Defense Health Care:
Additional Efforts Needed to Ensure Compliance with Personality Disorder Separation Requirements
GAO-09-31: Published: Oct 31, 2008. Publicly Released: Oct 31, 2008.
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.
Recommendations for Executive Action
Status: Closed - Implemented
Comments: In its comments to this report, the Department of Defense (DOD) concurred with this recommendation. In a January 2009 memo, the Under Secretary of Defense directed the military services to provide a report on their compliance with DOD's personality disorder separation guidance for fiscal years 2008 and 2009. Specifically, the compliance reports were to be based on, at minimum, a random sampling of at least 10 percent of all personality disorder separations for the respective service for the designated fiscal year and each case file sampled was to be checked for compliance with DOD's personality disorder separation requirements. Additionally the compliance reports should include the total number of personality disorder separations for the applicable fiscal year, and the total number of personality disorder separations that were for servicemembers who had served in immanent danger pay areas since September 11, 2011. Overall, the fiscal year 2008 compliance reports showed that three out of the four services were not in compliance with any personality disorder separation requirements. Each military service reported its findings of compliance based on its review of a sample of personality disorder separations; the sample size for each service ranged from 10 to 35 percent of the respective service's total personality disorder separations for fiscal year 2008. In addition, in a summary of the services' compliance reports, the Office of the Under Secretary of Defense stated that the military services' compliance with the additional personality disorder separation requirements that DOD added in 2008 was generally well below 90 percent. The Office of the Under Secretary attributed this level of compliance to the services not revising their own requirements to reflect DOD's changes until after fiscal year 2008 was complete. DOD's revisions to its personality disorder separation requirements became effective August 28, 2008. For fiscal year 2009, the military services improved their compliance with DOD's personality disorder separation requirements with sample sizes ranging from 10 to 45 percent. Specifically, in fiscal year 2009, only one of the military services was compliant with less than four of DOD's personality disorder separation requirements. The military services also stated that they expected their compliance with DOD's requirements to increase after fiscal year 2009, as all of the military services revised their own requirements to match those of DOD by August 2009.
Recommendation: To help ensure that DOD's requirements for personality disorder separations are met and to help increase assurance that these separations are appropriate, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to direct the Secretaries of the Army, the Air Force, and the Navy and the Commandant of the Marine Corps to develop a system to ensure that personality disorder separations are conducted in accordance with DOD's requirements.
Agency Affected: Department of Defense
Status: Closed - Implemented
Comments: In its comments to this report, the Department of Defense (DOD) partially concurred with this recommendation. In the January 2009 memo, DOD required the military services to provide a plan for correcting compliance deficiencies if the services found that their compliance with any DOD personality disorder separation requirement was less than 90 percent. According to their fiscal year 2008 reports, each service has planned or taken corrective actions to improve compliance. For example, the Army's report stated that as of March 13, 2009, the Army's Office of the Surgeon General will review all personality disorder separation cases to ensure that each contains the required documentation. Similarly, the Marine Corps will require the General Court Martial Convening Authority to certify that the requirements have been met. The military services also reported actions they will take to implement DOD's revised personality disorder separation requirements. For example, the Marine Corps will incorporate a checklist of the new requirements to be used with all personality disorder separations. Despite improvements in compliance for fiscal year 2009, none of the military services were 90 percent compliant with all of DOD's personality disorder separation requirements and as a result the military services submitted plans to correct these deficiencies. For example, in March 2010, the Army issued guidance to reinforce the counseling and rehabilitation requirements and also plans to perform a quarterly review of personality disorder separations. We did not verify whether the actions the services planned or reported as of March 2010 were actually realized.
Recommendation: To help ensure that DOD's requirements for personality disorder separations are met and to help increase assurance that these separations are appropriate, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to ensure that DOD monitors the military services' compliance with DOD's personality disorder separation requirements.
Agency Affected: Department of Defense