Obviously, when I come into possession of information about Vets, or even soon-to-be-Vets on the cusp of separation, I feel obligated to regurgitate it here. Sometimes what I get is from what need be considered a classified source. This is one of those occasions.
Remember the Col. Dallas Homas Memorial Bent Brain Clinic at The Madigan Home for Wayward Malingerers? Yep. Back in the news again. As some may remember, it appeared there was a Detroit-like assembly line production crew down there cranking out 30 minute, while-you-wait personality disorder diagnoses at a rate of 20 or so a day. This might not be remarkable if it was a joint endeavour by twenty or thirty counselors doing the intake. Try five on good day if nobody had the flu or a new perm scheduled.
After a careful observation conducted by a flyover at 20,000 feet, the assessment was made that no error existed, but… in order to be sure there would be a complete review all the way back to … 2010. Then 2009. Then it went back to 2007. Errors were being discovered and bulldozers for immediate backfill were needed. Col. Homas was temporarily relieved of his duties to prevent any more coercion of counselors. One up and quit anyway.
This was where matters stood until recently. With little fanfare, it was announced that there was no conspiracy to disenfranchise military personnel and give them the “slightly distorted (but not bent) brain syndrome which warrants NOT SERVICE CONNECTED. Troops don’t get it other than in the wallet. And wonder of wonders. A recently chastised and newly reoriented Col. Homas made a surprising reappearance at his old section.
A personality disorder is something you snuck into the service with. Whether its an uninhibited habit of picking your nose in public and digesting the mined product, washing your hands every five minutes, or the really disgusting habit of diving under things whenever a car backfires, the medical etiology always seems to be that it is something that always afflicted you. This means the Presumption of Regularity we all get at our induction physical is malleable. In medical records, it is abbreviated as EPTS (existed prior to service).
The escape hatch, if any of you wondered how that occurred, is located in the last part of 38 CFR §3.303(c)-to wit:
In the field of mental disorders, personality disorders which are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior, chronic psychoneurosis of long duration or other psychiatric symptomatology shown to have existed prior to service with the same manifestations during service, which were the basis of the service diagnosis, will be accepted as showing preservice origin. Congenital or developmental defects, refractive error of the eye, personality disorders and mental deficiency as such are not diseases or injuries within the meaning of applicable legislation.
Shrinks, and those minions who work for them in the enlisted ranks, are allowed to type up all manner of personality disorders on short notice and help the soldier get out. This would be fine if it resulted in remuneration down the road at the RO. It doesn’t, they don’t and therein lies the problem. And for the record, 38 CFR §3.303(c) has been around in its present iteration since before WW2.
What we heard from our troops inside the wire is simple. In order to do a proper intake on these poor souls, it’s necessary to sit down and do some serious talking to get inside their heads. You don’t have them fill out a questionnaire that says things like:
1) Where were you when the stressor happened? We’ll need the exact day/date and time. Location in GPS coordinate format is also required.
2) Did you feel any emotions of fear? Revulsion? Sadness?
3) Did you cry? Puke? Clap for joy? Pose for pictures with dead enemy combatants?
4) Did you pick your nose, steal anything, or wash your hands a lot?
5) Have you ever been arrested for theft or shoplifting? If yes, when?
6) Do you have any medical training that would allow you to diagnose yourself with a mental disorder?
7) Who told you you were in a war zone or is that just your subjective interpretation of where you were?
The only way this is accomplished is by one-on-one, down in the bunker examinations noting eye, hand and vocal distress. You do not accomplish this with eleven subjects a day including two fifteen minute smoke breaks and an hour for lunch. In your dreams, you’d like to see no more than three of these ladies or gentlemen a day. This would give you time to ascertain what they really suffer and a chance to read up on it and write it up properly.
What we’re hearing is that Col. Homas is trying to ramp this up again and turn it into the former “in-by-ten, out-by-1015 with a write up by 1030 hrs. Next?”. Our whisperblower complains of a new attempted workload schedule of eleven soldiers a day being ramrodded through to include writeups of confirmed diagnoses and Triage instructions. For most, this is their first visit to a mental health counselor who is even remotely capable of diagnosing the person. So much for that comprehensive retro-review back to 2007. If they are still losing twenty or more a month just in the Army, something’s amiss.
Think about that. This is worse than a MASH hospital. Do the math. Eleven brand new subjects divided (at best) by seven hours pencils out to a lot of DSM-IV errors. I envision spin-the-wheel Carnival GAF scores.
” Here we go, Sgt. Fuentes. Ohhhhh, Bummer. 70! Too bad. Some AWOL and petty theft. Shoplifting at the Commissary. Mood and sleeping disorders. Check. Suicidal ideation? I don’t see it. You feel okay, right? Controlled by medication… hmmm. Looks like we have a little bit of PD here, trooper. How’s about a nice long, General Discharge-type vacation and a free two year pass at the American Lake VAMC for mental health counseling? If it gets worse, vA’ll reevaluate you.”
This is what we are passing off as meaningful PTSD screening and solid investigative principles. Were this a civilian shrink, they’d demand five sessions @ 45 minutes to even consider a diagnosis and etiology. One for each Axis diagnosis and one for a comprehensive discussion with the soldier to confirm the long-term path to normalcy (if it can even be attained). By saddling counselors with an unmanageable, unrealistic workload, the Colonel and his merry band in effect have insured no meaningful good can ensue. Mercurial diagnostics, like MRIs, are not available in the mental health field yet. Pretending they are is a disservice to everyone but most of all the patient.
Here’s an example of what they looked like during the Vietnam Boundary Dispute. Same old shit, different day.
I never met any Majors about this. I was stationed in the desert at Edwards AFB. Women were rarer than sidewinder rattlesnakes. Lt. Meyer asked me if maybe it was time to “move on”. He explained that two years in SEA changes your outlook on life. Maybe that military gig wasn’t my cup of tea. What the Hell? I’d punched the clock for three years and six months. Uncle Sam was willing to let bygones be bygones and I’d get a honorable-type discharge. He’d just cook up some innocuous-sounding excuse and I could be on my way. I declined to sign the first one that admitted I was a homosexual. Somehow this sounded better.
Remember, there was no such thing as PTSD until 1982. Now it’s up and disappeared again. Amazing. Now you see it, now you don’t. I hear that happens a lot in war.