Background. I copied this from the official Army website.

CAC and Ft. Leavenworth > CAC > Staff > Office of the Staff Judge Advocate > Commander's Guide to Administrative Eliminations

Commander's Guide to Administrative Eliminations

SUBJECT: Administrative Separation Guide


1. Enclosed is the Administrative Separation (Chapter) Guide produced by the Criminal Law Division, Office of the Staff Judge Advocate. This guide is designed to assist commanders and first sergeants in expediting the processing of chapter actions. The provisions of AR 635-200 discussed throughout this guide apply to enlisted soldiers only. Ensure that you have the most recent version of AR 635-200, dated 26 June 1996. Inquiries concerning officer separations should be directed to the trial counsel at 684-4844.
2. The Criminal Law Division is here to support you in eliminating those soldiers who the command has decided need to be separated from the service. Your personnel section is responsible for producing the documentation necessary to separate soldiers assigned to your unit from the U.S. Army and for moving those documents through the system. The Criminal Law Division is responsible for producing these separation documents for the separate unit commands and for reviewing the packets.
3. The Army standard for processing a chapter action (without an administrative board) from company commander initiation to approval is 15 working days. Incomplete or inaccurate documentation slows this process. This guide will assist in ensuring elimination actions are complete and accurate, and that the due process rights of the soldier are protected.
4. Our office will continue to prepare the paperwork for the 705th MP Bn. For HQ, CAC, MEDDAC, MP Co., and VETCOM; coordinate with this office prior to initiating the chapter action if it is a Chapter 14 and you are recommending the soldier be separated from service with an Other Than Honorable Discharge or the soldier has over six years active duty, making him eligible for an Administrative Separation Board. This will ensure that the administrative separation process runs smoothly.
5. Make sure all of your actions are dated. There has been a recent rash of undated separation actions. While that does not make the action legally objectionable it may raise an issue at a later time.
6. Point of contact is the trial counsel at 4-4931 or the NCOIC, Criminal Law Division, at 4-4844.


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ATZL-SJA-CL


MEMORANDUM FOR Commanders and First Sergeants
SUBJECT: Common Questions Involving Chapter Actions


1. Enclosed is the 1st Edition of the Commander's Guide to Administrative Eliminations (Chapters). This Chapter Guide deals both with involuntary chapters and outlines the procedures for several voluntary chapters including Chapter 5-3 for Secretarial Authority ("Once in a Lifetime Opportunity") or Chapter 5-17 for early separation to further education. In addition, examples of the various DA Form 4187s needed for these voluntary chapters are included in the Appendix.
2. Voluntary Separation of Soldiers Denied Reenlistment (Chapter 16-5b). Soldiers with a locally imposed bar to reenlistment are no longer eligible for voluntary early separation on the grounds of inability to overcome the bar. A separation under Chapter 16-5b is no longer available to any soldier, whether they are serving on their first, second, or subsequent enlistment. The purpose of this change is to emphasize that the local bar to reenlistment is intended as a probationary device and rehabilitative tool, rather than a quick means of early separation. Soldiers with an approved bar to reenlistment are expected to serve until ETS.
3. Processing time. 100% of the Chapters not involving separation boards processed by the command should be completed within 15 working days. The clock starts when the soldier acknowledges receipt of the intended separation from the immediate commander. The clock stops after the appropriate approval authority takes action and the soldier is taken to the Transition Point for out-processing. However, commanders must understand that a chapter involving a separation board (i.e., the soldier has over 6 years of active duty and requests a board, the soldier is recommended for an Other Than Honorable discharge, or the soldier is facing elimination under the provisions of Chapter 15) is subject to a 50 day processing standard, from initiation by the immediate commander to approval by the appropriate separation authority. The key to expedient chapter processing is to insure that all required documents are present BEFORE requesting the preparation of the chapter packet.
4. Medical Examinations. Unless waived by HQDA, medical examinations are required for soldiers being processed for involuntary separation (AR 635-200, paragraph 1-34a). Soldiers facing elimination under the following chapters must have a medical examination: Chapters 5-11, 5-18 (if basis for chapter is for physical condition), 8 (must be recorded on Standard Form 88 and 93), 9, 11, 13, 14-12b, 14-12c, 15, and 18. Soldiers cannot "waive" the medical exam for these involuntary separations. Medical exams in these circumstances are to protect the United States and the soldier.
5. Separation Pay. Inquiries concerning separation pay should be directed to the Transition Point, at 4-2428. However four criteria govern separation pay:
a. Soldiers must have at least six years of active service (Reserve service does not count) at the time of separation.
b. Soldiers separated for misconduct (Chapter 14) or unsatisfactory performance (Chapter 13) ARE NOT entitled to separation pay.
c. Soldiers who request voluntary separation from the U.S Army under the provisions of AR 635-200 ARE NOT entitled to separation pay.
d. Soldiers involuntarily separated under the provisions of Chapter 5-8, 5-13, 5-18, 9, 15 or 18 are entitled to receive separation pay IF they have been on Active Duty for more than 6 years at the time of separation.
6. Medical Evaluation Boards. A soldier cannot be processed for administrative separation if the soldier has been referred to a Medical Evaluation Board (MEB) unless the soldier is recommended for elimination under Chapters 7, 14, or 15. The processing of the chapter paperwork for Chapters 7, 14, and 15 will coincide with processing through the MEB. If an MEB determines that the soldier should be referred to a Physical Evaluation Board (PEB), that determination and the chapter will be referred to the Commander, U.S. Army Combined Arms Center (CG). The CG will either approve the chapter or send the soldier through the PEB (see AR 635-200, paragraph 1-35). Questions regarding the MEB/PEB process should be directed to Medical Boards, 684-6433.
7. Right To Consult TDS Attorney. All solders facing involuntary separation have the right to consult with an attorney unless they waive that right. If a soldier wants to see an attorney, escort the soldier with the entire elimination packet to the Trial Defense Service (TDS). Chapter counseling takes place every Monday 0915-1015 hrs and Wednesday 1500-1600 hrs. TDS is located in building 244, at 415 Custer Avenue, and can be reached at 4-4559.
8. Any further questions regarding any information contained in this guide should be directed to your trial counsel or the NCOIC, Military Justice Section at 4-4844.

