Defense Health Care: Better Tracking and Oversight Needed of Servicemember Separations for Non-Disability Mental Conditions
Published: 2015-02-13T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Non-disability mental conditions, such as personality disorders, can render a servicemember unsuitable for military service and can lead to an administrative separation. GAO was mandated to report on non-disability mental condition separations. This report examines the extent to which (1) DOD and the military services are able to identify the number of enlisted servicemembers separated for non-disability mental conditions, and (2) the military services are complying with DOD requirements when separating enlisted servicemembers for non-disability mental conditions, including personality disorders, and how DOD and the military services oversee such separations. GAO analyzed DOD and the military services' separation policies, policies related to tracking separations, reports the military services submitted to DOD regarding compliance with separation requirements, and interviewed DOD and military service officials.
section_title: What GAO Found
paragraphs: The Department of Defense (DOD) and three of the four military services—Army, Navy, and Marine Corps—cannot identify the number of enlisted servicemembers separated for non-disability mental conditions—mental conditions that are not considered service-related disabilities. For most non-disability mental condition separations, these services use the broad separation code, “condition, not a disability,” which mixes non-disability mental conditions with non-disability physical conditions, such as obesity, making it difficult to distinguish one type of condition from the other. In contrast, the Air Force is able to identify such servicemembers because it uses all five of the separation codes specific to non-disability mental conditions. DOD policy requires the military services to use a separation code so that DOD can track and analyze separations. Moreover, federal standards for internal control state that all transactions need to be clearly and accurately documented and readily available for examination when needed. The three services had varying reasons as to why they use the broad separation code. For example, Army officials believed that stating in servicemembers' discharge papers that they were discharged for non-disability mental conditions might stigmatize them with future employers. However, DOD stated that there are ways to protect servicemembers in this regard by providing them with discharge papers that are more general and that do not disclose specific reasons for discharge. By not systematically identifying or periodically evaluating the number of separations for non-disability mental conditions, DOD and the services cannot assess how well the separation policy and process are working or inform key stakeholders, including the Congress, about separation frequency, trends, and other data.
The military services lack separation policies that address all of DOD's eight requirements for separating servicemembers with non-disability mental conditions; both DOD and the services also lack oversight over such separations. From fiscal years 2008 through 2012, DOD required the services to report on their compliance with DOD requirements for personality disorder separations, one of the non-disability mental conditions. Most of the services reported by fiscal year 2012 that they were not compliant with all eight requirements and many of the 20 reports contained incomplete and inconsistent information. For example, 19 reports were missing information on reserve members. DOD discontinued these reports and did not institute any other oversight, which is inconsistent with the internal control standard for monitoring. GAO also found, based on a review of the services' separation policies, that the services have not updated their policies to meet all DOD requirements for non-disability mental condition separations. For example, Navy officials stated that they were unaware that DOD separation policies had changed since 2008 until GAO's review. DOD officials stated that the military services are responsible for conducting oversight of their separation processes; however, GAO found that the military services do not have processes to oversee non-disability mental condition separations. Without up-to-date and consistent policies and oversight processes, DOD and the military services cannot ensure that servicemembers separated for non-disability mental conditions have been afforded the protections intended by DOD's separation requirements and that servicemembers have been appropriately separated for such conditions.
section_title: What GAO Recommends
paragraphs: GAO recommends that DOD and the military services develop a method to identify the number of servicemembers separated for non-disability mental conditions and take a number of actions to ensure that their policies and processes can ensure that servicemembers are appropriately separated for non-disability mental conditions in accordance with DOD's separation requirements. DOD generally concurred with GAO's recommendations, but did not provide information on how or when it plans to implement the recommendations.

section_title: Letter
paragraphs: The Department of Defense (DOD) requires that all servicemembers be  physically and psychologically suitable for military service. DOD policy  permits an enlisted servicemember to be involuntarily separated from the  military if the servicemember’s mental condition is severe enough that it  interferes with the servicemember’s ability to function in the military.  Servicemembers diagnosed with a mental condition may be eligible to  receive disability compensation benefits from the Department of Veterans  Affairs (VA) if the mental condition was incurred or aggravated while the  servicemember was on active duty, such as developing post-traumatic  stress disorder (PTSD) related to combat. However, if the mental  condition is not incurred or aggravated while on active duty, it is not  considered a service-related disability by DOD and VA; in other words, it  is considered a non-disability mental condition.
