Running Head: PERSONALITY DISORDER
The Nature of Personality Disorder
Discharge Policy in The United States
As of September 11, 2001
Executive Summary
By
Amy Leffingwell
California State University, Fresno
PERSONALITY DISORDER
Abstract
Since September 11, 2001, a rise in numbers of servicemembers discharged with a Personality
Disorder diagnosis has been well documented. This increase has not gone unnoticed and Congress has
taken initiative to hold hearings regarding the subject. The subject is controversial due to the lack of
benefits veterans receive with this diagnosis once they separate from the military. This study attempts to
highlight the policy, or lack thereof, spanning over the last decade, regarding Personality Disorder based
on discharge from the armed forces. Men and women who suffer from physical trauma as a result of
combat in war are not having their medical needs met because they sign discharge status documents
without knowing that Personality Disorder is considered a pre-existing condition. As a result, they are
excluded from their rightful Department of Defense and Veteran’s Administration benefits. This study
analyzes the thematic content found in individual government documents, which include: congressional
hearings, military policy and United States Government Accountability Office reports. The purpose of
this analysis is to identify the current status of Personality Disorder discharge policy and to provide
recommendations1 for materials that can be disseminated to professionals who provide services to
veterans. There is particular interest in developing materials for the future that will assist in identifying
effective advocacy strategies, informed by data, and relevant to social work practice.
1
See Attachment A: Some Recommendations
2
PERSONALITY DISORDER
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Introduction
Since September 11, 2001, the beginning of the Global War on Terror, Operation Iraqi Freedom
and Operation Enduring Freedom, veterans from these conflicts are seeing their benefits stripped because
of medical disabilities viewed as pre-existing conditions or non-combat related. These discharges result in
no disability pay and/or other veteran entitlements. Various discharge statuses can be given for medical,
traumatic or psychiatric purposes that entitle a veteran to benefits but others are disqualified from their
benefits or other assistance after being discharged with a Personality Disorder. Personality Disorder (PD)
is described in the Diagnostic and Statistical Manual of Mental Disorders-IV TR (DSM-IV TR) as an,
“Enduring pattern of inner experiences and behavior that deviates markedly from the expectations of the
individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable
over time, and leads to distress or impairment” (American Psychiatric Association, 2000, p. 685). This
type of military discharge or separation, called a 5-13 in the Army Directives (Personnel Separations,
2003), is the topic of this study.2
Problem Statement
Because Personality Disorders (PD) are considered pre-existing conditions by the military, all
benefits are denied to the veteran based on this premise (Personnel Separations, 2003). Personality
Disorders are considered pre-existing because they are most often diagnosed in adolescence. Therefore it
is puzzling that PD symptoms seem to appear after a servicemember receives physical wounds in combat
which are not observed to be present in any initial screenings/assessments prior to entry into the armed
services. All servicemembers are screened and diagnosed for psychological disorders or illnesses prior to
their enlistment and again before any deployment into combat.
There have not yet been any reports of servicemembers, who were given PD discharges, found to
have any issues psychologically or physically during any initial screenings prior to their enlistment or
deployment (J. Kors, personal communication, August 31, 2012). However, servicemembers are being
separated from service with this status oftentimes not understanding the implications of the diagnosis.
2
See Attachment B: Some Terms Defined
PERSONALITY DISORDER
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Further, if they are given this diagnosis before their enlistment period is complete, they must repay a
portion of their enlistment bonus back to the military branch in which they served (Personality Disorder
Discharges, 2010, p. 5).
There have been reports that servicemembers have been purposefully misinformed and convinced
to sign for PD discharge status documents, with the promise that their benefits would not be taken away
(Kors, 2007). If the PD discharge accusations are true, then the military is stripping these men and women
of their earned benefits after being wounded in combat for the United States. As a result, they leave
military service with a mental health status permanently attached to their records.
Most of these serviemembers have physical trauma, for example, disfiguration as a result of
combat, and have received Purple Heart Honors for their injuries as a sign of their courage in combat.
But, the military service branches are only acknowledging their PD diagnoses, in place of the physical
trauma. This has resulted in savings estimated at $14.2 billion that would have instead gone to more than
22,600 servicemembers’ benefits packages as of 2010 (Kors, 2010).
Purpose
This study’s overall purpose was to: (1) complete a review of Congressional hearings, Military
directives, and United States Government Accountability Office reports for thematic content necessary to
aid in development of advocacy strategies for dissemination and (2) identify and analyze past and current
policies regarding Personality Disorder (PD) discharge status from the military. An understanding of the
reasons given for discharging servicemembers with PDs was also sought.
