March 23rd, 2007
Just when you think you’ve heard everything rotten about this administration comes a new one. Joshua Kors, in the Nation reports that the military are using discharges for so-called personality disorders to force out wounded soldiers and deprive them of a lifetime of disability and medical benefits. As a researcher who has studied personality disorders, I find this especially appalling. Perhaps the personality disorder research community will take this cause on.
A six-month investigation has uncovered multiple cases in which soldiers wounded in Iraq are suspiciously diagnosed as having a personality disorder, then prevented from collecting benefits. The conditions of their discharge have infuriated many in the military community, including the injured soldiers and their families, veterans’ rights groups, even military officials required to process these dismissals.
They say the military is purposely misdiagnosing soldiers like Town and that it’s doing so for one reason: to cheat them out of a lifetime of disability and medical benefits, thereby saving billions in expenses.
In the Army’s separations manual it’s called Regulation 635-200, Chapter 5-13: “Separation Because of Personality Disorder.” It’s an alluring choice for a cash-strapped military because enacting it is quick and cheap. The Department of Veterans Affairs doesn’t have to provide medical care to soldiers dismissed with personality disorder. That’s because under Chapter 5-13, personality disorder is a pre-existing condition. The VA is only required to treat wounds sustained during service.
Soldiers discharged under 5-13 can’t collect disability pay either. To receive those benefits, a soldier must be evaluated by a medical board, which must confirm that he is wounded and that his wounds stem from combat. The process takes several months, in contrast with a 5-13 discharge, which can be wrapped up in a few days.
If a soldier dismissed under 5-13 hasn’t served out his contract, he has to give back a slice of his re-enlistment bonus as well. That amount is often larger than the soldier’s final paycheck. As a result, on the day of their discharge, many injured vets learn that they owe the Army several thousand dollars.
The military doctors are deliberately lying to soldiers, telling them that this discharge will be to their benefit:
One military official says doctors at his base are doing more than withholding this information from wounded soldiers; they’re actually telling them the opposite: that if they go along with a 5-13, they’ll get to keep their bonus and receive disability and medical benefits. The official, who demanded anonymity, handles discharge papers at a prominent Army facility. He says the soldiers he works with know they don’t have a personality disorder. “But the doctors are telling them, this will get you out quicker, and the VA will take care of you. To stay out of Iraq, a soldier will take that in a heartbeat. What they don’t realize is, those things are lies. The soldiers, they don’t read the fine print,” he says. “They don’t know to ask for a med board. They’re taking the word of the doctors. Then they sit down with me and find out what a 5-13 really means–they’re shocked.”
Veterans groups have seen this scenario repeated many times:
Russell Terry, founder of the Iraq War Veterans Organization (IWVO), says he’s watched this scenario play itself out many times. For more than a year, his veterans’ rights group has been receiving calls from distraught soldiers discharged under Chapter 5-13. Most, he says, say their military doctors pushed the personality disorder diagnosis, strained to prove that their problems existed before their service in Iraq and refused to acknowledge evidence of posttraumatic stress disorder (PTSD), traumatic brain injury and physical traumas, which would allow them to collect disability and medical benefits.
“These soldiers are coming home from Iraq with all kinds of problems,” Terry says. “They go to the VA for treatment, and they’re turned away. They’re told, ‘No, you have a pre-existing condition, something from childhood.’” That leap in logic boils Terry’s blood. “Everybody receives a psychological screening when they join the military. What I want to know is, if all these soldiers really did have a severe pre-existing condition, how did they get into the military in the first place?”
It appears that psychologists are among those lying to the wounded soldiers:
Town says Fort Carson psychologist Mark Wexler assured him that he would receive disability benefits, VA medical care and that he’d get to keep his bonus–good news he discussed with Christian Fields and Brandon Murray, two soldiers in his unit at Fort Carson. “We talked about it many times,” Murray says. “Jon said the doctor there promised him benefits, and he was happy about it. Who wouldn’t be?” Town shared that excitement with his wife, Kristy, shortly after his appointment with Wexler. “He said that Wexler had explained to him that he’d get to keep his benefits,” Kristy says, “that the doctor had looked into it, and it was all coming with the chapter he was getting.”