Subject: 22,500 Veterans denied benefits because of "pre-existing personality disorders"
On April 9, Specialist Jon Town was featured on the cover of The Nation, in an article that told how he was wounded in Iraq, won a Purple Heart and was then denied all disability and medical benefits. Town's doctor had concluded that his headaches and hearing loss were not caused by the 107-millimeter rocket that knocked him unconscious but by a psychological condition, "personality disorder," a pre-existing illness for which one cannot collect disability pay or receive medical care.
Jon Town became a national figure, the human face of the 22,500 soldiers discharged with personality disorder in the past six years. His story was picked up by the Army Times, Washington Post Radio and ABC News's Bob Woodruff. It was dramatized in a May episode of NBC's Law & Order. And rock star Dave Matthews began discussing Town's plight at every stop in his spring concert series. Many after they returned from Iraq wounded and sought treatment, each was diagnosed with a pre-existing personality disorder, then denied benefits. As in Town's case, Army doctors determined that the soldiers' ailments were pre-existing without interviewing friends, family or fellow soldiers who knew them before they were wounded in combat.
Maj. Gen. Gale Pollock, acting surgeon general of the Army, was briefed on the problems with the Army's personality disorder discharges. Instead of correcting cases like Town's, she buried them. The surgeon general released a series of memos filled with fabrications. Pollock then informed wounded soldiers that their cases had been thoroughly reviewed by an independent panel of health experts when in fact no such review was conducted. Her office had "thoughtfully and thoroughly" reviewed the personality disorder cases and determined that all of the soldiers, including Town, had been properly diagnosed. Pollock commended the doctors who diagnosed personality disorder for their excellent work.


After all is said and done, anytime a written test is administered, it is as only as good as the test subject interprets it. Very few tests are written by a person who quit school to join the military, or naval service in 1969. Thus the thinking pattern of the test creator is not always going to be compatible with the test subject.
I have witnessed a veteran who had the Silver Star Medal and the Combat Medical Badge be ruled out for PTSD, because he could not understand the questions. After a three year battle we finally got the diagnosis straight and another two years overcome the VA original denial.
Back in the 1980's I had a client who happened top be a great friend of mine who earned the Navy Cross in Vietnam have PTSD ruled out over a written test. After a few years we got him 50% PTSD. But it took considerable time because everyone does not have a psyche degree that takes the test!
my first PTSD claim was filed in February 1983. At one point in the early 80's I had a case with a veteran nicknamed "Critter" who was then an employee of the Ohio State Council of the VVA in Columbus. Critter served in Vietnam, was a 11Bravo and earned the CIB and ArCom with V device. After his tour in Vietnam he taught in the Army training classes, until he started suffering from nightmares and flashbacks with irritability. Well the irritability did not float well with his superiors who had never served in combat. Critter was examined by Army psychiatrist who had never heard of PTSD, because it did not exist at the time, as a diagnosis. In his second enlistment Critter was discharged due to a "Personality Disorder" as determined by the Medical Board.
We filed a PTSD claim in 1983 and after two rating board decisions, (we kept reopening with new and material evidence) it took three psychiatrists evaluations, to show he did not have a personality disorder, but did indeed suffer from PTSD.
Discharge issues are not always as they appear, nor are mental hygiene diagnosis. I do not feel this is political, but a policy that reappears periodically.

So what is the rest of the story?
Read the next post which was orginally on PTSD/GAF thread.

Yes you may have read it before, especially if you read my stuff on Sound Off!
Please read it again, I do believe it is worth a discussion on its own topic.
Dave Barker

Received this from a former DAV National Commander a personal friend of mine. He had received it from someone who worked in intelligence. Thought you would be interested in it.
May 2, 2008

-------Original Message-------

Subject: 22,500 Veterans denied benefits because of "pre-existing personality disorders"

This is long but worthwhile if you want to know what is happening to all too many of the troops. Italicized comments are his not the original author. This is information for discussion



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Specialist Town Takes His Case to Washington by JOSHUA KORS [from the October 15, 2007 issue]
On April 9, Spc. Jon Town was featured on the cover of The Nation, in an article that told how he was wounded in Iraq, won a Purple Heart and was then denied all disability and medical benefits. Town's doctor had concluded that his headaches and hearing loss were not caused by the 107-millimeter rocket that knocked him unconscious but by a psychological condition, "personality disorder," a pre-existing illness for which one cannot collect disability pay or receive medical care. [This sounds almost too insane to be true ... but read on]


Soon Town became a national figure, the human face of the 22,500 soldiers discharged with personality disorder in the past six years. His story was picked up by the Army Times, Washington Post Radio and ABC News's Bob Woodruff. It was dramatized in a May episode of NBC's Law & Order. And rock star Dave Matthews began discussing Town's plight at every stop in his spring concert series.

Further investigation by The Nation has uncovered more than a dozen cases like Town's from bases across the country. All of the soldiers interviewed passed the rigorous health screening given recruits before being accepted into the Army. All were deemed physically and psychologically fit in a second screening as well, before being deployed to Iraq, and served honorably there in combat. None of the soldiers interviewed during this eleven-month investigation had a documented history of psychological problems.

Yet after they returned from Iraq wounded and sought treatment, each was diagnosed with a pre-existing personality disorder, then denied benefits. As in Town's case, Army doctors determined that the soldiers' ailments were pre-existing without interviewing friends, family or fellow soldiers who knew them before they were wounded in combat.

In this article you will hear from Army doctors who say wounded soldiers are routinely misdiagnosed. One says he was pressured by superiors to diagnose personality disorder in cases where soldiers were physically wounded or suffering from posttraumatic stress disorder (PTSD).

Maj. Gen. Gale Pollock, acting surgeon general of the Army, was briefed on the problems with the Army's personality disorder discharges. Instead of correcting cases like Town's, she buried them. The surgeon general released a series of memos filled with fabrications. Pollock then informed wounded soldiers that their cases had been thoroughly reviewed by an independent panel of health experts when in fact no such review was conducted.

"This is not the way the government ought to work. It's not the way they should be responding to veterans," says Representative Bob Filner, chair of the House Committee on Veterans' Affairs. He first heard Town's story in April and began working soon afterward to bring the soldier to Washington. There Town would get his chance to tell Congress everything: about his diagnosis, his discharge and the work of Surgeon General Pollock.

