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How are service members harmed by a Personality Disorder or Adjustment Disorder discharge?

Veterans discharged on the basis of so-called Personality Disorder or Adjustment Disorder are denied access to the disability pay from the Defense Department or service-connected disability compensation from the Department of Veterans Affairs that they would have received if they had been discharged on the basis of Post-traumatic Stress Disorder (PTSD) or another disability. They typically cannot access the free medical care that they have earned through their military service. Finally, if they are discharged before they have completed their service contract, they must return a portion of their re-enlistment bonus to the government, a requirement that often pushes veterans into debt.

How much money has the government saved by refusing to provide benefits or medical care to these veterans?

The Defense Department has saved the military at least $4.5 billion in medical care and $8 billion in disability compensation by discharging disabled service members on the basis of Personality Disorder (or Adjustment Disorder).

What is a Personality Disorder?

A Personality Disorder is a mental health disorder that usually surfaces in pre-adolescence, adolescence, or early adulthood, is stable over time, and involves an enduring pattern of inner experience and behavior that deviates from the expectations of an individual's culture. The service branches define Personality Disorder as a condition pre-existing military service.

If Personality Disorder begins before a service member's military service, is there any way for the Defense Department to discover an individual's Personality Disorder before they begin active duty?

Yes. All service members receive a rigorous psychological screening before or during basic training. Service members are regularly prevented from deploying due to Personality Disorder. If the service members who were discharged on the basis of Personality Disorder actually had a Personality Disorder, this illness would have been diagnosed before they entered active duty.

What is an Adjustment Disorder?

Individuals can be diagnosed with an Adjustment Disorder if, within three months of experiencing a stressor, they experience emotional or behavioral symptoms that do not last for more than six months after the termination of the stressor. Individuals must either experience greater distress than would normally be expected or must be significantly impaired in social or occupational functioning. Finally, the behavior must not meet the criteria of clinical disorders such as PTSD.

What is PTSD, and how does it differ from Personality Disorder or Adjustment Disorder?

In order to be afflicted with PTSD, individuals must have been exposed to a traumatic event, such as military combat or sexual assault, which threatened theirs or others' physical integrity and to which they responded with intense fear, helplessness, or horror. Conversely, Personality Disorder is a permanent, stable condition which is unrelated to a stressor such as military combat. Adjustment Disorder by definition cannot last for more than six months following a stressor, and its symptoms cannot meet the criteria of PTSD. However, because the symptoms of PTSD, Personality Disorder, and Adjustment Disorder may appear similar, it is important that clinicians make their diagnosis carefully.

How do Defense Department diagnostic procedures regarding Personality Disorder differ from the procedures recommended by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and by the Department of Veterans Affairs?

Although the Defense Department claims to rely on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) in diagnosing mental illness, in practice, the military's methods for diagnosing Personality Disorder differ greatly from the recommended procedures in the DSM-IV-TR. The DSM-IV-TR requires that clinicians ensure that the personality traits indicating Personality Disorder were evident by early adulthood; are stable over time and across different situations; and are different from characteristics indicative of Mood or Anxiety Disorders such as PTSD. In order to assure a correct diagnosis, the DSM-IV-TR recommends that clinicians evaluate the stability of personality traits over time and in different situations by conducting more than one interview spaced out over time. The Department of Veterans Affairs advises clinicians to interview individuals who knew the service members before they entered the military prior to making Personality Disorder diagnoses in order to ensure that the Personality Disorder pre-existed military service.

Defense Department officials have stated that their clinicians generally interview only the service member when diagnosing Personality Disorder, instead of interviewing family members or friends who knew the person before he or she entered military service. Such diagnostic procedures make it difficult, if not impossible, to determine whether Personality Disorder preexisted deployment or was evident by early adulthood. Unless a service member has served in an "imminent danger pay area," the Defense Department does not require clinicians to interview service members more than once before making a determination of Personality Disorder. Clinicians are thus not required to determine whether an individual's symptoms are stable over time.

How do Defense Department discharge procedures diverge from their own regulations on Personality Disorder discharges?

Defense Department regulations on Personality Disorder discharges require that service members get formal counseling regarding the reason for their impending discharge and receive a Personality Disorder diagnosis from a psychiatrist or psychologist stating that the Personality Disorder interfered with their ability to function in the military. The Government Accountability Office (GAO) has found that DoD's compliance with the counseling requirement was as low as 40 percent between 2001 and 2007, as was its compliance with the diagnosis requirement. This noncompliance led the GAO to report in 2008 that "DoD does not have reasonable assurance that its key personality disorder separation requirements have been followed." In September 2010, the GAO reported that the Army, Marine Corps, and Navy were still not in compliance with updated Defense Department Personality Disorder discharge regulations.

Has Congress done anything to address this problem?

Yes, but its efforts have not succeeded in changing the Personality Disorder or Adjustment Disorder designations. In July 2007, the House Veterans' Affairs Committee held a hearing concerning charges that the Defense Department was wrongfully discharging service members on the basis of Personality Disorder. The National Defense Authorization Act of 2008 required the Defense Department to provide a report on Personality Disorder discharges which put forth the total number of such discharges per service branch between 2002 and 2007.

