Experts: Iraq Veterans Wrongly Diagnosed

‘Personality disorder’ assessment allows for quick honorable discharge but tags veterans with a label that is hard to remove.
by Anne Usher

Left, Former Army Pvt. Jason Harvey, shown here in Iraq, was diagnosed with depression and post-traumatic stress disorder. Harvey said he later was forced to agree to a diagnosis of a personality disorder. ‘They played me like a fiddle,’ he said.

WASHINGTON Soldiers suffering from the stress of combat in Iraq are being misdiagnosed by military doctors as having a personality disorder, lawyers and psychologists say, which allows them to be quickly and honorably discharged but stigmatizes them with a label that is hard to dislodge and can hurt them financially.

Though accurate for some, experts say, the personality disorder label has been used as a catch-all diagnosis to discharge personnel who may no longer meet military standards, are engaging in problematic behavior or suffer from more serious mental disorders. For returning veterans, the diagnosis can make it harder to obtain adequate mental health treatment if they must first show they have another problem, such as post-traumatic stress disorder…

“It’s an absolute disgrace to military medicine,” said Bridgette Wilson, a former Army medic who is now an attorney in San Diego serving mainly military clients. “I see it over and over again, the dramatic misuse of personality disorder diagnosis. It’s a fairly slick and efficient way to move some bodies through.” 

Military records show that since 2003, 4,092 Army soldiers and another 11,296 men and women in other branches of the armed services have been discharged after being diagnosed with the disorder.

A government worker at Fort Carson in Colorado who has access to personnel records and who spoke on condition on anonymity for fear of losing his job said Army psychologists there have diagnosed some soldiers with a personality disorder after a single evaluation lasting 10 minutes to 20 minutes.

Several soldiers at Fort Carson interviewed by Cox Newspapers said they have been given or offered the diagnosis in a handful of meetings lasting less than an hour.

The personality disorder diagnosis can result in a soldier getting an honorable discharge within days, which can be appealing for many returning from Iraq.

The timing of many of the discharges, in some cases within months after soldiers have returned, appears to violate the military’s rules, which say a personality disorder diagnosis should not be made if a soldier is experiencing “combat exhaustion or other acute situational maladjustments.”

Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, said he is unaware of any related discharges within three months of a deployment and has “full confidence in our medical personnel in their decision-making.”

Nonetheless, he asked Army surgeon general Lt. Gen. Kevin Kiley two weeks ago to review complaints of inadequate mental health care at Fort Carson. He said it was begun before Democratic Sens. Barbara Boxer of California and Barack Obama of Illinois and Republican Sen. Kit Bond of Missouri wrote a letter asking him to investigate such concerns after they were raised in a broadcast on National Public Radio.

“I’m concerned with any allegations that suggest we may have not taken the steps that we need to take to ensure that people are properly cared for,” he said, adding that soldiers are receiving the best mental military health care in history.

Proper evaluation

A personality order is defined as a deeply ingrained, abnormal behavior pattern that appears during childhood or adolescence.

Critics say that many soldiers returning from Iraq who are tagged with that label actually have post-traumatic stress disorder stemming from their combat experiences. A review of four soldiers’ medical records at Fort Carson and records from a soldier at another post show that they were diagnosed with post-traumatic stress disorder before or after their discharge.

Recommending a discharge on the basis of a personality disorder is a faster process than discharging someone for mental health problems of another nature. It requires only one military psychologist’s finding, and the paperwork usually takes only a couple of days.

A diagnosis of post-traumatic stress disorder, on the other hand, must be handled by a medical review board, which must confirm that the condition stems from combat, a process that usually takes several months.

Dr. Joseph Bobrow, a former chief psychologist at Kaiser Hospital in San Francisco, said a personality disorder is one of the most difficult diagnoses to confirm, particularly when there is cumulative trauma.

“I think it’s ludicrous to make a diagnosis of personality disorder in a 20- to 40-minute interview,” he said. “Even if you do a complete battery of psychological testing and intensive and informed clinical interviews over a week, some of those results can be and are contested in a court of law.”

Some of the soldiers at Fort Carson say they had been told by Army psychologists that the Department of Veterans Affairs would take care of them if their troubles persisted. A personality disorder, however, is considered a pre-existing condition, not one related to a soldier’s service, and Veterans Affairs can treat but not give disability benefits in these cases.

Many soldiers who sought mental health counseling after returning from Iraq, like former Spc. Donald Schmidt of Chillicothe, Ill., say they learned only after their discharge that they must repay part of their re-enlistment bonus based on the portion of time they did not serve more than $10,000 in Schmidt’s case.

He and many other soldiers interviewed by Cox Newspapers, lawyers and veterans groups also say they were not cautioned that a personality disorder diagnosis could damage their job prospects because prospective civilian employers may request access to their discharge papers. Those records usually describe anti-social traits and behaviors they are said to probably possess.

