RETURN OF THE "PD" - PERSONALITY DISORDER -- The "PD" was wrongly used to discharge thousands of troops during the Vietnam War. Now, it has returned as an easy way for the military to get rid troops instead of caring for their mental health needs. A "PD" is considered non-treatable and non-compensable by the VA.
During Vietnam the use of the "PD" discharge was common. Thousands of veterans still have the label "Personality Disorder, Unspecified" on their discharge papers. The "PD" was an easy out for the military. They claimed that the soldier brought the "PD" with them and that it had nothing to do with combat stress. Therefore, a "PD" was considered non-treatable and non-compensable by the VA. It was a pre-existing condition.
Well, the "PD" is back. Again, as easy out for the military. Just give them a label and you don't have to treat them or care for them. We have two stories. The first is about the "PD" and the second is about a soldier who got labeled with a "PD."
Experts: Iraq vets wrongly diagnosed
'Personality disorder' assessment allows for quick honorable discharge but tags veterans with a label that is hard to remove.
By Anne Usher
WASHINGTON BUREAU
WASHINGTON — Soldiers suffering from the stress of combat in Iraq are being misdiagnosed by military doctors as having a personality disorder, lawyers and psychologists say, which allows them to be quickly and honorably discharged but stigmatizes them with a label that is hard to dislodge and can hurt them financially.
Though accurate for some, experts say, the personality disorder label has been used as a catch-all diagnosis to discharge personnel who may no longer meet military standards, are engaging in problematic behavior or suffer from more serious mental disorders. For returning veterans, the diagnosis can make it harder to obtain adequate mental health treatment if they must first show they have another problem, such as post-traumatic stress disorder.
"It's an absolute disgrace to military medicine," said Bridgette Wilson, a former Army medic who is now an attorney in San Diego serving mainly military clients. "I see it over and over again, the dramatic misuse of personality disorder diagnosis. It's a fairly slick and efficient way to move some bodies through."
Military records show that since 2003, 4,092 Army soldiers and another 11,296 men and women in other branches of the armed services have been discharged after being diagnosed with the disorder.
A government worker at Fort Carson in Colorado who has access to personnel records and who spoke on condition on anonymity for fear of losing his job said Army psychologists there have diagnosed some soldiers with a personality disorder after a single evaluation lasting 10 minutes to 20 minutes.
Several soldiers at Fort Carson interviewed by Cox Newspapers said they have been given or offered the diagnosis in a handful of meetings lasting less than an hour.
The personality disorder diagnosis can result in a soldier getting an honorable discharge within days, which can be appealing for many returning from Iraq.
The timing of many of the discharges, in some cases within months after soldiers have returned, appears to violate the military's rules, which say a personality disorder diagnosis should not be made if a soldier is experiencing "combat exhaustion or other acute situational maladjustments."
Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, said he is unaware of any related discharges within three months of a deployment and has "full confidence in our medical personnel in their decision-making."
Nonetheless, he asked Army surgeon general Lt. Gen. Kevin Kiley two weeks ago to review complaints of inadequate mental health care at Fort Carson. He said it was begun before Democratic Sens. Barbara Boxer of California and Barack Obama of Illinois and Republican Sen. Kit Bond of Missouri wrote a letter asking him to investigate such concerns after they were raised in a broadcast on National Public Radio.
"I'm concerned with any allegations that suggest we may have not taken the steps that we need to take to ensure that people are properly cared for," he said, adding that soldiers are receiving the best mental military health care in history.
Proper evaluation
A personality order is defined as a deeply ingrained, abnormal behavior pattern that appears during childhood or adolescence.
Critics say that many soldiers returning from Iraq who are tagged with that label actually have post-traumatic stress disorder stemming from their combat experiences. A review of four soldiers' medical records at Fort Carson and records from a soldier at another post show that they were diagnosed with post-traumatic stress disorder before or after their discharge.
Recommending a discharge on the basis of a personality disorder is a faster process than discharging someone for mental health problems of another nature. It requires only one military psychologist's finding, and the paperwork usually takes only a couple of days.
A diagnosis of post-traumatic stress disorder, on the other hand, must be handled by a medical review board, which must confirm that the condition stems from combat, a process that usually takes several months.
Dr. Joseph Bobrow, a former chief psychologist at Kaiser Hospital in San Francisco, said a personality disorder is one of the most difficult diagnoses to confirm, particularly when there is cumulative trauma.
"I think it's ludicrous to make a diagnosis of personality disorder in a 20- to 40-minute interview," he said. "Even if you do a complete battery of psychological testing and intensive and informed clinical interviews over a week, some of those results can be and are contested in a court of law."
Some of the soldiers at Fort Carson say they had been told by Army psychologists that the Department of Veterans Affairs would take care of them if their troubles persisted. A personality disorder, however, is considered a pre-existing condition, not one related to a soldier's service, and Veterans Affairs can treat but not give disability benefits in these cases.
