[MESocofAmerica] How Specialist Town Lost His Benefits

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The Nation

 

This article can be found on the web at

http://www.thenation.com/doc/20070409/kors

 

How Specialist Town Lost His Benefits

by JOSHUA KORS

[from the April 9, 2007 issue]

 

Jon Town has spent the last few years fighting two battles, one against his

body, the other against the US Army. Both began in October 2004 in Ramadi,

Iraq. He was standing in the doorway of his battalion's headquarters when a

107-millimeter rocket struck two feet above his head. The impact punched a

piano-sized hole in the concrete

facade, sparked a huge fireball and tossed the 25-year-old Army specialist to

the floor, where he lay blacked out among the rubble.

 

" The next thing I remember is waking up on the ground. " Men from his unit had

gathered around his body and were screaming his name. " They started shaking

me. But I was numb all over, " he says. " And it's weird because... because for a

few minutes you feel like you're not really there. I could see them, but I

couldn't hear them. I couldn't hear anything. I started shaking because I

thought I was dead. "

 

Eventually the rocket shrapnel was removed from Town's neck and his ears

stopped leaking blood. But his hearing never really recovered, and in many ways,

neither has his life. A soldier honored twelve times during his seven years in

uniform, Town has spent the last three struggling with deafness, memory

failure and depression. By September

2006 he and the Army agreed he was no longer combat-ready.

 

But instead of sending Town to a medical board and discharging him because of

his injuries, doctors at Fort Carson, Colorado, did something strange:

They claimed Town's wounds were actually caused by a " personality disorder. "

Town was then booted from the Army and told that under a personality disorder

discharge, he would never receive disability or medical benefits.

 

Town is not alone. A six-month investigation has uncovered multiple cases in

which soldiers wounded in Iraq are suspiciously diagnosed as having a

personality disorder, then prevented from collecting benefits. The conditions of

their

discharge have infuriated many in the military community, including the

injured soldiers and their

families, veterans' rights groups, even military officials required to

process these dismissals. They say the military is purposely misdiagnosing

soldiers

like Town

and that it's doing so for one reason: to cheat them out of a lifetime of

disability and medical benefits, thereby saving billions in expenses.

 

The Fine Print

 

In the Army's separations manual it's called Regulation 635-200, Chapter

5-13: " Separation Because of Personality Disorder. " It's an alluring choice for

a

cash-strapped military because enacting it is quick and cheap. The Department

of Veterans Affairs doesn't have to provide medical care to soldiers dismissed

with personality disorder.

That's because under Chapter 5-13, personality disorder is a pre-existing

condition. The VA is only required to treat wounds sustained during service.

 

Soldiers discharged under 5-13 can't collect disability pay either. To

receive those benefits, a soldier must be evaluated by a medical board, which

must

confirm that he is wounded and that his wounds stem from combat. The process

takes several months, in contrast with a 5-13 discharge, which can be wrapped up

in a few days.

 

If a soldier dismissed under 5-13 hasn't served out his contract, he has to

give back a slice of his re-enlistment bonus as well. That amount is often

larger than the soldier's final paycheck. As a result, on the day of their

discharge, many injured vets learn that they owe the Army several thousand

dollars.

 

One military official says doctors at his base are doing more than

withholding this information from wounded soldiers; they're actually telling

them the

opposite: that if they go along with a 5-13, they'll get to keep their bonus and

receive disability and medical benefits.

The official, who demanded anonymity, handles discharge papers at a prominent

Army facility. He says the soldiers he works with know they don't have a

personality disorder. " But the doctors are telling them, this will get you out

quicker, and the VA will take care of you. To stay out of Iraq, a soldier will

take that in a heartbeat. What they don't realize is, those things are lies. The

soldiers, they don't read the fine print, " he says. " They don't know to ask

for a med board. They're taking the word of the doctors. Then they sit down

with me and find out what a 5-13 really means--they're shocked. "

 

Russell Terry, founder of the Iraq War Veterans Organization (IWVO), says

he's watched this scenario play itself out many times. For more than a year, his

veterans' rights group has been receiving calls from distraught soldiers

discharged under Chapter 5-13. Most, he says, say their military doctors pushed

the

personality disorder diagnosis, strained to prove that their problems existed

before their service in

Iraq and refused to acknowledge evidence of posttraumatic stress disorder

(PTSD), traumatic brain injury and physical traumas, which would allow them to

collect disability and medical benefits.