This study also sought to develop recommendations for social work professionals for advocacy
efforts when working with veterans who are facing or have already faced a PD discharge; these
recommendations are included. They provide information to educate social workers on related PD policy,
for development of competence based practice, given the vast numbers of servicemembers returning
home to the San Joaquin Central Valley, from combat.
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Methodology
Data for this study are from archival government documents. Supporting documents were found
through internet access including, in part, the Pentagon, Library of Congress, and Veterans
Administration website domains. Policies and practices regarding personality disorder (PD) discharge in
the past as well as any future policy proposals mentioned in the data have been analyzed, utilizing data
from Congressional hearings, Military directives, and United States Government Accountability Office
reports. Through review and critical analysis, thematic points have been summarized for each document
reviewed and brief recommendations have been made to aid in possible advocacy tools, including strategy
materials, for social workers in veteran related fields.
The research questions for this study are as follows:
1. What function does a 5-13 discharge status serve, and what was the rationale for its inception?
2. How have servicemembers historically been informed about their PD discharge, who
determines their discharge status and what information are they provided with at point of
separation?
3. What type of legal responsibilities, if any, do superior officers have to the discharged
servicemember?
4. What physical or psychological wounds have servicemembers, discharged with a 5-13 status
received?
5. What actions have been taken since the last hearings held in 2010, to insure the Department of
Defense’s compliance with Congress’s instructions to investigate all PD discharges?
6. What is the status of the PD discharge policy at present and what is the current number of
servicemembers discharged with 5-13?
7. What outreach efforts are being made, and by whom, to educate veterans of their rights?
PERSONALITY DISORDER
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The methodology for this study was chosen because it not only locates and utilizes data relevant
to the topic, but also summarizes their content in order to provide recommendations for possible advocacy
strategies informed by these data. There are three methodological stages in this research study: (1)
Identification of government documents relevant to PD discharges, informed by literature, (2) Deductive
analyses of key points/concepts found within the documents, pooled into summaries, (3)
Recommendations for advocacy and empowerment to enhance professional’s practice competency while
working with veterans.
Throughout the literature, it has been noted that risk factors that are significant to military service
are discoverable prior to service through improved and proper assessment and screening (Larsson,
Broman, & Harms-Ringdahl, 2009). The preponderance of literature regarding PD, PTSD, the Veterans
Administration (VA), the Department of Defense (DOD), and military policy, points towards a need for
revitalization of assessment, which determines a servicemember’s entry and separation from the armed
services. The discussion currently unfolding is whether there have been accurate justifications for mental
health diagnoses for those separated from the military. However, current literature finds that regardless of
justification there is little discrepancy over the profound impact of mental illness on veterans.
Results
The four major findings of this study include:
1. Confusing eligibility and benefit procedures of both the Department of Defense (DOD) and the
Veterans Administration (VA) are typical barriers for veterans and service providers.
2. There is an apparent lack of cohesion and cooperation attested to through poor communication between
the VA and DOD.
3. There is no uniform set of policies within the DOD, nor are the required discharge regulations for PD
being followed in the military service branches.
4. There is no evidence of further Congressional oversight regarding PD discharge problems.
PERSONALITY DISORDER
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Discussion
Changes for personality disorder (PD) discharge policy have been slow in coming. During the
2010 Committee of Veterans Affairs Congressional hearing, it was found the Department of Defense
(DOD) had not yet begun Congress’ suggested investigations into PD cases, nor had the DOD begun to
notify any veterans of their right to appeal, per the instructions from the original investigatory
Congressional hearing in 2007. Though changes are moving slowly, there are many agencies working
with veterans that are in support of change and are fervently advocating on veterans’ behalves.
The DOD and the Veterans Administration (VA) struggle immensely in performing related tasks
together. Although the two agencies have created a joint commission to work together, it does not
necessarily mean they are effective in this task. The most significant area of disconnect is the interaction
between the agencies when servicemembers are transitioning from DOD care in the military into the VA
system. Despite each agency’s multiple attempts to improve coordination of transitioning
servicemembers, problems are still present.
The real trouble lies in the DOD’s resistance to recommendations. In contrast to the DOD, the
VA is more proactive. The VA created an agreement between the agency and the DOD to strengthen the
referral process and include social workers in servicemember’s transitioning process between the DOD
and VA. The use of social workers is of significant importance because they help ease the transfer of
servicemembers between the two agencies. Social workers help reduce stress levels during the lengthy
process of transition. They also act either as a liaison between agencies and the patient or they empower
the patient to stand up for him/herself regarding their personal care.