'Thoroughly Evaluated and Reviewed'

Andrew Pogany, an investigator for the soldiers' rights group Veterans for America, has been looking into personality disorder discharges for two years. The discharge, officially known as Regulation 635-200, Chapter 5-13, is simply a loophole, he says, to dismiss wounded soldiers without providing them benefits. Pogany says Town's case is a textbook example of how Chapter 5-13 is being applied. Town had no history of psychological problems and had served seven years, winning a dozen medals, before being discharged with a personality disorder.

The investigator was so disturbed by the Army's use of 5-13 discharges that he brought his research to Pollock. In late October 2006, he and Steve Robinson, Veterans for America's director of veterans affairs, met with Pollock and presented her with a stack of personality disorder cases, including Town's. The surgeon general promised a thorough review.

On March 23, five months after her meeting with Pogany, Pollock released her findings. Her office had "thoughtfully and thoroughly" reviewed the personality disorder cases and determined that all of the soldiers, including Town, had been properly diagnosed. Pollock commended the doctors who diagnosed personality disorder for their excellent work.

Four days later the military followed up with a press release, this one signed by Lieut. Col. Bob Tallman, the Army's chief of public affairs. Tallman's memo provided further detail on Pollock's review. A panel of behavioral health experts had reviewed the personality disorder cases, Tallman wrote, and they didn't stop at the stack of cases presented to the surgeon general. They "thoroughly evaluated and reviewed" all the Chapter 5-13s from the past four years at Fort Carson, where Specialist Town had been based, and determined that all of those cases had been properly diagnosed as well.

There was a glaring problem with Pollock's review. In the five months she spent "thoughtfully and thoroughly" reviewing the cases, her office did not interview anyone, not even the soldiers whose cases they were reviewing.

Asked how he could call the surgeon general's review "thorough" when no soldiers were interviewed, Tallman said he could not. "Let me be honest with you," he said. "I know nothing about this memo and little to nothing about the review." Tallman said the memo bearing his name was actually ghostwritten by Pollock's office. The lieutenant colonel added that as far as he knew, Pollock conducted no review at all.

Pollock's office quickly admitted that it had ghostwritten the Tallman memo but assured veterans' groups that the surgeon general had indeed conducted a review. In an e-mail Pollock's chief spokeswoman, Cynthia Vaughan, explained that the surgeon general did not want to interview soldiers because she felt they had no medically valid information to share. "Calling a soldier who underwent a 5-13 Chapter in 2003 and asking him (in 2007) to recall his mental condition in 2003 does not hold medical validity," Vaughan wrote.

That statement angered many soldiers, including Jon Town. "You'd think I'd remember, even today, if I had headaches and hearing loss before the rocket attack," he says. The surgeon general tried to quell veterans' groups by emphasizing that, as stated in the March memos, the comprehensive review was conducted by a panel of health experts and that those experts "did not provide the initial evaluations." This wasn't a case of one doctor reviewing his own work, the surgeon general said.

Both of those assurances crumbled on May 4, when Army Times reporter Kelly Kennedy revealed that in fact there was only one reviewer: Col. Steven Knorr. Knorr was a strange choice to be the sole reviewer. He was far from an objective observer. As chief of Fort Carson's Behavioral Health unit, Knorr had overseen all the original diagnoses and, in his capacity as a psychiatrist, also diagnosed several soldiers with personality disorder.

Months earlier Knorr had spoken out in defense of the Army's practice of not interviewing soldiers' family or friends before labeling their condition "pre-existing." Unlike his staff, he said, family members are not trained to recognize signs of personality disorder, so speaking to them would be of limited value. "The soldier's perception and their parents' perception is that they were fine. But maybe they didn't or weren't able to see that wasn't the case."



In the same interview, published in The Nation, Knorr said there was a simple reason why in so many cases the lifelong condition of personality disorder isn't apparent until after troops serve in Iraq. Traumatic experiences, he said, can trigger a condition that has lain dormant for years. "[Troops] may have done fine in high school and before, but it comes out during the stress of service," he said. Knorr's assertion was a sharp break from the accepted medical understanding of personality disorder and provoked a flood of angry letters from psychiatrists and veterans' leaders. [This sounds too Kafka-esque to be real but these guys are too real and very scary! Even granting Knorr's point, wouldn't the combat experience in fact be causative and the reason to allow medical benefits?]

Veterans were further agitated by a vivid profile of Knorr, by NPR's Daniel Zwerdling broadcast in late May. Zwerdling details a memo written by Knorr in which he advises his doctors that trying to save every soldier is a "mistake." "We can't fix every Soldier," the memo states. "We have to hold Soldiers accountable for their behavior. Everyone in life beyond babies, the insane, and the demented and mentally retarded have to be held accountable for what they do in life."

Knorr's memo, which he posted on his office's bulletin board, warns his doctors not to take soldiers' descriptions of their ailments at face value. "We're not naïve, and shouldn't automatically believe everything Soldiers tell us," the colonel writes. Knorr also urges his doctors to discharge troubled soldiers quickly--as he puts it, "Get rid of dead wood."

"That memo made me sick," says Russell Terry, founder of the Iraq War Veterans Organization. "It's incomprehensible that [Pollock] would choose him to lead the review." Terry says that if she had wanted to do a real review, the surgeon general could have organized a panel of impartial medical experts. "By having Knorr review his own stuff, there's no outside opinion, no one to uncover the misdiagnoses--no one to object."

The surgeon general declined to be interviewed. But in a recent statement, Pollock defended her office's review and showed continued support for Knorr, calling him an "appropriate" choice to spearhead the review.

By May the Army had a nascent PR nightmare on its hands. The story of Pollock, Knorr and the "thoughtful and thorough" five-month review had been picked up by news talk programs on NPR, Washington Post Radio and ABC News. To stem the tide, officials at Fort Carson did something odd: They released a new memo stating that fifty-six soldiers discharged from Fort Carson with personality disorder actually had PTSD.

It was a stunning admission. As soon as they released it, officials tried to downplay it. Col. John Cho, former commander of Fort Carson's hospital, quickly submitted a second statement, saying that the first memo was not an admission of guilt. Soldiers suffering from PTSD could be rightfully discharged with personality disorder if they had that condition too and their PTSD was not "severe," he said. But Army Regulation 40-501, Chapter 3-33, is clear. It states that if a soldier is suffering from PTSD, he must be discharged by a medical board, which can provide him the lifetime of disability and medical benefits denied soldiers discharged with personality disorder.