 

" These soldiers are coming home from Iraq with all kinds of problems, " Terry

says. " They go to the VA for treatment, and they're turned away. They're told,

'No, you have a pre-existing condition, something from childhood.' " That leap

in logic boils Terry's blood. " Everybody receives a psychological screening

when they join the military. What I want to know is, if all these soldiers

really did have a severe pre-existing condition, how did they get into the

military in the first place? "

 

Terry says that trying to reverse a 5-13 discharge is a frustrating process.

A soldier has to claw through a thicket of paperwork, appeals panels and

backstage political dealing, and even with the guidance of an experienced

advocate,

few are successful. " The 5-13, " he says, " it's like a scarlet letter you

can't get taken off. "

 

In the last six years the Army has diagnosed and discharged more than 5,600

soldiers because of personality disorder, according to the Defense Department.

And the numbers keep rising: 805 cases in 2001, 980 cases in 2003, 1,086 from

January to November 2006. " It's getting worse and worse every day, " says the

official who handles discharge papers. " At my office the numbers started out

normal. Now it's up to

three or four soldiers each day. It's like, suddenly everybody has a

personality disorder. "

 

The reason is simple, he says. " They're saving a buck. And they're saving the

VA money too. It's all about money. "

 

Exactly how much money is difficult to calculate. Defense Department records

show that across the entire armed forces, more than 22,500 soldiers have been

dismissed due to personality disorder in the last six years. How much those

soldiers would have collected in disability pay would have been determined by a

medical board, which evaluate just how disabled a veteran is. A completely

disabled soldier receives

about $44,000 a year. In a recent study on the cost of veterans' benefits for

the Iraq and Afghanistan wars, Harvard professor Linda Bilmes estimates an

average disability payout of $8,890 per year and a future life expectancy of

forty years for soldiers returning from service.

 

Using those figures, by discharging soldiers under Chapter 5-13, the military

could be saving upwards of $8 billion in disability pay. Add to that savings

the cost of medical care over the soldiers' lifetimes. Bilmes estimates that

each year the VA spends an average of $5,000 in medical care per veteran.

Applying those numbers, by discharging

22,500 soldiers because of personality disorder, the military saves $4.5

billion in medical care over their lifetimes.

 

Town says Fort Carson psychologist Mark Wexler assured him that he would

receive disability benefits, VA medical care and that he'd get to keep his

bonus--good news he discussed with Christian Fields and Brandon Murray, two

soldiers

in his unit at Fort Carson. " We talked about it many times, " Murray says. " Jon

said the doctor there promised him benefits, and he was happy about it. Who

wouldn't be? " Town shared

that excitement with his wife, Kristy, shortly after his appointment with

Wexler. " He said that Wexler had explained to him that he'd get to keep his

benefits, " Kristy says, " that the doctor had looked into it, and it was all

coming

with the chapter he was getting. "

 

In fact, Town would not get disability pay or receive long-term VA medical

care. And he would have to give back the bulk of his $15,000 bonus. Returning

that money meant Town would leave Fort Carson less than empty-handed: He now

owed the Army more than $3,000. " We had this on our heads the whole way, driving

home to Ohio, " says Town. Wexler made him promises, he says, about what would

happen if he went along

with the diagnosis. " The final day, we find out, none of it was true. It was

a total shock. I felt like I'd been betrayed by the Army. "

 

Wexler denies discussing benefits with Town. In a statement, the psychologist

writes, " I have never discussed benefits with my patients as that is not my

area of expertise. The only thing I said to Spc. Town was that the Chapter 5-13

is an honorable discharge.... I assure you, after over 15 years in my

position, both as active duty and now civilian, I don't presume to know all the

details about benefits and therefore do not discuss them with my patients. "

 

Wexler's boss, Col. Steven Knorr, chief of the Department ofBehavioral Health

at Evans Army Hospital, declined to speak about Town's case. When asked if

doctors at Fort Carson were assuring patients set for a 5-13 discharge that

they'll receive disability

benefits and keep their bonuses, Knorr said, " I don't believe they're doing

that. "

 

Not the Man He Used to Be

 

Interviews with soldiers diagnosed with personality disorder suggest that the

military is using the psychological condition as a catch-all diagnosis,

encompassing symptoms as diverse as deafness, headaches and schizophrenic

delusions. That flies in the face of the Army's own regulations.