It is necessary for Congress to follow up with VA and DOD progress in the near future. If this
does not occur, the problem will continue to repeat. In the 2007 hearing regarding PDs, multiple tasks
were delegated and changes were expected to be made. As of the 2010 hearing, the DOD still had no
responses or answers for the Committee on Veterans Affairs. Also, other cases of erroneous PD
discharges have come forward bringing the subject back into the spotlight in media once again. At this
point, it is required for the Committee of Veterans Affairs, perhaps in conjunction with the Committee of
PERSONALITY DISORDER
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Armed Forces, to update the public on the status of PD discharges. The public wants to know what has
changed, what has not changed, what will change and who will make change happen.
All members of the VA workforce, the DOD staff and all medical, physical, psychological
providers, as well as all other staff who come in contact with veterans must become educated on DOD
and VA policies. Likewise, those working in these areas must become educated on each agency’s process
and procedures related to DOD and VA policies. It is also recommended that a clear set of ramifications
for non-compliance to any and all policies should be set. Blatant non-compliance should be addressed
through administrative or monetary sanctions. These sanctions would be dependent on the level of noncompliance and the effects left as a result. This will help ensure the cycle of needed change within the
agencies will begin.
Policy Implications
The cost of the current inefficient system is largely felt on a federal level, but is felt more so in
the smaller community settings that are taking the brunt of the costs. On a macro level there is need for
policy change to either eradicate this type of discharge from the military altogether, or to create legalities
around it to protect the servicemembers and their earned benefits. Veterans need to be educated regarding
the availability of the Veterans Administration (VA) to them and VA efforts at outreach must continue.
On a mezzo level, the VA and the communities that each hospital resides in are affected the most
by this problem. With veterans not aware that they can go to the VA, community providers, social service
agencies, medical and faith based non-profit organizations, as well as homeless shelters and food pantries,
carry the weight. This costs the community the funds required for care of the homeless and low-income
veterans, when the VA could be caring for them instead: the VA is meant for this. Further, if the
Department of Defense (DOD) was properly diagnosing their servicemembers, and discharging them
accordingly, their share of the cost of veterans’ care would not also fall onto the VA and trickle inevitably
to communities.
On a micro level, for a veteran who has been treated negatively, feelings of mistrust towards the
military are not unusual. These feelings can be extended to social workers and other practitioners. Social
PERSONALITY DISORDER
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workers must be prepared when working with veterans and servicemembers that mistrust is likely present.
This mistrust can be cause for veterans to not seek care. Practitioners need to acknowledge that veterans
face feelings of worthlessness and hopelessness and they may even start to believe that there was cause
for them to be removed from their duties, even though they know they do not have any PDs. This is why
the relationship between social worker and client/veteran must be strongly established. Social workers,
who advocate for veterans with a PD discharge, must be educated on past and current significant policy
and legislation that relates to PD’s, in order to practice competently. Therefore, if a social worker is
figuratively going into battle with a veteran they must know past policies and practices having already
occurred and where the policies and practices currently stand.
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PERSONALITY DISORDER
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders. (4th ed.). Washington DC: American Psychiatric Association.
Kors, J. (2007, April 09). Thanks for nothing: How specialist town won a purple heart
and lost his benefits. The Nation, Retrieved from http://www.joshuakors.com/part1.htm
Kors, J. (2010, October 15). Specialist town takes his case to Washington. The nation,
Retrieved from http://www.joshuakors.com/part2.htm
Larsson, H., Broman, L., & Harms-Ringdahl, K. (2009). Individual risk factors associated
with premature discharge from military service. Military Medicine, 174(1), 9-20.
Personality Disorder Discharges: Impact on Veterans Benefits: Hearing before the
Committee on Veterans Affairs, 111th Cong. 97 (2010) (testimonies of: Berger, T., Buyer, S.,
Draper, D., Fairweather, A., Filner, B., Hebert, L., Kors, J., Luther, C., Sullivan, P., Zeiss, A.)
Personnel Separations, Active Duty Enlisted Administrative Separations, (635-200),
Department of the Army (2003).
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PERSONALITY DISORDER
Attachment A: Some Recommendations
Q: What do persons who advocate for/work with veterans need most?