Servicemember separations from the military for non-disability mental  conditions are processed as administrative separations, and DOD has  requirements that the military services—Army, Air Force, Navy, and  Marine Corps—must follow when processing these separations. DOD’s  current processing requirements apply to separations for all non-disability  mental conditions; however, prior to 2011, most of the department’s  requirements only applied to separations for one type of non-disability  mental condition—personality disorder, which is defined as a long- standing, inflexible pattern of behavior that deviates markedly from  expected behavior, has an onset in adolescence or early adulthood, and  leads to distress or impairment.
In 2008, we conducted a review of records of enlisted servicemembers  who had served in Operation Enduring Freedom or Operation Iraqi  Freedom and had been separated from the military because of a  personality disorder. We found that DOD and the military services did not  have adequate oversight to ensure that separation requirements were  being adhered to when servicemembers were separated for personality  disorders. We made recommendations to improve DOD’s and the military  services’ oversight of such separations. As a result of our review, in  January 2009, DOD required the military services to annually review a  sample of personality disorder separations to determine whether DOD  separation requirements were being followed and to report the results to  DOD.
The National Defense Authorization Act (NDAA) for Fiscal Year 2014  mandated GAO to examine issues regarding separations of  servicemembers for non-disability mental conditions. For our review, we  examined (1) the extent to which DOD and the military services are able  to identify the number of enlisted servicemembers separated for non- disability mental conditions, and (2) the extent to which the military  services are complying with DOD requirements when separating enlisted  servicemembers for non-disability mental conditions, including personality  disorders, and how DOD and the military services oversee such  separations. The NDAA also mandated GAO to report on the ability of  servicemembers administratively separated for a non-disability mental  condition to receive VA health benefits, which is addressed in appendix I.
To analyze the extent to which DOD and the military services are able to  identify the number of enlisted servicemembers that were administratively  separated because of a non-disability mental condition, we reviewed  DOD and the military services documents, such as DOD’s policy on the  use of codes to track specific types of separations, and interviewed DOD  and military service officials to understand the type of tracking conducted  and data maintained on separations for non-disability mental conditions,  and any requirements related to tracking such separations. Our review of  documents and interviews allowed us to determine the type of information  that DOD and the military services have available to identify  servicemembers separated because of non-disability mental conditions.  We assessed this information against DOD policy—which requires  separation codes to be used by the military services so that DOD can  track and analyze separations by their cause, as well as against the  federal internal control standards. The federal internal control standards  require agencies to have control activities that help ensure management’s  directives are carried out. For example, management should have a  control that all transactions—such as the separations of enlisted  servicemembers—are clearly documented and the documentation should  be available for examination.
To determine the extent to which the military services are complying with  DOD requirements when separating enlisted servicemembers for non- disability mental conditions, including personality disorders, and how  DOD and the military services oversee such separations, we reviewed  DOD’s and the military services’ separation policies to identify  requirements for separating servicemembers for non-disability mental  conditions, how these requirements evolved since our last review in 2008,  and whether the requirements have been consistent between DOD and  each of the military services’ policies. We also interviewed DOD and  military service officials to understand the services’ administrative  separation processes for non-disability mental conditions and any  oversight conducted by DOD or the military services to ensure the  processes in place are effective in ensuring DOD separation  requirements are met. Lastly, we reviewed and analyzed annual reports  the military services submitted to DOD from fiscal year 2008 through  fiscal year 2012 on their compliance with DOD’s separation requirements  when separating servicemembers for a personality disorder. Our  interviews and review of policies and compliance reports allowed us to  determine the practices that DOD and the military services use to oversee  separations of enlisted servicemembers for a personality disorder or other  non-disability mental conditions. We assessed the information we  collected against DOD’s separation policy. In addition, we assessed the  information against the federal internal control standard for monitoring,  which states that there should be reasonable assurance that ongoing  monitoring occurs in the course of normal operations. The standard also  states that, when deficiencies have been identified, there should be a  process to resolve them; and that the resolution process is not complete  until action has been taken to correct deficiencies, produce  improvements, or demonstrate that findings and recommendations do not  warrant management action.
