In 2007, a high-ranking Navy doctor sent a sobering warning to colleagues: The service may be discharging soldiers for misconduct when in fact they are merely displaying symptoms of post-traumatic stress disorder.
By doing so, the anonymous doctor noted in a memo to other medical administrators, the service may be denying those troops their rights to Veterans Affairs benefits — including treatment for medical conditions they incurred while serving on the battlefield.
In the future, any military personnel facing dismissal for misconduct after a deployment should be screened first for PTSD, the memo said. The recommendation was never implemented.
High-ranking Navy doctors who oversee medical care for the Marines say such screenings would help avoid sending troops back into society without the ability to get treatment for combat-induced illness from the very government that dispatched them to the battlefield.
"Post-deployment misconduct, especially in a Marine who has previously served honorably, may indicate an unrecognized and unhealed line-of-duty stress injury that deserves expeditious medical evaluation and, when indicated, appropriate treatment," said the memo, a copy of which was obtained by The Washington Times.
The Pentagon confirmed the memo's authenticity, but could provide no further information on the author or the names of the recipients. Veterans' mental health issues have come under increasing scrutiny during the years of the war on terrorism. The latest example is Monday's release of a government study showing a dramatic increase in suicides among young veterans.
The PTSD memo also warned, "If adjudication of misconduct charges results in a less-than-honorable discharge, the Marine may lose eligibility for ongoing treatment in the Veterans Administration health care system."
The memo recommended that screening for all troops facing misconduct discharges be implemented by May 1, 2007, but that recommendation was never followed.
"There is not a formal process or directive that I am aware of where [troops discharged for misconduct] must be screened," The Times was told by Frederick "Fritz" Kass, the director of clinical programs for the Marine Corps.
Mr. Kass said the document raises the issue of "service members who are given adverse separation discharges who are at risk of not being eligible for treatment in the VA system."
"It appears it was to make others aware of that as they move forward," he said.
The Pentagon's ability to diagnose and care for its own has come under renewed scrutiny since May 11, when, authorities say, Army Sgt. John Russell killed five fellow soldiers at a stress clinic in Iraq.
Sgt. Russell's father has said his son, who served three tours in Iraq, feared that he was being ousted from the military after being sent to the clinic by a commanding officer with whom he had fought and was told to surrender his gun.
No one knows how many more Sgt. Russells are out there, or how many have been discharged for misconduct, but two sets of statistics hint at the potential scale of the problem.
The Army told The Washington Times that 27,973 troops from that branch alone have been dismissed from service on punitive discharges from October 2002, the start of fiscal 2003 and just before the Iraq war began, to May 2009. Close to half — almost 12,700 — were ousted in fiscal 2003.
A good portion of those who have seen combat duty can be expected to have PTSD. The 2008 Rand Corp. study, which found that one in every five Iraq and Afghanistan veterans suffers from PTSD or major depression, also determined that rates of PTSD were highest in the Army and the Marines and that 45 percent of those surveyed said they had seen dead or seriously injured noncombatants.
What's being done
One of the soldiers is Special Operations Command Sgt. Adam Boyle.
Sgt. Boyle was thrown out of the Army because of a "pattern of misconduct," even though he had been diagnosed with PTSD. As a combat veteran who served two tours in Iraq, Sgt. Boyle began experiencing intense pangs of guilt and anger and was diagnosed with post-traumatic stress disorder at a stress clinic in Iraq.
"I was always in the field before then," he recalled. "I did everything you can imagine from patrols to raids to capturing enemy POWs, interrogations, reconnaissance by fire. Everything you can imagine that put me in harm's way, and I was OK with it."
The bad feelings began to set in after two of his buddies were killed, one of them newly married with a child. "Those deaths haunted me, the idea of their families back home without them," he said.
After his diagnosis, Sgt. Boyle was sent to North Carolina's Fort Bragg, an assignment he resented because he thought he should be fighting the war. At Fort Bragg, he was given heavy antidepressants and sleeping aids that he said caused him to oversleep and miss formation on several occasions, a major transgression in the military.
He wanted to return to Iraq to fight, but the medications barred him from more deployments and he became miserable and agitated. Sgt. Boyle went on to spar with commanding officers who, he said, were unaware of his combat experience. He drank heavily, couldn't control his rage and ended up in trouble with the law.
He reached the tipping point when he experienced a flashback while supervising a session at the firing range at Fort Bragg.
"I was supposed to be keeping an eye on [the soldiers], keep them safe and doing the right thing," Sgt. Boyle recalled. "At one point, I went into a flashback into a firefight, and I was in Iraq. And during that flashback, I zoned out and forgot what I was doing.
"I snapped out of it and realized I missed the whole firing sequence, and it scared the hell out of me. I can't operate as a soldier if I can't concentrate on a firing range like that. That helped me realize I had to get out."
At that point, in consultation with his psychiatrist, Sgt. Boyle began seeking a medical discharge based on his PTSD. But the process was slow; he was allotted only one hour per month with his psychiatrist to plan proceedings and receive counseling for his existing problems.
Some of those problems were documented in a domestic violence complaint filed by a former girlfriend who said Sgt. Boyle assaulted her, although she never brought charges.
"His command has been contacted numerous times by myself and friends trying to get Adam's behavior under control," she said in the complaint. "I would like to see him get serious help and be removed from anyone else he could cause harm to."
