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 service members 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 service members 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 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 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 service member.
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 six 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 service member," 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 two 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.
Thomas J. Berger, Ph.D.
Dr. Tom Berger is a Life Member of Vietnam Veterans of America (VVA) and founding member of VVA Chapter 317 in Kansas City, Missouri. After serving as chair of VVA's national PTSD and Substance Abuse Committee for almost a decade, he joined the staff of the VVA national office as "Senior Policy Analyst for Veterans' Benefits & Mental Health Issues" in 2008, and then in June 2009, was appointed as "Executive Director of the VVA Veterans Health Council". As such, he is a member and former Chair of the Veterans Administration's (VA) Consumer Liaison Council for the Committee on Care of Veterans with Serious Mental Illness (SMI Committee); he is also a member of the VA's Mental Health Quality Enhancement Research Initiative Depression Executive Committee (MHQUERI) and the South Central Mental Illness Research and Education Clinical Center (SC MIRECC). Dr. Berger also serves as a member of the National Center for PTSD's Educational Advisory Board.
In addition, Dr. Berger holds the distinction of being the first representative of a national veterans' service organization to hold membership on the VA's Executive Committee of the Substance Use Disorder Quality Enhancement Research Initiative (SUD QUERI). Dr. Berger also serves as a reviewer of research proposals for DOD's "Congressionally Directed Medical Research Programs". He is a member of VVA's national Health Care, Government Affairs, Agent Orange and Toxic Substances, and Women Veterans committees. Dr. Berger served as a Navy Corpsman with the 3rd Marine Corps Division in Vietnam, 1966-68. Following his military service and upon the subsequent completion of his postdoctoral studies, he held faculty, research and administrative appointments at the University of Kansas in Lawrence, the State University System of Florida in Tallahassee, and the University of Missouri-Columbia, as well as program administrator positions with the Illinois Easter Seal Society and United Cerebral Palsy. His professional publications include books and research articles in the biological sciences, wildlife regulatory law, adolescent risk behaviors, and post-traumatic stress disorder.
Dr. Berger now devotes his efforts full-time to veterans' advocacy at the local, state and national levels on behalf of Vietnam Veterans of America. He presently resides in Silver Spring, Maryland.
VIETNAM VETERANS OF AMERICA
September 15, 2010
The national organization Vietnam Veterans of America (VVA) is a non-profit veterans' membership organization registered as a 501(c) (19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.
For Further Information, Contact:
Executive Director of Policy and Government Affairs
Vietnam Veterans of America.
(301) 585-4000, extension 127