This is not intended as a criticism of all military psychiatrists, but it is a pattern that often requires increased assistance from counselors or attorneys. In almost all cases involving military psychiatric issues, it is valuable for members to obtain an independent civilian evaluation, preferably at the outset of the case. This allows clients and counselors or attorneys to weigh options before raising any issues with the military and to consider the accuracy of military diagnoses.
While the military is not bound by civilian reports, they can assist servicemembers in gaining access to military medical care and can be persuasive with commands, medical officers and military psychiatrists or psychologists. The absence of confidentiality in the military medical system deserves special emphasis. Soldiers and sailors often assume that their discussions with doctors and other mental health professionals will remain private. Unfortunately, reports of evaluations and treatment are often available to commands and may be used in virtually all military administrative and disciplinary proceedings.
Statements or misstatements in psychiatric reports can lead to accusations of fraudulent enlistment as for concealment of preenlistment psychiatric conditions or treatment , accusations of malingering or making false statements, and disciplinary action or involuntary discharge for violation of military regulations or the UCMJ. For example, soldiers who reveal illegal drug use to military psychiatrists normally face involuntary discharge. In one Navy case, statements about symptoms made during a psychological evaluation were treated as threats against superior officers, leading to court-martial and a bad conduct discharge.
In working with military clients, it is important to discuss the impact of psychiatric diagnoses and discharges on military service and civilian careers. Soldiers and sailors sometimes find that commands view emotional distress as an indication of weakness and unreliability. This may improperly affect performance evaluations, promotions, desirable assignments and career prospects. In addition, information or misinformation about psychiatric problems may become a matter of common knowledge within commands.
Informal harassment of members with obvious emotional problems or with known psychiatric diagnoses is common; such abuse is, of course, all the more difficult to handle when members are trying to cope with emotional distress in the first place.
While military records are considered private outside the military setting, and are unavailable to civilians and to many government agencies, nothing prevents potential employers from inquiring about military service.
Veterans are routinely asked to provide copies of their DD discharge documents when applying for jobs. When a DD notes medical discharge or retirement or Conditions and Circumstances Not Constituting a Disability, the diagnosis is not normally given, but employers commonly ask, despite the protections of federal law.
In personality disorder discharges, those words are normally used as the narrative reason for discharge on the DD As a result, Congress has required changes to military regulations to ensure that servicemembers facing misconduct discharges and the like particularly those who have served in combat areas have mental health evaluations to determine whether psychiatric problems contributed to, mitigated, or caused the alleged misconduct.
Military policies regarding psychiatric conditions are based on standards and diagnoses adopted by the American Psychiatric Association APA , and reflect the views and assumptions of the mainstream psychiatric establishment in this country. Nontraditional psychiatric diagnoses and therapy are normally treated with contempt in the military setting.
This manual attempts to define individual psychiatric disorders, listing specific symptoms and criteria for each and often including detailed discussion of conditions which may be related to or mistaken for others. DSM-5 also attempts to consider gender, racial and cultural differences which may affect diagnosis, including behavior which may be entirely appropriate in one culture or religion but considered symptomatic of illness in another. Axis I was used to report the vast majority of psychiatric conditions, from schizophrenia and PTSD to sleep disorders and short-term adjustment disorders.
Axis II included personality disorders and mental retardation. Axis III was used for physical illnesses and injuries; Axis IV for psychosocial and environmental issues such as occupational problems or problems with the legal system; and Axis V for a global assessment of functioning on a scale of 1 to DSM-5 suggests that some diagnostic decisions be deferred when a serious and acute disorder makes evaluation of other conditions difficult.
Personality disorder diagnoses are sometimes deferred when a serious disorder such as anxiety or panic disorder requires immediate treatment, and considered later when the other disorder becomes stable or remits. The DSM describes the criteria, course, associated features and specific cultural, age and gender features of disorders, their prevalence, and differential diagnoses for each listed disorder.
This provides mental health practitioners and military counselors or attorneys with an important tool for gauging the validity and significance of particular diagnoses. This is not to suggest that counselors and attorneys should second-guess psychiatrists and attempt to make diagnoses, but rather that they can assist clients in considering whether to question diagnoses, obtain independent evaluations, and seek or object to discharge based on the military diagnoses. By way of example, these efforts can help clients discover whether the diagnosis of an adjustment disorder with depressed mood is a misdiagnosis of a much more serious major depressive disorder, whether a diagnosis of schizophrenia is actually a less serious schizoid personality disorder, or whether a diagnosis of personality disorder not otherwise specified may be based solely on religious or political differences with military policies and practices.