Many soldiers who sought mental health counseling after returning from Iraq, like former Spc. Donald Schmidt of Chillicothe, Ill., say they learned only after their discharge that they must repay part of their re-enlistment bonus based on the portion of time they did not serve — more than $10,000 in Schmidt's case.
He and many other soldiers interviewed by Cox Newspapers, lawyers and veterans groups also say they were not cautioned that a personality disorder diagnosis could damage their job prospects because prospective civilian employers may request access to their discharge papers. Those records usually describe anti-social traits and behaviors they are said to probably possess.
In her 13 years in practice, San Diego attorney Wilson said she has seen dozens of Marines from nearby Camp Pendleton and soldiers from other posts separated for a personality disorder when the real reason, in her view, has been to punish a soldier, avoid paying disability benefits for a more serious condition or get rid of someone deemed undesirable.
Though some of her clients have personality disorders, she said, most who received the diagnosis and discharge had minor behavioral problems or were diagnosed with bipolar disorder or severe depression by either military or civilian psychologists.
About three-quarters of her clients who have been diagnosed with a personality disorder, she said, weren't given any psychological test. Rather, she said, the diagnosis was based on a roughly 45-minute interview.
Lynn Gonzalez, a counselor at the San Diego Military Counseling Project, an information and support organization for active-duty personnel having problems with the military, said the quick tagging of soldiers with the disorder has happened "enough that what we tend to do now is push guys to go to a private psychiatrist so they have more information for a proper diagnosis."
Col. Steven Knorr, chief of psychiatry at Fort Carson's Evans Army Community Hospital, said it would be rare for a doctor to diagnose and discharge a soldier for having a personality disorder in just one session, as asserted by some soldiers.
Besides examining a patient's medical history and sometimes doing psychological testing, he said, psychologists normally will talk with soldiers about how they're coping and how they feel about military service and get their commander's assessment.
"The vast majority of people I've seen separated with personality disorder are pleased with that," Knorr said.
Altering diagnoses
For nearly a year after his return from Iraq in August 2005, former Pvt. Jason Harvey had gone without any follow-up evaluations at Fort Carson after screening positive for possible post-traumatic stress disorder and a traumatic brain injury, his records show.
After a suicide attempt in May, records show that the 23-year-old was diagnosed with depression and post-traumatic stress disorder, but in late June the Army tried to discharge him with a personality disorder. Harvey said he was told by a staff psychologist in a joint meeting with his commander that if he did not agree to an honorable discharge, the commander would pursue a punitive discharge.
"They played me like a fiddle," Harvey said, adding he was wrongly told the medical retirement fell under the same category as post-traumatic stress disorder. In fact, it is a nonmedical discharge.
Also at Fort Carson, after two tours in Iraq, Schmidt, 22, told a psychologist he was feeling violent impulses as a result of marital difficulties. The decorated soldier is on guard constantly and "quick to anger" when he had not been that way before, said his mother, Patrice Semtner-Myers.
Schmidt said his Army psychologist, Dr. Michael Pantaleo, made the diagnosis after several meetings lasting between 15 and 30 minutes each and never asked him questions about his behavior before joining the Army. Pantaleo did not return calls seeking comment.
Schmidt was discharged "without a dime in his pocket," his mother said.
"The soldiers are often too stupid to know what they've done" when they accept the disorder or seek it, Wilson said. "They go out and discover the state police department really isn't interested in someone discharged with a personality disorder or find they have trouble getting security clearances."
Some military psychologists appear to be violating guidelines in the Diagnostic and Statistical Manual of Mental Disorders, the psychiatric manual used by the military.
If a soldier complains of mental problems after returning from combat, a personality disorder is supposed to be ruled out for an unspecified amount of time because some of its characteristics, such as problems interacting with others and substance abuse, overlap with some of the hallmarks of post-traumatic stress disorder.
The Pentagon "is not familiar with the rules, or they are choosing to ignore them," said Paul Sullivan, director of programs for Veterans for America, a Washington-based nonprofit.
Knorr said it's possible for soldiers at Fort Carson to be diagnosed with mild post-traumatic stress disorder but be discharged for a personality disorder, but he thought that would be rare. An extremely low number might be later diagnosed with a disabling case of stress disorder, he said.
Dr. Bob Scaer, a neurologist and trauma expert in Boulder, Colo., who worked at Fort Carson as an unseasoned resident clinician 41 years ago, said commanders back then would send him soldiers that they wanted to remove from service.
"I'd rubber-stamp the discharge," he said. "This was an excuse for discarding soldiers who didn't fit in."
He said he has seen a few soldiers from Fort Carson recently who were misdiagnosed with a personality disorder after having initially been diagnosed by Army psychiatrists with stress disorder. The military, he said, is making problematic behavior among some returning soldiers "out to be a personality disorder, and it's not. It's well-known as a symptom of trauma."
Determination of personality disorder
Medical guidelines for each service:
Army: Requires a psychologist's findings.
Navy: Vague language; not clear that determination must come from a mental health professional or command.
Marines: Similar to Army rules but two forms of documents required. Same doctor must render findings on a Marine's impairment and on written nonmedical evidence to show examples of inability to function in the corps.
