Defense Health Care:
Status of Efforts to Address Lack of Compliance with Personality Disorder Separation Requirements
GAO-10-1013T: Published: Sep 15, 2010. Publicly Released: Sep 15, 2010.
This testimony discusses the Department of Defense's (DOD) separation requirements for enlisted servicemembers diagnosed with personality disorders and the military services' compliance with these requirements. DOD requires that all enlisted servicemembers, including those serving in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), be physically and psychologically suitable for military service. Enlisted servicemembers who fail to meet this standard may be involuntarily separated from the military. One psychological condition that can render an enlisted servicemember unsuitable for military service is a personality disorder, which is defined as a long-standing, inflexible pattern of behavior that deviates markedly from expected behavior, has an onset in adolescence or early adulthood, and leads to distress or impairment. Although a personality disorder by itself does not make enlisted servicemembers unsuitable for military service, DOD policy allows for involuntary separation from the military if a servicemember's disorder is severe enough that it interferes with his or her ability to function in the military. DOD data show that from November 1, 2001, through June 30, 2007, about 26,000 enlisted servicemembers were separated from the military because of a personality disorder. Of these 26,000 servicemembers, about 2,800 had deployed at least once in support of OEF/OIF. Accurately diagnosing enlisted servicemembers who have served in combat with a personality disorder can be challenging. Specifically, some personality disorder symptoms--irritability, feelings of detachment or estrangement from others, and aggressiveness--are similar to the symptoms of post-traumatic stress disorder (PTSD), a condition for which OEF/OIF enlisted servicemembers may also be at risk. According to mental health experts and military mental health providers, one important difference between a personality disorder and PTSD is that a personality disorder is a long-standing condition, whereas PTSD is a condition that follows exposure to a traumatic event. According to the American Psychiatric Association and the American Psychological Association, the only way to distinguish a personality disorder from a combat-related mental health condition, such as PTSD, is by obtaining an in-depth medical and personal history from the enlisted servicemember that is corroborated, if possible, by others such as family members and friends. DOD has three key requirements that the military services--Army, Air Force, Marine Corps, and Navy--must follow when separating enlisted servicemembers because of a personality disorder. Specifically, before they are separated because of a personality disorder, enlisted servicemembers 1) must receive notification of their impending separation because of a personality disorder; 2) must receive, prior to the notification, a diagnosis of personality disorder by a psychiatrist or psychologist who determines that the personality disorder interferes with the enlisted servicemember's ability to function in the military; and 3) must receive formal counseling about their problem with functioning in the military. This statement provides information from a report we issued in 2008 on our review of personality disorder separations in the military services. It also provides an update on the actions DOD has taken since August 2008 related to the recommendations we made in that report.
In summary, our 2008 review found that the documented compliance with DOD's requirements for personality disorder separations varied by requirement and by military installation. Additionally, we found that DOD did not have reasonable assurance that its key personality disorder separation requirements had been followed by the military services. Since our 2008 review, DOD has taken some action to implement our recommendations. However, we have not verified whether the actions the services planned or reported to DOD to increase compliance were actually realized. Because the military services have not demonstrated full compliance with DOD's personality disorder separation requirements, we reiterate the importance of DOD implementing our 2008 recommendations. In 2008, we found that, while compliance with DOD's requirement that servicemembers be notified of an impending personality disorder separation was high among the four installations, it varied considerably for the other two requirements. Specifically, at the four installations, we found that (1) compliance with the notification requirement was at or above 98 percent, (2) compliance with the requirement related to the personality disorder diagnosis by a psychiatrist or psychologist ranged from 40 to 78 percent, and (3) compliance with the requirement for formal counseling ranged from 40 to 99 percent. We also found variation in the enlisted Navy servicemembers' personnel records we reviewed. Ninety-five percent of these records demonstrated compliance with the notification requirement, 82 percent demonstrated compliance with the requirement related to the personality disorder diagnosis, and 77 percent demonstrated compliance with the requirement for formal counseling. Moreover, we found in our prior work that DOD did not have reasonable assurance that its key personality disorder separation requirements had been followed by the military services. To address this issue, we recommended that DOD (1) direct the military services to develop a system to ensure that personality disorder separations are conducted in accordance with DOD's requirements, and (2) monitor the military services' compliance with DOD's personality disorder separation requirements. In August 2008, after our review was completed, DOD updated its requirements for personality disorder separations to clarify its three key requirements and include additional requirements to help ensure that servicemembers are not incorrectly separated because of a personality disorder. DOD's revised requirements for personality disorder separations required that enlisted servicemembers be advised that the diagnosis of a personality disorder does not qualify as a disability.