In fact, Town would not get disability pay or receive long-term VA medical care. And he would have to give back the bulk of his $15,000 bonus. Returning that money meant Town would leave Fort Carson less than empty-handed: He now owed the Army more than $3,000….
Wexler denies discussing benefits with Town. In a statement, the psychologist writes, “I have never discussed benefits with my patients as that is not my area of expertise. The only thing I said to Spc. Town was that the Chapter 5-13 is an honorable discharge…. I assure you, after over 15 years in my position, both as active duty and now civilian, I don’t presume to know all the details about benefits and therefore do not discuss them with my patients.”
It seems likely that the military psychologists and psychiatrists are diagnosing PTD-like conditions as a “personality disorder”:
Wexler did not reply to repeated requests seeking comment on Town’s diagnosis. But Col. Knorr of Fort Carson’s Evans hospital says he’s confident his doctors are properly diagnosing personality disorder. The colonel says there is a simple explanation as to why in so many cases the lifelong condition of personality disorder isn’t apparent until after serving in Iraq. Traumatic experiences, Knorr says, can trigger a condition that has lain dormant for years. “They may have done fine in high school and before, but it comes out during the stress of service.”
“I’ve never heard of that occurring,” says Keith Armstrong, a clinical professor with the Department of Psychiatry at the University of California, San Francisco. Armstrong has been counseling traumatized veterans for more than twenty years at the San Francisco VA; most recently he is the co-author of Courage After Fire: Coping Strategies for Troops Returning From Iraq and Afghanistan and Their Families. “Personality disorder is a diagnosis I’m very cautious about,” he says. “My question would be, has PTSD been ruled out? It seems to me that if it walks like a duck, looks like a duck, let’s see if it’s a duck before other factors are implicated.”
The Army holds soldiers’ medical records and contact information strictly confidential. But The Nation was able to locate a half-dozen soldiers from bases across the country who were diagnosed with personality disorder. All of them rejected that diagnosis. Most said military doctors tried to force the diagnosis upon them and turned a blind eye to symptoms of PTSD and physical injury.
One such veteran, Richard Dykstra, went to the hospital at Fort Stewart, Georgia, complaining of flashbacks, anger and stomach pains. The doctor there diagnosed personality disorder. Dykstra thinks the symptoms actually stem from PTSD and a bilateral hernia he suffered in Iraq. “When I told her my symptoms, she said, ‘Oh, it looks like you’ve been reading up on PTSD.’ Then she basically said I was making it all up,” he says.
The military psychologists are also getting very good at diagnosis. It only takes 30 minutes for them to diagnose personality disorder:
Wooldridge says his psychologist, Capt. Patrick Brady of Baynes-Jones Army Community Hospital, saw him for thirty minutes before making his diagnosis. Soon after, Wooldridge was discharged from Fort Polk under Chapter 5-13.
In my experience, you could hardly inquire about the PD symptoms in that time.
If true, these accounts are an abomination. The APA and the American Psychiatric Association’s ethics committees should investigate. Notice that the articles gives plenty of names and facts with which to launch an investigation.
Meanwhile, these reports are relevant to the issue of psychologists’ participation in interrogations. If military psychologists and psychiatrists are willing to accede to situational pressure and give a false diagnosis that can cause irreparable damage to their soldier-patients, who were wounded fighting the country’s wars, how in the world can one expect an isolated psychologist-interrogator to withstand the intense pressure of an intelligence system dedicated to using abusive techniques to break down alleged “enemy combatants?” It strains credulity, doesn’t it? But the, many of the pro-interrogations arguments of the APA strain credulity.