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U.S. Military Discharges and Pre-existing Personality Disorders: A Health Policy Review

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Abstract

The Department of Defense (DoD) is facing allegations service members were wrongfully discharged for pre-existing personality disorders. From 2001 to 2007, 26,000 enlisted service members were discharged for a pre-existing personality disorder (2.6 % of total discharges). With national media attention of the issue, personality disorder discharges were reduced by 31 % in 2008 with new discharge procedures issued by the DoD. Even with the reduction, a government review found the DoD did not adhere to its discharge protocols. The objective of this paper is to explore personality disorders in the military, analyze various costs to stakeholders, and identify potential policy alternatives.

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References

  • American Psychological Association, Personality Disorders. (2013). Retrieved from http://www.dsm5.org/Documents/Personality%20Disorders%20Fact%20Sheet.pdf.

  • Booth-Kewley, S., & Larson, G. E. (2005). Predictors of psychiatric hospitalization in the Navy. Military Medicine, 170, 87–93.

  • Burnam, M. A., Meredith, L. S., Tanielian, T., & Jaycox, L. H. (2009). Mental health care for Iraq and Afghanistan war Veterans. Health Affairs, 28, 771–782. doi:10.1377/hlthaff.28.3.771.

    Article  PubMed  Google Scholar 

  • Cardona, R. A., & Ritchie, E. C. (2007). U.S. military enlisted accession mental health screening: History and current practice. Military Medicine, 172, 31–35.

    Article  PubMed  Google Scholar 

  • Cigrang, J. A., Carbone, E. G., Todd, S., & Fiedler, E. (1998). Mental health attrition from Air Force Basic Military Training. Military Medicine, 163, 834–838.

    CAS  PubMed  Google Scholar 

  • Clark, K. L., Mahmoud, R. A., Krauss, M. R., Kelley, P. W., Brubb, L. K., & Ostroski, M. R. (1999). Reducing medical attrition: The role of the Accession Medical Standards Analysis and Research Activity. Military Medicine, 164(7), 485–487.

    CAS  PubMed  Google Scholar 

  • Defense Health Agency. (2014). Separating from active duty: Health care coverage options for separating service members (fact sheet). Retrieved from http://www.tricare.mil/Publications.aspx.

  • Department of Defense Instruction 1332.14. (2008). Enlisted administrative separation procedures. Retrieved from http://www.dtic.mil/whs/directives/corres/pdf/133214p.pdf.

  • Department of the Navy, Conduct and Separations Division. (2009). Compliance report on personality disorder (PD) separations. Retrieved from http://www.vva.org/PPD-Documents/11_L_0109VVA_Navy_310_321.pdf.

  • Gunderson, E. K., & Hourani, L. L. (2003). The epidemiology of personality disorders in the U.S. Navy. Military Medicine, 168(7), 575–582.

    PubMed  Google Scholar 

  • Hoge, C. W., Lesikar, S. E., Guevara, R., Lange, J., Brundage, J. F., Engel, C. C., et al. (2002). Mental disorders among U.S. military personnel in the 1990s: Association with high levels of health care utilization and early military attrition. American Journal of Psychiatry, 159, 1576–1583.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., Toboni, H. E., Messer, S. C., Bell, N., Amoroso, P., & Orman, D. T. (2005). The occupational burden of mental disorders in the U.S. military: Psychiatric hospitalizations, involuntary separations, and disability. American Journal of Psychiatry, 162, 585–591.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullerton, C. S., Hwang, I., et al. (2014). Thirty-day prevalence of DSM-IV mental disorders among nondeployed Soldiers in the US Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry: Advance online publication. doi:10.1001/jamapsychiatry.2014.28.

    Google Scholar 

  • National Defense Authorization Act for Fiscal Year 2014. (2013), Pub. L. No. 113-66, H.R. 3304, § 574, 102-103.

  • Military One Source. (2013). 2012 demographics: Profile of the military community. Washington, D.C.: Office of the Deputy Under Secretary of Defense. Retrieved from http://www.militaryonesource.mil/12038/MOS/Reports/2012_Demographics_Report.pdf.

