Trouble 'Adjusting' to Sexual Assault May Be Getting U.S. Military Members Booted Without VA Benefits

James Nash/FlickrJames Nash/FlickrAre dodgy diagnoses being used to save the military money on mental health care? That's the charge from some legislators and activists, who say U.S. service members with post-traumatic stress disorder (PTSD) are being diagnosed with and discharged for "adjustment disorders" instead, and that this is especially true for those who report being sexually assaulted. 

What's to gain from the latter diagnosis? The question is probably better phrased, "What's to lose?" For the U.S. military and government, adjustment disorder diagnoses provide a way to lose benefit obligations.

Because adjustment (and personality and mood) disorders are considered preexisting conditions, the Department of Veteran's Affairs (VA) isn't required to cover veterans' treatment for these conditions as it would be for veterans' discharged with PTSD. Under a law enacted in 2008, veterans with PTSD get an honorable discharge and medical care.  

Rep. Mike Coffman (R-Colo.) introduced a provision to the annual defense authorization bill—passed by the House May 22—that would give service members discharged with mental illness an opportunity to appeal the military's diagnosis.

"As a Marine Corps combat veteran, I cannot accept the fact that combat veterans have been discharged who were clearly suffering from PTSD," Coffman said in a statement. "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."

Coffman's provision was accepted* by the Rules Committee, along with a provision from Rep. Jackie Speier (D-Calif.) that would require the inspector general of the Department of Defense (DOD) to review all personality and adjustment disorder designations given to service members who report sexual assaults.

"The personality disorder designation often is used as a tool to retaliate against survivors for coming forward," Speier's amendment said. She also says that the adjustment disorder diagnosis is used in the same way.

It's impossible for you or me to determine whether the bulk of adjustment disorder diagnoses are justified. But there's no doubt they're increasing. From The Washington Times:

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. 

General mental health care trends could be at play, but the extent of this shift doesn't seem to belie totally good-faith diagnostic efforts. More believable to me than a coordinated plot to discredit rape victims, however, is that this could be a ploy to save the VA and other federal agencies money. (I don't doubt that discrediting or shushing up assault complaintants is sometimes a welcome side effect.)

Regardless of why adjustment disorder diagnoses are rising, the diagnosis is a strange one for soldiers who report sexual assault. Being sexually assaulted can obviously produce lingering psychological trauma, and surely this is severe enough in some cases to warrant military discharge. But severe, negative, post-assault responses would seem to be a very classic form of PTSD.

"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,” psychologist David L. Kupfer told The Washington Times

"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." 

Adjustment disorder is also a type of stress-related mental illness, with symptoms including anxiety, depression, crying spells, anger, feeling overwhelmed, and trouble sleeping, according to the Mayo Clinic. But it's triggered not by discrete, traumatic events but relatively commonplace life changes, such as moving, starting at a new school or job, ending a relationship, etc.

It's a diagnosis for people who have a high degree of trouble coping with new circumstances—the Diagnostic and Statistical Manual of Mental Disorders ("psychiatry's bible") describes it as "marked distress that is in excess of what would be expected from exposure to the stressor." Are military psychiatrists suggesting that sexual assault is a standard part of military life, one which some people just have a pathologically hard time adjusting to? It sure seems that way. 

To be clear, the adjustment disorder diagnoses aren't only going to those who report being sexual assault victims. For example: During a deployment to Iraq in 2008, former Army Pfc. Michael Nahas survived two roadside bomb explosions and one rocket-propelled grenade attack. He began feeling "anxious and guilty about people he believed had died needlessly," according to Veterans Today, and eventually attempted suicide. He was diagnosed with PTSD at the hospital, went back to his unit, and was given an administrative discharge for adjustment disorder. 

And in November 2013, the Veterans Legal Services Clinic at Yale Law School filed a federal lawsuit on behalf of William Cowles. The suit claims Cowles, a 20-year veteran of the U.S. Army National Guard, was erroneously diagnosed with an adjustment disorder instead of PTSD, barring him from collecting military retirement benefits.  

*Correction: An earlier version of this post said that Coffman's and Speier's provisions were among 136 defense bill amendments rejected by the Rules Committee. 

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • Paul.||

    COMMENTING IS A HUMAN RIGHT!

  • Rich||

    You're suffering from an ADJUSTMENT DISORDER!

  • Almanian!||

    THIS WHOLE COMMENTS SECTION IS DISORDERED!!

  • Andrew S.||

    You want the truth about squirrels? YOU CAN'T HANDLE THE TRUTH ABOUT SQUIRRELS?

  • ||

    This week's VICE had a segment on the VA. It was very depressing.

  • Paul.||

    Did the story have Maher's fingerprints all over it, or was it pretty good?

  • ||

    I don't know what Maher's fingerprints look like, but it was basically asserting that the VA was using cheap prescription drugs--from anti-depressants to opiates--instead of more expensive therapy and that was permanently keeping the veterans in the throes of PTSD.

    I don't know how correct it was, but I can totally see a government run health care system doing anything it can to reduce costs, even at the cost of people, so that part rang true.

  • Paul.||

    Not sure if you know, but Vice is executive produced by Bill Maher. I like most of what Vice produces, but sometimes they can't help but get a jab in at the Koch brothers. Plus, their climate change stories are a bit breathless.

  • ||

    Sure, I know, and yes, their "climate change" stories are very retarded. Like anything else, some of their stories are super interesting and well done, and some are stupid.

  • Plàya Manhattan.||

    If the stories aren't about fucking donkeys, then I just don't care.

  • Paul.||

    Ok, but this story was about the fucking VA. Ok?

  • Plàya Manhattan.||

    I hope that can work the donkey sex angle somehow.

