Snapshot: Foreign Service Regional Medical Officers/Psychiatrists

Posted: 2:06 am EDT

According to a job announcement posted earlier this year, there are Foreign Service Regional Medical Officers/Psychiatrists assigned at the following locations:

  • Accra
  • Amman
  • Athens
  • Bangkok
  • Beijing
  • Bogota
  • Cairo
  • Dakar
  • Frankfurt
  • Jakarta
  • Lima
  • London
  • Manama
  • Mexico City
  • Moscow
  • Nairobi
  • New Delhi
  • Pretoria
  • Tokyo
  • Vienna
  • District of Columbia

RMO/Ps also serve on temporary duty in high threat locations (e.g., Afghanistan, Iraq, Libya, Pakistan and Yemen etc.) and in post-disaster environments (e.g., post-earthquake Haiti, etc).  The U.S. embassies in Libya and Yemen are currently on suspended operations, and temporarily located in Tunisia and Saudi Arabia respectively.

The latest available data on FS skills group published via in 2013 indicates that the State Department has 24 psychiatrists and 4 mental health specialists. There are 275 overseas posts. As of 2014, there are 13,801 employees (FSOs – 8,042; Specialist – 5,759) and 11,701 adult family members overseas according to an April 2015 FLO data; a total FS population overseas of 25,202.  If we include the Civil Service employees and the locally employed staff, the State Department has a total workforce of 71,782. Let’s try and do the math.

— That’s one psychiatrist/mental health specialist for every 492 Foreign Service employees.

— Or one psychiatrist/mental health specialist for every 900 FS employees and family members.

— Or one psychiatrist/mental health specialist covering at least nine diplomatic/consular posts overseas.

— Or one psychiatrist/mental health specialist for every 2,562 State Department employees domestic and overseas.


No Comparator Case For DS Agent With PTSD — Failure to Follow Regs, Lack of Candor Charges Came 2 1⁄2 Years Late

Posted: 3:12 am  EDT


This is a case of a DS Agent charged with lack of candor and failure to follow regulations for incidents that took place in 2010 related to his PTSD.   The State Department issued a final decision to  suspend the agent for 12 days.  According to the ROI, the deciding official at the agency level grievance “also considered the mitigating factors and gave grievant credit for having no past formal disciplinary record and a satisfactory work history. The deciding official also noted grievant’s potential for rehabilitation, while recognizing that grievant clearly was embarrassed by his diagnosis of PTSD, and feared that he might be stigmatized by the label, or that he might even lose his job with the Department.”

A couple things striking about this case.  Following grievant’s military service in Iraq in 2006, he started having panic attacks and severe anxiety, for which he was prescribed several medications – none of which he says worked very well. His symptoms became worse over time. In 2009 he was diagnosed as having Post Traumatic Stress Disorder (PTSD).  The incidents that ultimately led to the two charges occurred in November 2010; yet the Department did not propose disciplinary action until April 24, 2013 – a span of 29 months. The ROI does not explain the delay.

Grievant reportedly denied during the interviews with that he had been diagnosed with PTSD, saying instead that he had been treated for anxiety and panic attacks. And yet, according to the ROI, grievant avers that “he discussed his PTSD diagnosis in considerable detail with the DS investigators, and authorized release of his medical records.”

Grievant admits he did not comply with Department regulations requiring him to report that he had been prescribed psychiatric medications, but claims he was unaware of the policy requiring him to do so. He claims that he was not alone in being unaware of this requirement, as many other DS officers to his knowledge were also unaware of the regulation.

Since grievant is a DS agent, the Department has also cited 12 FAM Exhibit 023 2.5, its Deadly Force and Firearms Policy (which we can no longer read online, as it’s now behind the firewall). 12 FAM Exhibit 023 section 2.5 12 FAH-9 H-030 appears specific to prescription medication.  The State Department showed, and the FSGB agreed that there are no similar cases that presented the same set of circumstances as in this grievant’s case.

The Board held that grievance be granted in part and denied in part. The Board remanded the case to the Department to consider an appropriate penalty in view of their decision not to sustain two specifications of one of the two charges.


