all these cases that there was a pattern of behavior that
predated deployment.
Personality Disorder Diagnoses from 2006 to 2009
Question 4: Can the Army explain why the number of the personality
disorder discharges doubled between 2006 and 2009 and how many of those
qualified to retain their benefits?
Answer: The number of Soldiers discharged from the Army for
personality disorder from 2006 to 2009 did not increase, the number
decreased. In 2006, 1,071 Soldiers were separated for personality
disorder. In 2007 a total of 1,066 Soldiers were separated compared to
641 Soldiers in 2008, and 575 Soldiers in 2009. Soldiers who are
separated from Active Duty are fully eligible for all transition
services provided by the Army Career and Alumni Program (ACAP).
Programs available within ACAP include pre-separation counseling,
employment assistance, Veteran's Benefits Briefing, and the Disabled
Transition Assistance Program (DTAP). Pre-separation counseling
provides Soldiers information about services and benefits they have
earned while on Active Duty. Employment assistance consists of
individual voluntary one-on-one counseling, employment workshop,
resume, and more. The Veterans Benefits Briefing is a 4-hour long
briefing provided by Veterans Affairs counselors covering all VA-
controlled services and benefits that a Soldier can receive or may be
eligible for after separation. DTAP is a 2-hour long briefing provided
by VA counselors. Soldiers who are separated due to medical or physical
injuries, as well as Soldiers who believe that they will file a VA
Disability Claim, are highly encouraged to attend this briefing.
Benefits are generally based on the Soldier's characterization of
discharge as opposed to the chapter of AR 635-200 under which an
administrative separation is processed. Soldiers discharged for
personality disorder are normally awarded an honorable discharge and
eligible for the same benefits as any Soldier separating under
honorable conditions with similar lengths of service.
Adjustment Disorder Diagnoses
Question 5: Is the Army now relying on a different designation--
referred to as ``adjustment disorder''--to dismiss soldiers?
Answer: No. Adjustment disorders are a basis for administrative
discharge under Army Regulation 635-200, Enlisted Separations, Chapter
5-17. To endorse an adjustment disorder separation, the Office of The
Surgeon General requires clinical documentation that the Soldier
manifests a long-standing, chronic pattern of difficulty adjusting, and
that the Soldier is not amenable to behavioral health treatment nor
will respond to Command efforts at rehabilitation (e.g., transfer,
disciplinary action, or reclassification).
DD 214
Question 6: On the DD 214 where it asks for a narrative reason for
discharge is it common to list ``personality disorder'' if in fact the
soldier was diagnosed with a personality disorder?
Answer: Yes, it is common to list ``personality disorder'' on the
DD Form 214 when an enlisted Soldier has been diagnosed with
personality disorder and separated for that reason in accordance with
Army Regulation 635-200, Active Duty Enlisted Administrative
Separations, paragraph 5-13. However, not all Soldiers diagnosed with
personality disorder are separated for that reason. Separation for
personality disorder is not appropriate when separation is also
warranted under another chapter of the regulation. Enlisted Soldiers
diagnosed with personality disorder but separated under a different
chapter of the regulation will not have personality disorder listed on
their DD Form 214.
Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
The Honorable Robert M. Gates
The Secretary
U.S. Department of Defense
The Pentagon
Washington, DC 20301-1155
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
CW:ds
__________
Hearing Date: September 15, 2010
Committee: HVA, Member: Congressman Filner, Witness: Mr. Hebert
Personality Disorders
Question 1: Some individuals contend that personality disorders are
not possible for servicemembers who must demonstrate physical and
mental fitness for duty. How do you respond to these assertions?
Answer: Qualified medical professionals have diagnosed Personality
Disorders in Servicemembers who previously demonstrated physical and
mental fitness for duty. Latent symptoms do occur and may present
themselves after exposure to differing conditions.
FY 2009 Military Services Compliance Reports
Question 2: Do you know when the fiscal year 2009 compliance
reports for each of the military services that were supposed to be
submitted to DoD by March 31, 2010, will be submitted to DoD?