 

According to those regulations, to be classified a personality disorder, a

soldier's symptoms had to exist before he joined the military. And they have to

match the " personality disorder " described in the Diagnostic and Statistical

Manual of Mental Disorders, the national standard for psychiatric diagnosis.

Town's case provides a

clear window into how these personality disorder diagnoses are being used

because even a cursory examination of his case casts grave doubt as to whether

he

fits either criterion.

 

Town's wife, for one, laughs in disbelief at the idea that her husband was

suffering from hearing loss before he headed to Iraq. But since returning, she

says, he can't watch TV unless the volume is full-blast, can't use the phone

unless its volume is set to high.

Medical papers from Fort Carson list Town as having no health problems before

serving in Iraq; after, a Fort Carson audiologist documents " functional

(non-organic) hearing loss. " Town says his right ear, his " good " ear, has lost

50

percent of its hearing; his left is still essentially useless.

 

He is more disturbed by how his memory has eroded. Since the rocket blast, he

has struggled to retain new information. " Like, I'll be driving places, and

then I totally forget where I'm going, " he says. " Numbers, names, dates--unless

I knew them before, I pretty much don't remember. " When Town returned to his

desk job at Fort Carson, he found himself straining to recall the Army's

regulations. " People were like, 'What are you, dumb?' And I'm like, 'No, I'm

probably smarter than you. I just can't remember stuff,' " he says, his

melancholy

suddenly replaced by anger. " They don't understand--I got hit by a rocket. "

 

Those bursts of rage mark the biggest change, says Kristy Town. She says the

man she married four years ago was " a real goofball. He'd do funny voices and

faces--a great Jim Carrey imitation. When the kids would get a boo-boo, he'd

fall on the ground and pretend he got a boo-boo too. " Now, she says, " his

emotions are all over the place.

He'll get so angry at things, and it's not toward anybody. It's toward

himself. He blames himself for everything. " He has a hard time sleeping and

doesn't

spend as much time as he used to with the kids. " They get rowdy when they

play, and he just has to be alone. It's almost like his nerves can't handle it. "

 

Kristy begins to cry, pauses, before forcing herself to continue.

She's been watching him when he's alone, she says. " He kind of... zones out,

almost like he's in a daze. "

 

In May 2006 Town tried to electrocute himself, dropping his wife'shair dryer

into the bathtub. The dryer short-circuited before it could electrify the

water. Fort Carson officials put Town in an off-post hospital that specializes

in

suicidal depression. Town had been promoted to corporal after returning from

Iraq; he was stripped of that rank and reduced back to specialist. " When he

came back, I tried to be the same, " Kristy says. " He just can't. He's definitely

not the man he used to be. "

 

Town says his dreams have changed too. They keep taking him back to Ramadi,

to the death of a good friend who'd been too near an explosion, taken too much

shrapnel to the face. In his dreams Town returns there night after night to

soak up the blood.

 

He stops his description for a rare moment of levity. " Sleep didn't use to be

like that, " he says. " I used to sleep just fine. "

 

How the Army determined then that Town's behavioral problems existed before

his military service is unclear. Wexler, the Fort Carson psychologist who made

the diagnosis, didn't interview any of Town's family or friends. It's unclear

whether he even questioned Town's fellow soldiers in 2-17 Field Artillery, men

like Fields, Murray and

Michael Forbus, who could have testified to his stability and award-winning

performance before the October 2004 rocket attack. As Forbus puts it, before

the attack Town was " one of the best in our unit " ; after, " the son of a gun was

deaf in one ear. He seemed lost and disoriented. It just took the life out of

him. "

 

Town finds his diagnosis especially strange because the Diagnostic Manual

appears to preclude cases like his. It says that a pattern oferratic behavior

cannot be labeled a " personality disorder " if it's from a head injury. The

specialist asserts that his hearing loss, headaches and anger all began with the

rocket attack that knocked him unconscious.