Grievant faces two charges – Lack of Candor and Failure to Follow Regulations – that were leveled against him because of statements he made during a Department investigation about incidents that took place while he was in the U.S. on leave in 2010. He is a Diplomatic Security Special Agent who was admitted to the hospital on two occasions (on consecutive days) after he drank alcohol heavily and took an unknown quantity of prescription medications after he became upset about the breakup of his engagement to be married. The investigation revealed discrepancies between the information grievant gave to investigators and that found in his medical records. Records show that grievant suffers from PTSD and that he had not reported this fact to the Department. The investigation report claims that grievant denied during interviews that he had ever been diagnosed with PTSD or that he was ever in a treatment program to address the condition. His records also show that he had been prescribed several psychiatric medications, and contained no evidence that grievant had reported to the Department either the PTSD diagnosis, or the prescription medicines which are required to be reported under the agency’s Deadly Force and Firearms policy. The Department’s final decision provided for a 12-day suspension without pay.

Grievant denies the majority of the specifications cited in the charges. He claims to have discussed his PTSD diagnosis in detail with the investigators and avers that he responded candidly to all of the questions posed to him during two DS interviews. He admits that he did not report the prescription medicines, but argues that he was unaware he needed to do so. Grievant also claims that the charges are untimely, having been brought after a very long delay – nearly 2 1⁄2 years after the incidents, and that the delay has prejudiced his ability to present his case. He claims to have been particularly disadvantaged in that he is unable to find witnesses who could corroborate his positions or shed light on the quantity of medications he took prior to the 2010 incidents. He also argues that the proposed penalty, in any case, is overly harsh in light of penalties the Department has imposed for like offenses. He requests that those charges/specifications the Department is unable to establish should be overturned, and the 12-day suspension should be mitigated.

Click on the image or the link below to read ROI in pdf file. The file is redacted and originally published online by the Foreign Service Grievance Board.

2014-020 - 04-29-2015 - B - Interim Decision_Redacted-2-02

FSGB Case 2014-020 – 04-29-2015 – B |DS Agent – PTSD Case                         (click image to read in pdf)

2014-020 – 04-29-2015 – B – Interim Decision_Redacted-2

The regs apparently say that “a DSS Special Agent who is taking prescription medication to notify his supervisor and submit a medical certificate or other administratively acceptable documentation of the prescription … to the Domestic Programs Division of the Office of Medical Services immediately after beginning the medication.” We don’t know what happens to DS agents who self report as required by regulations.  Are their USG-issued weapons removed? Are they subject to reassignment? Is there a perception that this is an embarrassment?

Given that many Diplomatic Security personnel have now done multiple tours to war zones and high threat posts, is this really an isolated case of not self-reporting both the PTSD diagnosis and the use of prescription medication?

We sent this individual to Iraq in 2006. He came back with unseen wounds. And here he is in 2015, still fighting his battle.   What can the State Department do to make employees with potential PTSD less fearful of being stigmatized in coming forward and acknowledging they need help? What can the Bureau of Diplomatic Security do more for its agents? How can this be made into a less lonely fight?


June Is PTSD Awareness Month — Let’s Talk Mental Health, Join Us at the Forum

Posted: 11:13 pm  EDT

Join us at the forum today at, noon – 2pm, EST

I’ve blogged about mental health in the State Department for years now (see links below). I know that a mental health issue affecting one person is not a story of just one person.  It affects parents, spouses, children, siblings, friends; it affects the home and the workplace. It is a story of families and communities. While there is extensive support in the military community, that’s not always the case when it comes to members of the Foreign Service.

I once wrote about a former Foreign Service kid and his dad with severe PTSD. A few of you took the time to write and/or send books to the ex-FS employee incarcerated in Colorado, thank you.

I’ve written about Ron CappsRachel SchnellerCandace Faber, FSOs who came forward to share their brave struggles with all of us. There was also a senior diplomat disciplined for volatile behavior who cited PTSD, I’ve also written about Michael C. Dempsey, USAID’s first war-zone related suicide, and railed about suicide prevention resources.  The 2014 Foreign Service Grievance Board 2014 annual report says that eight of the new cases filed involved a claim that a disability, Post Traumatic Stress Disorder (PTSD), or other medical condition affected the employee performance or conduct that resulted in a separation recommendation.