Answer: Yes. All Military Departments have submitted their fiscal
year 2009 Personality Disorder Separation Reports. Dates submitted:
Dept of Navy-6 Apr 10; Air Force-23 Apr 10; Army-14 Jun 10. Based on
the Services reports, on 10 September 2010, USD (P&R) directed the
Military Departments to report their compliance with DoD Personality
Disorder separation guidance through FY 2012 for continued review by
USD (P&R).
Oversight of FY 2008 Services Corrective Action Plans
Question 3: How is DoD ensuring that the corrective action plans
discussed by each of the military services in their fiscal year 2008
compliance reports are being implemented by the services?
Answer: To ensure that the corrective action plans are being
implemented, the Department required the Services to report their
compliance with Personality Disorder separation guidance for FY 2008
and FY 2009. Significant compliance improvement was reported in FY 2009
versus FY 2008. However, the Services were not yet 100 percent
compliant with all eight DoD Personality Disorder Separation
requirements. Therefore, on 10 Sep 2010, the Under Secretary of Defense
for Personnel and Readiness directed the Military Departments to
continue to report on their compliance with DoD Personality Disorder
Separation guidance through FY 2012, which will be reviewed by the
Under Secretary of Defense for Personnel and Readiness.
DoD Plans to Implement a Long-Term Reporting System
Question 4: Does DoD plan to implement a long-term system of
reporting, beyond the fiscal years 2008 and 2009 compliance reports,
for each of the military services to document their compliance with
personality disorder separation requirements?
Answer: Yes. On September 10, 2010, the Under Secretary of Defense
for Personnel and Readiness directed the Military Departments to
continue to report on their compliance with DoD Personality Disorder
Separation guidance through FY 2012. These reports will be reviewed by
the Under Secretary of Defense for Personnel and Readiness.
Personality Disorder Separation
Question 5: How does DoD plan to oversee the military services'
compliance with DoD personality disorder separation requirements?
Answer: In order to oversee the Military Services' compliance with
DoD Personality Disorder separation requirements, DoD requires the
Military departments to provide a report on compliance. On January 14,
2009, the Military Departments were directed to provide a report on
compliance with DoD Personality Disorder separation guidance contained
in DoDI 1332.14 for FY 2008 and FY 2009. While significant improvement
in compliance has occurred, it is clear that compliance reporting
should continue. Therefore, on September 10, 2010, the Under Secretary
of Defense for Personnel and Readiness directed the Military
Departments to continue their compliance reporting through FY 2012.
These reports will be personally reviewed by the USD (P&R). Further
extensions will be considered until USD (P&R) is satisfied that full
compliance is being achieved.
Personality Disorder Separation
Question 6: Please explain how enlisted servicemembers who are
separated with a personality disorder diagnosis got into the service in
the first place. Does DoD or the military services have any kind of
test or assessment that could help detect a personality disorder prior
to a recruit coming into the service?
Answer: All applicants for military service go through a multi-step
medical screening process. An essential part of that screening is a
medical exam at a Military Entrance Processing Station (MEPS). With
respect to Personality Disorder, the following applies:
1. Applicants are required to complete a medical pre-screening (DD
2807-2 Medical Prescreen of Medical History Report) before reporting to
the MEPS. That form is reviewed by the MEPS' Medical Staff to identify
individuals who require additional screening. The question on the form
related to mental health issues is:
a. Have you seen a psychiatrist, psychologist, counselor or
other professional for any reason (inpatient or outpatient) including
counseling or treatment for school, adjustment, family, marriage or any
other problem, to include depression, or treatment for alcohol, drug or
substance abuse?
2. Furthermore, all applicants undergo a medical evaluation that
includes a review of medical history and physical with a licensed
physician. Included in the medical history at the time of the
examination are the following questions:
a. Nervous trouble of any sort (anxiety or panic attacks)?
b. Received counseling of any type?
c. Depression or excessive worry?
d. Been evaluated or treated for a mental condition?
e. Attempted suicide?
