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 service members 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 service members 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 three 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 service members’ 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 service members who served honorably during war is wrong and a violation of military regulations.  Our service members 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 healthcare and benefits during a time of tight budgets.  Our veterans and families lose because some won’t receive urgently needed healthcare, 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 healthcare 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 five 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 six 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 healthcare, 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 five 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 service member 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 three 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 service members.  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 service members.  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 service members, 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 six months after veterans return.  This upholds our military’s need to field a fit fighting force while protecting the health of our individual service members.

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 service members 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 healthcare.

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 service member 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 service member, 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 service members with PTSD and/or TBI to seek care, beyond what has already been established.  VCS also supports mandatory reintegration training for every service member, regardless of discharge, except for dishonorable discharges.

In conclusion, the problem of improper discharges is caused 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 six 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 two roadside bomb explosions and one 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 three weeks, he said he had three 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 Lt. Col. 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.”