  • kacey||

    You have to remember that there are people here that only want to read news that agrees with them or says what they rant to their friends about.

  • tarran||

  • Paul.||

    What about OUR PEOPLE, BOB?!!

  • Ken Shultz||

    Jipping the volunteers, who really do deserve the full support of the taxpayers, makes all the money they squander on useless crap even worse.

    Why is it that the magic of Keynesian economics, according to Democrats, only works when the money is squandered on useless pork?

  • Invisible Finger||

    The volunteers signed up and fought for Keynesian economics and they should get it.

  • kacey||

    Wow you win the internets!

  • DJF||

    How about if we pull all US military personnel back to the US, and then cut the defense department to the point where its just there to defend the US.

    I bet that would reduce the rate of PTSD and any other head acronyms in the military faster then all the other proposals put together.

    It would drive the policy makers in Washington but that is just a bonus.

  • DJF||

    It would drive the policy makers in Washington crazy but that is just a bonus.

  • Heroic Mulatto||

  • Ken Shultz||

    Obama is such a lying sack of shit--and then he goes and says stuff like that out loud, too?

    There's the lie part:

    "But what makes us exceptional is not our ability to flout international norms and the rule of law; it's our willingness to affirm them through our actions," Obama said.

    He couldn't really believe that's the way he's conducted the War on Terror, could he? He's either really that delusional, or he's a bald-faced liar.

    But yeah, just the headline: "Obama outlines foreign policy vision of 'might and right'"

    Might and right? Who has Obama been reading, Ragnar Redbeard?

    Actually, that would explain a lot!

    http://en.wikipedia.org/wiki/Might_Is_Right

  • Invisible Finger||

    In Obama's defense, he's just reading what's been given to him.

  • ||

    Further in his defense, he didn't know what the interview would be about until he read about it in the newspaper.

  • Almanian!||

    I was watching the WWi/WWII thing on History last night. Turns out the US had an army of about 100K early 1900's. I thought - "that seems about right. Why don't we have that now?"

    Of course, the breathless types will chime in with, "BUT ZOMFG TWO WORLD WARS AND WE WERE UNPREPARED AND..." And we ramped up and got involved (when we shouldn't have) in WWI, and got involved when we kind of had to in WWII and did just fine.

    Yeah, we shouldn't be utterly unprepared like WWII. But we couldn't cut our current force in 1/2 and be just as safe?

    I think we could. The gummint WON'T, but it could...

  • Anon E. Mouse||

    "and got involved when we kind of had to in WWII and did just fine."

    The 407,316 killed, and 671,846 wounded US Military personnel might disagree with your assertion that we "did just fine".

  • Paul.||

    I don't mind having a larger, high tech army for the modern world. What I do mind is extending its mission to stuff that doesn't involve war.

    Using our military as an ongoing occupational force is one example.

  • Anon E. Mouse||

    I agree. Once diplomacy has failed and the dogs of war have been unleashed, there shouldn't be anything left to occupy. I'm of the "best friend, worst enemy" doctrine.

  • Bobarian||

    "Using our military as an ongoing occupational force is one example."

    And we're already significantly cutting our force while we're still doing this shit.

  • Tim||

    " Listen, Betty, don't start up with your 'white zone' shit again."

  • SIV||

    those who report being sexually assaulted

    Is this a different category than "those who were sexually assaulted" ?

    Obviously there is a lot of overlap but treating those outside the intersection of those two sets differently doesn't seem out of line.

  • Elizabeth Nolan Brown||

    No, used to indicate the category includes people who've made assault/rape accusations that have led to charges/convictions (or whatever the military equiv. of that is) and those who've reported it and for whatever reason no charges were brought or no one was convicted.

  • SIV||

    those who've reported it and for whatever reason no charges were brought or no one was convicted.

    If victims of actual sexual assaults qualify for PTSD disability pensions that would be a strong incentive for others to make unfounded or false reports. I believe this is quite common with PTSD claims unrelated to sexual assault.

  • Scarecrow Repair||

    If they were healthy enough (physically and mentally) to enlist, then any contrary diagnosis on discharge is by definition the result of the enlistment, and up to the VA to treat.

  • John Rohan||

    Why don't these articles ever interview someone who disagrees?

    I'm a combat veteran, I'm career Army (and still serving) and I disagree with giving sex assault victims the same status that you would a wounded veteran.

    Don't get me wrong, it's not that I don't have sympathy for victims. But EVERY victim of sex assault should have access to treatment for it. That doesn't mean they should be recognized as disabled veterans. Should they get the special license plates too? There's no difference between a female soldier who was sexually assaulted, vs. a political intern who was sexually assaulted, vs. a college student who was sexually assaulted. They should all get treatment. But not from the VA.

    Keep in mind some of the context here too. PTSD is so easy to fake that the military almost encourages people to claim it. I feel almost like a sucker because I'm not jumping on that bandwagen to get bonuses after I retire. I know of one soldier who is getting disability pay for PTSD even though he never saw combat, and even though he returned to Afghanistan as a civilian employee!

  • foodscientist||

    AGREED on all fronts. I am a Gulf War I vet and as a Navy Corpsman saw issues with military medicine first-hand. Treating ACTIVE DUTY and WOUNDED VETS should be a priority; but the system is GROSSLY burdened with retirees and dependent "whales" who drain resources (sounds eerily similar to Medicare/Medicaid, eh?). Additionally, ask any vet to point to buddies who BS'd the system into providing disability for phantom back/knee injuries (not combat-related by the way).

  • heartburn||

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online

  • Video Game Nation: How gaming is making America freer – and more fun.
  • Matt Welch: How the left turned against free speech.
  • Nothing Left to Cut? Congress can’t live within their means.
  • And much more.

SUBSCRIBE

advertisement