 

Wexler did not reply to repeated requests seeking comment on Town's

diagnosis. But Col. Knorr of Fort Carson's Evans hospital says he's confident

his

doctors are properly diagnosing personality disorder. The colonel says there is

a

simple explanation as to why in so many cases the lifelong condition of

personality disorder isn't apparent

until after serving in Iraq. Traumatic experiences, Knorr says, can trigger a

condition that has lain dormant for years. " They may have done fine in high

school and before, but it comes out during the stress of service. "

 

" I've never heard of that occurring, " says Keith Armstrong, a clinical

professor with the Department of Psychiatry at the University of California, San

Francisco. Armstrong has been counseling traumatized veterans for more than

twenty years at the San Francisco VA; most recently he is the co-author of

Courage

After Fire: Coping Strategies

for Troops Returning From Iraq and Afghanistan and Their Families.

" Personality disorder is a diagnosis I'm very cautious about, " he says. " My

question

would be, has PTSD been ruled out? It seems to me that if it walks like a duck,

looks like a duck, let's see if it's a duck before other factors are

implicated. "

 

Knorr admits that in most cases, before making a diagnosis, his doctors only

interview the soldier. But he adds that interviewing family members, untrained

to recognize signs of personality disorder, would be of limited value. " The

soldier's perception and their

parents' perception is that they were fine. But maybe they didn't or weren't

able to see that wasn't the case. "

 

Armstrong takes a very different approach. He says family is a " crucial part "

of the diagnosis and treatment of soldiers returning from war. The professor

sees parents and wives as so important, he encourages his soldiers to invite

their families into the counseling sessions. " They bring in particular

information that can be helpful, " he says. " By not taking advantage of their

knowledge

and support, I think we're doing soldiers a disservice. "

 

Knorr would not discuss the specifics of Town's case. He did note, however,

that his department treats thousands of soldiers each year and says within that

population, there are bound to be a small fraction of misdiagnosed cases and

dissatisfied soldiers. He adds that the soldiers he's seen diagnosed and

discharged with personality disorder are " usually quite pleased. "

 

The Army holds soldiers' medical records and contact information strictly

confidential. But The Nation was able to locate a half-dozen soldiers from bases

across the country who were diagnosed with personality disorder. All of them

rejected that diagnosis. Most said military doctors tried to force the

diagnosis upon them and turned a blind eye to symptoms of PTSD and physical

injury.

 

One such veteran, Richard Dykstra, went to the hospital at Fort Stewart,

Georgia, complaining of flashbacks, anger and stomach pains. The doctor there

diagnosed personality disorder. Dykstra thinks the symptoms actually stem from

PTSD and a bilateral hernia he suffered in Iraq. " When I told her my symptoms,

she said, 'Oh, it looks like you've been reading up on PTSD.' Then she basically

said I was making

it all up, " he says.

 

In her report on Dykstra, Col. Ana Parodi, head of Behavioral Health at Fort

Stewart's Winn Army Hospital, writes that the soldier gives a clear

description of PTSD symptoms but lays them out with such detail, it's " as if he

had

memorized the criteria. " She concludes that Dykstra has personality disorder,

not

PTSD, though her report also notes that Dykstra has had " no previous

psychiatric history " and that she confirmed the validity of his symptoms with

the

soldier's wife.

 

Parodi is currently on leave and could not be reached for comment. Speaking

for Fort Stewart, Public Affairs Officer Lieut. Col. Randy Martin says that the

Army's diagnosis procedures " have been developed over time, and they are

accepted as being fair. " Martin said he could not address Dykstra's case

specifically because his files have been

moved to a storage facility in St. Louis.

