DOD Health: Actions Needed to Ensure Post-Traumatic Stress Disorder and Traumatic Brain Injury Are Considered in Misconduct Separations
Fast Facts
PTSD and traumatic brain injury can affect the behavior of servicemembers in the Armed forces and may lead to separations for misconduct. We examined misconduct separations and found that servicemembers diagnosed with PTSD, TBI, or certain other conditions can receive an "other than honorable" discharge—making them potentially ineligible for VA health benefits.
However, not all of the military services have consistent policies in place to address the impact of these disorders on misconduct separations. We recommended that DOD direct the military services to address inconsistencies in their separation policies.
Diagnosis Status and Characterization of Service for Servicemembers Separated for Misconduct from Fiscal Years 2011 through 2015
DOD Separations for Misconduct graphic
Highlights
What GAO Found
GAO's analysis of Department of Defense (DOD) data show that 62 percent, or 57,141 of the 91,764 servicemembers separated for misconduct from fiscal years 2011 through 2015 had been diagnosed within the 2 years prior to separation with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), or certain other conditions that could be associated with misconduct. Specifically, 16 percent had been diagnosed with PTSD or TBI, while the other conditions, such as adjustment and alcohol-related disorders, were more common. Of the 57,141 servicemembers, 23 percent, or 13,283, received an “other than honorable” characterization of service, making them potentially ineligible for health benefits from the Department of Veterans Affairs (VA).
GAO found that the military services' policies to address the impact of PTSD and TBI on separations for misconduct are not always consistent with DOD policy. For example, contrary to DOD policy, Navy policy does not require a medical examination—or screening—for certain servicemembers being separated in lieu of trial by court-martial to assess whether a PTSD or TBI diagnosis is a mitigating factor in the misconduct charged. This type of separation occurs when a servicemember facing a trial by court-martial requests, and is approved, to be discharged administratively. In addition, GAO found that two of the four military services have TBI training polices that are inconsistent with DOD policy.
GAO also found that the Army and Marine Corps may not have adhered to their own screening, training, and counseling policies related to PTSD and TBI. For example, GAO found that 18 of the 48 nongeneralizable sample separation packets reviewed for Marine Corps servicemembers administratively separated for misconduct lacked documentation showing that the servicemember had been screened for PTSD and TBI. During interviews with Army officers, GAO found that some officers may not have received training to identify mild TBI symptoms, despite Army policy that all servicemembers should be trained. Further, GAO found instances in which both Army and Marine Corps may not have adhered to their counseling policies, which require that servicemembers, specifically prior to requesting separation in lieu of trial by court-martial, be counseled about their potential ineligibility for VA benefits and services. For 11 of the 48 separation packets included in GAO's analysis of Army servicemembers who requested separation in lieu of trial by court-martial, there was no documented evidence—or the evidence was unclear—as to whether the servicemembers received counseling.
Finally, while Army and Marine Corps have some available data on servicemembers' screenings, training, and counseling, the military services do not use these data to routinely monitor whether they are adhering to relevant policies. Federal internal control standards call for agencies to establish monitoring activities to ensure internal control systems and evaluate results. Without monitoring adherence to these policies, the military services cannot provide assurance that servicemembers with PTSD and TBI are receiving adequate consideration of their conditions as well as the services DOD has established for them.
Why GAO Did This Study
The Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 contains a provision that GAO examine the effect of PTSD, TBI, and certain other conditions on separations for misconduct. This report examines (1) the number of servicemembers separated for misconduct who were diagnosed with PTSD, TBI, or certain other conditions and were potentially ineligible for VA benefits and services; (2) the extent to which military services' policies to address the impact of PTSD and TBI on separations for misconduct are consistent with DOD's policies; (3) the extent to which Army and Marine Corps have adhered to their policies; and (4) the extent to which DOD, Army, and Marine Corps monitor adherence to the policies. GAO analyzed DOD data; reviewed applicable policies; interviewed DOD, Army, Marine Corps, Air Force, and Navy officials; visited two Army and one Marine Corps sites selected on factors such as separation rates; and reviewed a nongeneralizable sample of Army and Marine Corps servicemember misconduct separation documents.
