Females in Combat
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Diagnosis kills veteran's benefits
Cape man among many battling Army
By JENNIFER BOOTH REED Originally posted on September 23, 2007 Andrew West/news-press.com
Christopher Gearhart, 35, of Cape Coral served nearly 14 years in the military — including three tours of duty in Iraq, two with the Navy and one with the Army.
Christopher Gearhart served 13 years in the military. He would have put in more time were it not for a hospitalization, a diagnosis and a discharge last year.
While on duty last December, Gearhart, 35, of Cape Coral fell into a state of mania.
He doesn't remember much, only that he was going nonstop, 24 hours a day. It was worse than being drunk, Gearhart said. Colleagues would recount what he did or said, and Gearhart could recall none of it.
The soldier was sent to a private psychiatric hospital and diagnosed with bipolar disorder, a chemical imbalance that causes his emotions to swing wildly — from mania to depression.
His discharge came soon after, and with it, the military washed its hands of him, he says.
Gearhart is receiving no Veterans Administration benefits. He has no job, no disability pay, and most critically, no health benefits. He is managing his illness with whatever drug samples doctors at Lee Mental Health are able to find for him. The drugs otherwise cost $2,000 a month, Gearhart said.
He said U.S. Army officials reclassified his bipolar disease as a "personality disorder," which covers such things as antisocial, obsessive or histrionic behaviors.
Gearhart said he was told he could not receive benefits because of the diagnosis, which is generally considered a pre-existing condition.
Similar stories have been echoed in media reports across the country. About 22,500 service people have been diagnosed with personality disorders since 2001.
Now, some watchdog groups and lawmakers are charging the military has turned the diagnosis into a catch-all, used to discharge those with a multitude of ailments, including post-traumatic stress disorder.
A congressional inquiry was launched this summer into the personality disorder diagnoses and alleged denial of benefits.
An Army official, however, said these veterans are eligible for VA benefits, although they may not get them as quickly as, say, a combat-wounded soldier.
"There's a lot of misinformation out there, which is unfortunate," said Col. Elspeth Ritchie, an Army psychiatric consultant and director of the Proponency Office of Behavioral Health.
She referred specific questions about benefits to the Department of Veterans Affairs. The News-Press spoke to two public information officers there requesting details but did not get a response.
Removed from service
Gearhart's discharge came after 12 years in the U.S. Navy, a year in the Reserves and four months in the Army, where he had planned to finish out his military career.Gearhart said an Army officer brought him his discharge papers while he was being treated at Texas State Mental Hospital, where his commanders sent him after he had spent six weeks in a private psychiatric hospital.
"He said you're being discharged for a personality disorder," Gearhart recalled. "I said I didn't have personality disorder. I have bipolar."
Gearhart does not have copies of his diagnoses from Texas, but he provided The News-Press with doctors' notes from Ruth Cooper Center in Fort Myers, Riverside Behavioral Health Center in Punta Gorda and a private psychiatrist, all of which confirmed his bipolar disease.
Diagnosis difficult
Ritchie couldn't talk about Gearhart's case because of medical privacy laws.But from her general description of mental health conditions, it's difficult to see how Gearhart could be diagnosed with a personality disorder.
Ritchie said neither bipolar nor post traumatic stress disorder are personality disorders. The Army uses standard medical definitions of mental health conditions, and bipolar does not fall into the personality disorder spectrum.
"This has to be a deeply ingrained, maladaptive behavior that interferes with a soldier's ability to perform his duty," she said.
But she also said the diagnoses could be complicated. Symptoms of borderline personality disorder could overlap with symptoms of bipolar.
Ritchie said it could take psychological testing and a thorough review of the soldier's history to determine whether he showed a long-standing pattern of behaviors, which would suggest personality disorder.
The Army would likely consider opinions of civilian doctors, Ritchie said, but military physicians would issue a final behavioral analysis and diagnosis.
Gearhart had three other hospitalizations while on duty and was hospitalized once through Florida's Baker Act while on leave. All of those incidents were for depression, Gearhart said. The hospital stays were short, and the doctors who stabilized him did not diagnose the bipolar at the time.
Even so, he moved up the Naval ranks to a grade of E-6. The highest rank for enlisted personnel is E-9.
Gearhart did not yet have copies of his brief Army record, but he provided copies of his Navy discharge papers, all of them "honorable" and coded RE-R1, which meant he was eligible to return to military duty. The discharge papers list numerous awards and designations, including two Bronze Stars and good conduct medals.
"If he was in the military 13 years, there is no way he could have had a personality disorder," said Paul Sullivan, a former Department of Veterans Affairs administrator who now runs the Washington D.C.-based advocacy group Veterans for Common Sense.
He doesn't know Gearhart, but he's been following cases like his across the country.