How has the Defense Department responded to the 2007 uproar over Personality Disorder discharges?

Congressional action forced the Defense Department to release a 2008 report in which the Department admitted for the first time that nearly 22,700 service members had been discharged on the basis of Personality Disorder between 2002 and 2007. By August 2008, pressure from the media, VVA and other veterans' organizations, and Congress prompted the Defense Department to update its Personality Disorder discharge procedures to improve the accuracy of diagnoses.

After discharging an average of 3,750 service members per year for Personality Disorder between 2001 and 2007, DoD has discharged only 960 service members in 2008; 1,426 in 2009; and 650 to date in 2010. Meanwhile, discharges for PTSD have significantly increased,and Adjustment Disorder discharges have dramatically increased from 1,453 in 2006 to 3,844 in 2009. The decrease in Personality Disorder discharges and increase in Adjustment Disorder discharges suggest that the Defense Department is continuing to misdiagnose service members under a new label so as to receive less scrutiny from Congress and the media. In addition, the increase in PTSD discharges since 2007 indicates that some, if not all, of the service members discharged on the basis of Personality Disorder before 2008 ought to have been diagnosed with PTSD.

In light of the dramatic decrease in Personality Disorder discharges after 2007, has the Defense Department changed the discharge designations of those service members discharged on the basis of Personality Disorder before 2008?

The Defense Department has not changed the discharge designations of any of the nearly 22,700 service members discharged on the basis of Personality Disorder before 2008. These 22,700 veterans, many of whom may have PTSD, remain unable to access the benefits to which disabled veterans are entitled.

The Defense Department and its service branches have repeatedly demonstrated their unwillingness seriously to review the Personality Disorder discharges of these veterans. In 2005, Acting Surgeon General of the Army Gale Pollock stated her office had "thoughtfully and thoroughly" reviewed a series of Personality Disorder discharge cases over a period of five months and had not found any error in the reasons given for the discharges. In fact, the review was neither thoughtful nor thorough: during the five months, the Surgeon General's office did not interview anyone—not even the veterans who had been incorrectly discharged. Soon afterward, Army Lieutenant Colonel Bob Tallman released a report claiming that his office had reviewed all the Personality Disorder discharges that had occurred since 2001 and found no evidence of misdiagnosis. LTC Tallman later admitted that he had not written the report and that no such review had ever occurred. In 2010, the Army again asserted that no service member had been inappropriately discharged. The Defense Department has insisted that the pre-2008 discharges were not characterized by "systematic or widespread error." The Army and the Defense Department refuse to release records or to explain exactly what procedures they used in their reviews. According to the Department of Veterans Affairs, any review that did not involve interviews of people who knew the service members before they entered military service is insufficient.

What is the nature of the Vietnam Veterans of America lawsuit?

The lawsuit is a response to the violation of the Freedom of Information Act (FOIA) by the Departments of Defense, Veterans Affairs, and Homeland Security. FOIA mandates that agencies respond to requests within 20 business days of receipt. The Department of Defense, the Department of Homeland Security (which oversees the Coast Guard) and the Department of Veterans Affairs have failed to respond to the FOIA requests which Vietnam Veterans of America (VVA) sent in October, even though they store many of their records electronically. VVA hopes that the judicial system will force these agencies to respond appropriately and provide the records necessary to help veterans discharged on the basis of Personality Disorder and Adjustment Disorder get their discharges reviewed and, where warranted, their benefits restored.

VVA is particularly disappointed that the Defense Department and its service branches—Army, Marines, and Navy—have refused to provide records. In 2008, under pressure from Congress, these service branches did provide records to the Defense Department indicating the exact number of Personality Disorder discharges between 2002 and 2007. The fact that these branches, in 2008, admitted having the records which VVA is seeking, makes it even more surprising that the branches refuse to abide by FOIA.

What records do your Freedom of Information Act requests seek?

VVA seeks records related to the Personality Disorder and Adjustment Disorder discharges occurring after September 11, 2001. In particular, the records requested concern how and how often the Defense Department (and its components—the Army, Air Force, Marines, Navy, and National Guard) and the Department of Homeland Security (and its component, the Coast Guard) determine that a soldier merits a Personality Disorder or Adjustment Disorder discharge. The records further seek the methodology by which the Defense Department, its components, and the Coast Guard determined that 26,000 service members discharged since 2001 on the basis of a Personality Disorder were diagnosed correctly. VVA also seeks information on how the Defense Department and the Department of Homeland Security respond to requests for Personality Disorder or Adjustment Disorder discharge upgrades. To view VVA's Freedom of Information Act request, go to [link to the request].

Why now?

All of the nearly 26,000 service members inappropriately discharged on the basis of Personality Disorder since 2001 remain unable to access the disability benefits and free health care they are due. The same is true for those service members improperly discharged on the basis of Adjustment Disorder. VVA hopes that the records it receives from the military will convince Congress to mandate a systematic review of these discharges, a review which includes interviews of family and friends who knew the veterans before their military service began. Only when every service member wrongly discharged on the basis of Personality Disorder or Adjustment Disorder receives an appropriate discharge will VVA stop fighting for the rights of these veterans.

 

 

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