Defense Health Care: Additional Efforts Needed to Ensure Compliance with Personality Disorder Separation Requirements
At DOD, a personality disorder can render a servicemember unsuitable for service. GAO was required to report on personality disorder separations and examined (1) the extent that selected military installations complied with DOD’s separation requirements and (2) how DOD ensures compliance with these requirements.
GAO reviewed a sample of 312 servicemembers’ records from four installations, representing the Army, Air Force, and Marine Corps, that had the highest or second highest number of Operation Enduring Freedom or Operation Iraqi Freedom servicemembers separated because of a personality disorder. The review is generalizable to the installations, but not to the services. GAO also reviewed 59 Navy servicemembers’ records, but this review is not generalizable to the installation or the Navy because parts of the separation process could have been completed at multiple locations.
GAO’s review of enlisted servicemembers’ records found that the selected military installations GAO visited varied in their documented compliance with DOD’s requirements for personality disorder separations. DOD has requirements for separations because of a personality disorder, which is defined as an enduring pattern of behavior that deviates markedly from expected behavior and has an onset in adolescence or early adulthood.
The three key requirements established by DOD are that enlisted servicemembers (1) must be notified of their impending separation because of a personality disorder, (2) must be diagnosed with a personality disorder by a psychiatrist or psychologist who determines that servicemembers’ personality disorder interferes with their ability to function in the military, and (3) must receive formal counseling about their problem with functioning in the military. For the four installations, compliance with the notification requirement was at or above 98 percent. The compliance rates for the requirement related to the personality disorder diagnosis ranged from 40 to 78 percent.
For the requirement for formal counseling, compliance ranged from 40 to 99 percent. GAO’s review of the documentation in the enlisted Navy servicemembers’ records found that compliance varied by requirement. Ninety-five percent of enlisted Navy servicemembers’ records had documentation indicating that enlisted servicemembers had been notified of their impending separation because of a personality disorder.
Eighty-two percent had documentation that indicated compliance with the requirement that enlisted servicemembers must be diagnosed with a personality disorder by a psychiatrist or psychologist who determines that the personality disorder interferes with servicemembers’ ability to function in the military. Seventy-seven percent had documentation indicating compliance with the requirement for formal counseling.
DOD does not have reasonable assurance that its key personality disorder separation requirements have been followed. DOD policy directs the military services to implement and ensure consistent administration of DOD’s requirements for separating enlisted servicemembers because of a personality disorder. According to military service officials, the military services delegate to commanders with separation authority at military installations sole responsibility for ensuring that the separation requirements are followed for enlisted servicemembers under their command.
When asked about the low rates of compliance for some of the separation requirements that GAO found, military officials responsible for reviewing the servicemembers’ records with whom GAO spoke could not explain why these separations were approved if compliance with the separation requirements was not documented in the servicemembers’ records. The military services have not established a way to determine whether the commanders with separation authority are ensuring that DOD’s key separation requirements are met, and DOD does not have reasonable assurance that its requirements have been followed.