Personality disorders, considered less serious and almost impossible to cure, may be grounds for administrative discharge, but not medical discharge or retirement. Short-term or less serious conditions such as adjustment disorders were not grounds for administrative or medical discharge in the past, largely because they are expected to have less effect on performance of duties and to improve with time or treatment.
However, such conditions have more recently become common grounds for administrative discharge. Commanders may discharge soldiers and sailors fairly easily on the basis of these less significant conditions while they are in entry-level status the first days of active duty service. This is often done under the very broad discharge category of Entry Level Performance and Conduct. Some of the conditions, including more serious ones, may be grounds for discharge for failure to meet enlistment medical standards, if discovered in the first months of service.
In addition, the various services have expanded and revised the DoD discharge of Conditions and Circumstances Not Constituting a Disability to include some of these diagnoses, with variation from service to service; this discharge is more commonly used after the first six months of service. Major changes in procedures for medical discharge and retirement have occurred in the last several years, and an understanding of the system is essential for servicemembers trying to navigate it, and for counselors and attorneys assisting them.
Medical disability separations may result from serious psychiatric disorders such as major depressive disorders, PTSD, other anxiety disorders, schizophrenia and the like. The controlling regulation is DoD Instruction More specific guidelines for psychiatric conditions warranting discharge or retirement are left to the individual services and their regulations. The service regulations occasionally differ in language so that it is always worth reviewing the specific service regulation when considering individual cases.
The causes for referral to an MEB [medical evaluation board, normally the first step in military discharge or retirement] are as follows:. The causes for referral to an MEB include persistence of symptoms or associated personality change sufficient to interfere with the performance of duty or social adjustment. The causes for referral to an MEB are eating disorders that are unresponsive to treatment or that interfere with the satisfactory performance of duty.
These include:. Any psychotic episode other than those with a brief duration, good prognosis and clearly identifiable and reversible cause must meet MEB. Mental conditions requiring MEB: 5. Conditions that are expected to have persistent duty impairment more than 1 year despite treatment. Getting an early discharge is not easy and the procedures can be complicated.
Discharge regulations are intended to give commanders control over their troops to maintain good order and discipline.
You must persuade your command that a discharge is warranted and in the best interests of the military. You can call us at the GI Rights Hotline for help. The regulations give commanding officers a great deal of discretion, and only minimal guidelines, for deciding whether or not discharge is appropriate. Policies may differ from one command to another even within the same base and a command can change policy without warning. The military normally will not discharge a member with a short-term and treatable condition.
The military assumes that discharges under this section are initiated by a commanding officer when a problem comes to his or her attention, usually by way of military medical or psychiatric reports. It is useful to talk frankly with immediate superiors and others higher in the command about your symptoms and feelings. Although commands can be unreceptive to emotional or physical problems, you can try to approach them like a patient seeking help.
An outright request for discharge often meets with absolute rejection. It is more useful to show the commanding officer the evidence of the problem, explain the feelings and symptoms briefly, and simply ask for help. This gives the command the opportunity to recommend discharge on their own initiative. You can mention all symptoms which affect your performance and ability to function in the military, and perhaps role-play a few hostile questions.
You can try being open without minimizing your symptoms, and you may want to avoid becoming antagonistic. Military psychiatrists are on the lookout for exaggeration of symptoms. You can talk about why you are not able to perform your duties, and avoid framing the conversation with the military psychiatrist around a desire for discharge.
It is essential that you do not lay all blame for your condition on the military. Military psychiatrists can be friendly and supportive, but it is not unusual to find rude, unconcerned, or openly hostile doctors. You may actually be harassed or insulted by the psychiatrist, and you may want to resist the temptation to respond in kind. Most psychiatrists can be persuaded to take your problems seriously if you persist in discussing them.
Military psychiatrists will often diagnose the condition and may recommend discharge after the first interview. If this does not happen if they fail to recognize the condition, or diagnose a less serious condition , it may be necessary to make repeated visits to the psychiatrist until it seems the doctor understands the seriousness of the problem.
With some of these conditions, local commands are reluctant to believe that the problem exists and to grant discharge. You may get separated for behavior associated with depression, so if he doesn't get treatment it won't be able to be considered as a mitigating factor. Further, if he has no record of it, he won't be compensated for it, or receive treatment for it from the VA.
He needs to seek treatment, zero upside of not seeking treatment. Vote up. Vote down. I agree with 1SG. The worse thing he can do is ruin his career for behavioral issues that can be treated. Am retired, and as mentioned if no record its hard to be compensated for it. There are ways, but it's much harder.
Seek the help needed, let no one tell you any different. Taking that frist step is hard, no lie, but once you do All the Best to You.
Need to talk LTC Jason Mackay. Doing nothing about it will get you separated. SFC Join to see.
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