All positive responses are addressed by the examining physician at
the time of the physical examination. In addition, through the course
of interactions with military and medical professionals, symptoms which
present themselves result in further examinations.
It is possible for a person who is separated with a personality
disorder to enter a Service. If during the examination, an applicant
fails to reveal a personality disorder or another mental health issue
and none are detected, the applicant may be deemed qualified from a
mental health standpoint. However, it should be noted that this
screening process is unlikely to identify all cases of personality
disorder. Even if a recruit has a history of difficulties working or
getting along with others, which might provide a clue to possible
personality disorder, that behavior might not have resulted in a
medical evaluation or diagnosis that could later be reviewed during an
entrance examination. A person also may enter service without a
personality disorder and develop one over time that leads to
separation.
Personality Disorder Separation
Question 7: DoD's August 2008 policy requires that the military
services comply with additional requirements when separating enlisted
servicemembers diagnosed with a personality disorder who served in an
imminent danger pay area. This policy applies to servicemembers
separated as of August 28, 2008, and is intended to make sure that
these servicemembers do not have post-traumatic stress disorder or some
other combat-related condition. What action is DoD taking for those
servicemembers who were separated with a diagnosis of a personality
disorder prior to August 28, 2008, and who served in an imminent danger
pay area?
Answer: On September 10, 2010, the Under Secretary of Defense for
Personnel and Readiness directed the Military Departments to report by
March 31, 2011, actions taken to:
1. Identify Servicemembers who have deployed in support of a
contingency operation since September 11, 2001, and were later
administratively separated for a personality disorder, regardless of
years of service, without completing the enhanced screening
requirements for Post-Traumatic Stress Disorder (PTSD) and Traumatic
Brain Injury (TBI).
2. Inform Servicemembers of the correction of discharge
characterization process.
3. Inform Servicemembers on how to obtain a mental health
assessment through the Department of Veterans Affairs.
4. Identify these individuals to the Department of Veterans
Affairs.
The Office of the Under Secretary of Defense (Personnel and
Readiness) will examine the reports and ensure that the Services
perform the latter three actions for any Servicemember found to have
not received the services.
Adjustment Disorder Diagnoses
Question 8: Has DoD reviewed the allegation that the military
services may be discharging enlisted servicemembers with a diagnosis of
adjustment disorder in order to reduce the number of personality
disorder discharges? If so, what did DoD find? If not, does DoD intend
to review this?
Answer: Yes, the Department has conducted this review. When this
allegation came to light, the Department examined the number of
Servicemembers administratively separated for Personality Disorder and
Adjustment Disorder since 2000. Defense Manpower Data Center (DMDC)
data showed the Air Force was the only Service that separated
Servicemembers for Adjustment Disorder.
Air Force clinicians are sensitive to the need and requirement to
evaluate for potential disability when an administrative separation is
being considered. Clinicians follow current DoD and Air Force guidance
when making these recommendations regarding administrative separations.
The Air Force is fully compliant with the DoD Personality Disorders
separation guidance. It is understood that under the Diagnostic and
Statistic Manual (DSM), Personality Disorders and Adjustment Disorders
are not substitutes for one another. Data are collected and coded
separately, but they often co-exist. Substituting one diagnosis for
another simply to avoid administrative or clinical review is neither
appropriate nor authorized.
The Air Force reviewed data related to the separation of Airmen for
Adjustment Disorders and Personality Disorders. The percentage of Air
Force mental health discharges for Personality Disorders has always
been quite small (approximately 5-8 percent of the total number of
mental health discharges).
Adjustment Disorder Diagnoses
Question 9: What action has DoD taken to ensure that servicemembers
discharged with a diagnosis of adjustment disorder do not have post-
traumatic stress disorder or traumatic brain injury? Do symptoms for an
adjustment disorder overlap with symptoms for PTSD or TBI?
Answer: On August 28, 2008, the Department issued new policy on
personality disorders separations, which added greater rigor and
oversight. The revised policy only permits a personality disorder
separation if diagnosed by a psychiatrist or PhD-level psychologist.