We conducted this performance audit from April 2014 to February 2015 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
subsections: section_title: Military Services’ Separation Process
paragraphs: Enlisted servicemembers can be separated from the military when they  are found to be unsuitable for continued military service. If a  servicemember is diagnosed with a non-disability mental condition that  interferes with the servicemember’s ability to function in the military, a  commanding officer may initiate the separation process. Separated  servicemembers may appeal their separation to a discharge review board  within 15 years after separation from the military. Further, separated  servicemembers may appeal the discharge review board’s decision by  applying to a board for the correction of military records.
section_title: Separation Documentation
paragraphs: Once enlisted servicemembers have been separated from military  service, they receive a certificate of release from the military— Department of Defense Form 214 (DD Form 214)—that includes dates of  service, last duty assignment, pay grade and rank, awards received, and  a characterization of their service—such as honorable or general under  honorable conditions.entities, such as the applicable military service, VA, and the  servicemember. Servicemembers receive two copies of the DD Form  214—a copy that includes the characterization of their service and the  reason for the separation and one that does not. The reason for the  separation is noted by a separation code, as well as a narrative that  explains the reason for the separation.
section_title: Separation Codes
paragraphs: According to DOD policy, separation codes are to be used by the military  services so that data on the cause of separations can be collected and  trends in separations analyzed, which may, in turn, influence changes in  DOD separation policy. DOD established six separation codes that the  military services may use for non-disability mental conditions on the DD  Form 214, but the military services have discretion as to which codes they  choose to use. Five of these separation codes pertain only to non- disability mental conditions. They are (1) acute adjustment disorder, (2)  disruptive behavior disorder, (3) impulse control disorder, (4) personality  disorder, and (5) other non-disability mental disorder. The sixth code  available for use by the military services, “condition, not a disability,” is a  broader separation code that includes both non-disability physical and  mental conditions.
section_title: DOD’s Separation Requirements
paragraphs: DOD’s separation policy, dated January 27, 2014, contains eight  separation requirements that the military services must follow when  separating enlisted servicemembers for non-disability mental conditions.  Of the eight separation requirements, five apply to all enlisted  servicemembers and three more apply only to enlisted servicemembers  who served in an imminent danger pay (IDP) area, such as Iraq or  Afghanistan.  1.  The servicemember must be notified in writing that a non-disability  mental condition is the basis of the proposed separation,  2.  the servicemember must be formally counseled concerning  deficiencies and afforded an opportunity to overcome those  deficiencies,  3.  evidence must demonstrate that the servicemember is unable to  function effectively because of a non-disability mental condition,  4.  the servicemember must receive a non-disability mental condition  diagnosis by a authorized mental health provider,5.  the servicemember must be counseled in writing that the diagnosis of  a non-disability mental condition does not qualify as a disability.
For servicemembers who served in an IDP area, the non-disability mental  condition diagnosis must  6.  be corroborated by a peer- or higher-level mental health professional,  7.  be endorsed by the military service’s surgeon general, and  8.  include an assessment to determine whether the servicemember has  symptoms of PTSD or other mental illness co-morbidity.
Over time, DOD has expanded its separation requirements. In 2011 and  2014 DOD revised its policy by extending its separation requirements to  apply to servicemembers being separated for any non-disability mental  condition. See table 1 for an explanation of the policy changes since  2008.
section_title: DOD and Three of the Four Military Services Cannot Identify the Number of Enlisted Servicemembers Separated for Non- Disability Mental Conditions
paragraphs: DOD and three of the four military services—Army, Navy, and Marine  Corps—cannot identify the number of enlisted servicemembers separated  for non-disability mental conditions because, for most separations, they  do not use available codes to specifically designate the reason why  servicemembers were separated. Instead, they use the broad separation  code, “condition, not a disability,” that mixes non-disability mental  conditions with non-disability physical conditions, making it difficult to  distinguish one from the other without a time-consuming and resource- intensive record review. In contrast, the Air Force is able to track the  specific reasons for its servicemember separations because it uses the  full array of separation codes available.
DOD policy requires a separation code to be used by the military services  so that DOD can track and analyze the reason for separations and  evaluate DOD’s separation policy to determine if changes are needed.  However, according to DOD officials, the military services can choose to  use any of the six available codes that DOD provides the military services  to record non-disability mental conditions, including the “condition, not a  disability” code. Moreover, under the internal control standard for control  activities, all transactions—such as separations of enlisted  servicemembers—need to be clearly and accurately documented so they  can be examined when needed; for example, to monitor trends in the  reasons for servicemembers’ separations.
The three military services had varying reasons for using the broad  separation code, “condition, not a disability.” Navy and Marine Corps  officials stated that they have historically used this code for most  separations but Navy officials could not explain why they use this broad  code instead of using one of the separation codes specific to non- disability mental conditions. Marine Corps officials cited concerns with  potential stigma the servicemember may face if a more specific code is  used. Army officials had a similar concern, stating that they use the broad  separation code for most non-disability mental condition separations to  protect enlisted servicemembers after they leave the service. Army and  Marine Corps officials told us they were concerned that employers may  request the servicemember’s copy of the DD Form 214 that has the  separation code on it, and having a code specific to a mental condition  might stigmatize the servicemember. Army officials stated that this issue  has been discussed in media articles for several years.