With very few exceptions, people who write to this blog about mental health and PTSD do so only on background. Here are a few:

  • A State Department employee with PTSD recently told this blog that “Anyone outside of our little insular community would be appalled at the way we treat our mentally ill.”  The individual concludes with clear frustration that it “seems sometimes the only unofficially sanctioned treatment plan encouraged is to keep the commissaries well stocked with the adult beverage of your choice.” 
  • Another one whose PTSD claim from service at a PRT in Iraq languished at OWCP said, “I can assure you that OER and State Med have been nothing but obstructions… as a vet, I have been treated at VA for the past ten months, else I would have killed myself long ago.”
  • Still another one writes: “VA indicates the average time between trauma and treatment-seeking is eight years. The longer it is undiagnosed and treated, the more difficult to ameliorate. I have a formal diagnosis from VA but could not even get the name of a competent psychiatrist from DoS. The bulk of DoS PTSD claims are still a few years away (2008/2009 PLUS 8), with no competent preparation or process.”
  • A friend of a State employee wrote that her DOS friend was “deployed/assigned to a  war-torn country not too long ago for a year. Came back with PTSD and  was forced by superiors to return to very stressful/high pressure work  duties while also seeking medical attention for an undiagnosed then, but eventually diagnosed (took about 6 months) disease  triggered by environmental conditions where s/he was last posted.”
  • Another FSO said, “I actually thought State did a decent job with my PTSD. After I was subject to an attack in Kabul, the social worker at post was readily available and helpful. He indicated I could depart post immediately if I needed to (and many did after the attack). When I departed post I was screened for PTSD and referred to MED here in DC. After a few sessions here with MED, I was referred to a private psychologist who fixed things up in a few months.”
  • One FSO who suffered from PTSD assured us that “State has come a very long way since 2005” and that it has made remarkable progress for an institution. Her concerns is that PTSD is widespread in the Department in the sense that people develop it in a wide range of posts and assignments. She cited consular officers in particular, who evacuate people from natural disasters and civil wars and deal with death cases on a regular basis, and are particularly at risk.


Screen Shot 2015-06-03

June is PTSD Awareness Month. We are hosting a forum at for an open discussion on PTSD.

It’s not everyday that we get a chance to ask questions from somebody with post traumatic stress disorder. On Monday, June 29, FSO Rachel Schneller will join the forum and answer readers’ questions  based on her personal experience with PTSD.  She will be at this blog’s forum from noon to 2 pm EST. She will join the forum in her personal capacity, with her own views and not as a representative of the State Department or the U.S. Government.  She’s doing this as a volunteer, and we appreciate her time and effort in obtaining official permission and  joining us to help spread PTSD awareness. Please feel free to post your questions here.

Rachel Schneller joined the Foreign Service in 2001. Following a tour in Iraq 2005-6, she was diagnosed with PTSD. Her efforts to highlight the needs of Foreign Service Officers returning from tours in war zones helped prompt a number of changes in the State Department, for which she was awarded the 2008 Rivkin Award for Constructive Dissent.

Prior to joining the U.S. Department of State, Rachel served as a Peace Corps volunteer in Mali from 1996-98. She earned her MA from the Johns Hopkins School of Advanced International Studies (SAIS) in 2001. We have previously featured Rachel in this blog here, and here.

The forum, specifically created for PTSD discussion is setup as an “open” forum at this time; readers may post questions without registration.  We’re hosting, same Privacy Policy apply.


Below are some of our previous blog posts on mental health, PTSD, security clearance and the State Department’s programs:

What to do when different voices start delivering multiple démarches in your head?]

USAID’s First War-Zone Related Suicide – Michael C. Dempsey, Rest in Peace

State Dept’s Suicide Prevention Resources — A Topic So Secret No One Wants to Talk About It

Former Foreign Service Kid Writes About Dad With Severe PTSD  (Many thanks to readers who took the time to write and send books to Tony Gooch! We appreciate your kindness).

