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DoD Rethinks 'Personality Disorder' Separations
Tom Philpott | November 13, 2008
Crackdown Begins On 'Personality Disorder' Separations
Under pressure from Congress and following the Army's lead, the Department of Defense has imposed a more rigorous screening process on the services for separating troubled members due to "personality disorder."
The intent is to ensure that, in the future, no members who suffer from wartime stress get tagged with having a pre-existing personality disorder which leaves them ineligible for service disability compensation.
Since the attacks of 9/11, more than 22,600 servicemembers have been discharged for personality disorder. Nearly 3400 of them, or 15 percent, had served in combat or imminent danger zones.
Advocates for these veterans contend that at least some of them were suffering from Post-Traumatic Stress Disorder (PTSD) or traumatic brain injury but it was easier and less costly to separate them for personality disorder. By definition, personality disorders existed before a member entered service so they do not deemed a service-related disability rating. A disability rating of 30 percent or higher, which most PTSD sufferers receive, can mean lifelong access to military health care and on-base shopping.
Over the last 18 months, lawmakers and advocates for veterans have criticized Defense and service officials for relying too often on personality disorder separations to release member who deployed to Iraq, Afghanistan or other another areas of tension in the Global War on Terrorism.
A revised DoD instruction (No. 1332.14), which took effect without public announcement August 28, responds to that criticism. It only allows separation for personality disorder for members currently or formerly deployed to an imminent danger areas if: 1) the diagnosis by a psychiatrist or a PhD-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 too into account a possible tie or "co-morbidity" with symptoms of PTSD or war-related mental injury or illness.
Sam Retherford, director of officer and enlisted personnel management in the Office of the Secretary of Defense, said adding "rigor and discipline" to the process when separating deployed members for personality disorder is "very important," considering what is at stake for the member.
Last year several congressional hearings focused on overuse of personality disorder separation after The Nation magazine exposed apparent abuses in a March 2007 article. It described the experience of Army Specialist Jon Town. In October 2004, while Town stood in the doorway of his battalion's headquarters in Ramadi, Iraq, an enemy rocket exploded into the wall above his head, knocking him unconscious.
When he came to, Town was numb all over, bleeding from his ears, and had shrapnel wounds in his neck. For two years he struggled with deafness, loss of memory and depression before the Army, in September 2006, separated Town after seven years' service. He was separated for a pre-existing personality disorder and without disability benefits. Writer Joshua Kors suggested there might be thousands of veterans like Town, separated administratively to save the services billions of dollars in benefits.
Last year, moved by this story and others, the Senate adopted an amendment to the fiscal 2008 defense authorization bill from now president-elect Barack Obama (D-Ill.), Kit Bond (R-Mo.) and Joseph Liberman (ID-Conn.). It directed Defense officials to report on service use of personality disorder separations, and the Government Accountability Office to study how well the services follow DoD 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. A few months ago the Army tightened its own rules for using personality disorder separations.
In June, the Defense Department reported to Congress that it would add "rigor" to its personality disorder separation policy, previewing the changes implemented in late August. The Navy strongly had 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 Defense officials insisted on the changes.
The DoD report in June showed the Navy led all services in personality disorder separations. For fiscal years 2002 through 2007, the Navy total was 7554 versus 5923 for the Air Force, 5652 for the Army and 3527 for the Marine Corps. The Army led in personality disorder separations to members who had wartime deployments, with a total of 1480 over six years. The Navy total was 1155, the Marine Corps 455 and the Air Force 282.
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 service member," the report said.
In late October, GAO released its findings based on a review of service jackets for 312 members separated for personality disorder from four military installations. It said the services were not reliably compliant even with the pre-August regulation governing separations. For example, only 40 to 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.
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