The purpose of the medical examination—or screening—is to assess  whether these conditions were a mitigating factor in the behavior that  resulted in the misconduct charge. Many Servicemembers Separated for Misconduct Had PTSD, TBI, or Certain Other Conditions; About a Quarter Were Potentially Ineligible for VA Benefits and Services

Our analysis of DOD data shows that 91,764 servicemembers were  separated for misconduct from fiscal years 2011 through 2015; of these  servicemembers, 57,141—62 percent—had been diagnosed within the 2  years prior to their separation with PTSD, TBI, or certain other conditions  that could be associated with misconduct. Looking at the  conditions individually, 8 percent had been diagnosed with PTSD and 11  percent had been diagnosed with TBI, while other conditions, such as  adjustment and alcohol-related disorders were more common. Further, of these servicemembers, 23 percent, or 13,283, received an  “other than honorable” characterization of service, making them  potentially ineligible for VA benefits and services, including health care. Our assessment  was based on the following requirements set forth in DOD’s screening  policy, which align with applicable statutory requirements:  1.  do the military services’ screening policies apply to servicemembers  diagnosed with PTSD or TBI by a physician, clinical psychologist,  psychiatrist, licensed clinical social worker, or psychiatric advanced  practice registered nurse;  2.  do the military services’ screening policies apply to servicemembers  facing administrative separation under conditions other than  honorable, including those separating in lieu of trial by court-martial;  and  3.  do the military services’ screening policies identify an appropriate  official to review the results of the screening before deciding whether  the servicemember’s service was “other than honorable?”
We did not assess the military services’ consistency with DOD’s  screening policy regarding the types of providers eligible to perform  screenings because at the time of our review, DOD’s policy was  inconsistent with the law in one respect. We found that two of the four military  services’ TBI training policies are inconsistent with DOD policy. This is consistent with DOD policy. Army and Marine Corps May Not Have Adhered to Their Own Policies Related to PTSD and TBI Screening, Training, and Counseling

In our review of separation documents and interviews with installation- level Army and Marine Corps officials we found that the Army and Marine  Corps may not have adhered to their own screening, training, and  counseling policies. In  11 of the 48 packets included in our analysis of Army servicemembers  who requested separation in lieu of trial by court-martial, we found that  there was no documented evidence or the evidence was unclear as to  whether the servicemembers were counseled on their potential ineligibility  for VA benefits and services. DOD, Army, and Marine Corps Do Not Routinely Monitor Adherence to Policies to Address the Impact of PTSD and TBI on Servicemembers

DOD does not routinely monitor the military services’ adherence to  policies for screening servicemembers for PTSD and TBI prior to  separating them for misconduct, training officers on how to identify  symptoms of TBI in the deployed setting, and counseling servicemembers  on eligibility for VA benefits and services. While both Army and Marine Corps have  some data available that could make it possible for them to monitor  whether their screening, training, and counseling policies are being  adhered to as required, the two military services are not routinely using  these data to do so because of limited resources in some instances,  according to an official. Federal internal control standards call for  agencies to establish activities to monitor internal control systems and  evaluate results. However, we found that Air Force and Navy’s  pre-separation screening and training policies are inconsistent with DOD  policy. Furthermore, we found that the Army and Marine Corps may not  always be adhering to their own policies and that monitoring of the  policies—which could include a review of documentation, data analyses,  or other oversight mechanisms—by DOD, Army, and Marine Corps is  limited. Recommendations for Executive Action

To increase its assurance that PTSD and TBI are appropriately  considered prior to separating certain servicemembers from the military  for misconduct, the Secretary of Defense should take the following five  actions:  Direct the Air Force and Navy to address inconsistencies with DOD policy  in their policies related to  screening certain servicemembers, including servicemembers  separating in lieu of trial by court-martial, for PTSD and TBI and  reviewing the results prior to separation for misconduct; and  training servicemembers, including officers, on how to identify mild  TBI symptoms in the deployed setting. Appendix IV: Characterization of Service for Servicemembers Separated for Misconduct from Fiscal Years 2011 through 2015 and Previously Diagnosed with PTSD, TBI, or Certain Other Conditions