Recommendations
GAO is making five recommendations, including that DOD direct the Air Force and Navy to address inconsistencies in their screening and training policies and ensure that the military services monitor adherence to their screening, training, and counseling policies. DOD agreed with four of GAO's recommendations, but did not agree to address inconsistencies in training policies. GAO maintains inconsistencies should be addressed, as discussed in the report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to screening certain servicemembers, including servicemembers separating in lieu of trial by court-martial, for PTSD and TBI and reviewing the results prior to separation for misconduct. |
Closed – Implemented
DOD concurred with this recommendation. In 2018, the Air Force and the Navy revised their separation policies to be consistent with the DOD Instruction to include additional screening of servicemembers, including those being separated in lieu of trial by court-martial, who have been diagnosed for PTSD or TBI prior to separation for misconduct. We believe that DOD's actions have satisfied the intent of our recommendation and we consider this recommendation implemented.
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| Department of Defense | To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting. |
Closed – Implemented
At the time of report publication DOD indicated it did not concur with this recommendation. However after publication, the department indicated it concurred with the recommendation. In July 2022, the Air Force implemented changes to Air Force Instruction 44-102 by incorporating the policies and procedures in DODI 6490.11--DOD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting and combatant command guidance. In June 2022, the Navy responded that it implemented an Instruction--the Bureau of Medicine and Surgery Instruction 6310.16: Navy Medicine Training Requirement for Healthcare Professionals in Traumatic Brain Injury. This instruction, approved on June 1, 2022, mandates all Navy healthcare personnel, who may be called to evaluate, treat, or assist individuals presenting with TBI, complete the tri-Service developed TBI training. We believe DOD's actions have satisfied the intent of our recommendation and we consider this recommendation as implemented.
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| Department of Defense | To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to screening certain servicemembers for PTSD and TBI prior to separation for misconduct. |
Closed – Implemented
DOD concurred with this recommendation. For the years 2018 through 2021, the department required the military services to provide annual compliance reports on how they are monitoring adherence to policies related to screening certain servicemembers for PTSD and TBI prior to separation for misconduct. In October 2022, the department indicated that the military services demonstrated that they were enforcing policies related to screening certain servicemembers for PTSD and TBI prior to separation for misconduct and that annual reporting was no longer required. However, in an October 2022 memo, DOD directed the military services to continue monitoring misconduct separation on a routine basis.
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| Department of Defense | To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting. |
Closed – Implemented
DOD concurred with this recommendation. In May 2018, the Army responded that mandatory mild TBI training was initiated in 2015 and it is also included in pre-deployment training requirements (since 2011). The training is monitored through the Army's Digital Training Management System. The Air Force responded that mild TBI training required by DoDI 6490.11 is fully implemented by the Air Force. The Air Force added that the system for monitoring adherence is in effect. For example, the training requirements are incorporated into Expeditionary Readiness Training Checklist. Unit Deployment Managers review these checklists prior to clearing an individual to proceed on their deployment. The Navy responded that TBI and PTSD were added to the Unit Marine Awareness and Prevention Integrated Training for Leaders in July 2017. In addition, The Navy's Operational Stress control program includes PTSD and TBI as two of the more prominent conditions that must be treated by a medical or mental health professional. In June 2022, the Navy responded that the Bureau of Medicine and Surgery Instruction 6310.16, approved on June 1, 2022, outlines requirements for training officers to document training in the Fleet Management and Planning System or the electronic training record. We believe DOD's actions have satisfied the intent of our recommendation and we consider this recommendation as implemented.
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| Department of Defense | To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to counseling about VA benefits and services during the process of separating certain servicemembers for misconduct. |
Closed – Implemented
DOD concurred with this recommendation. For the years 2018 to 2021, the department required the military services to provide annual compliance reports on how they are monitoring adherence to policies related to counseling about VA benefits and services during the process of separating certain servicemembers for misconduct. In October 2022, the department indicated that the military services demonstrated that they were enforcing policies related to counseling about VA benefits and services during the process of separating certain servicemembers for misconduct and that annual reporting was no longer required. However, in an October 2022 memo, DOD directed the military services to continue monitoring misconduct separation on a routine basis.
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