Ron Capps | Back From The Brink: War, Suicide, And PTSD

Rachel Schneller | PTSD: The Best Thing that Ever Happened to Me

Senior Diplomat Disciplined for Volatile Behavior Cites PTSD in Grievance Case, Fails

Pick the Long or Short Form, But Take the Post-Traumatic Stress Disorder (PTSD) Screening

On the Infamous Q21, PTSD (Again) and High Threat Unaccompanied Assignments

Ambassador Crocker Arrested for Hit and Run and DUI in Spokane

Quickie | Running Amok: Mental Health in the U.S. Foreign Service

Former FSO William Anthony Gooch: No Mercy for Broken Men?

Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Clinton issues note on mental health; seeking help a sign of maturity and professionalism

EFM shouldn’t have to see three RMOs, do a PPT presentation and wait 352 days for help

Join the Petition: Revised Q21 for the Foreign Service

State Dept’s WarZone Deployment Incentives, Programs, Training and Medical Support

DMW: Mental Health Treatment Still a Security Clearance Issue at State Department

Insider Quote: Returning to the Real World

What’s State Doing with Question 21?


Foreign Service Grievance Board Annual Report 2014 — Noteworthy Cases

Posted: 1:30  am EDT


The Foreign Service Grievance Board recently released its 2014 annual report:

A primary goal of the Board continuing during this past year (and in prior years) has been to improve its timeliness in terms of issuing its orders and decisions. The Board is acutely aware of the short timeframes that impact the careers of Foreign Service employees, and especially the schedules of various agency-appointed boards that grant tenure, decide on promotions, rank (and “low rank”) employees, and make other career-defining personnel decisions. While the Board does not fully control the entire grievance appeal process, e.g., the period during which the parties engage in sometimes lengthy discovery or file time- consuming motions, it has put in place procedures to expedite where possible those actions it does control.
The three-member panels selected to decide grievance appeals continued to work effectively during the year, producing several orders and decisions with significant issues of first impression or complexity. Social media has had an impact on some of the Board’s grievance appeals, and is likely to expand as a growing presence in both professional and personal interactions among Foreign Service employees. The increased exposure of what may have been considered private communications in the past has produced challenging questions regarding standards for personal and professional conduct of Foreign Service personnel, including the issue of what is a reasonable expectation of privacy; similarly, rapid changes in technology, in particular the growth of digitally based communications and cyber tools such as cloud computing, have altered methods of information storage, access and security that undoubtedly affect Foreign Service operations. These developments, along with rapidly evolving social and demographic changes, both within the Foreign Service and the society at large, are likely to influence to some degree future grievance disputes. A major challenge for the Board is to maintain its level of institutional and technological awareness to keep pace with the dynamic environment in which future dispute resolution will be necessary.

See the stats here:  Snapshot: Foreign Service Grievance Board Annual Report 2014 – Statistics

According to the 2014  report, the largest number of grievance appeals by office were those filed by employees of the Department’s Bureau of Diplomatic Security (31% of the total). The Board is now seeing cases on disability, Post Traumatic Stress Disorder (PTSD), or other medical condition that affected the employee performance or conduct that resulted in a separation recommendation.  The average time for disposition of a case, from time of filing to Board decision, withdrawal, or dismissal, was 45 weeks. This is two weeks longer than the average time of disposition in 2013. The Board currently has 19 members, with 12 retired foreign affairs members and 7 legal professionals.

Below is an excerpt from the report:

Fifty-three new cases were filed with the Board in 2014, comparable to the number filed the previous year (54). Over the past six years, the number of new cases has ranged from a high of 74 to a low of 43. Of the 2014 cases, 47 cases were filed by employees of the Department of State (or survivors of State Department employees); five by employees of USAID; and one by AFSA. No cases were filed by employees of the other agencies under the Board’s jurisdiction.
Timeliness of disciplinary actions, as governed by agency regulations, also continued as an issue of concern to employees. In three new cases filed, the employees alleged that delays ranging from 14 to 36 months violated Department regulations and disadvantaged them. Two cases involving timeliness were decided by the Board this year. In the first case, the Board found that a three-year delay was prejudicial to the employee and dismissed the charges. In the second, a two-year delay was deemed not to be prejudicial, but the charges were dismissed as not proven.

