Unfit for Duty? Military Dependent Medical Record Policy Needs More Transparency

Military Dependent Medical Records 550px

Military dependents who received short term mental health assistance as children could now potentially be excluded from joining the military as adults.

For years, military families have been bombarded with messages encouraging them to seek behavioral health assistance. They’ve heard that seeking help is a sign of strength, and are told, they’re not alone and that getting help builds resilience. Sound familiar?

The Department of Defense (DoD) rightly encouraged families to seek behavioral health care to help them deal with the strains of military life compounded by 17+ years of combat operations. Messages from DoD and the Services were instrumental in breaking down the stigma associated with mental health care. They led many families experiencing tremendous stress to seek help and become more resilient. But now, those same families are facing unfair judgment; behavioral health notations in childhood military health system medical records could prevent their kids from entering the military themselves.

The Military Times recently reported about two sisters who wanted to follow their father, their grandfather, and their great-grandfather into military service. Both were denied eligibility to enlist because of mental health notations from their early teenage years documented in their military dependent medical records. Providers never shared their notations with the girls, or their parents, and all were unaware that their dependent medical records would be merged with their new service member record when they enlisted—something that does not happen for civilian enlistees. Since the Military Times article was published, several families have spoken up about similar experiences, including two families who shared stories of their kids being removed from Navy recruit training due to behavioral health treatment they received as young children.

What does this policy say to our military families? How does it protect our military children?

We are worried that it increases the stigma associated with reaching out for help, as well as parents’ willingness to communicate honestly with medical providers and seek necessary treatment for their children. We are also concerned that records may include misleading notations or inaccurate childhood mental health diagnoses.

We do not suggest allowing those unfit for duty to enter the military, but the policy of merging and sharing dependent records is concerning. And we are not alone in our objections.

Three retired military psychiatrists recently expressed concerns in a Military Times op-ed and encouraged DoD to reconsider the policy.

We believe the first step in addressing these concerns is greater transparency of the policy and process related to military dependent medical records for new recruits.

We have asked Congress to include a report requirement in the FY19 NDAA that mandates the DoD and Services provide details on three things:

  1. The scope of the issue

  2. The guidance the Services receive on how to interpret and evaluate military dependent medical records

  3. And the oversight in place to ensure those records are being interpreted and used appropriately.

We have also requested the report include details on the appeals or waiver process and the policy for examining childhood medical records of entrants who are not former military dependents. 

Given the betrayal and distrust military families are feeling after reading the Military Times reporting, we don’t think a report is too much to ask. What do you think? Please share your thoughts in the comments section.

   