Fort Carson officials provided an unintentionally comic coda to their admission when they insisted that all fifty-six cases were properly diagnosed, shortly after Cho admitted in writing that his office could find only fifty-two of them. Base officials said the remaining four cases had been lost or misplaced. They could not explain how they knew those cases were properly diagnosed when they couldn't be found. "It's incredible when you think about it," says Pogany. "They're doing everything they can to cover this up--and doing a lousy job of it."

On May 16, Army officials clarified: The four-year review of personality disorder cases trumpeted in the Tallman memo never occurred.

'I Refused to Diagnose as They Wanted'

By the time Dr. Michael Chen stepped down, he had been serving the Army for more than thirty years. The psychiatrist had treated soldiers at several bases and looked forward to continuing his work at a new installation after being transferred.

Chen's enthusiasm was short-lived. Soon he began clashing with his superiors. "I refused to diagnose as they wanted," he says. "They wanted the diagnoses to be personality disorder, instead of PTSD." The psychiatrist says the soldiers he saw weren't suffering from pre-existing conditions; they had PTSD and traumatic brain injury (TBI). Chen says he relayed this information to his colonel, to no avail. "The establishment wants to hear what the establishment wants to hear."

Chen is not the doctor's real name. Because he fears retribution from the Army, the psychiatrist agreed to speak only if his name and base were not revealed. He says he wasn't the only doctor pressured to misdiagnose: Other psychiatrists were pressed as well, resulting in numerous fraudulent diagnoses of personality disorder. "I've seen that story happen hundreds of times," he says.

While serving at the Army hospital, Chen did diagnose personality disorder. But eventually the absurdity of the recommended diagnoses proved too much. The psychiatrist recalls one soldier who returned from Iraq with a massive hunk of his right calf missing. "They thought he had personality disorder," Chen says, the anger in his voice suddenly palpable. "Imagine: You get your leg blown off, you get a Purple Heart and now they say it's from personality disorder. It's absurd." Frustrated, the psychiatrist approached the commanding general of the hospital. Chen says he met with the official numerous times. But the pressure to misdiagnose continued.

"It's just criminal," he says. The doctor says that at his base wounded soldiers were treated like broken appliances: When they no longer functioned, the command simply wanted to "throw them out" with a pre-existing condition. "And it's appalling to me that my colleagues would go along with it."

The psychiatrist says he doesn't blame the commanding general for the pressure on him and other doctors to misdiagnose soldiers. Their meetings made it clear that the general was simply taking orders from "high up on the food chain." In some sense, says the doctor, that was to be expected, because with personality disorder, there's so much money at stake. The Nation reported in April that the military is saving $12.5 billion in disability and medical care by discharging soldiers under Chapter 5-13, a figure drawn from a recent Harvard study by Professor Linda Bilmes. Chen believes $12.5 billion is a gross underestimate--that from what he's seen at his medical center, if all the wounded soldiers returning from Iraq were properly diagnosed, the long-term cost of benefits would be exponentially larger.

As it was, says Chen, the medical ethic at the Army hospital followed the guidelines of the Knorr memo, which urged doctors not to take soldiers' descriptions of their ailments at face value. The psychiatrist's own approach was radically different. "If a soldier said he had PTSD, I wrote up 'PTSD.' Finally I was told I couldn't see any more soldiers because I diagnosed PTSD too much." Chen left the hospital soon after. Today he treats patients at a nonmilitary facility.

Dr. Brian Harrison still works for the military. Like Dr. Chen, his years as an Army psychiatrist have been contentious. Harrison says that at his medical center, "there has been a tradition of 'underdiagnosing.'" That means soldiers with PTSD don't always receive that diagnosis. And their health isn't always the top concern. Foremost on the command's mind, says Harrison, is getting soldiers back to Iraq. He says doctors at his base understand that when wounded soldiers seek treatment from them, their job is to get the soldiers back to the battlefield, even if they are traumatized. The psychiatrist quotes his hospital's chief of Behavioral Health as saying, "If they're not suicidal or homicidal, they're fit to go back." If they don't meet that standard, the doctors are to get rid of them fast. Wounded soldiers are "seen as damaged merchandise," Harrison says. "The command wants people like that out of their hair, out of their way."

Harrison is also a pseudonym. The doctor says he is speaking out in violation of an e-mail from his superiors ordering psychiatrists at his facility not to talk to the media. If he gives his name, he says, he could be fired.

The doctor says he has never been pressured to misdiagnose. The biggest challenge he has faced is making a correct diagnosis, given the brevity of his appointments. Until recently, he was allowed to meet with soldiers for an hour. But now, he says, the chief of his department has pressed him to cut his evaluation time to half an hour and make future appointments between fifteen and thirty minutes. "I can't do an evaluation in half an hour," says the psychiatrist. "To properly diagnose a soldier, you need at least an hour." Like Chen, Harrison doesn't blame his department's chief, noting that there's pressure on him from his superiors--"the money managers," Harrison calls them. "Those jackasses--they don't have any clinical experience, they've never worked with soldiers, and they don't care."

The bitterness in his voice is broken suddenly with a warm laugh. "Maybe I'm just old-fashioned," says the elderly doctor. Harrison has been practicing psychiatry for almost forty years and still insists on some decidedly "old-fashioned" techniques, like interviewing soldiers' families when diagnosing a pre-existing condition to see whether the soldiers' troubles existed before joining the service. Other doctors at the Army hospital "don't make any effort to do that," he says. "And they don't have time to. They're busy herding people through."

Surgeon General Pollock declined to comment on Chen's and Harrison's allegations. In a statement, she says she is disturbed by the idea that "individuals [are] pressuring providers to falsify diagnoses.... Such conduct, of course, would be totally unacceptable." Pollock advises doctors who feel under pressure to diagnose personality disorder to contact the Inspector General. She asks soldiers who feel they have been misdiagnosed to approach her directly. Due to "my concern over these issues, they may provide their information to me and I will have the staff review their records."

