Enlisted servicemembers can be separated from the military when they are found to be unsuitable for continued military service. According to DOD regulations, enlisted servicemembers can be separated for reasons such as misconduct, failure to overcome substance abuse, and certain mental health conditions, including a personality disorder. A personality disorder by itself does not make enlisted servicemembers unsuitable for military service. DOD requires that the disorder be severe enough that it interferes with an enlisted servicemember’s ability to function in the military. DOD and the military services require that to diagnose a personality disorder a psychiatrist or psychologist use criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was developed by the American Psychiatric Association. Similarly, in the private sector, clinicians use criteria in the DSM to diagnose a personality disorder, but in some instances, clinicians other than psychiatrists or psychologists, such as licensed clinical social workers, may make this diagnosis. Diagnosing a personality disorder in a servicemember who has served in combat can be complicated by the fact that some symptoms of a personality disorder may be similar to symptoms of combat-related mental health conditions. For example, both personality disorder and PTSD have similar symptoms of feelings of detachment or estrangement from others, and irritability. According to the American Psychiatric Association and the American Psychological Association, the only way to distinguish a personality disorder from a combat-related mental health condition, such as PTSD, is by getting an in-depth medical and personal history from the servicemember that is corroborated, if possible, by family and friends. According to DOD officials, the three key requirements that the military services must follow when separating an enlisted servicemember are designed to help ensure that enlisted servicemembers are separated for the appropriate reason. Documentation of compliance with these requirements is to be included in the separation packet found in the enlisted servicemember’s personnel record, as required by the military services. The separation packet is required to contain other documents related to the enlisted servicemember’s separation. According to officials from the military services, the servicemember’s immediate commander gives the separation packet to an installation official who is to review the packet to verify that the requirements for the personality disorder separation have been met. If this review verifies that the requirements have been met, the separation packet is then sent to a commander at the installation who has authority for approving a personality disorder separation for that enlisted servicemember. This commander is a higher- level officer than the enlisted servicemember’s immediate commander. A military installation may have more than one commander who has the authority to approve separations because of a personality disorder. However, each commander with separation authority approves separations only for enlisted servicemembers under his or her command. Once enlisted servicemembers have been separated from military service, they receive certificates of release from the military, which include information on the reason for separation and an official characterization of their time in the service. For enlisted servicemembers separated because of a personality disorder, their certificates of release would state that the reason for their separation was a personality disorder. Employers may request to see separated servicemembers’ certificates of release to verify their military service, and employers may make employment decisions based on the information they see on servicemembers’ certificates of release. Enlisted servicemembers have protections available to them when going through the separation process. All enlisted servicemembers can submit statements on their own behalf to the commander with separation authority, consult with legal counsel prior to separation, and obtain copies of the separation packet that is sent to the commander with separation authority. In addition, enlisted servicemembers with 6 or more years of military service are eligible to request a hearing before an administrative board. An administrative board hearing allows enlisted servicemembers to have legal representation, call witnesses, and speak on their own behalf in defending against the recommended separation. The board includes at least three members who, following a hearing, make a recommendation to the commander with separation authority as to whether the enlisted servicemember should be separated. Enlisted servicemembers also have protections available to them after they have been separated. They may challenge the reasons given for their separations after they have been separated from the military. Within 15 years after separation from the military, enlisted servicemembers may appeal their separation to a discharge review board. Further, enlisted servicemembers may appeal the discharge review board’s decision by applying to a board for the correction of military records. The four military installations we visited varied in their compliance with DOD’s three key requirements for personality disorder separations. For the four installations, compliance with the first requirement—to notify enlisted servicemembers of their impending separation because of a personality disorder—was at or above 98 percent. For the second requirement, that enlisted servicemembers must be diagnosed with a personality disorder by a psychiatrist or psychologist who determines that the