‘Adjustment disorder’ discharges beg explanation - Army Community - Army Discussions - Army Times

‘Adjustment disorder’ discharges beg explanation

While deployed to Iraq with the 4th Infantry Division, former Army Pfc. Michael Nahas said he watched 14 people die in a 2008 explosion in Mosul.

A few months after returning home to Fort Carson, Colo., Nahas, on a heavy prescription of Xanax, tried to commit suicide in the bathroom of his off-post apartment by jabbing IV tubes in his wrists, intending to bleed out.

Miraculously, Nahas’ wife found him before he died and help arrived in time.

In a photo of the aftermath provided by his family, the tub, walls and floor are splashed crimson, and a bloody smiley faced smeared on the tiles eerily peers down at the carnage.

After his suicide attempt, Nahas spent time in an inpatient clinic and was diagnosed with PTSD, which should have led to the standard medical disability retirement process.

But in April, his battalion gave him administrative discharge for “adjustment disorder” and sent him back to civilian life — with no benefits.

Veterans advocates say Nahas’ case exemplifies a troubling new trend in the use of adjustment disorder diagnoses for mental health issues, including PTSD.

Adjustment disorder is a fairly broad label that is used, for example, as a quick and simple way to discharge boot camp recruits who find they just can’t cope with military life.

But some advocates say the services are misusing adjustment disorder to discharge some combat veterans who, like Nahas, may be traumatized by their wartime experiences.

The reason, they say, is cost.

Under a 2008 change in law, a diagnosis of PTSD is supposed to trigger an automatic 50 percent disability rating — along with lifetime medical retirement pay and health care benefits.

But a service member found to have adjustment disorder can be given a simple administrative discharge that carries no benefits — and no cost to the military.

Defense officials insist that budget considerations play no role in such decisions. But a similar scenario unfolded a few years ago when administrative discharges for “pre-existing personality disorder” began to rise, topping 1,000 in 2006 and 2007.

Congress enacted new rules in 2008 to curb use of that diagnosis — and discharges plunged to just 260 last year, according to data gathered by the office of Sen. Christopher “Kit” Bond, R-Mo., who took a leading role in effort to enact those new rules.

But simultaneously, discharges for the category of conditions that includes adjustment disorder began to soar, from 1,453 in 2006 to 3,844 last year — a spike of 165 percent.

Those trend lines have stoked fresh charges from advocates that the military is seeking to hold down its costs by shortchanging troops with mental health issues on health care and other benefits.

Even more egregiously, Nahas’ case shows that some troops already formally diagnosed with PTSD are being administratively discharged with no benefits — a violation of the law enacted by Congress in 2008. Some advocates say they know of hundreds of such cases.

Sadly, this only perpetuates the stigma of weakness that clings to mental health issues suffered by today’s combat vets.

Congress deserves credit for its 2008 move to swiftly address questionable discharges for pre-existing personality disorders.

Now, with the military’s suicide rate at record levels and mental health issues continuing to wreak havoc among troops, lawmakers must remain vigilant and demand an explanation from DoD for the rapid rise in discharges for adjustment disorder.