Flying Blind

In May, before most in Washington had even heard of Chapter 5-13, Senator Kit Bond was studying the discharge--and calling for its abolition. "You have 22,000 soldiers who passed through all the tests required to send them to Iraq, and they came back and were diagnosed with a pre-existing condition? It just doesn't compute. We need to fix the system," he says. "They ought not have the 5-13 as an easy way to put these soldiers out." As the system is now, the Senator says, some of the cases he's seen "just scream out to me: 'This person was railroaded.'"

The Republican from Missouri helped put together a coalition of thirty-one senators spanning the political spectrum, from Hillary Clinton to Joseph Lieberman to fellow conservative Elizabeth Dole. In June they wrote a letter to Defense Secretary Robert Gates requesting that he investigate the 5-13 discharge process. Bond also co-wrote a defense authorization amendment with Senator Barack Obama and others that would put a temporary freeze on all personality disorder discharges. The amendment has been referred to the Armed Services Committee.

The past year has exposed several problems in the way we're treating veterans, says Bond. "And this 5-13 seems to be a major part of the problem."

By July the Senate wasn't the only organization in Washington concerned about personality disorder. The Department of Veterans Affairs was worried too. "We wanted to prioritize injured [Iraq War] veterans. We want to provide a seamless transition" from the Army, says a top VA official. But with these personality disorder discharges, "you have people now falling through the cracks." The official, who demanded anonymity because he had not received clearance to speak, says the problem with phony discharges like personality disorder is that they short-circuit the VA's Red Flag system.

The Red Flag system is an informal name for the VA's method of identifying the most wounded soldiers. The agency does this, explains the official, by keeping its eye on the Army's medical board hearings, where wounded soldiers are supposed to go before their discharge. The board evaluates injured soldiers and gives them a disability rating. Under the Red Flag system, those who leave the Army's medical board hearings with a high disability rating are flagged and targeted for immediate medical care.

But soldiers discharged with personality disorder are denied the opportunity to see a medical board and thus don't get a disability rating. As a result, they fly under the VA's radar. Those who need immediate medical care get dumped into the stack of 800,000 cases currently waiting to be processed by the VA. For the VA to function, says the official, the Army has to pass wounded soldiers through its medical boards. Otherwise, the agency is flying blind.

Jon Town knows firsthand the price of that blindness. He submitted an application for VA medical care shortly before leaving the Army. Seven months later he was still waiting for his first doctor's appointment.

Without medical treatment, Town struggled alone with deafness, memory loss, insomnia and a headache that was still raging three years after the rocket attack. The specialist tried to take a few jobs, but each time he was fired after his health proved too much of an issue. His wife, Kristy, had to keep the family of four afloat with her minimum-wage job on the assembly line at Filtech, an oil-filter manufacturer in their hometown of Findlay, Ohio. Soon the family was teetering on the verge of bankruptcy. In May, the phone company shut off their service because the Towns couldn't pay their bill.

The media took note. In April came the Nation article, followed by the Law & Order episode, which introduced Town's story to 9 million viewers. When musician Dave Matthews saw the article and began discussing it in concerts, his enraged fans took up a collection for Town, which raised $3,000. The guitarist followed up by posting a petition on his website, urging Congress to hold hearings on personality disorder. Within weeks the petition was signed by 23,000 people.

"There are times when an injustice is so clear, it's not a matter of opinion," says Matthews. "Nobody would argue that what's happening to Jon Town is right. And to think that it's happening over and over again...it's just astounding. It's a crime against these young people that's so profound--and it's happening right now. I had to ask myself, 'Does America think this is OK?'" People won't think it's OK once they learn what's going on, says Matthews. "We can fix this catastrophe. It's just a matter of getting people to know about it."

Soon Nation readers, NBC viewers and Matthews fans were reaching out to Town en masse: e-mails, phone calls, small personal checks. The local chapter of Veterans of Foreign Wars organized a motorcycle ride to honor his service. A veteran from Boston offered Town his disability pay until the specialist could secure his own.

Strangely enough, Town's big break came not from Matthews, NBC or even Senator Bond but from Lou Wilin, a reporter at the Findlay Courier, Town's hometown paper (circulation 23,000). After reading Town's story in The Nation, Wilin wrote a profile of the soldier, which ran in the newspaper's April 16 edition. The article caught the eye of an admiral in the VA who happens to live a few miles east of Findlay. The admiral flagged Town's case, kicked it to the Cleveland VA, which passed it to the Dayton VA, where case manager Janine Wert was ready to take action. Wert received Town's case the morning of April 19 and had the soldier in her office before the end of lunch. She listened to his story and cried.

"His childhood, high school and military history--none of it supports a personality disorder. When you're a teenager, there are certain things that pop up that are vividly obvious, red flags for personality disorder. Those aren't present in Jon's history," says Wert, a social worker with a master's degree in mental health. Wert says Town's PTSD and TBI symptoms were obvious from their first meeting. She was struck by the absurdity of the Army's diagnosis. "I have never in my life heard of personality disorder causing deafness," says the counselor.

Wert arranged an immediate doctor's appointment for Town and scheduled an evaluation by a VA medical board. On June 11 the VA ruled that Town was in fact wounded in combat. The agency declared him 100 percent disabled.

Town's VA rating guaranteed him disability and medical benefits for the rest of his life. The VA also provided the disability pay that Town should have received in the months following his discharge. On June 25, just weeks after his family's phone had been shut off, the specialist received a check for $20,000.

"I almost started to cry," says Town. "They were ready to repossess everything. And now I knew we weren't going to lose our cars to bankruptcy, that we'd have food on the table for years to come.... There isn't a word for what I was feeling."

The diagnosis was a remarkable victory for the Town family--and a pointed defeat for the Army, which to this day insists that Town was not wounded in combat and that his health problems stem from a personality disorder. He still has not received any of the benefits owed him by the Army.

"This is a scandal," Representative Filner said in May. And members of his VA Committee would be interested in pursuing it, "but right now, they just don't know anything about it." With the uproar about Town, Filner saw an opportunity to change that. On July 12 he announced that his committee would hold a hearing on personality disorder. To do it right, he said, "we definitely want to hear from soldiers."

Filner had a particular soldier in mind.