Implementation of this change has increased the Department's confidence
in our ability to accurately diagnose personality disorders. This
change also serves to improve the identification of any co-morbidity of
PTSD or TBI.
In addition, Servicemembers who have served in an imminent danger
pay area must have their diagnosis corroborated by a peer psychiatrist,
PhD-level psychologist, or higher level mental health professional and
endorsed by the Surgeon General of the Military Service concerned. This
change specifically addresses concerns that Servicemembers suffering
PTSD or TBI might be separated without proper treatment under the non-
compensable, exclusive diagnosis of a personality disorder. To ensure
continued monitoring of this critical process, the Department
implemented oversight mechanisms to include an annual personality
disorder report and periodic reviews of personality disorder separation
data by the Department's Medical and Personnel (MedPers) Council.
With regard to whether there can be overlap between the cognitive
and behavioral symptoms of adjustment disorder (particularly mixed
type) and PTSD or TBI, the answer is yes. Examples of potentially
overlapping symptoms include subjective memory difficulties, mood
problems, impulsivity, anger or withdrawal. However, diagnosis is not
made solely on reported symptoms. Evaluation includes interview,
medical history, and mental status examination. Additional physical
examination, laboratories, imaging, psychological testing, and other
evaluations are performed as appropriate. There are distinguishing
factors of each condition used to make an accurate diagnosis.
Prerequisite to each condition is the root cause of the inciting event.
In the case of PTSD, it is exposure to an event where there was risk to
life or limb of self or others. In the case of TBI, it is a blast or
blow to the head. In the case of an adjustment disorder, the stressor
is usually a more common psychosocial one, such as problems in a
relationship, problems in adjusting to military life, or legal
problems. When the stressor is removed, the adjustment disorder should
resolve. With the understanding that an individual can have one, two,
or all three diagnoses simultaneously, a review of personal history is
necessary to separate the three conditions under most circumstances.
FY 2009 Military Services Compliance Reports
Question 10: Ms. Draper stated that, as of August 31, 2010, DoD had
not received the military services' FY 2009 reports on compliance with
the additional personality disorder requirements implemented in 2008.
When do you expect to receive these reports?
Answer: These reports have been received by DoD. All of the
Military Departments have submitted their fiscal year 2009 Personality
Disorder Separation Reports. (Dates submitted: DoN-6 Apr 10; AF-23 Apr
10; Army-14 Jun 10.)
Committee on Veterans' Affairs
Washington, DC.
September 21, 2010
The Honorable Eric K. Shinseki
The Secretary
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. Secretary:
In reference to our Full Committee hearing entitled ``Personality
Disorder Discharges: Impact on Veterans' Benefits,'' that took place on
September 15, 2010, I would appreciate it if you could answer the
enclosed hearing questions by the close of business on October 29,
2010.
In an effort to reduce printing costs, the Committee on Veterans'
Affairs, in cooperation with the Joint Committee on Printing, is
implementing some formatting changes for materials for all full
Committee and Subcommittee hearings. Therefore, it would be appreciated
if you could provide your answers consecutively and single-spaced. In
addition, please restate the question in its entirety before the
answer.
Due to the delay in receiving mail, please provide your response to
Debbie Smith by fax at 202-225-2034. If you have any questions, please
call 202-225-9756.
Sincerely,
BOB FILNER
Chairman
CW:ds
__________
Questions for the Record
The Honorable Bob Filner, Chairman, House Committee on Veterans'
Affairs, ``Personality Disorder Discharges: Impact on Veterans'
Benefits''
September 15, 2010
Question 1: Does VA track the cases where veterans are granted
service connection for PTSD or other mental health conditions even
though they were discharged from the military with a personality
disorder?
Response: VA does not systematically track instances where Veterans
are discharged from the military with a personality disorder and are
subsequently granted service connection for PTSD or other mental health
conditions. VA generally reviews and decides issues that are
specifically claimed by the Veteran. Unless the Veteran claims the
issue of service connection for a personality disorder, there is no
requirement for VA to electronically enter information about the
condition into the corporate system. Thus, the requested data cannot be
obtained through VA's corporate computer system.