Eight of the new cases filed involved a claim that a disability, Post Traumatic Stress Disorder (PTSD), or other medical condition affected the employee performance or conduct that resulted in a separation recommendation. Four involved allegations of alcohol abuse. The largest number of grievance appeals by office were those filed by employees of the Department’s Bureau of Diplomatic Security (31% of the total).

A number of individually noteworthy cases were filed in 2014:

    • A USAID case involved the starting salary of a new hire, whose documentation of his previous salary while self-employed was alleged to be fraudulent. The grievant was one of several USAID new hires who were issued bills of collection for overpayment of salary following an agency audit of the starting salaries of new hires. Regulations for establishing starting salaries primarily took into account standard salary histories, and did not address factors stemming from self-employment or lower salaries/stipends earned while an applicant was earning an advanced degree.
  • The daughter of a State Department employee contested a bill of collection issued by the Department for $311,000 in overpayment of a survivor annuity and denial of a waiver for the overpayment. The grievant was unaware that she needed to notify the Department upon the death of her mother. Survivor annuity payments were deposited into a joint account for several years before the error was discovered.
  • AFSA filed an implementation dispute challenging the Department’s decision to deny payment of Meritorious Service Increases (MSIs) to outstanding employees identified by the selection boards in 2013. AFSA maintained that its agreement to defer such payments during sequestration of the budget in 2013 did not extend to a discretionary decision by the Department to withhold such payments permanently after the funds were available.
  • A former president of AFSA contested the propriety of an email sent out by senior Department staff criticizing her for an op-ed piece she had co- authored with two former ambassadors. The op-ed piece, published in the Washington Post, expressed the authors’ perception that State was inappropriately placing an increasing number of civil service and political appointees in the highest leadership positions. The grievant also challenged the failure of one of the authors of the email to recuse herself from service on the grievant’s promotion board that year.
  • A retired Foreign Service Officer filed a grievance alleging that remedies granted to him pursuant to the first grievance ever filed, in 1972, under authorities preceding the establishment of the Foreign Service Grievance Board, had never been implemented. He is seeking monetary relief.
  • A grievant who in 1998 claimed bias on the basis of sexual orientation and a procedural error, and who appealed the FSGB decisions to both the district court and court of appeals, filed a new grievance claiming that Time-In-Class (TIC) and Time-in-Service (TIS) extensions awarded in that case had never been properly implemented, resulting in his impending separation for expiration of his TIS.


The Board resolved 12 appeals from discipline imposed by the Department of State. There were no appeals from disciplinary decisions of other agencies. In discipline cases, the agency has the burden to prove that the charge is factually correct; has a nexus to employment; and that the penalty is appropriate. The appeals covered a range of issues: alcohol and/or weapons-related incidents (five cases); filing false claims for reimbursement; false statements given to explain an absence from work; failure to maintain control of a diplomatic pouch; interfering with an investigation; the appearance of prostitution (two cases); and a security violation. In eight of the cases the charged employee alleged that the penalty was too harsh. In five of the discipline cases the Board affirmed the Department’s decision; in two it found in favor of the charged employee; in one it partially affirmed and partially reversed; and four cases were settled before reaching a decision on the merits. Nine of the cases involved employees of the Office of Diplomatic Security.

In one discipline case and a handful of others, the employees claimed that the incidents were related to the stress of service at hardship posts. As more employees are assigned to posts in countries where violence is endemic, the Board will be sensitive to similar conditions in appeals arising from this issue.


Eighteen appeals involving inaccuracies, omissions, prejudicial statements, or prejudicial errors in employees’ Official Performance Files that could affect their promotion and/or tenuring competitiveness were decided by the Board. The Board affirmed the agency decision in ten of the cases; reversed in two; and partially affirmed, partially reversed in three cases. Two appeals were settled, and one was withdrawn.