'This Would Be Wrong'

July 25. By 10 am, it's standing room only at the Cannon House Office Building, the hearing room swimming with men in uniform, veterans with camouflage accessories, protesters in bright pink sporting handwritten placards demanding justice for soldiers. A row of photographers crouch beside the CBS News camera; reporters for ABC News, NPR and the New York Times have set up shop behind the soldier at the witness desk.

Not surprisingly, Town didn't sleep the night before. His headache is still raging; his eyes look a bit bloodshot. But his blond bangs are combed, and his favorite red-striped Old Navy shirt is gone, as is the brown ball cap and reflective sunglasses, replaced with a well-pressed navy suit and crimson tie. Town holds his dog tags in his hand and rubs them nervously between his thumb and forefinger as he looks up at the committee, his voice defiant and jittery.

"I want to state that I did not have a personality disorder before I went into the Army, as they have stated in my paperwork. I did not suffer severe nonstop headaches. I did not have memory loss. I did not have endless, sleepless nights. I have posttraumatic stress disorder and traumatic brain injury now due to the injuries I received in the war, for which I received a Purple Heart," he says. "I shouldn't be labeled for the rest of my life with a personality disorder, and neither should my fellow soldiers who also incorrectly received this stigma."

Filner looks down at the specialist with paternal eyes. When the applause dies down he says, "Thank you, Mr. Town. You did not sign up to have to do this. But you are helping a lot of people, and we thank you for your courage."

Two hours later Surgeon General Pollock's psychological consultant, Col. Bruce Crow, sits at the witness desk. Pollock herself was called to testify; her name appeared on the original witness list. But today she's nowhere to be found, a fact that angers several of the Congressmen. Speaking in her stead, Crow says, "Questions have been raised about whether Army psychiatrists and psychologists are misdiagnosing soldiers with personality disorder instead of correctly diagnosing PTSD or traumatic brain injury." If they are misdiagnosing soldiers, says Crow, "this would be wrong."

Pollock's consultant says that the surgeon general is reviewing the cases of 295 soldiers discharged with personality disorder. Pollock will conduct the review, says Crow, by having "a team of senior mental health providers" look over the soldiers' paperwork.

Filner shakes his head, baffled. "The first panel shocked me," says Filner, referring to Town's testimony. "You guys shocked me even more." The allegation "that there's a systematic and policy-driven misdiagnosis of PTSD as personality disorder to get rid of soldiers early, to prevent any expenditures in the future, which were calculated in the billions of dollars...it's a pretty serious allegation." Crow looks back at Filner. He says nothing. "And if you think that we're going to believe an evaluation of 295 cases, whichever ones you happen to pick--that we're going to believe what you say--I'll tell you now, I'm not going to believe it. So why bother?" says the chairman. "Let's have an independent evaluation."

When the hearing ends, Crow exits. Several Congressmen walk toward the gallery to shake Town's hand. The hearing went well, says the soldier. He was glad to hear support on both sides of the aisle for the Bond/Obama amendment to freeze 5-13 discharges and its companion legislation in the House, HR 3167, put forward by Congressman Phil Hare and others.

Now that Town has gotten his VA benefits, his eye has turned toward the national issue of 5-13 discharges. That is where there's a lot of work left to be done, he says. Town points out that still today, not a single person has been held responsible for the 5-13 discharges--not Surgeon General Pollock, not Colonel Knorr, not even the Army psychologist who diagnosed his personality disorder, Dr. Mark Wexler.

And there hasn't been any effort to go back through the files and find the thousands of Jon Towns who are struggling right now without benefits or the media spotlight. "The Army needs to go back and find these guys," says the specialist. "They need to show up and say, 'We apologize--and we're here to rectify the situation.'"

Until that happens, he says, his work is not done.



*****

With all due respect the article is no more, or less political than any other disagreement with the military/naval services handling of those who have mental hygiene issues.
I posted the article because it rings of truth and facts that I have vividly observed intensly since my first PTSD claim was filed in February 1983.

I had written part (the lead) and posted the Philpott article following on Sound Off in early December 2008 on the "PTSD: Still Under Fire" topic
As you can see by my articles, published in the 1980's through the current day, my argument regarding "personality disorder" has remained constant.

This diagnosis was once used because the providers were unaware of the true effect of the stressful trauma imposed on the patient. It appeared to many, even after the research indicated strong proof of the stressful event was invoking the anxiety disorder, we now know as PTSD. Some of the providers simply did not keep pace, others ignored the research, finally as in Texas earlier this year, Dr. Perez suggested in an e-mail providers use "personality disorder" diagnosis to slow down the PTSD claims in the VA system. A tragic event which drew attention for a few days and simply forgotten by most.

Here is an article published two weeks ago on Military.com, which gives some insight on the severity of this problem.

DoD Rethinks 'Personality Disorder' Separations
Tom Philpott | November 13, 2008
Crackdown Begins On 'Personality Disorder' Separations

Under pressure from Congress and following the Army's lead, the Department of Defense has imposed a more rigorous screening process on the services for separating troubled members due to "personality disorder."

The intent is to ensure that, in the future, no members who suffer from wartime stress get tagged with having a pre-existing personality disorder which leaves them ineligible for service disability compensation.

Since the attacks of 9/11, more than 22,600 servicemembers have been discharged for personality disorder. Nearly 3400 of them, or 15 percent, had served in combat or imminent danger zones.

Advocates for these veterans contend that at least some of them were suffering from Post-Traumatic Stress Disorder (PTSD) or traumatic brain injury but it was easier and less costly to separate them for personality disorder. By definition, personality disorders existed before a member entered service so they do not deemed a service-related disability rating. A disability rating of 30 percent or higher, which most PTSD sufferers receive, can mean lifelong access to military health care and on-base shopping.

Over the last 18 months, lawmakers and advocates for veterans have criticized Defense and service officials for relying too often on personality disorder separations to release member who deployed to Iraq, Afghanistan or other another areas of tension in the Global War on Terrorism.

A revised DoD instruction (No. 1332.14), which took effect without public announcement August 28, responds to that criticism. It only allows separation for personality disorder for members currently or formerly deployed to an imminent danger areas if: 1) the diagnosis by a psychiatrist or a PhD-level psychologist is corroborated by a peer or higher-level mental health professional, 2) if the diagnosis is endorsed by the surgeon general of the service, and 3) if the diagnosis too into account a possible tie or "co-morbidity" with symptoms of PTSD or war-related mental injury or illness.