personality disorder interferes with servicemembers’ ability to function in the military, the compliance rates ranged from 40 to 78 percent. Compliance ranged from 40 to 99 percent for the third requirement, that enlisted servicemembers receive formal counseling about their problem with functioning in the military. Our review of the documentation in the enlisted Navy servicemembers’ separation packets found that compliance varied by requirement. Across the four installations, the percentage of enlisted servicemembers’ separation packets that documented compliance with the notification requirement ranged from 98 to 100 percent. Of the 312 enlisted servicemembers’ separation packets included in our review, only 4 did not contain documentation that the servicemembers received notification that they were being separated because of a personality disorder. We did not assess whether the separation packets for these 4 servicemembers had documentation that indicated compliance for the remaining two key separation requirements. Across the four installations, the percentage of enlisted servicemembers’ separation packets that had documentation indicating compliance with all three parts of the second requirement—that enlisted servicemembers separated because of a personality disorder (1) be diagnosed with a personality disorder (2) by a psychiatrist or psychologist who (3) determines that the personality disorder interferes with servicemembers’ ability to function in the military—ranged from 40 to 78 percent. Noncompliance with this requirement occurred in two ways: enlisted servicemembers’ separation packets did not contain the medical form used to document the three parts of this requirement or servicemembers’ separation packets contained the medical form but documentation on the form for one or more of the three parts of this requirement was missing or incorrect. Figure 1 summarizes the four installations’ compliance rates for this requirement. We found that 34 enlisted servicemembers’ separation packets did not contain a medical form, which is used to document compliance with the three parts of this requirement. We also found that of the enlisted servicemembers’ separation packets that contained a medical form, the medical form in 66 of these packets did not contain information needed to fulfill all three parts of the requirement. For example, 27 of these 66 enlisted servicemembers’ medical forms had documentation indicating that the servicemember had been diagnosed with a personality disorder, but there was also information in the medical form indicating that the diagnosis was not made by a psychiatrist or psychologist. In some of these cases, we found that the diagnosis of a personality disorder was made by a licensed clinical social worker or other type of provider, such as a battalion surgeon. We found that compliance with the requirement that enlisted servicemembers receive formal counseling about their problem with functioning in the military ranged from 40 to 99 percent. Across the four installations, we found that 42 enlisted servicemembers’ separation packets did not contain a counseling form documenting that servicemembers received formal counseling as required. As a result, these 42 servicemembers’ separation packets were noncompliant with this requirement. Figure 2 summarizes the four installations’ compliance rates for this requirement. Our review of the documentation in 59 enlisted Navy servicemembers’ separation packets found that compliance varied by requirement. Of the separation packets that we reviewed, 95 percent had documentation indicating that enlisted servicemembers had been notified of their impending separation because of a personality disorder. (Three enlisted servicemembers’ separation packets did not contain documentation of this requirement, and as a result, we did not assess compliance with the remaining two requirements for these three servicemembers’ separation packets.) The requirement that enlisted servicemembers be diagnosed with a personality disorder by a psychiatrist or psychologist who determines that the personality disorder interferes with servicemembers’ ability to function in the military had a compliance rate of 82 percent for the 56 remaining enlisted Navy servicemembers’ separation packets that we reviewed. Of the 56, we found that 1 enlisted Navy servicemember’s separation packet did not contain a medical form, which is used to document compliance with the three parts of this requirement. We also found that 9 of the 56 enlisted Navy servicemembers’ separation packets contained a medical form, but did not have documentation indicating compliance with all three parts of this requirement. Most of these—6—did not have documentation indicating that the diagnosis of a personality disorder was made by a psychiatrist or psychologist. For the requirement for formal counseling, 77 percent of the 56 enlisted Navy servicemembers’ separation packets contained documentation that enlisted servicemembers received formal counseling about their problem with functioning in the military. DOD does not have reasonable assurance that its key personality disorder separation requirements have been followed. DOD policy directs the military services to implement and ensure consistent administration of DOD’s requirements for separating enlisted servicemembers because of a personality disorder. In turn, according to officials in each of the military services, the military services delegate to commanders with separation authority at the military installations sole responsibility for ensuring that the requirements are followed for enlisted servicemembers under their command.