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Adjustment disorder may now net disability pay

Critics: Diagnosis had been used to avoid paying benefits

Oct. 11, 2013 - 04:58PM   |  
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The Pentagon has changed its physical disability policy to include chronic adjustment disorder as a condition potentially eligible for disability compensation.

The Defense Department amended DoD Instruction 1332.38 in April to name chronic adjustment disorder as incompatible with military service, but possibly service-related and therefore eligible for disability compensation.

The change is notable because thousands of service members have been discharged for adjustment disorder, which had been previously characterized as a condition present before troops joined the military, and therefore ineligible for compensation or mental health treatment.

A Defense Department spokeswoman said the change was made to bring the policy in line with the Veterans Affairs Department’s schedule of rating of disabilities.

Critics have charged that the military services used the diagnosis of adjustment disorder in lieu of post-traumatic stress disorder to avoid paying benefits to troops who could no longer serve.

In 2006, 1,453 troops were discharged for adjustment disorder from the services. That figure rose to 3,844 in 2009. In the Army alone, 6,492 soldiers were discharged for adjustment disorders between 2008 and 2010, according to figures obtained by the Vietnam Veterans of America and Yale Law School’s Veterans Legal Services Clinic.

Lawmakers have pressed the Defense Department to examine the more than 31,000 discharges since 2001 for adjustment disorders and personality disorders, another group of mental health conditions considered to presage military service.

Efforts have been made to review at least some of the cases. Last June, then Defense Secretary Leon Panetta ordered the review of thousands of military mental health discharges for those whose diagnoses were changed to a non-compensable condition like adjustment or personality disorders during a medical evaluation board.

In August, the Pentagon’s top doctor issued a memo stipulating that an adjustment disorder diagnosis should not be given if a more specific disorder, like PTSD or personality disorder, also could explain the symptoms.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, said separation for adjustment disorder for those who have deployed to a combat zone requires additional screening.

The diagnosis “requires an evaluation for PTSD, must be corroborated by a peer or higher level mental health professional and endorsed by the surgeon general of the military department concerned,” Woodson wrote.

In March, Rep. Tim Walz, D-Minn., introduced a bill that would have required the Pentagon to review all of the discharges for personality or adjustment disorders since Sept. 11, 2001. That legislation has not moved, but the fiscal 2014 defense authorization bill calls for the Government Accountability Office to evaluate the use of personality and adjustment disorder discharges by the services since Jan. 1, 2007.

Both Iraq and Afghanistan Veterans of America and the Wounded Warrior Project have pressed Congress to pressure the Pentagon to review the thousands of discharges of personnel for personality or adjustment disorders.

Women’s groups like Equality Now and the Service Women’s Action Network also have charged that the two diagnoses are being misused to discharge sexual assault victims.

A Pentagon spokeswoman, Army Lt. Col. Catherine Wilkinson, did not disclose how many troops have been or would be affected by the change.

She added that the military services initially thought there would be “thousands of cases.” But a DoD review of the criteria necessary to determine a diagnosis of chronic adjustment disorder showed the standards the services used to for their estimates were only a small part of the overall requirements needed to determine a legitimate diagnosis, Wilkinson said.■

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