Sam Retherford, director of officer and enlisted personnel management in the Office of the Secretary of Defense, said adding "rigor and discipline" to the process when separating deployed members for personality disorder is "very important," considering what is at stake for the member.

Last year several congressional hearings focused on overuse of personality disorder separation after The Nation magazine exposed apparent abuses in a March 2007 article. It described the experience of Army Specialist Jon Town. In October 2004, while Town stood in the doorway of his battalion's headquarters in Ramadi, Iraq, an enemy rocket exploded into the wall above his head, knocking him unconscious.

When he came to, Town was numb all over, bleeding from his ears, and had shrapnel wounds in his neck. For two years he struggled with deafness, loss of memory and depression before the Army, in September 2006, separated Town after seven years' service. He was separated for a pre-existing personality disorder and without disability benefits. Writer Joshua Kors suggested there might be thousands of veterans like Town, separated administratively to save the services billions of dollars in benefits.

Last year, moved by this story and others, the Senate adopted an amendment to the fiscal 2008 defense authorization bill from now president-elect Barack Obama (D-Ill.), Kit Bond (R-Mo.) and Joseph Liberman (ID-Conn.). It directed Defense officials to report on service use of personality disorder separations, and the Government Accountability Office to study how well the services follow DoD own rules for processing such separations.

The Army meanwhile reviewed its own use of personality disorder separations for more than 800 soldiers who had wartime deployments. That review quickly found some "appalling" lapses, said an official, including incomplete files and missing counseling statements. A few months ago the Army tightened its own rules for using personality disorder separations.

In June, the Defense Department reported to Congress that it would add "rigor" to its personality disorder separation policy, previewing the changes implemented in late August. The Navy strongly had opposed the changes because it frequently uses personality disorder separations to remove sailors found too immature or undisciplined to cope with life at sea.

Requiring their surgeon general to review every personality disorder separation from ships deployed in combat theaters would be too burdensome, the Navy argued. But Defense officials insisted on the changes.

The DoD report in June showed the Navy led all services in personality disorder separations. For fiscal years 2002 through 2007, the Navy total was 7554 versus 5923 for the Air Force, 5652 for the Army and 3527 for the Marine Corps. The Army led in personality disorder separations to members who had wartime deployments, with a total of 1480 over six years. The Navy total was 1155, the Marine Corps 455 and the Air Force 282.

DoD said it found "no indication" that personality disorder diagnoses of deployed members "were prone to systematic or widespread error." Nor did internal studies show "a strong correlation" between personality disorder separations and PTSD, brain injury or other mental disorders.

"Still, the Department shares Congress' concern regarding the possible use of personality disorder as the basis for administratively separating this class of service member," the report said.

In late October, GAO released its findings based on a review of service jackets for 312 members separated for personality disorder from four military installations. It said the services were not reliably compliant even with the pre-August regulation governing separations. For example, only 40 to 78 percent of enlisted member separated for personality disorder had documents in their files showing that a psychiatrist or qualified psychologist determined that their disorder affected their ability to function in service.

Sounds like they have put together a post Iraq war plan to get rid of the people that they had to lower standards for to have enough troops to fight the Iraq war and they want to get rid of them without any benefits because benefits cost tax dollars.

It will be interesting to see what Obama does about this.

This is just part of trend I’ve seen under the current administration like when they wanted doctors to under diagnosed PTSD cases to save money and keep troops on the battle field.

"http://www.vawatchdog.org/07/nf07/nfFEB07/nf021307-5.htm"

Dave, I really enjoyed this aricle and it furthers my beleif that we are all just numbers to the DOD and individual service branches.

This "Personality or is it PTSD" subject is currently what I am reporting to the seven AMVETS post meetings that I attend in central and southern Ohio. In each meeting I am allowed to give the "Service Officers report" and thus I do give a report, every single time.

"Personality or is it PTSD" will be the lead article in the post newsletters I either publish, or contribute to which again totals seven. In my opinion this personality disorder subject is as important as any other issue that has come on the veteran scene, since my first day as a VFW Service Officer in November 1977. How the politicians in Washington DC can sit around and do nothing, until we the people overwhelm them with letters of protest is beyond me. It makes me wonder if the fog zone politician has any human basic values in practice.

We keep electing those who never wore a military uniform, because they are good ol' boy's (or good ol' girls) and these people are so far out of it, they simply have no idea of what is happening. A few years ago, before the great meltdown on Military.com I remarked "we need to elect veterans to represent us!" I was darn near tarred and feathered for my position. If some could have found me, it may well have happened. Today I still believe we need to elect veterans to Congress, those who wore the military or naval uniform in the line of duty. Not the just local politicians who rose to power because of the precinct workers pushed them to power. Who do you feel Senator Phineas Foghorn is going to look out for today? Some veteran who is so disabled he, or she cannot get out to vote, or the precinct workers who can deliver the votes to keep his machine in power?

Unfortunately for the veterans, the power goes to the people who can do the most for the politician! In related matters we have observed some extremely low blows to veterans in decisions through the courts. An example is the Haas decision or the Blue Water Navy Agent Orange issue. Navy Commander Haas had appealed a Board of veterans Appeals decision, properly following all rules and reguations to the U.S. Court of Veterans Appeals. The court rules in favor of the veteran. So the law whould have benefitted all Blue Water veterans. In an unheard of move the Administration appealed the decision to the U.S. Federal District Court of Appeals, which overturned the U.S. Court of Veterans Appeals. This was directly against all former policy as well as against the intent of the hard fought Judicial Review law passed in 1988!

Now we have active duty military psychiatrists and psychologists making false diagnosis, as well as some in the VA encouraging the same. These people being caught in the act of doing this to our brave defenders and the politicians in Congress appear to be unaware of anything other than staying in power.

By the way for those seeking me with buckets of tar, my main office is at Chillicothe VAMC, where I am Tuesday, Thursday and Friday. Monday at the Portsmouth VA Clinic, Wednesday Ironton AMVETS and the doors are always open!

quote:

This is just part of trend I’ve seen under the current administration like when they wanted doctors to under diagnosed PTSD cases to save money and keep troops on the battle field.