Posted June 1, 2018

Comments

From: Shelli on: July 30, 2018
This is discrimination against military kids. I do not believe that any military kid should be discriminated against because of access to child hood records. We all know that military life is tough and sometimes may be we decided to take the military up on the "get help" issue being shoved down our throats. Well look where it got us. Our kids are being discriminated against and honestly most of the ones being forced out like my son would be some of the best service members around because of the fact they are use to the life style, they honor it, and for most of them it's all they know. What are we supposed to become a society that tells our kids they are not allowed to be sad - not ever or it will haunt them for the rest of their lives? This needs to be fixed.
From: Joe on: June 26, 2018
The bottom line up front is that if someone does not meet the standard, they should not be allowed to serve. That is not in dispute here. The problem presented, rather, is that military kids and non-military kids are clearly being treated very different by the military accessions complex whereby the formers’ records are forcibly accessed and the laters’ are not. Making matters worse, after the military kids’ records are forcibly accessed, working diagnoses or things long since resolved, even errors, are being held against them despite the accuracy or current prognosis of the recruit. We are failing to connect the dots that after 17 years of war, the entire military community – both service and family members – were coaxed into getting treatment and were interrogated at every medical contact as to whether they were a threat to themselves or others, and assured their answers would be 100% confidential and without retribution. The military community was highly encouraged under anti-stigma and “ready & resilient” campaigns to get help and bear all in the interest of national security (the health and readiness of our military) – another stark difference between military and civilian kids. Then, many years after those campaigns have led to the saturation of military kids’ records across the nation, military screeners are forcibly accessing those records and kicking kids out of the military, or stigmatizing and rejecting them under “never-waiver” polices, for the help they accepted in good faith. And the biggest injustice is that young adults in this situation are getting clean bills of health from the same DoD providers, yet they are having no bearing on their suitability assessments today. All the while, non-military kids are coming into the military disclosing nothing more, and being held accountable to nothing more, than what they want the military to know (remember their records will not / cannot be forcibly accessed). If we think all these non-military kids coming in with perfect medical and mental health records is reality, we are kidding ourselves. The military is simply enjoying that “ignorance is bliss” with non-military dependent applicants who “check no” all the way down their questionnaires (as instructed by their recruiters), while disparately scrutinizing and betraying the trust of military dependent applicants. No one is advocating for lowering standards or assuming risk. That is a non-starter. Let’s look beyond superficial objections to confronting this issue for what it is: negative, disparate impacts on military kids and an intuitional betrayal of trust. Trust must be restored, and we must call on Congress to take action to protect military families today and in the future.
From: HJ on: June 17, 2018
It isn't that getting treatment for mental health disqualifies you. It is that your condition may present a higher risk to both you and your fellow airmen. Some conditions (which includes diagnosis, treatment, AND outcome) don't present a higher risk. Some do. People who try to get in without telling the military about their condition seem to have an incentive to minimize or be less than forthcoming. But today's military has to be able to field an effective force at all times. So does the applicant's benefits take precedence over an effective force? That is what you must consider.
From: sarah on: June 7, 2018
This is ridiculous. The recruits that had issues as children, both non-dependent and dependent, and DID NOT get treatment are the recruits that should be barred. Getting treatment for any condition that can be resolved should not be held against these dependents nor should it bar them from military service. This seems like a violation of privacy and maybe should go to court.
From: HJ on: June 6, 2018
Since when is warfare fair? I find it deeply disturbing that psychiatrists and editors at Military Times are so unaware of the primary purpose of our military and the effects it can have on service members. The military’s purpose isn’t to hand out scholarships. It isn’t to give people benefits. It isn’t to make sure people have a job. It isn’t to make sure COLA and OHA and payroll dollars get spent. It isn’t to give Congress something to spend money on. It isn’t to give patronage to military children. The purpose of our military is to fight and die to defend and protect our freedoms and our nation. While I can understand how the National Military Family Association would advocate for families, this article shows a decided lack of critical thinking, of journalistic research or of even basic knowledge into what a medical record actually is or even a rudimentary understanding of ethics. It is not anyone’s birth right to serve in the military. In an all-volunteer force, it is a privilege. The article declares that a policy of reviewing actual medical records of applicants somehow harms or penalizes military kids. How anyone can state that it is a “penalty” to not fight and die for your country is stunning. Who is penalized when individuals get what they want (not really knowing what that entails) but fail at the job of defeating the enemy? Wouldn’t the taxpayers’ be penalized if the military hired individuals who go to combat and then can’t complete the mission due to known medical risks? I could envision articles then being written as to why the services took these individuals and then “injured” them in combat. And then I could imagine other articles complaining of the wasted taxpayer dollars in training and equipping individuals who can’t do the mission. We already have plenty of experience with how combat stress impacts healthy and resilient folks. It can break them. It does break them. It breaks those with preconditions at an even higher rate, leaving combat commanders in the field short of the troops required to do the mission. If someone develops a mental health condition that requires treatment from a mental health provider, then that reality is what it is (regardless of being a military dependent or whether diagnosed by military, or one source or civilian docs). If the condition has high risk features, and we allow that condition into the military with a known higher failure rate under stress, who is actually penalized? Everyone is. The individual is broken by the stress, the commander doesn’t have enough trained, effective troops, the military cannot complete the mission, and the taxpayer wasted money training an ineffective force. Everyone is penalized. And if parents are “withholding” needed mental health care with an eye on their children’s future GI bill or ROTC scholarship rather than their current health, then what kind of adult will that childhood produce? Human nature is to seek what each individual desires. Prior to 1973, individuals lied to avoid serving their country. Now, they lie to get their “benefits”. The anecdote cited in the Military Times editorial is the classic “one side of the story” designed to illicit sympathy of the reader against “the man” - those mean people who run the military and denied a child’s “dream”. What is stunning to me is that so-called “journalists and editors” who published the piece are so unprofessional, incurious and incapable of wider thinking, that the article doesn’t even consider, mention or perhaps even conceive the counterpoints above. And then for this “featured news” story to call for a Congressional report asking them to tell you the scope of the problem? Most applicants (~80%) get into the military meeting all the medical standards the DOD requires. Of the remaining 20%, half of those get into the military with a medical waiver (acceptable risk). Of the remaining disqualified 10%, only approximately 10% of those are military dependents. The scope of this problem is quite small. Thus, for this
From: Steve Sttobridge on: June 2, 2018
Just one more case of DoD's misuse of health care data and its refusal to responsibly acknowledge and fairly address the issues it imposes on servicemembers and family members complying with military orders.
From: Deborah DeLisle on: June 1, 2018
Knowing how many issues are included under behavioral health, I find this "1 size fits all" denial to serve offensive and demeaning to youth who still have a lot of potenial, if given a chance. Case in point. our son was diagnosed as child with ADHD, and in order to enter the military he had to have been away from meds and support for many years, before they would accept him. He is nearing 18 years now and has thrived. He has shown valuable leadership skills to those he's worked with and to new service members.
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