In contrast, both Air Force and DOD officials told us that they do not have  evidence that including the separation code on the DD Form 214 has  caused problems for servicemembers, as suggested by the Army. An Air  Force official said that, unlike the Army, the Air Force does not have  information that using these codes has caused problems for separated Air  Force servicemembers. Likewise, DOD officials told us that they have not  heard that this is a problem. According to DOD officials, characterization  of service, such as honorable or dishonorable, is usually the piece of  information that employers want from the form. By including the  characterization of service on both of the servicemember’s copies of the  DD Form 214, DOD believes that the servicemember could provide an  employer with the copy that does not contain the reason for the  separation and the employer will be satisfied because the  characterization of service is indicated.
Because the three military services are using the broad separation code  “condition, not a disability” for most separations, the resulting data cannot  be used to identify the number of servicemembers separated for non- disability mental conditions. There is no other systematic way to track  these separations; that is, without a tedious and time-consuming manual  review. In one instance for example, in response to a request from DOD  for information on the number of separations for non-disability mental  conditions, the Army undertook a 6-month manual review of over 2,000  servicemember files—all because it does not delineate separations for  non-disability mental versus non-disability physical conditions in any data  system. If DOD and the military services cannot systematically identify or  periodically evaluate the number of enlisted servicemembers separated  for non-disability mental conditions, they cannot assess how well the  separation policy and process is working or respond specifically to key  stakeholders, including the Congress, about trends in or concerns about  separations for non-disability mental conditions.
section_title: Military Services’ Separation Policies Do Not Address All DOD Requirements for Non-Disability Mental Conditions Separations, and DOD and the Services Lack Oversight of Such Separations
paragraphs: From fiscal years 2008 through 2012, when the services were filing  compliance reports, most services did not report full compliance with  DOD separation requirements for separations for personality disorder. We  also found that the reports contained incomplete and inconsistent data,  and DOD conducted limited review of these reports. Further, based on a  review of separation policies, we found that none of the services’ policies  address all DOD requirements for non-disability mental condition  separations. Additionally, DOD and the military services do not have  oversight processes in place to ensure compliance with DOD  requirements in this regard.
subsections: section_title: Most Services Did Not Report Full Compliance with Requirements for Personality Disorder Separations, the Reports Contained Incomplete and Inconsistent Data, and DOD Conducted Limited Review
subsections: section_title: Most of the Military Services Had Not Reported Full Compliance When DOD Discontinued the Compliance Reports
paragraphs: From fiscal years 2008 through 2012, DOD required the military services  to monitor and report to DOD on their compliance with DOD requirements  for separating servicemembers for personality disorders; however, while  the services generally reported improved compliance over the 5 years of  reporting, we found in the 2012 compliance reports that three of the  services had not yet achieved full compliance with all of DOD’s 2008  separation requirements. For each of the 20 compliance reports the  services submitted for fiscal years 2008 through 2012, the military  services were required to review a sample of at least 10 percent of their  personality disorder separations for the fiscal year and assess the  service’s compliance with DOD’s 2008 separation requirements.  Compliance, according to DOD, was achieved if the sample reviewed met  a 90 percent compliance threshold for each requirement. According to  DOD officials, the annual compliance reports were discontinued in 2013  because the military services’ 2012 compliance reports indicated that the  services were compliant with all of DOD’s 2008 requirements. However, it  is unclear how DOD came to this conclusion when our review of the 2012  compliance reports found that the Air Force, Marine Corps, and Navy did  not report compliance with all DOD requirements. Specifically, the Marine  Corps reported compliance below 90 percent with one requirement and  the Air Force was below this compliance rate for two requirements.  Further, the Navy did not report on its compliance with three of the eight  separation requirements, so DOD could not have known the Navy’s level  of compliance in those areas.