 

William Wooldridge had a similar fight with the Army. The specialist was

hauling missiles and tank ammunition outside Baghdad when, he says, a man

standing

at the side of the road grabbed hold of a young girl and pushed her in front

of his truck. " The little girl, " Wooldridge says, his voice suddenly quiet,

" she looked like one of my

daughters. "

 

When he returned to Fort Polk, Louisiana, Wooldridge told his doctor that he

was now hearing voices and seeing visions, hallucinations of a mangled girl

who would ask him why he had killed her. His doctor told him he had personality

disorder. " When I heard that, I flew off the handle because I said, 'Hey, that

ain't me. Before I went over there,

I was a happy-go-lucky kind of guy.' " Wooldridge says his psychologist, Capt.

Patrick Brady of Baynes-Jones Army Community Hospital, saw him for thirty

minutes before making his diagnosis. Soon after, Wooldridge was discharged from

Fort Polk under Chapter 5-13.

 

He began to fight that discharge immediately, without success. Then in March

2005, eighteen months after Wooldridge's dismissal, his psychiatrist at the

Memphis VA filed papers rejecting Brady's diagnosis and asserting that

Wooldridge suffered from PTSD so severe, it made him " totally disabled. " Weeks

later

the Army Discharge Review

Board voided Wooldridge's 5-13 dismissal, but the eighteen months he'd spent

lingering without benefits had already taken its toll.

 

" They put me out on the street to rot, and if I had left things like they

were, there would have been no way I could have survived. I would have had to

take myself out or had someone do it for me, " he says. The way they use

personality disorder to diagnose and discharge, he says, " it's like a mental

rape.

That's the only way I can describe it. "

 

Captain Brady has since left Fort Polk and is now on staff at Fort

Wainwright, Alaska; recently he deployed to Iraq and was unavailable for

comment. In a

statement, Maj. Byron Strother, chief of the Department of Behavioral Health at

Baynes-Jones hospital, writes that allegations that soldiers at Fort Polk are

being misdiagnosed " are not true. " Strother says diagnoses at his hospital

are made " only after careful consideration of all relevant clinical observation,

direct examination [and] appropriate testing. "

 

If there are dissatisfied soldiers, says Knorr, the Fort Carson official,

" I'll bet not a single one of them has been diagnosed with conditions that are

clear-cut and makes them medically unfit, like schizophrenia. "

 

Linda Mosier disputes that. When her son Chris left for Iraq in 2004, he was

a " normal kid, " she says, who'd call her long-distance and joke about the

strange food and expensive taxis overseas. When he returned home for Christmas

2005, " he wouldn't sit down for a meal with us. He just kept walking around. I

took him to the department store for slacks, and he was inside rushing around

saying, 'Let's go, let's go, let's go.' He wouldn't sleep, and the one time he

did, he woke up screaming. "

 

Mosier told his mother of a breaking point in Iraq: a roadside bomb that blew

up the truck in front of his. " He said his buddies were screaming. They were

on fire, " she says, her voice trailing off. " He was there at the end to pick

up the hands and arms. " After that Mosier started having delusions. Dr. Wexler

of Fort Carson diagnosed

personality disorder. Soon after, Mosier was discharged under Chapter 5-13.

 

Mosier returned home, still plagued by visions. In October he put a note on

the front door of their Des Moines, Iowa, home saying the Iraqis were after him

and he had to protect the family, then shot himself.

 

Mosier's mother is furious that doctors at Fort Carson treated her son for

such a brief period of time and that Wexler, citing confidentiality, refused to

tell her anything about that treatment or give her family any direction on how

to help Chris upon his return

home. She does not believe her son had a personality disorder. " They take a

normal kid, he comes back messed up, then nobody was there for him when he came

back, " Linda says. " They discharged him so they didn't have to treat him. "

 

Wexler did not reply to a written request seeking comment on Mosier's case.

 

Thrown to the Wolves

 

Today Jon Town is home, in small-town Findlay, Ohio, with no job, no

prospects and plenty of time to reflect on how he got there. Diagnosing him with

personality disorder may have saved the Army thousands of dollars, he says, but

what did Wexler have to gain?