Question 2: How many personality disorder discharges have you seen
since the new policy was implemented where the servicemember may have
served in combat?
Response: Deferred to Committee to forward to DoD.
Question 3: It's said that PTSD symptoms mimic personality
disorders. Is there standard clinical guidance that allows for proper
diagnosis of personality disorders?
Response: The standard clinical guidance for the diagnosis of both
PTSD and personality disorders is found in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR) published by the American Psychiatric Association. A
personality disorder is defined by the DSM-IV-TR as an enduring pattern
of inner experience and behavior that deviates markedly from the
expectations of the individual's culture, manifested in cognition (ways
of perceiving or interpreting events and others' behavior), affect
(including the range, intensity, ability to manifest, or
appropriateness of emotional responses), interpersonal functioning, and
impulse control. Essentially, this means that a person with a
personality disorder displays behavior and attitude that is a stable,
long-term characteristic of the individual and that differs from
cultural norms in problematic ways. Specifically, DSM-IV TR requires
that, ``The pattern is stable and of long duration and its onset can be
traced back at least to adolescence or early adulthood.'' On the other
hand, PTSD is an anxiety disorder that may develop at any point of the
lifespan as a response to traumatic event(s) and is not seen as a
stable, longstanding characteristic of the individual.
When clinicians provide a differential diagnosis between PTSD and
personality disorders, they take several factors into account. For
example, a new diagnosis of a personality disorder should not be made
if the person currently also meets criteria for another major mental
health disorder. Specifically, it requires that, ``The enduring pattern
is not better accounted for as a manifestation or consequence of
another mental disorder,'' and that, ``The enduring pattern is not due
to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g., head
trauma).'' Primarily, these requirements exist because the problems
exhibited by individuals with personality disorders can also be
symptoms of other mental health conditions, and without a prior
personality disorder diagnosis, the clinician cannot assume that these
symptoms represent long-standing, enduring characteristics of the
individual, rather than being symptoms of a new major mental health
disorder.
Question 3(a): Are personality disorders inherently pre-existing,
or is it possible to develop a personality disorder as a result of
military service? If so, how does the C&P examination process consider
this possibility?
Response: As noted above, a personality disorder is ``an enduring
pattern of inner experience and behavior . . . The pattern is stable
and of long duration and its onset can be traced back at least to
adolescence or early adulthood.'' Therefore, most cases of personality
disorders would manifest prior to a person's military experience.
However, it is possible that the diagnosis may not be made until one's
military service. A personality disorder would not be considered to
develop as a result of military service in the same way that PTSD might
have a precipitating event that occurred as part of an individual's
military service. However, it is possible that some individuals may not
have encountered the sorts of challenging experiences in a structured
setting (which could include basic training or combat experiences) that
would have precipitated recognition of the fact that the individual
meets criteria for a personality disorder until the individual entered
military service.
Compensation and Pension (C&P) examination processes begin with the
Veterans submitting a claim. An appropriate interview is then arranged
to examine the clinical basis for the claim. A diagnosis given by DoD
when the Veteran separates, while reviewed as part of the medical
record, is not determinative of the diagnosis established as a result
of the C&P examination. The Veteran will be evaluated as to whether the
diagnosis for which he or she submits a claim is substantiated
according to DSM-IV-TR criteria. For mental health claims, only
doctoral level, licensed Psychologists or Psychiatrists can conduct the
diagnostic interview. Service connection may not be granted for a
personality disorder; only acquired psychiatric disorders, which are
categorized separately in the DSM-IV-TR, may be service connected.
Question 4: In your testimony, you note that veterans are not bound
by any diagnosis from DoD when seeking treatment from VA or when
submitting a claim for service connection. While this may be true, do
you believe that these veterans face an uphill battle in proving that
their pre-existing conditions were aggravated by or worsened by their
service?