Among the 20 compliance reports submitted during fiscal years 2008  through 2012, the services reported the most difficulty meeting the  requirement to notify all servicemembers that a personality disorder  diagnosis does not constitute a disability. For example, the Marine Corps  reported 78 percent or less compliance with this requirement in 3 of its   5 reports. finding itself noncompliant with this DOD requirement, the Air Force  acknowledged that its policy incorrectly stated that servicemember  notification was only required for servicemembers who served in an IDP  area. However, even after the Air Force updated its policy in September  2010 and made a correction in this regard, the Air Force’s compliance  with this requirement was 81 percent in fiscal year 2011 and 89 percent in  fiscal year 2012. Because three of the four services were noncompliant  with at least one requirement in their 2012 reports, DOD’s discontinuation  of these reports was premature. The federal internal control standard for  monitoring states that there should be reasonable assurance that ongoing  monitoring occurs in the course of normal operations. Further, it requires  reasonable assurance that deficiencies are identified and corrected or  otherwise resolved.
section_title: Many Compliance Reports Were Incomplete or Contained Inconsistent Information
paragraphs: Our review of the services’ compliance reports found examples of  incomplete and inconsistent information in many of the 20 compliance  reports submitted by the military services to DOD between fiscal years  2008 and 2012.
The Marine Corps reported 90 percent compliance in its fiscal year 2008 report and   100 percent compliance in its fiscal year 2011 report.
Compliance information for reservists and National Guard  members was missing. Nineteen of the 20 compliance reports did  not assess compliance with separation requirements for reservists  and National Guard members who were separated while not on active  duty. Some military service officials stated that they did not provide  information on these reservists and National Guard members because  DOD did not specifically ask for them to be included in the reports.  However, DOD instructed the Secretaries of the Army, the Air Force,  and the Navy and the Commandant of the Marine Corps to include a  random sampling of all personality disorder separations for each  military department, in which reservists and National Guard members  are included as part of their respective departments.
Compliance information for servicemembers who served in an  IDP area was missing. Eight of the 20 compliance reports did not  indicate how many of the servicemembers in their review sample had  served in an IDP area, if any. As a result, it is not clear the extent to  which compliance was assessed in these reports for the three  separation requirements that apply only to servicemembers who  served in an IDP area. Further, in its fiscal year 2011 report, Navy  reported that its review sample did not include any servicemembers  who served in an IDP area. Therefore, Navy could not have assessed  compliance with the three separation requirements that apply to these  servicemembers, even though Navy reported 100 percent compliance  with them. While DOD did not explicitly state that servicemembers  that served in an IDP area should be included in the sample reviewed  by the military services, three of the eight separation requirements  only apply to such servicemembers, so the need to include these  types of servicemembers in the review sample in order for DOD to  gauge compliance should have been clear.
The Navy had incomplete information in its fiscal year 2010  compliance report. The Navy failed to complete the reporting  requirement for its fiscal year 2010 compliance report because its  findings were based on a 4 percent sample of the total number of  servicemembers separated for a personality disorder in that fiscal  year—not the 10 percent required by DOD. In its compliance report,  Navy stated that additional separations would be reviewed to fulfill  DOD’s sample size requirement, but according to DOD and Navy  officials, the results of this review were never reported to DOD. When  asked about these additional reviews, Navy officials could not offer an  explanation regarding whether the reviews were conducted.
In addition to incomplete information in the compliance reports, we found  that two of the four services—Army and Navy—reported inconsistent  numbers in several of their compliance reports. Specifically, DOD  required the services to include in each annual compliance report the total  number of personality disorder separations. However, the Army’s and the  Navy’s reports of these numbers were not consistent across the 5 years,  as demonstrated in table 2. According to DOD officials, DOD could not  find documentation of follow-up with the services regarding these  inconsistencies.
Based on interviews with officials from DOD and the military services, we  found that almost no follow-up was conducted by DOD with the military  services regarding the compliance reports even though the services  reported noncompliance with separation requirements across the 5 years  of reports. DOD officials stated that they received the annual compliance  reports from the military services and assumed that the information  provided in these reports was accurate, given that they were signed by  each of the three military service secretaries and a representative of the  Commandant of the Marine Corps.
By not reviewing the information provided, DOD did not know that the  reports contained inconsistent and incomplete information, and the  agency made the decision to end the compliance reports based on what  we found to be faulty assurances of compliance. To discontinue  compliance reporting and not institute any other type of oversight is  inconsistent with the standards for internal control in the federal  government, which states that there should generally be assurance that  ongoing monitoring occurs in the course of normal operations.
section_title: The Military Services’ Policies Have Not Been Updated to Fully Address DOD Requirements for Separating Servicemembers for All Non-Disability Mental Conditions
paragraphs: In addition to problems we identified with compliance reports focusing on  personality disorder separations, we also found that the Army, the Navy,  the Marine Corps, and components of the Air Force—namely, the  Reserves and National Guard—have been separating servicemembers  for non-disability mental conditions according to policies that are not  consistent with all DOD requirements. Each of the services has policies  for separating servicemembers for non-disability mental conditions;  however, we found these policies to be inconsistent with DOD policy  because they have not been updated to include all of the changes in DOD  requirements over time. Specifically, we found the following.