 

Quite a lot, says Steve Robinson, director of veterans affairs at Veterans

for America, a Washington, DC-based soldiers' rights group. Since the Iraq War

began, he says, doctors have been facing an overflow of wounded soldiers and a

shortage of rooms, supplies and time to treat them. By calling PTSD a

personality disorder, they usher

one soldier out quickly, freeing up space for the three or four who are

waiting.

 

Terry, the veterans' advocate from IWVO, notes that unlike doctors in the

private sector, Army doctors who give questionable diagnoses face no danger of

malpractice suits due to Feres v. U.S., a 1950 Supreme Court ruling that bars

soldiers from suing for negligence. To maintain that protection, Terry says,

most doctors will diagnose personality disorder when prodded to do so by

military

officials.

 

That's precisely how the system works, says one military official familiar

with the discharge process. The official, who requested anonymity, is a lawyer

with Trial Defense Services (TDS), a unit of the Army that guides soldiers

through their 5-13 discharge. " Commanders want to get these guys out the door

and

get it done fast.

Even if the next soldier isn't as good, at least he's good to go. He's

deployable. So they're telling the docs what diagnosis to give to get what

discharge. "

 

The lawyer says he knows this is happening because commanders have told him

that they're doing it. " Some have come to me and talked about doing this.

They're saying, 'Give me a specific diagnosis. It'll support a certain

chapter.' "

 

Colonel Martin of Fort Stewart said the prospect of commanders pressuring

doctors to diagnose personality disorder is " highly unlikely. " " Doctors are

making these determinations themselves, " Martin says. In a statement, Col.

William

Statz, commander at Fort Polk's Baynes-Jones hospital, says, " Any allegations

that clinical

decisions are influenced by either political considerations or command

pressures, at any level, are untrue. "

 

But a second TDS lawyer, who also demanded anonymity, says he's watched the

same process play out at his base. " What I've noticed is right before a unit

deploys, we see a spike in 5-13s, as if the commanders are trying to clean

house, get rid of the soldiers they don't really need, " he says. " The chain of

command just wants to eliminate them and get a new body in there fast to plug up

the holes. " If anyone shows even moderate signs of psychological distress, he

says, " they're kicking them to the curb instead of treating them. "

 

Both lawyers say that once a commander steps in and pushes for a 5-13, the

diagnosis and discharge are carved in stone fairly fast. After that happens, one

lawyer says he points soldiers toward the Army Board for Correction of

Military Records, where a 5-13 label could be overturned, and failing that,

advises

them to seek redress from their

representative in Congress. Town did that, contacting Republican

Representative Michael Oxley of Ohio, with little success. Oxley, who has since

retired,

did not return calls seeking comment.

 

Few cases are challenged successfully or overturned later, say the TDS

lawyers. The system, says one, is essentially broken. " Right now, the Army is

eating

its own. What I want to see is these soldiers getting the right diagnosis, so

they can get the right help, not be thrown to the wolves right away. That is

what they're doing. "

 

Still, Town tries to remain undaunted. He got his story to Robinson of

Veterans for America, who brought papers on his case to an October meeting with

several top Washington officials, including Deputy Surgeon General Gale Pollock,

Assistant Surgeon General Bernard DeKoning and Republican Senator Kit Bond of

Missouri. There Robinson laid out the larger 5-13 problem and submitted a

briefing specifically

on Town.

 

" We got a very positive response, " Robinson says. " After we presented, they

were almost appalled, like we are every day. They said, 'We didn't know this

was happening.' " Robinson says the deputy surgeon general promised to look into

Town's case and the others presented to her. Senator Bond, whose son has

served in Iraq, floated the idea of a Congressional hearing if the 5-13 issue

isn't

resolved. The senator

did not return calls seeking comment.

 

In the meantime, Town is doing his best to keep his head in check. He says

his nightmares have been waning in recent weeks, but most of his problems

persist. He's thinking of going to a veterans support group in Toledo,

forty-five

miles north of Findlay. There will be guys there who have been through this, he

says, vets who understand.

 

Town hesitates, his voice suddenly much softer. " I have my good days and my

bad days, " he says. " It all depends on whether I wake up in Findlay or Iraq. "