Actions Needed to Ensure Post-Traumatic Stress Disorder and Traumatic Brain Injury Are Considered in Misconduct Separations
May 16, 2017
The Honorable John McCain Chairman
The Honorable Jack Reed Ranking Member
Committee on Armed Services United States Senate
The Honorable Mac Thornberry Chairman
The Honorable Adam Smith Ranking Member
Committee on Armed Services House of Representatives
Mental health conditions and cognitive impairments such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are “signature wounds” of the conflicts in Afghanistan and Iraq, according to the Department of Defense (DOD) and published research.1 PTSD, TBI, and other mental and physical conditions can go unrecognized and unacknowledged by the military, family members, and society in general. Because these conditions can adversely affect servicemembers’ moods, thoughts, and behavior, they may lead to disciplinary infractions and subsequent separations for misconduct from the military. Misconduct separations can result from actions and behaviors such as drug use, insubordination, absence from the military without leave, and criminal behavior. In some cases, servicemembers separated for misconduct are not eligible for benefits and services from the Department of Veterans Affairs (VA).
Congress and others have raised questions about whether servicemembers with PTSD or TBI resulting from their military service may be separated for misconduct without appropriate consideration of these conditions. For example, Congress has passed a law requiring the military services—Army, Marine Corps, Air Force, and Navy—to assess the impact of a PTSD or TBI diagnosis before separating certain servicemembers for misconduct under regulations prescribed by DOD.2 To implement this requirement, DOD has issued policies, and each of the military services has its own policies to address servicemember separations for misconduct that involve PTSD or TBI. Nevertheless, advocacy groups and media reports have described instances of servicemembers with symptoms of PTSD and TBI being discharged for misconduct without adequate treatment or consideration of these symptoms.3 In May 2016, the Army’s Audit Agency weighed in on this topic, finding that the Army did not have sufficient documentation to demonstrate that it had considered whether PTSD or TBI was a mitigating factor in certain servicemembers’ behavior prior to separating them for misconduct.4
The Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 contains a provision that we examine the impact of mental and physical trauma, including PTSD, TBI, and other combat traumas, on the separation of servicemembers from the military services for misconduct.5 In this report, we examine
1. the number of servicemembers separated for misconduct in fiscal years 2011 through 2015 who were diagnosed with PTSD, TBI, or and services;
2. the extent to which the military services’ policies to address the impact of PTSD and TBI on the separation of servicemembers for misconduct are consistent with DOD’s policies;
3. the extent to which the Army and Marine Corps have adhered to their policies to address the impact of PTSD and TBI on the separation of servicemembers for misconduct; and
4. the extent to which DOD, the Army, and Marine Corps monitor adherence to policies to address the impact of PTSD and TBI on the separation of servicemembers for misconduct.
To examine the number of servicemembers who were separated for misconduct in fiscal years 2011 through 2015, diagnosed with PTSD, TBI, or certain other conditions, and potentially ineligible for VA benefits and services, we obtained data from three sources.6 We obtained separation data from DOD’s Defense Manpower Data Center (DMDC), medical data from DOD’s Defense Health Agency (DHA), and data on VA eligibility determinations from the Veterans Benefits Administration. We limited our analysis to active duty servicemembers, both officers and enlisted, who were separated for misconduct from the Army, Marine Corps, Air Force, or Navy in fiscal years 2011 through 2015.7 We assessed the reliability of the DMDC, DHA, and VA data in several ways, including discussing the reliability of the data with DOD and VA officials, performing electronic tests of the data to identify any outliers or anomalies, reviewing relevant documentation, and comparing the data with data from published sources. We determined that the data were sufficiently reliable for the purposes of our reporting objectives. For additional information about the data analysis, see appendix I.
To examine the extent to which the military services’ policies to address the impact of PTSD and TBI on the separation of servicemembers for misconduct are consistent with DOD’s policies, we reviewed the military services’ policies related to (1) assessing the impact of a PTSD or TBI diagnosis prior to separating certain servicemembers for misconduct, (2) training servicemembers on how to identify mild TBI symptoms in the deployed setting, and (3) counseling servicemembers being separated for misconduct about potential ineligibility for VA benefits and services.8 We compared the extent to which the military services’ policies, as provided by these military services, are consistent with DOD’s related policies in the above three areas.9 In addition, we interviewed DOD and military service officials regarding the policies. For this and subsequent objectives, we focused our review on the screening and counseling of enlisted servicemembers because they represented the vast majority (98 percent) of separations for misconduct identified in our first objective. We focused our review of TBI training requirements on the training of officers, consistent with our reporting objectives under the Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015.10
To examine the extent to which the Army and Marine Corps have adhered to their policies designed to address the impact of PTSD and TBI on the separation of servicemembers for misconduct, at the national level we reviewed separation documents contained in final personnel files for a small, nongeneralizable sample of Army and Marine Corps enlisted servicemembers who were separated during fiscal years 2011 through 2015.11 We also interviewed Army and Marine Corps headquarter officials. In addition, we reviewed relevant documents and interviewed officials regarding screening, training, and counseling during three site visits. Specifically, we visited two Army installations—Fort Bragg (NC) and Fort Sill (OK)—and one Marine Corps installation—Camp Pendleton (CA). We selected the sites based on the number of servicemembers separated for misconduct and geographic variation.12 We limited our review to the Army and the Marine Corps for this and subsequent objectives because of the resource intensive nature of the site visits. We selected the Army and Marine Corps because, as of 2014, these two military services represented over half (almost 60 percent) of all servicemembers in the United States military forces.
To examine the extent to which DOD, the Army, and the Marine Corps monitor adherence to policies to address the impact of PTSD and TBI on the separation of servicemembers for misconduct, we reviewed relevant documents and interviewed officials from DOD, the Army, and the Marine Corps. We determined whether or to what extent they collect and monitor data related to the military services’ adherence to screening, training, and counseling policies. We compared these efforts to relevant standards for internal control in the federal government.13
We conducted this performance audit from August 2015 to May 2017 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.
Excerpts:
Service Characterization for Separating Servicemembers: Potential Impact on VA Benefits and Services
When a servicemember separates from the military, DOD characterizes the nature of that servicemember’s military service. Administrative separations generally result in one of three potential characterizations of service, which determine a servicemember’s eligibility for VA benefits and services. Specifically,
• servicemembers who receive an “honorable” characterization of service are eligible for all VA benefits and services;
• servicemembers who receive a “general” characterization of service are eligible for most VA benefits and services, with the exception of some VA education assistance; and
• servicemembers who receive an “other than honorable” characterization of service may not be eligible for any VA benefits and services, including health care.15
According to DOD policy, servicemembers separating under either type of administrative misconduct separation will normally receive a characterization of service of “other than honorable,” though other characterizations may be warranted depending on the circumstances
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