A: Education
The following are few recommendations for possible incorporation into any training materials, curricula, or for
personal growth. These recommendations are made exclusively for the purpose of educating individuals, groups,
community leaders/stakeholders, advocates or anyone interested in competently working with veterans, from an
evidence based perspective, to support self-determination and promote social justice as described in the National
Association of Social Workers ethical guidelines.
(1) Maintain current knowledge of Department of Defense and Veterans Administration regulations as well as
legislation, lobbying efforts and other movements aimed at supporting veterans.
(a) Information can be obtained from these internet resources.
(i) U.S. Department of Defense: http://www.defense.gov/
(ii) U.S. Department of Veterans Affairs: http://www.va.gov/
(iii) U.S. House of Representatives: http://www.house.gov/
(iv) U.S. Senate: http://www.senate.gov/
(v) Veterans for Common Sense: http://veteransforcommonsense.org/
(vi) Vietnam Veterans of America: http://www.vva.org/
(vii) Disabled American Veterans: http://www.dav.org/
(viii) AMVETS: http://www.amvets.org/
(2) Learn and understand the appeals process for veteran disability claims and maintain current knowledge on
veterans’ rights to use of the Medical Evaluation Board.
(a) This information can be found at the following internet resources:
(i) Veterans Medical Advisor: http://www.veteransmedadvisor.com/
(ii) http://www.ultimatedisabilityguide.com/veteran_social_security.html
(iii) Warrior Transition Command: http://wtc.army.mil/soldier/medical_boards.html
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(3) Memorize key components of military culture and language. A free online course to study Military Culture can
be found at: http://deploymentpsych.org/training/training-catalog/military-cultural-competence (This course can also
be taken for continuing education units for a fee). Learn how to address a veteran appropriately, phrase questions
appropriately and how to utilize terminology familiar to military and veteran culture. At the same time, maintain an
open mind and respect how a person identifies themselves. Below are examples.
(a) Some examples of terminology used by the military and veterans are as follows:
(i) Theatre of Combat: the war effort taking place during specific eras e.g. Vietnam or Operation
Enduring Freedom.
(ii) Fired on: Being shot at whether friendly or not, during combat or not, during deployment or
while state-side.
(iii) Deployment: being sent outside of the United States.
(iv) State-side: serving in the United States.
(b) Different titles are given for a servicemember depending on with whom they have enlisted. For
example, a member in the Army is called a ‘Soldier’. But a member in the Navy for instance, would not be
called a Soldier; they are called ‘Sailors’.
(c) Another example of military culture includes the strong attachment, respect and sense of responsibility
to one another that servicemembers and veterans hold onto to. Trust is key because their lives have often
depended on one another in combat situations. Therefore broken trust in any capacity by anyone can be
viewed as an ultimate betrayal because it can be tied to trust needed in life or death situations.
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PERSONALITY DISORDER
Attachment B: Some Terms Defined
Department of Defense (DOD)
A department of the federal executive branch entrusted with formulating military policies and maintaining American
military forces. Its top official is the civilian Secretary of Defense. It is headquartered in the Pentagon.
Veterans Administration (VA)
The federal agency charged with administering benefits provided by law for veterans of the Armed Forces.
United States Military
The Armed Forces: the military establishment of the U.S. nation.
Soldier
A person who serves in the United States Army, is engaged in military service, is an enlisted person distinguishable
from a commissioned officer, and has some specific military skill or experience in the Army (This term is not
exchangeable with any others in this document).
Commander
The commanding officer of a unit within any military service branch; first supervisory position in chain of command
for enlisted servicemembers.
Servicemember/Member
Any person enlisted in active duty in any of the military service branches: the Navy, Marines, Air Force or Army, or
serving in the Reserves or National Guard for the United States Military.
Veteran
Any person who has been discharged or separated from the United States Military as active duty or
Reserve/National Guard regardless of characterization assigned person upon separation; does not have to be a
combat veteran nor from any specific war time effort.
Separation
Being separated from military service duties (Can be used in exchange for ‘Discharge’ in the entirety of this
document).
Discharge
Relieved of charge; relieved of obligation to the United States Military/Department of Defense (Can be used in
exchange for ‘Separation’ in the entirety of this document).
PERSONALITY DISORDER
Characterization
The characterization a servicemember receives upon separation from Military Service. This includes: Honorable,
General, Other Than Honorable, Bad Conduct, Dishonorable, Officer Discharge or Entry-Level Separation. Each
classification of discharge whether due to a personality disorder or some other mental health disorder, or physical
injury or trauma etc. is placed underneath one of these seven separation characterizations.
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