Two of the appeals contested IERs issued by the Office of the Inspector General, one involving an ambassador and the second a public affairs officer. In the first, the Board found that the right to counseling applied equally to ambassadors as to other employees. Although the bar may be higher in what an ambassador is expected to know, the Board found that in this particular case the ambassador had no reason to know of the deficiencies identified in the IER, and, therefore, lack of counseling by her supervisors prior to inclusion of the criticisms in the IER and her OPF was not harmless error. The Board also found that several comments in the IER about another, identifiable employee should not have been included in the ambassador’s OPF. The Board ordered that the IER be removed from the ambassador’s OPF. The second case was settled and withdrawn prior to a decision on the merits.

See The Buck Stops Where? Ambassador Files Grievance Over an OIG Evaluation Report


In general, the Board does not have jurisdiction over assignment actions. However, the Board may hear appeals in which the employee alleges a procedural violation of the assignment process. Two such cases were resolved last year. The first case stemmed from the 2012 violence in Benghazi. The employee alleged that he was removed from his position based on ill-founded conclusions by the Benghazi Accountability Review Board, and that he had been made a scapegoat as part of a politically motivated damage control effort. Prior to the conclusion of the appeal process, the grievant retired from the Department. The Board found that most of the remedies he had requested were no longer viable post-retirement, and it therefore drew no conclusions based on the merits. In the second case, the Board also found that the requested remedy, a change in eligibility requirements for long- term training, was outside its authority and dismissed the case for lack of jurisdiction.

See The Cautionary Tale of Raymond Maxwell: When the Bureaucracy Bites, Who Gets The Blame?


Eight appeals involving financial claims were resolved by the Board last year, each presenting different, complex issues:

  • In an appeal challenging denial of a medical evacuation allowance, the Department followed a long-established Standard Operating Procedure in denying medical evacuation for a high-risk pregnancy prior to the 24th week of gestation. The employee was directed to seek instead the lower separate maintenance allowance, even though all medical personnel agreed that grievant’s spouse needed to return to the U.S. in the 10th week of pregnancy.  The Board found that the Department’s practice was inconsistent with its own regulations and directed the Department to recalculate grievant’s per diem based on the medical evacuation rate.See High Risk Pregnancy Overseas: State/MED’s SOP Took Precedence Over the FAM? No Shit, Sherlock!
  • Six Security Engineering Officers (SEOs) challenged the Department’s decision to limit hiring of their class to an FP-06 pay level, while hiring preceding classes with similar qualifications up to the FP-04 level. In addition to charging a violation of merit principles, the grievants claimed that there were no jobs available at the lower level, so they were unjustly required to work at a higher pay grade than they were being paid. The case was resolved with respect to four grievants when they withdrew their appeals. The appeal of the other two is pending.
  • A career Civil Service employee was given a Limited Non-career Appointment in the Foreign Service, then granted a conversion to career Foreign Service. While in the U.S. working to satisfy the language requirement for a pending overseas FS assignment, grievant’s position was first designated FP-02, then retroactively downgraded to GS-12. The Department required her to reimburse the overpayment in salary resulting from the initial designation. The Board found that, while the Department’s regulations regarding conversions are unclear, in this case the downgrade without notice was an improper application of the relevant laws and regulation, and the employee was entitled to recover the funds repaid to the Department.
  • The Department denied a cash award to an employee for a suggestion he had made and that it had implemented. The primary basis for denial was that grievant had received a cash award for a similar reason, and thus was not permitted a second cash award for the suggestion. Grievant also claimed that the official who denied the award was the deciding official in a disciplinary action pending against him, and thus should have recused himself. The Board found that the two awards were for different purposes and thus not prohibited by the regulation, and agreed that the deciding official should have recused himself from the award decision. It remanded the case to the Department to reconsider its original decision.
  • A Diplomatic Security agent was required to surrender his law enforcement credentials and was denied law enforcement availability pay (LEAP) when the Secret Service investigated him regarding a collectible coin that he had purchased and sold, which turned out to be counterfeit. The investigation remained pending for a number of years, with no charges brought against the agent. During that time, his LEAP pay remained in abeyance. The Board found that although the Department did not have regulations addressing these circumstances, it had implemented a clear and consistent policy and did not act arbitrarily in denying grievant LEAP pay.
  • A retired criminal investigator with the USAID Inspector General’s Office alleged that the State Department miscalculated his retirement annuity by applying a pay cap imposed by the USAID IG through a 2006 memorandum. The Board found that the Department’s reliance on the memorandum was proper, and denied grievant’s claim to a higher annuity. The grievant has appealed this decision to the D.C. district court.