Response: Because personality disorders are considered
constitutional or developmental abnormalities, they are not diseases in
the meaning of applicable legislation for disability compensation
purposes. Therefore, personality disorders are not subject to service
connection (this includes service connection on the basis of
aggravation). In instances where a Servicemember enters service with a
pre-existing personality disorder, it is possible that a superimposed
disease or injury could occur. In these cases, service connection would
be warranted for the additional resultant disability. An example would
be PTSD superimposed on the personality disorder. When adjudicating
these types of cases, VA reviews all evidence of record and then
renders a fair and equitable decision based on the merits of the case.
Question 5: Do VA clinicians administering C&P examinations receive
training on distinguishing between PTSD or TBI and a personality
disorder? Do non-VA clinicians contract to administer C&P examinations?
Response: The standard clinical guidance for the diagnosis of PTSD
and personality disorders is found in the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
published by the American Psychiatric Association. Psychiatrists and
psychologists, who are the clinicians conducting the C&P examinations
for mental health conditions, receive training on the diagnostic
nomenclature, as well as related guidance on differential diagnosis
provided in the DSM-IV-TR during their graduate and postgraduate
training. Knowledge of this clinical guidance is tested through state
professional licensure exams and reinforced through professional
continuing education.
VHA requires that its clinicians complete certification training
before performing C&P examinations. Certification training is available
and required for both PTSD and TBI. VHA has conducted in depth training
programs on a variety of mental health subjects during National C&P
Conferences. PTSD is included in these conferences, as is TBI. VHA held
a four day National Conference August 5-7, 2008 specifically to address
PTSD and TBI. Included in this national conference were programs
titled:
Overview of PTSD Regulations;
PTSD Stressor Identification and Other Key Exam Items;
PTSD Measures; and
PTSD, Psychiatric and Medical Co-Morbidities.
The next conference is being planned for early summer 2011.
VHA can hire (contract) part time C&P exam services. Those
providers examine on site and are required to follow the same
certification and registration process as full-time examiners. Some
facilities have chosen to contract with QTC Medical Services, Inc., one
of VBA's large C&P exam contractors. These exams are done in private
doctor's offices.
Non-VA clinicians are contracted to administer C&P examinations
through a contractor. The contractor trains non-VA clinicians to
conduct high quality examinations. Contractor training includes VA's
rating criteria, issues identified in current VA fast letters,
including PTSD and TBI, and other updates such as the recent PTSD
regulation change.
The contractor subcontracts with mental health and medical
professionals who are certified and licensed in their area of
expertise. The contractor only uses physicians and psychologists for
mental health assessments, rather than mid-level clinicians. Examiners
are required to use examination worksheets for PTSD/Mental Health and
TBI, which have specific guidelines. Initial examination worksheets are
closely reviewed, and refresher training is provided to address any
issues. The contractor provides annual refresher training and sends a
monthly training letter with updates on C&P exams.
An examiner's quality is measured immediately after he is trained
and begins doing C&P exams. The contractor does a 100 percent review of
the first 10 exams of each worksheet before the examiner is allowed to
work independently. The contractor also has an internal process to
track the examiner's quality. If the work is unsatisfactory, then the
individual is retrained before scheduling additional exams. If
retraining fails to correct quality deficiencies, the examiner will not
be allowed to continue conducting examinations. C&P Service's Contract
Exam Staff also conducts quarterly reviews of exams done by the
contractor.
Question 6: Mr. Sullivan of Veterans for Common Sense stated a
concern that veterans who have been discharged due to a personality
disorder ``frequently believe they are not entitled to full VA
benefits.'' Does VA provide any outreach to these veterans to ensure
they understand the benefits they are entitled to?
Response: Although VA does not have a specific outreach program for
Veterans discharged due to personality disorders, our current
separation programs provide assistance to these Veterans. VA openly
encourages all Servicemembers to complete the Transition Assistance
Program (TAP) or Disabled Transition Assistance Program (DTAP). DoD
supports VA by affording each Servicemember the opportunity to attend
TAP/DTAP prior to and even after leaving the military.