The Army active duty separation policy is not consistent with one of  DOD’s separation requirements. not been expanded to apply to servicemembers separated for all non- disability mental conditions. In addition, the Army Reserves and  National Guard separation policy was updated in March 2014 yet  does not contain all of DOD’s separation requirements, such as the  requirement that servicemembers be counseled in writing that their  diagnosis does not qualify as a disability.
Army Regulation 635-200 Personnel Separations Active Duty Enlisted Administrative  Separations (Washington, D.C.: Sep. 6, 2011) and Army OTSG/MEDCOM Policy Memo  14-049 Administrative Separation of Soldiers for Personality Disorder (PD) under  Chapters 5-13 and 5-17, or Other Designated Physical or Mental Conditions under  Chapter 5-17 (Fort Sam Houston, T.X.: Jun. 23, 2014).
The Navy’s separation policy has not been updated to be fully   The Navy officials stated they were  consistent with DOD policy.unaware that DOD had revised its separation policy in 2011, and  again in 2014, until we discussed this with them in May 2014 during  the course of our review.
The Marine Corps’ separation policy has not been updated to be fully  consistent with DOD policy, since the Navy is responsible for revising  and implementing such policies for the Marine Corps.
The Air Force Reserves and National Guard separation policy was  created in 2005 and has not been updated over time as DOD has  updated its separation requirements for non-disability mental  conditions. For example, the policy does not contain the separation requirements applicable to servicemembers who served in an IDP  area.
Because the services have been separating servicemembers based on  outdated DOD policy, some servicemembers may not have been afforded  the protections intended by DOD’s updated separation requirements. For  example, servicemembers who served in an IDP area may not have had  their diagnosis endorsed by the military services’ Office of the Surgeon  General as required by DOD and have been separated without the benefit  of a confirmation of their diagnosis by this senior medical entity.
During the course of our review, we also found that the Air Force National  Guard does not have a process to separate National Guard members for  non-disability mental conditions. In 2013, Air Force National Guard  reported that it had not been separating Guard members for non-disability  mental conditions because it did not have a process to get a mental  health assessment or diagnosis for National Guard members. National  Guard members believed to have non-disability mental conditions were  either returned to duty or separated for another reason such as  misconduct or unsatisfactory performance of duty. According to DOD  policy, when separation for unsatisfactory performance or misconduct is  warranted, separating a servicemember for a non-disability mental  condition is not appropriate. Under federal internal control standards,  control activities should be established to help ensure that performance is  correctly assessed and transactions are accurately recorded.  Accordingly, there should be processes in place so that, if a  servicemember is identified as potentially having a non-disability mental  condition that affects the member’s ability to perform military duties, that  servicemember can be separated for such a condition in accordance with  DOD requirements, if appropriate.
The Air Force developed a corrective action plan to address the National  Guard’s inability to separate National Guard members for non-disability  mental conditions; however, this plan was never implemented. According  to officials, the biggest challenge in implementing the plan was that the  Air Force National Guard does not have authorized mental health  providers who can diagnose non-disability mental conditions. Without a  mental condition diagnosis by an authorized mental health provider, a  servicemember cannot be separated for a non-disability mental condition,  according to Air Force policy. According to officials, the Air Force National Guard would need to be tasked and provided related funding to  have these providers available. The officials could not provide any further  information on why no further action was taken to correct this identified  problem. Further, Air Force officials stated that they could not identify the  number of servicemembers potentially affected by this problem without  conducting a comprehensive file review. Air Force National Guard  members that are thought to have a non-disability mental condition but  are separated for another reason, such as misconduct, risk not receiving  the protections of DOD’s separation requirements.
section_title: DOD and the Military Services Do Not Conduct Oversight for Servicemember Separations for Non- Disability Mental Conditions
paragraphs: Beyond the limited review DOD conducted of the military services’  compliance reports conducted for personality disorder separations, which  was discontinued after fiscal year 2012, DOD and military service officials  stated they do not conduct any oversight of all non-disability mental  condition separations. In September 2011, DOD revised its separation  policy by expanding the three requirements that apply to servicemembers  who served in an IDP area to include servicemembers separated for any  non-disability mental conditions, not just for personality disorders. In  January 2014, DOD again revised this policy and expanded the  separations requirements so that all eight requirements apply to  servicemembers separated for any non-disability mental condition.  However, DOD officials stated that they have not required the military  services to conduct any review of their compliance with DOD’s separation  requirements for all non-disability mental conditions to determine whether  they are being followed. As noted previously, the internal control standard  for monitoring states that controls should be designed to assure that  ongoing monitoring occurs in the course of normal operations.