THAT IS A GROSS OVERSTATEMENT...I DO NOT BELIEVE FOR ONE MINUTE THAT PRESIDENT BUSH WAS, OR WOULD BE, PART OF A PLAN TO UNDER DIAGNOSE OR TO SAVE MONEY AT THE EXPENSE OF THOSE SERVING.

THE "NON-VETERAN" EMPLOYEES OF THE VA WERE THERE LONG BEFORE THIS ADMINISTRATION...AND WILL STILL BE THERE IN THE NEXT. YOUR POLITICS ARE SHOWING...SHOW THERE IS MINE.

This is a very old issue.

For many decades, DoD has kept itself above the fray by throwing military personnel under the wagon and diagnosing them with Personality Disorders even though they may indeed have PTSD or a variety of other disorders.

It's not a political area, but instead a very complex area of discussion.

This is not a political issue...rather, it is a complex psychological and perhaps even...a medical issue as well.

There are researchers from Harvard University and elsewhere who have worked very hard to try to figure out more about PTSD and Personality Disorders. They have largely determined that the Personality Disorder side of things is the simple way out.

Let's take a deep breath here before getting more deeply involved in this entire matter.


Thanks everyone for your comments and kind personal attention to this matter.

WILL DO...BLAMING "THIS ADMINISTRATION" IS GITTIN VERY, VERY OLD! LET'S JES SEE IF "THE ONE" CAN DO ANY BETTER?

The old term "Weasel Words" is what this reminds me of... first, the DOD and VA said PTSD does not exist...then someone proves it...so then what? They use the same diagnosis and symptoms and call it "Personality Disorder". Just change the name of the disease and make it genetic? That is what this is about. It is called blowing smoke up your azz.

Horray for semantics!!!!!!

quote:

Originally posted by RONCO:
WILL DO...BLAMING "THIS ADMINISTRATION" IS GITTIN VERY, VERY OLD! LET'S JES SEE IF "THE ONE" CAN DO ANY BETTER?

Although the current administration could have done alot better:

-The 9/11 G.I. Bill took too long
-Early Reserve retirement isn't retroactive to 9/11
-Where's my AIP? Oh, that right. I'm not eligible anymore.

I think they did alright. PTSD isn't new. Vets have been fighting this fight since WWII. Vietnam was the last time we made any progress (as in very little).

THANKS FOR SERVING, MARK...AND, WELL SAID

quote:

Originally posted by OldAFcop:
This is a very old issue.

For many decades, DoD has kept itself above the fray by throwing military personnel under the wagon and diagnosing them with Personality Disorders even though they may indeed have PTSD or a variety of other disorders.

It's not a political area, but instead a very complex area of discussion.

This is not a political issue...rather, it is a complex psychological and perhaps even...a medical issue as well.

There are researchers from Harvard University and elsewhere who have worked very hard to try to figure out more about PTSD and Personality Disorders. They have largely determined that the Personality Disorder side of things is the simple way out.

Let's take a deep breath here before getting more deeply involved in this entire matter.


Thanks everyone for your comments and kind personal attention to this matter.

I agree with your post. It is not a political issue. My statement was and is "In my opinion this personality disorder subject is as important as any other issue that has come on the veteran scene, since my first day as a VFW Service Officer in November 1977. How the politicians in Washington DC can sit around and do nothing, until we the people overwhelm them with letters of protest is beyond me. It makes me wonder if the fog zone politician has any human basic values in practice."

My point is with the evidence presented those people in the Senate and House of Representatives are sitting idle while these problems continue. This is not party politics, it simply is those in legislative power can take action and they do not. My post also contained "Now we have active duty military psychiatrists and psychologists making false diagnosis, as well as some in the VA encouraging the same. These people being caught in the act of doing this to our brave defenders and the politicians in Congress appear to be unaware of anything other than staying in power."

Sometimes those who represent us need to take action. I had articles from Harvard which I wished to post links on another Sound Off PTSD topic, but at the time the links were completely prohibited so they were not made.
Thanks for you input OldAFcop!

RONCO is right, this is not an issue that can be laid on the feet of the President, this is ongoing since I filed my first successful PTSD claim in February 1983. It has been mentioned the Personality Disorder diagnosed was made frequently during the Vietnam war.

From the book The Combat Veteran From WWII To The Present:
A new and short chapter
Personality Disorder Diagnosis' Need To Be Reviewed. Now!

Since 1983 many veterans have been to my office who suffered with PTSD, had a current diagnosis and a verifiable stressor, yet the VA would deny the claim because in 1969 or '71 an Army psychiatrist diagnosed a personality disorder. Most VA rating specialists may not be aware, PTSD did not exist on paper in the 1960's and 70's, but it existed in the veterans! I had one veteran nicknamed "Critter" with whom it took 3 years, to get the VA past the 1969 personality disorder diagnosis.
This man was a 4.0 soldier according to his DA Form 20 until he returned from Vietnam! He had been an instructor in the NCO school of that day with outstanding ratings. Suddenly at Fort Knox he ran into so-called adjustment problems with a 2nd Lieutenant, a recent ROTC graduate and Critter found himself in front of the Army psychiatrist and out of the Army. Sad but true.
Those days found thousands of personnel misdiagnosed! I have seen, reviewed, studied and submitted evidence for my clients, usually proving the case; but sadly not always. Critter won his case, but several years later died of cancer.
Now we see doctors deliberately giving personality disorder diagnosis to save money!!! How utterly evil. I feel the real personality disorder is found within those quacks, committing that evil deed against those who have borne the burden. Yes I said quacks. How can these people be professing medical or psychiatric professionals and commit this sin against those who place their lives in danger for the nation.
How utterly evil when people can for the sake of a budget intentionally misdiagnose a veteran who offered their life to preserve this nations policies around the world. When we are in the gravest of times conflict against terrorism, a war which has entered the mainland of the United States, we have major agencies working against those valiant defenders. The military/naval psychiatrist and the VA! How sad that I cannot put these comments into strong enough appropriate words. How sad the when politicians ignore completely what is going on, the Congress, Executive Branch, as well as Judicial ignore and possibly refute the severity of veterans problems and issues. We have all volunteer service which is given lip service only by elected politicians who have never, ever been in harm's way defending this nation.



Here is the link on the book: http://forums.military.com/eve/forums/a/tpc/f/8280047191001/m/8290078391001