Air Force: Alone in requiring oversight where commanders fail to act on appropriate findings. Commander must have decision reviewed by discharge authority.
Personality disorder discharges
Year Army Air Force Navy* Marines
2001 805 Unavailable 1,389 443
2002 734 1,523 1,733 460
2003** 980 1,496 1,316 328
2004 988 1,307 1,253 414
2005 1,038 928 1,176 475
2006 (through Nov.) 1,086 1,085 1,076 442
Totals 5,631 6,339 7,943 2,562
*Navy numbers are for fiscal, not calendar, year.
**Iraq war started in March 2003.
Source: Department of Defense
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Vet plagued by combat stress, not the label he was discharged under
Soldier's original diagnosis of a personality disorder found to be false.
By Anne Usher
WASHINGTON BUREAU
WASHINGTON — William Wooldridge was guiding his tanker truck along a crowded highway in the Iraqi city of Hilla weeks after the U.S. invasion in 2003 when an explosion forced his convoy to a halt.
Moments later, a bus packed with people pulled alongside the truck behind him and exploded. In his rear-view mirror, he saw women and children thrown from the bus by the force of the blast.
Ordered to help protect the convoy, the 37-year-old from Arkansas said he was unable to assist dozens of injured and dying civilians. With an Iraqi in a pickup truck pointing a machine gun at him, he says, he sped away and kept moving, despite running over a young Iraqi girl. Wooldridge had been in Iraq for only a matter of hours.
In the ensuing months with the Arkansas National Guard's 1123rd Transportation Company, he would see a Marine and several others die and have a rocket-propelled grenade bounce off the hood of his truck. He remembers sitting on his truck in a quiet moment when the final blow came: a letter from home claiming that his wife was having an affair.
About a week later, he was flown out under medical orders after his commanders discovered he had hollow-pointed the tips of some of his rounds of ammunition. "I was planning on killing these people," he says of the men in his unit. "We were all ticking time bombs."
Three months after returning to Fort Polk, La., Wooldridge was discharged. His severance wasn't for psychological wounds brought on by combat-related trauma but because an Army doctor determined after having him take a survey — twice after "answering inconsistently" — that he had a personality disorder.
In February 2005, Wooldridge checked into a ward for mental patients in a hospital run by the Department of Veterans Affairs in Memphis, Tenn. During his six weeks there, doctors found to be false the original diagnosis of personality disorder, an enduring pattern of anti-social behavior usually manifesting itself in early adolescence. It would take another three months to get the discharge revised.
Letters sent to the VA proving his actual prognosis, necessary for him to get disability benefits, included several from doctors declaring that he was disabled by post-traumatic stress disorder stemming from his service in Iraq and one from his commander, Sgt. Les White, attesting to the convoy incident. Wooldridge, he wrote, is an exemplary, hardworking soldier.
His regional VA office initially denied the claim, saying that despite White's letter, Wooldridge could not prove he was exposed to "a combat stressor." Ultimately, a review board in Washington helped get his post-traumatic stress disorder claim approved.
"I was never told I had a personality disorder until I went to Iraq and fell victim to combat stress," he said from his trailer in Blytheville, Ark.
His discharge papers for a personality disorder said in part: "William is not likely to trust others. He is likely to hold grudges . . . may self-mutilate."
"If someone sees this in the civilian world, especially for a truck driver, they'll think they can't trust him with our truck," he said. "Who's gonna hire you?"
Some of the anti-social traits of post-traumatic stress disorder, such as anger and occasionally strong emotions, could be mistaken for a personality disorder. But with the severity of symptoms such as his — which Wooldridge says prompted him to relinquish custody of his two young sons to his ex-wife and his daughter to his parents — "there's no way to confuse the issue."
He says he is absent-minded, is plagued by guilt and has a hard time organizing or remembering simple tasks.
"You can't deal with any kind of stress," he said. "The simplest little things set you off." With doctors telling him this reaction is to be expected, he wonders why he had to go to such lengths to prove he was suffering from post-traumatic stress disorder.
"The military robbed me of the pride and prestige of being a combat veteran who served his country," he wrote in an e-mail. "We are being used as a resource, then discarded as trash when no longer useful to them. Our lives are destroyed, and the military blames it on us."
VA disability benefits are not granted for a personality disorder but can cover as much as $2,000 a month for a veteran found to be disabled by post-traumatic stress disorder. Wooldridge said he is now receiving about $800 a month.
For his close friend Doug Barber, Wooldridge says, "it was too little, too late." Barber also was discharged for having a personality disorder but was later diagnosed with post-traumatic stress disorder, documents obtained by veterans groups show. He shot himself in January after a two-year struggle for treatment.
"The military promised we'd be taken care of no matter what," Wooldridge wrote. "I'm here to say if he would have received (VA benefits) in a timely manner, where he could of focused on his disability, and getting help, instead of having to prove it was service connected . . . he would still be here."
Death, for Wooldridge, is an everyday thought. "But every day I find one more reason not to take my own life."