According to DOD officials, the military services are responsible for  conducting oversight of their separation processes, not DOD. However,  while some of the military services have review steps within their process  for separating servicemembers for non-disability mental conditions, none  of the services have an entity-wide oversight process, such as conducting  an annual review, to oversee separations and provide reasonable  assurance that the review steps they have in place are effective at  ensuring DOD separation requirements are met. Specifically, we found  their review processes are the following:
The Air Force separation process includes reviews of separation  packages—which is prepared by a commanding officer—by the Air  Force central personnel office and a Judge Advocate General (JAG)  Corps attorney prior to separation. Officials from these offices told  us that the purpose of the reviews is to ensure that the appropriate  documentation is present to support the separation.
The Army’s JAG Corps also reviews all separation packages prior to  separation to ensure documentation is present and is consistent with  law and policy, according to Army officials. While this is the current  practice, Army officials also told us that they have plans in place to  start conducting oversight of separations for non-disability mental  conditions. Specifically, Army officials stated that separations for non- disability mental conditions will be included as part of the Army  Organizational Inspection Program, which will review a sample of  active duty servicemember separations at local commands to see if  documentation is present that indicates that DOD separation  requirements have been met. These inspections will not include  reserve and National Guard member separations. Army officials  stated they plan to conduct the first inspection in January 2015.
The Marine Corps Judge Advocates review the separation packages  for personality disorder separations—but not for other non-disability  mental conditions separations—to ensure documentation is present  and is consistent with law and policy, according to Marine Corps  officials.
The Navy does not conduct any review of the separation package  prepared by a commanding officer prior to the servicemember’s  separation.
The absence of a routine and comprehensive entity-wide oversight  mechanism—such as an annual compliance review—prevents the military  services from knowing if they are complying with all of DOD requirements  and appropriately separating servicemembers with non-disability mental  conditions.
section_title: Conclusions
paragraphs: The inability to easily identify the number of enlisted servicemembers  separated for non-disability mental conditions hinders oversight by DOD  and the military services to ensure that servicemembers are being  separated appropriately. For example, without such data, DOD cannot  determine how many separated servicemembers have served in IDP  areas—who may be at greater risk of having a service-related mental  condition, such as PTSD—or determine if these servicemembers have  been afforded the protections intended by the separation requirements,  such as ensuring they are assessed for service-related mental conditions  prior to being separated for a non-disability mental condition. Further, lack  of such data prevents DOD from being able to conduct analyses—such  as trends in non-disability mental condition separations over time—that  are important for determining whether the separation policy is working,  and if not, how it should be changed.
Absent an effective process for monitoring and reporting compliance,  DOD and the military services cannot assure that the military services are  complying with DOD requirements for separating servicemembers with  non-disability mental conditions. The fact that some military services were  not aware of or had not yet aligned their policies or processes with  updated DOD requirements for separating servicemembers with non- disability mental conditions is of particular concern. Because the services  have been separating servicemembers based on outdated DOD policy,  the military services may not have been affording all servicemembers with  the protections that DOD intended through its recent updates of  separation requirements for non-disability mental conditions. As a result,  some servicemembers may have been separated for non-disability  mental conditions inappropriately. It is also of concern that, although the  Air Force reported its inability to separate National Guard members for  non-disability mental conditions in 2013, it has made no progress in  correcting this issue. Meanwhile, these members risk not receiving the  protections intended by DOD’s separation requirements.
section_title: Recommendations for Executive Action
paragraphs: To improve identification of enlisted servicemembers separated for non- disability mental conditions, and to provide reasonable assurance that  enlisted servicemembers, including Air Force National Guard members,  are separated for non-disability mental conditions as appropriate and in  accordance with DOD requirements, we recommend that the Secretary of  Defense take the following six actions:
Direct the Under Secretary of Defense for Personnel and Readiness  and the Secretaries of the Army and the Navy and the Commandant  of the Marine Corps to use the separation codes specific to a non- disability mental condition or develop another uniform method to track  servicemembers who have been separated for specific non-disability  mental conditions so that this information can be easily retrieved.
Direct the Under Secretary of Defense for Personnel and Readiness  and the Secretary of the Air Force to take steps to ensure there is an  appropriately staffed process to identify and administratively separate  enlisted National Guard members who are unable to function  effectively in the National Guard because of a non-disability mental  condition.