In her 13 years in practice, San Diego attorney Wilson said she has seen dozens of Marines from nearby Camp Pendleton and soldiers from other posts separated for a personality disorder when the real reason, in her view, has been to punish a soldier, avoid paying disability benefits for a more serious condition or get rid of someone deemed undesirable.

Though some of her clients have personality disorders, she said, most who received the diagnosis and discharge had minor behavioral problems or were diagnosed with bipolar disorder or severe depression by either military or civilian psychologists.

About three-quarters of her clients who have been diagnosed with a personality disorder, she said, weren’t given any psychological test. Rather, she said, the diagnosis was based on a roughly 45-minute interview.

Lynn Gonzalez, a counselor at the San Diego Military Counseling Project, an information and support organization for active-duty personnel having problems with the military, said the quick tagging of soldiers with the disorder has happened “enough that what we tend to do now is push guys to go to a private psychiatrist so they have more information for a proper diagnosis.”

Col. Steven Knorr, chief of psychiatry at Fort Carson’s Evans Army Community Hospital, said it would be rare for a doctor to diagnose and discharge a soldier for having a personality disorder in just one session, as asserted by some soldiers.

Besides examining a patient’s medical history and sometimes doing psychological testing, he said, psychologists normally will talk with soldiers about how they’re coping and how they feel about military service and get their commander’s assessment.

“The vast majority of people I’ve seen separated with personality disorder are pleased with that,” Knorr said.

Altering diagnoses

For nearly a year after his return from Iraq in August 2005, former Pvt. Jason Harvey had gone without any follow-up evaluations at Fort Carson after screening positive for possible post-traumatic stress disorder and a traumatic brain injury, his records show.

After a suicide attempt in May, records show that the 23-year-old was diagnosed with depression and post-traumatic stress disorder, but in late June the Army tried to discharge him with a personality disorder. Harvey said he was told by a staff psychologist in a joint meeting with his commander that if he did not agree to an honorable discharge, the commander would pursue a punitive discharge.

“They played me like a fiddle,” Harvey said, adding he was wrongly told the medical retirement fell under the same category as post-traumatic stress disorder. In fact, it is a nonmedical discharge.

Also at Fort Carson, after two tours in Iraq, Schmidt, 22, told a psychologist he was feeling violent impulses as a result of marital difficulties. The decorated soldier is on guard constantly and “quick to anger” when he had not been that way before, said his mother, Patrice Semtner-Myers.

Schmidt said his Army psychologist, Dr. Michael Pantaleo, made the diagnosis after several meetings lasting between 15 and 30 minutes each and never asked him questions about his behavior before joining the Army. Pantaleo did not return calls seeking comment.

Schmidt was discharged “without a dime in his pocket,” his mother said.

“The soldiers are often too stupid to know what they’ve done” when they accept the disorder or seek it, Wilson said. “They go out and discover the state police department really isn’t interested in someone discharged with a personality disorder or find they have trouble getting security clearances.”

Some military psychologists appear to be violating guidelines in the Diagnostic and Statistical Manual of Mental Disorders, the psychiatric manual used by the military.

If a soldier complains of mental problems after returning from combat, a personality disorder is supposed to be ruled out for an unspecified amount of time because some of its characteristics, such as problems interacting with others and substance abuse, overlap with some of the hallmarks of post-traumatic stress disorder.

The Pentagon “is not familiar with the rules, or they are choosing to ignore them,” said Paul Sullivan, director of programs for Veterans for America, a Washington-based nonprofit.

Knorr said it’s possible for soldiers at Fort Carson to be diagnosed with mild post-traumatic stress disorder but be discharged for a personality disorder, but he thought that would be rare. An extremely low number might be later diagnosed with a disabling case of stress disorder, he said.

Dr. Bob Scaer, a neurologist and trauma expert in Boulder, Colo., who worked at Fort Carson as an unseasoned resident clinician 41 years ago, said commanders back then would send him soldiers that they wanted to remove from service.

“I’d rubber-stamp the discharge,” he said. “This was an excuse for discarding soldiers who didn’t fit in.”

He said he has seen a few soldiers from Fort Carson recently who were misdiagnosed with a personality disorder after having initially been diagnosed by Army psychiatrists with stress disorder. The military, he said, is making problematic behavior among some returning soldiers “out to be a personality disorder, and it’s not. It’s well-known as a symptom of trauma.”

Determination of personality disorder

Medical guidelines for each service:

Army: Requires a psychologist’s findings.

Navy: Vague language; not clear that determination must come from a mental health professional or command.

Marines: Similar to Army rules but two forms of documents required. Same doctor must render findings on a Marine’s impairment and on written nonmedical evidence to show examples of inability to function in the corps.

Air Force: Alone in requiring oversight where commanders fail to act on appropriate findings. Commander must have decision reviewed by discharge authority.

Personality disorder discharges

*Navy numbers are for fiscal, not calendar, year.

**Iraq war started in March 2003.

Source: Department of Defense