Judicial Actions Involving Board Rulings

One new case was filed in the District Court for the District of Columbia last year. Gregory Picur, retired from USAID’s Office of Inspector General, appealed the Board’s decision to uphold the Department’s calculation of his retirement annuity. A decision is pending.

Three other cases are pending decisions in federal court:

    • The five plaintiffs in Richard Lubow, et al. v. United States Department of State, et al. (923 F. Supp. 2d 28 (D.D.C. 2013)), retired and active duty Diplomatic Security agents who served in Iraq in 2004, appealed a district court decision granting summary judgment to the Department. The plaintiffs had grieved the Department’s application of a cap on their premium pay during their time in Iraq and its decision not to grant them a waiver of repayment of the amounts they had been paid in excess of that cap. The Board had affirmed the Department’s decision applying the cap and denying the waiver.
      (note: a ruling was issued on this case this past week, we will post separately)
    • In November 2012, Jeremy Yamin petitioned the D.C. district court to review a FSGB order denying in part his request for attorney fees incurred in a grievance appeal.
  • In January 2011, Joan Wadelton appealed a Board decision ordering six new reconstituted selection boards be convened as the remedy for three prior grievances. Ms. Wadelton’s appeal contests the Board’s decision to order a new round of reconstituted boards, rather than direct a promotion, as she had requested. Ms. Wadelton is separately engaged in litigation against the Department concerning compliance with three related FOIA requests she filed seeking certain Department records about her. The Department has completed its production of documents pursuant to those requests and is currently engaged in briefing related to motions for summary judgment. (see  Former FSO Joan Wadelton With Truthout Goes to Court Over FOIA Case)

One of the “other” cases adjudicated by the Board.

[T]he employee had been assigned to a senior job in an international organization for five years by virtue of separation/transfer with reemployment rights. Under that particular arrangement, his OPF was not reviewed for promotion for those years, and he was reemployed by State at the same grade as when he had left. Grievant contested the legality of that policy. The Board found that, although there was confusion within State about the ramifications of different transfer/secondment actions and grievant had not always been given consistent information, the precepts were clear and no remedy was warranted. Grievant has two related cases pending. (see Secondments to international organizations and promotions? Here comes the boo!).

The full report is available here.


Burn Bag: One RMO/P’s ‘just need a man’ prescription

Via Burn Bag:

“When I finally saw the Regional Medical Officer/Psychiatrist (RMO/P) for help, I was told I just needed a man to make me happy.”

Via reactiongifs

Via reactiongifs



* * *

Former FSO Candace Faber on Coming Home With the Maladies of War

— Domani Spero

Candace Faber joined the Foreign Service when she was twenty-four. She learned Dari, Polish, and Russian. At twenty-eight, she was off to Afghanistan where she spent a year at a “a tiny, crowded, dysfunctional world—one we could not leave.”  She wrote that she “often fantasized about walking off compound, just like Sergeant Bowe Bergdahl did in Paktika. In my imagination, even the Taliban seemed kinder than my colleagues.”

She was thirty years old when she resigned from the the FS.

Via Candace Faber on Medium – The Other Veterans:

[S]eeing them take this woman’s very real suffering so lightly, dismissing both her service and her fears as a woman, did more than hurt. It invalidated my own experience.

If a military veteran on a PRT had no right to struggle with readjustment, then by comparison, my year at the U.S. embassy compound in Kabul was a joke. My closest brush with terrorism was a distribution of children’s books I attended in Logar Province, pulling schoolchildren, government officials, and journalists together in a single building. The next day, that building was attacked by a vehicle-borne IED, and two of my colleagues were injured. I was shaken, but I wasn’t there. I also wasn’t there during the September 10 attacks, a fact that only seemed to invalidate my experience further.