Direct the Secretaries of the Army, the Air Force, and the Navy and  the Commandant of the Marine Corps to update their services’  administrative separation policies to be consistent with DOD  regulations for those servicemembers separated for all non-disability  mental conditions.
Direct the Secretaries of the Air Force and the Navy and the  Commandant of the Marine Corps to implement processes to oversee  separations for non-disability mental conditions, such as reinstituting  the requirement of annual compliance reporting of a sample of  administrative separations, using current DOD policy requirements as  review criteria for servicemembers of all military services and their  Reserve components.
Direct the Secretary of the Army to ensure that Army’s planned  oversight of separations for non-disability mental conditions is  implemented and incorporates reservists and National Guard  members separated for such conditions, or that Army implement  another process to oversee such administrative separations using  current DOD policy requirements as review criteria for all  servicemembers, including reservists and National Guard members.
Direct the Under Secretary of Defense for Personnel and Readiness  to review any processes used by the military services to oversee such  administrative separations to ensure compliance with DOD  requirements.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided DOD and VA a draft of this report for advance review and  comment. DOD provided written comments, which we have reprinted in  appendix II. DOD generally concurred with our six recommendations.  Regarding our recommendation that DOD direct the Secretaries and  Commandant to use the existing separation codes specific to a non- disability mental condition or develop another uniform method to track  such servicemember separations, DOD provided several reasons why it  would not use the existing separation codes specific to non-disability  mental conditions, including the possible stigmatization of the  servicemember, but DOD agreed with the need to develop a method to  uniformly track such separations. In its comments, DOD did not outline  how it would develop a method to track these servicemember  separations, nor when it would implement this or other of our  recommendations. DOD and VA also provided technical comments,  which we incorporated as appropriate.
We are sending copies of this report to the appropriate congressional  committees; the Secretary of Defense; the Secretaries of the Army, the  Air Force, and the Navy; the Commandant of the Marine Corps; the  Under Secretary of Defense for Personnel and Readiness; the Secretary  of Veterans Affairs; and other interested parties. In addition, this report is  available at no charge on the GAO Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7114 or williamsonr@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made major contributions to  this report are listed in appendix III.
section_title: Appendix I: Eligibility of Servicemembers Separated for Non-Disability Mental Conditions for Veterans’ Health Benefits
paragraphs: Like any veteran separated from military service under other than  dishonorable conditions, veterans separated for non-disability mental  conditions are eligible to receive Department of Veterans Affairs (VA)  health care benefits, if they meet certain service requirements.  Generally, servicemembers must have served 24 continuous months, or  the full period for which they were called or ordered to active duty, in  order to be eligible to receive VA health care benefits.
Once VA determines the eligibility of veterans who have applied for VA  health care, it assigns them to an enrollment priority group.  Generally,  VA assigns veterans separated for non-disability mental conditions to  priority groups 5 through 8. VA assigns the veterans as follows:  If the veteran has served in an imminent danger pay (IDP) area:   the veteran is afforded what is known as enhanced enrollment status  and is generally assigned to priority group 6. The veteran is not  subject to copayments for visits or medications for conditions  potentially related to their service in an IDP area, such as physical   The veteran remains enrolled as  injuries incurred while in service.priority group 6 for 5 years after discharge from the military. If during  this 5-year, post-discharge period an eligibility status is gained that  affords enrollment in a higher priority group, such as the finding of a  compensable service-related medical condition, the veteran is  immediately moved to the higher priority group. Once the 5-year term  has ended, the veteran remains enrolled in the VA health care system  but his priority for enrollment is reassessed and the veteran may be  shifted to priority group 5, 7, or 8 depending on his household income.
If the veteran has not served in an IDP area: the veteran is  assigned to priority group 5, 7, or 8 based on income level. Veterans  enrolled in these priority groups must agree to pay applicable  copayments. Veterans remain enrolled in the VA health care system  but are reassessed annually, and placed in a priority group based on  the veteran’s household income. (See fig. 1)
Once assigned a priority group and enrolled in VA’s health care system,  the veteran is eligible to receive VA’s medical benefits package, which  covers most of VA’s medical services such as preventive care, and  outpatient and inpatient diagnostic and treatment services, and includes  services for mental health conditions.
section_title: Appendix II: Comments from the Department of Defense
section_title: Appendix III: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Marcia A. Mann (Assistant  Director), Zhi Boon, Deirdre Brown, Cathleen J. Hamann, Lisa Opdycke,  Vikki Porter, and Laurie F. Thurber were major contributors to this report.  Jacquelyn Hamilton provided legal support.