Alleging misdiagnoses, veterans’ advocates battle Army

Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.

“We really have an obligation to go back and make sure troops weren’t misdiagnosed,’’ said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit, Give an Hour, connects troops with volunteer mental health professionals.

The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.

Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

Defined as a “deeply ingrained maladaptive pattern of behavior,’’ a personality disorder is considered a “preexisting condition’’ that relieves the military of its duty to pay for the person’s health care or combat-related disability pay.

According to figures provided by the Army, the service discharged about 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.

After an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure that post-traumatic stress or a brain injury was not the underlying cause.

After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.

At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD, twice as many as two years before.

The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.

“We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder,’’ wrote Maria Tolleson, a spokeswoman at the US Army Medical Command, which oversees the health care of soldiers, in an e-mail.

Command officials declined to be interviewed.

Advocates for veterans are skeptical of the Army’s assertion that it made no mistakes. They say symptoms of PTSD — anger, irritability, anxiety, and depression — can easily be confused for the Army’s description of a personality disorder.

They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.

“There’s no reason to believe personality discharges would go down so quickly’’ unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, codirector of the National Veterans Legal Services Program.

Stichman’s organization is working through a backlog of 130 individual cases of wounded service members who believe they were wrongly denied benefits.

Chuck Luther, who decided to rejoin the Army after the Sept. 11 attacks, previously served eight years before being honorably discharged.

“I knew what combat was going to take,’’ he said.

Luther, who lives near Fort Hood, Texas, said he received eight mental health evaluations from the Army, each clearing him as “fit for duty.’’

Luther was seven months into his deployment as a reconnaissance scout in Iraq’s violent Sunni Triangle in 2007 when he says a mortar shell slammed him to the ground. He later complained of stabbing eye pain and crippling migraines, but was told by a military doctor that he was faking his symptoms to avoid combat duty.

Luther says he was confined for a month in a 6-by-8-foot room without treatment. At one point, Luther acknowledges, he snapped, biting a guard and spitting in the face of a military chaplain.

After that episode, Luther says, the Army told him he could return home and keep his benefits if he signed papers admitting he had a personality disorder. If he didn’t sign, he said, he was told he would be kicked out eventually anyway. Luther, whose account was first detailed by The Nation, signed the papers.

Luther’s case highlights the irony in many personality discharges. A person is screened mentally and physically before joining the military. But upon returning from combat, that same person is told he or she had a serious mental disorder that predated military service.

As in the civilian world, where many insurance companies deny coverage for illnesses that develop before a policy is issued, the government can deny a service member veteran health care benefits and combat-related disability pay for preexisting ailments.