  • Mojtabai, R., Olfson, M., & Mechanic, D. (2002). Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry, 59, 77–84.

    Article  PubMed  Google Scholar 

  • Personality disorder discharges: Impact on Veterans’ benefits: Hearing before the Committee on Veterans’ Affairs U.S. House of Representatives, 111th Cong. 1 (2010).

  • Raine, A., & Benishay, D. (1995). The SPQ-B: A brief screening instrument for schizotypal personality disorder. Journal of Personality Disorders, 9(4), 346–355.

    Article  Google Scholar 

  • RAND Corporation. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. (Monograph). Retrieved from http://www.rand.org.

  • Richardson, J. S. (2010). Curing “bad paper”: A primer on review of discharges from the military. The Federal Lawyer, 57, 47–54.

    Google Scholar 

  • Silver, J. M., McAllister, T. W., & Yudofsky, S. C. (2011). Textbook of traumatic brain injury. Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Types of Administrative Discharges. (1999), 32 C.F.R. § 724.109.

  • Under Secretary of Defense, Personnel and Readiness. (2010). Screening of personality and adjustment disorder discharges. Retrieved from http://www.vva.org/PPD-Documents/11_L_0109VVA_Army_357_377.pdf.

  • U.S. Department of Veterans Affairs. (2010). Other Than Honorable discharges: Impact on eligibility for VA Health Care Benefits. (Fact Sheet No. 16-8). Washington, DC.

  • U.S. General Accounting Office. (1997). Military attrition: Better screening of enlisted personnel could save DoD millions of dollars (GAO Publication No. GAO/T-NSIAD-97-102). Retrieved from http://www.gao.gov/assets/110/106731.pdf.

  • U.S. General Accounting Office. (1998). Military attrition: Better data, coupled with policy changes, could help the services reduce early separations (GAO publication No. GAO/T-NSIAD-98-213). Retrieved from http://www.gao.gov/assets/160/156305.pdf.

  • U.S. General Accounting Office. (1998). Military attrition: DoD needs to better analyze reasons for separation and improve recruiting systems (GAO Publication No. GAO/T-NSIAD-98-117). Retrieved from http://www.gao.gov/assets/110/107274.pdf.

  • U.S. Government Accountability Office. (2008). Defense health care: Additional efforts needed to ensure compliance with personality disorder separation requirements (GAO Publication No. GAO-09-031). Retrieved from http://www.gao.gov/assets/290/283014.pdf.

  • U.S. Government Accountability Office. (2010). Defense health care: Status of efforts to address lack of compliance with personality disorder separation requirements (GAO Publication No. GAO-10-1013T). Retrieved from http://www.gao.gov/assets/130/125240.pdf.

  • Vietnam Veterans of America. (2012). Casting troops aside: The United States military’s illegal personality discharge disorder program. Ader, M., Cuthbert, R., Hoechst, K., Simon, E. H., Strassburger, Z., & Wishnie, M. Silver Spring, MD.

  • Walter Reed Army Institute of Research, Preventive Medicine Program, Accession Medical Standards Analysis & Research Activity. (2013). 2013 annual report. Retrieved from http://www.amsara.amedd.army.mil/Documents/AMSARA_AR/AMSARA%20AR%202013_final.pdf.

  • Weiser, C. (2010). Guaranteeing Health Benefits for America’s Wounded Soldier: Closing the pre-existing personality disorder loophole. Federal Circuit Bar Journal, 20, 101–120.

    Google Scholar 

  • U.S. Department of Veterans Affairs. (n.d.). Health benefits: Returning servicemembers (OEF/OIF/OND). Retrieved from http://www.va.gov/HEALTHBENEFITS/apply/returning_servicemembers.asp.

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Acknowledgments

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The author expresses sincere gratitude to the blind reviewers for their valuable critique and review of this manuscript.

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Correspondence to Todd C. Leroux.

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Leroux, T.C. U.S. Military Discharges and Pre-existing Personality Disorders: A Health Policy Review. Adm Policy Ment Health 42, 748–755 (2015). https://doi.org/10.1007/s10488-014-0611-z

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  • DOI: https://doi.org/10.1007/s10488-014-0611-z

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