Lawmakers say they fear the Defense Department has found a new way to drum sexual assault victims out of the service: by diagnosing adjustment disorder and having them discharged from the military.
It's the latest technique the department has used to retaliate against troops who report they were sexually assaulted, according to members of Congress who are determined to use this year's defense policy debate to curtail the practice and get justice for the service members who they say were illegally discharged in the past.
"It's like a 'Whac-A-Mole,'" said Rep. Jackie Speier, California Democrat. "Every time we shut them down on something, they'll find a way around it."
Using the adjustment discharge diagnosis is the latest tactic, Ms. Speier said. Before 2007, it was giving complaining service members a "personality disorder" diagnosis. According to a Vietnam Veterans of America study, the military discharged 31,000 service members because of a personality disorder from 2001 to 2010.
But after lawmakers and the press reported on the high rate of such disorder diagnoses tied to sexual assault cases, the number dropped — and the number of adjustment diagnoses began to rise.
In the Air Force, for example, personality disorder discharges went from more than 1,200 in fiscal 2007 down to just over 100 two years later in fiscal 2009, according to a Yale Law report. Adjustment disorder discharges in the Air Force spiked over that same period, increasing sevenfold.
"They've taken personality disorder discharges and are now charging it as an adjustment disorder discharge," said Greg Jacob, policy director at the Service Women's Action Network. "It's the same process with a different label."
Congress is trying to take the first steps. Ms. Speier introduced a provision to the defense policy bill that requires the Defense Department's inspector general to review personality and adjustment disorder discharges for victims of sexual assault to see if officials followed the rules to diagnose and discharge. If not, the bill would require a service member's record to be updated.
"We've got to right a wrong here, and I think that it was a catchall phrase to basically sweep members of the military out that they didn't want to have making noise, and that was one way of silencing them. It's shameful, and [we've] got to rectify it," she said.
The Defense Department declined to provide a statement on the changing diagnoses or on a potential review of the numbers.
With sexual assaults reaching what some lawmakers call epidemic proportions in the military, both the Pentagon and Congress are trying to find ways to curtail the abuse. But some lawmakers say they need to also make sure the victims aren't getting left behind.
In particular, members of Congress say they fear sexual assault victims are sometimes seen as troublemakers and are being pushed out of the service through medical diagnoses.
Even though both concern the mental health of a service member, personality disorder and adjustment disorder are not the same thing, said David L. Kupfer, a psychologist in Falls Church.
Personality disorder is something that usually shows up in childhood or adolescence and lasts a lifetime. An adjustment disorder, on the other hand, is a difficulty in handling a single stressful event, like parents' divorce, that usually lasts no more than six months. The exception is if a stressful situation becomes chronic, like living at home while one's parents are constantly fighting, that the symptoms could be more long-term, he said.
Mr. Kupfer said the numbers suggest military doctors are overdiagnosing adjustment and personality disorders and underdiagnosing post-traumatic stress disorder. He said it would benefit the military financially not to have to dole out for the treatment that could result from a PTSD diagnosis.
"It's likely that if the person doesn't have symptoms when they enter the military and then is exposed to traumatic stress — the two classic ones in the military are combat and sex assault — it's most likely PTSD," he said. "When you look at the numbers, it does seem like there is some financial incentive affecting the diagnosis of people who are showing symptoms after exposure to trauma."
Mr. Jacob, the policy director at the Service Women's Action Network, said it's not only wrong to prematurely end someone's career with a bad diagnosis, but the consequences can reverberate even after that person re-enters civilian life. Those diagnosed with adjustment or personality disorders are denied access to disability benefits or free VA care because both disorders are considered pre-existing conditions not related to service, Mr. Jacob said.
Medical discharges are a worry for members of Congress, who said they believe some troops suffering from PTSD are being discharged for other reasons — and that keeps them from being able to get VA care. Rep. Mike Coffman, Colorado Republican, attached a provision to the House defense policy bill that would give discharged service members diagnosed with a mental health condition a chance to appeal and to be seen by a psychiatrist or psychologist.
"As a Marine Corps combat veteran, I cannot accept the fact that combat veterans have been discharged who were clearly suffering from PTSD and that they were not only denied treatment before being discharged, but because of the type of discharge they received, did not have access to mental health care after they left the military," the congressman said in a statement.
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