"They used personality disorder just to get rid of him," Sullivan said.
'Disgraceful'
Gearhart's medical debt totals $8,000 — and that's not including a weeklong hospitalization at Riverside Behavioral Health Center in Punta Gorda.Cases like his are infuriating some lawmakers.
"We think it's a disgraceful situation. We think it's a deliberate policy to use up kids and then try to save money," said U.S. Rep. Bob Filner, a California Democrat who chairs the House Committee on Veterans Affairs.Filner ordered hearings on the subject last summer.
Since then, two Illinois Democrats, U.S. Rep. Phil Hare and Sen. Barack Obama, have filed legislation asking for a moratorium on personality disorder diagnoses."It's an epidemic and it's an abuse of the system by the military to kick out veterans and save money by denying veterans their health care and disability benefits," said Sullivan of Veterans for Common Sense.
According to the Army, the number of soldiers discharged for personality disorders today is lower than that of the late 1990s. Of the 80,000 soldiers who left service in 2006, 1,086 were discharged for personality disorders.
Even so, the Army is reviewing the discharges of all combat veterans diagnosed with personality disorders since 2001, said Ritchie, the Army colonel.
"We certainly are aware of the allegations and we are taking them very seriously," she said.
Ritchie said she doesn't believe the allegations of intentional misdiagnoses.
"A military physician wants to do the right thing by the soldier. The amount of disability benefits is not an issue," Ritchie said.
A kid again
On a recent morning, Gearhart settled into an armchair in his parents' Cape Coral home. He's living with them until he can find a job and start a civilian life."It's like I'm a kid again living at home," Gearhart said.
It's hard to read his emotions. He's frustrated by the situation, but his voice and his expressions don't reveal much. Whether that's because of his medications or his underlying self or a practiced ability to stay cool under pressure is impossible to know.
Gearhart has experience in nuclear engineering and accounting, compliments of the Navy. He also put himself through two years of law school.
He said his bipolar disease is under control, as long as he can get medication. He said he should have been diagnosed with the disorder years ago.
"Looking back on it now, I just thought it was me," he said.
Hope isn't lost.
Ritchie said any soldier who questions his discharge can appeal to the Army Board for Correction of Military Records. They also can call a hotline for wounded soldiers and their families to discuss health and benefits concerns."If we did, by any chance, do the wrong thing, we want to right it," Ritchie said.
Gearhart has joined the American Legion in the hopes he can purchase insurance through the organization. He is in the process of applying for drug assistance programs from the pharmaceutical companies that make his medication.
And he appealed the VA's denial of benefits, although he wonders whether the government he served will now assist him.
"All those years spent in the military, it's hard to walk away with nothing," he said.
"But it's so hard to fight the government."
U.S. ARMY REGULATIONS
The personality disorder discharge falls under Chapter 5 of the Army Regulations. The chapter is titled “Separation for Convenience of the Government.”
It reads:
“Under the guidance in chapter 1, section II, a soldier may be separated for personality disorder (not amounting to disability (see AR 635–40)) that interferes with assignment or with performance of duty, when so disposed as indicated in a, below.
a. This condition is a deeply ingrained maladaptive pattern of behavior of long duration that interferes with the soldier’s ability to perform duty. (Exceptions: combat exhaustion and other acute situational maladjustments.) The diagnosis of personality disorder must have been established by a psychiatrist or doctoral-level clinical psychologist with necessary and appropriate professional credentials who is privileged to conduct mental health evaluations for the DOD components. It is described in the Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders, 4th edition.
b. Commanders will not take action prescribed in this chapter in lieu of disciplinary action solely to spare a soldier who may have committed serious acts of misconduct for which harsher penalties may be imposed under the UCMJ.
c. Separation because of 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. Separation for personality disorder is not appropriate when separation is warranted under chapters 4, 5, 7, 9, 10, 11, 13, 14, 15, or 18 of this regulation; AR 380–67; or AR 635–40.
d. Nothing in this paragraph precludes separation of a soldier who has such a condition for other reasons authorized by this regulation.
e. Separation processing may not be initiated under this paragraph until the soldier has been counseled formally concerning deficiencies and has been afforded ample opportunity to overcome those deficiencies as reflected in appropriate counseling or personnel records. (See para 1–16.)
f. When it has been determined that separation under this paragraph is appropriate, the unit commander will take the actions specified in the notification procedure. (See chap 2, sec I.)
g. For separation authority, see paragraph 1–19.
h. The service of a soldier separated per this paragraph will be characterized as honorable unless an entry-level separation is required under chapter 3, section III. Characterization of service under honorable conditions may be awarded to a soldier who has been convicted of an offense by general court-martial or who has been convicted by more than one special court-martial in the current enlistment, period of obligated service, or any extension thereof.”