Tables 9 and 10 provide information on characterization of service for  servicemembers who were administratively separated for misconduct or  administratively separated in lieu of trial by court-martial from fiscal years  2011 through 2015 and diagnosed within the 2 years prior to separation  with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), or  certain other conditions.
Why GAO Did This Study

The Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 contains a provision that GAO examine the effect of PTSD, TBI, and certain other conditions on separations for misconduct. This report examines (1) the number of servicemembers separated for misconduct who were diagnosed with PTSD, TBI, or certain other conditions and were potentially ineligible for VA benefits and services; (2) the extent to which military services' policies to address the impact of PTSD and TBI on separations for misconduct are consistent with DOD's policies; (3) the extent to which Army and Marine Corps have adhered to their policies; and (4) the extent to which DOD, Army, and Marine Corps monitor adherence to the policies. GAO analyzed DOD data; reviewed applicable policies; interviewed DOD, Army, Marine Corps, Air Force, and Navy officials; visited two Army and one Marine Corps sites selected on factors such as separation rates; and reviewed a nongeneralizable sample of Army and Marine Corps servicemember misconduct separation documents.

What GAO Found

GAO's analysis of Department of Defense (DOD) data show that 62 percent, or 57,141 of the 91,764 servicemembers separated for misconduct from fiscal years 2011 through 2015 had been diagnosed within the 2 years prior to separation with post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), or certain other conditions that could be associated with misconduct. Specifically, 16 percent had been diagnosed with PTSD or TBI, while the other conditions, such as adjustment and alcohol-related disorders, were more common. Of the 57,141 servicemembers, 23 percent, or 13,283, received an “other than honorable” characterization of service, making them potentially ineligible for health benefits from the Department of Veterans Affairs (VA).
GAO found that the military services' policies to address the impact of PTSD and TBI on separations for misconduct are not always consistent with DOD policy. For example, contrary to DOD policy, Navy policy does not require a medical examination—or screening—for certain servicemembers being separated in lieu of trial by court-martial to assess whether a PTSD or TBI diagnosis is a mitigating factor in the misconduct charged. This type of separation occurs when a servicemember facing a trial by court-martial requests, and is approved, to be discharged administratively. In addition, GAO found that two of the four military services have TBI training polices that are inconsistent with DOD policy.
GAO also found that the Army and Marine Corps may not have adhered to their own screening, training, and counseling policies related to PTSD and TBI. For example, GAO found that 18 of the 48 nongeneralizable sample separation packets reviewed for Marine Corps servicemembers administratively separated for misconduct lacked documentation showing that the servicemember had been screened for PTSD and TBI. During interviews with Army officers, GAO found that some officers may not have received training to identify mild TBI symptoms, despite Army policy that all servicemembers should be trained. Further, GAO found instances in which both Army and Marine Corps may not have adhered to their counseling policies, which require that servicemembers, specifically prior to requesting separation in lieu of trial by court-martial, be counseled about their potential ineligibility for VA benefits and services. For 11 of the 48 separation packets included in GAO's analysis of Army servicemembers who requested separation in lieu of trial by court-martial, there was no documented evidence—or the evidence was unclear—as to whether the servicemembers received counseling.
Finally, while Army and Marine Corps have some available data on servicemembers' screenings, training, and counseling, the military services do not use these data to routinely monitor whether they are adhering to relevant policies. Federal internal control standards call for agencies to establish monitoring activities to ensure internal control systems and evaluate results. Without monitoring adherence to these policies, the military services cannot provide assurance that servicemembers with PTSD and TBI are receiving adequate consideration of their conditions as well as the services DOD has established for them.

What GAO Recommends

GAO is making five recommendations, including that DOD direct the Air Force and Navy to address inconsistencies in their screening and training policies and ensure that the military services monitor adherence to their screening, training, and counseling policies. DOD agreed with four of GAO's recommendations, but did not agree to address inconsistencies in training policies. GAO maintains inconsistencies should be addressed, as discussed in the report.