Sgt. Boyle became so intoxicated and disorderly during a weekend getaway that police were called. When they attempted to restrain him, he fought back. "I wrestled with the cops," Sgt. Boyle said. "I don't know if it's part of my Iraq issues or not, but I couldn't handle being restrained."
A judge ultimately dismissed the charges, but Sgt. Boyle said that incident was "the straw that broke the camel's back" for the Army, which found his behavior unacceptable.
Even though he was being considered for medical discharge, he was ousted with a general discharge based on misconduct.
"Mr. Boyle demonstrated a repetitive pattern of misconduct in civil jurisdictions," Carol Darby, chief of media and community relations for the Army's Special Operations Command, said about Sgt. Boyle's dismissal. "During that same time frame, he was actively receiving medical attention.
"Nowhere in our four major criteria for PTSD does it allow for breaking the law," she said.
Sgt. Boyle said he was scheduled to receive a general discharge with "other-than-honorable" conditions, but has been fighting to have it changed to "under honorable conditions."
Still, the general discharge isn't as good as an "honorable discharge" or "medical discharge," which would guarantee him access to medical and compensation benefits. He also must repay the Army the $18,500 enlistment bonus he received for signing up for his second tour of duty.
Lawyer Jason Perry has taken on Sgt. Boyle's case pro bono and is working to have the dismissal upgraded to a medical discharge.
Veterans Affairs does provide some counseling services for Sgt. Boyle, but the burden is on him to prove that his injuries were combat-induced. He will be able to access medical care much more easily if Mr. Perry succeeds in having his discharge upgraded.
Veterans' advocate and lawyer Carissa Picard has been on a one-woman mission to raise awareness about troops being ousted from service as a result of deployment-induced mental health issues.
"Rather than treating that soldier as if they are treating him [for] a war injury, they treat that soldier with derision," Ms. Picard said.
She got a bad feeling after reading in September 2008 that post-deployment soldier Spc. Jody Michael Wirawan had fatally shot his commanding officer and then turned his gun on himself.
"If we are going to continue to engage in these prolonged military conflicts overseas, then mental health care has to be made a priority," she said in a posting to Bloggernews.com. "It has to be generously funded by Congress and aggressively utilized by the Department of Defense. If we don't, then this won't be the last time you will read a headline like this."
Her grim prediction was borne out eight months later when Sgt. Russell opened fire on fellow soldiers at a stress clinic in Iraq.
When asked what he thought of Sgt. Russell's crimes, Sgt. Boyle said, "I know exactly what's going on. There's been more than a few times I had very unpleasant thoughts dealing with the chain of command.
"Putting myself in that position, dealing with what I was dealing with at Fort Bragg, if I took that scenario and moved it to Iraq, I can't imagine what that situation would be like. That's a scary thought."
Sgt. Boyle added: "Good soldiers shouldn't have to go through that, especially if they are out in Iraq risking their lives and then to expect there's not going to be ramifications. That's like taking a good dog and beating it constantly, and it bites you, and you don't understand why."
Bart Stichman, co-executive director of the National Veterans Legal Services Program, said his office sees "a certain number of cases" in which the military has failed to properly discern between PTSD and misconduct.
"We have clients that fall into that pattern," Mr. Stichman said. "They have PTSD, and they don't get adequate treatment, and when they don't get treatment they act out. They use drugs or alcohol, and the military discharges them for misconduct."
Mr. Stichman added that this presumes that the military perfectly diagnoses PTSD, a disorder that can be difficult to discern. In the meantime, any untreated service member still shows the symptoms, including acting out in ways that can lead to misconduct and other legal charges.
"This is a subset of that, based on a subjective judgment," Mr. Stichman said of his PTSD cases. "You and I could look at a case and say this misconduct is due to a mental disorder, and someone else will say, 'Sure, he had a mental disorder, but his misconduct wasn't due to his mental disorder.'"
What's being done
The government took aggressive action to diagnose and treat veterans suffering from PTSD in 2007 after a flurry of studies, recommendations and reports addressing veterans' care, including the bipartisan commission to investigate Walter Reed Army Medical Center, led by former Senate Majority Leader Bob Dole and former Health and Human Services Secretary Donna E. Shalala.
On Monday, the Veterans Affairs Department released preliminary data showing that the suicide rate of young veterans, most of whom likely served in Iraq or Afghanistan, has risen by more than one-fourth.
The suicide rate among 18- to 29-year-old men who have left active military duty rose from 44.99 suicides per 100,000 men in 2005 to 56.77 in 2007, based on Centers for Disease Control and Prevention figures taken from 16 states.
The active military is seeing the same problem, with the Army cataloging a record number of suicides last year.
"Why do we know so much about suicides but still know so little about how to prevent them?" VA Secretary Eric Shinseki told a suicide prevention conference Monday in Washington, according to wire service reports. "Simple question, but we continue to be challenged."
Among the many centers that address mental health issues are the Defense and Veterans Brain Injury Center, the Center for Deployment Psychology, the Deployment Health Clinical Center, the Center for the Study of Traumatic Stress, the National Center for Telehealth and Technology, and the National Intrepid Center of Excellence that's scheduled to open later this year.
Yet those centers won't necessarily benefit military personnel like Sgt. Boyle.
"Instead of being honorably retired, he's now an ex-soldier with a general discharge and no guaranteed access to health care or treatment," said his attorney, Mr. Perry.