In my mind and that of my colleagues, neither that woman nor I had the right to struggle with our transition. There was no excuse save PTSD, and I didn’t have that. I couldn’t have it. I wasn’t a veteran.
It has been a hard journey, as everyone close to me can attest. Resignation has also had financial consequences. But money matters very little compared to having my mental health back. As of today, I have not had an anxiety attack in months. I credit psychotherapy for my recovery. The only question in my mind is why it took so long for me to get help—and why no one in the Department of State, not even when I announced my intention to resign, suggested the option. Instead, I suffered alone for a year and a half, convinced that I was simply a broken person who could never be put back together again. All of that could have been avoided.


Ms. Faber notes that “the paper-based screening” given to her in Kabul was very limited.   “This seems like more of a way to shield the Foreign Service from liability than a good faith effort to support its corps.” She suggested that this should be replaced with in-person screening at appropriate intervals.

Once more, we’re hearing about the security clearance process; she writes, “the federal security clearance process must get rid of its prejudice against mental health treatment, which deters people from seeking the care they need. There is a double standard here: If you are physically wounded in action, you are a hero. But if you come back from a theater of war psychologically broken, wired to treat everyone as a threat, and angry at the world, you cannot seek help without risking your security clearance—and with it, your job.”

Read in full here.

Below are some of our previous blog posts on mental health, PTSD, security clearance and the State Department’s programs:


* * *






Enhanced by Zemanta

Former Foreign Service Kid Writes About Dad With Severe PTSD

— Domani Spero

In 2012, we blogged about a retired FS employee, William “Tony” Gooch who was sentenced to 12 years in prison – the maximum he faced under a plea agreement in a Nov. 7, 2010 episode, in which he reportedly rammed a Jeep into his estranged wife’s home before setting it ablaze. (See Former FSO William Anthony Gooch: No Mercy for Broken Men?).  Colorado Spring’s The Gazette covered the hearing in 2012.

We recently received a note from his son, Andy Gooch (he was referencing our blogpost below):

I came across this article the other day while searching to see if there was anything out there on my father, William Gooch (Tony). He is currently incarcerated and subjected to the brutality of prison life. He was in fact diagnosed with severe PTSD, depression, and substance dependence after serving State Department which the court system neglected to take into consideration. This whole situation frustrates me everyday. In fact, I clearly remember like it was yesterday after I told the judge my little amount of overseas experience. “This sounds like something out of a Jason Bourne movie,” stated the judge. It was as though he was calling not only my statement, but my fathers career a fabricated story.

Anyway, since then, my father and I have published a book on Amazon about his life. It’s called “My Mind, A Different Place.” If you are interested in his story, please look into it. Below is the hyperlink.

It’s unfortunate how the path of one’s career is often times vulnerable to acquiring PTSD, yet others don’t see/understand the reality.

William Gooch (Andy)

News report said that Tony Gooch’s career with the State Department ended with a medical discharge after he suffered a breakdown during an assignment in Kingston, Jamaica. On the prologue of the book, Andy Gooch writes that he moved to Centennial, Colorado in 2004 to live with his father  who was then retired from the State Department.  “It took me all these years to understand him, and to see what he was going through. At that time, my ignorance was bliss. Had I known then what I know now, I would have done a lot more to help my dad, ” he writes.

According to Andy , his father is not getting the mental health treatment he should be getting and his physical condition is deteriorating.  Due to this, he said his family is “currently filing action against the state.”  Andy also said that his father is allowed to accept some items like books and magazine through the mail writing,  “He is so isolated from the outside world I’m sure anything from anybody would be great.”

If you want to help, you may send cards, books or magazines to William “Tony” Gooch’s address below:

William Gooch #157833
AVCF Unit 4-B
12750 HWY 96
Ordway, CO 81034

Andy Gooch graduated from Virginia Commonwealth University in 2012 and is a second lieutenant in a Field Artillery Battery with the Army National Guard.

* * *

Enhanced by Zemanta

State Dept Regional Psychiatrist William Callahan, 53, Dies in Cape Town

— Domani Spero

We previously posted about the December 12 death of a U.S. Embassy Accra employee while visiting Cape Town, South Africa. (See US Embassy Accra Employee Falls to Death on South Africa’s Table Mountain). We subsequently learned the identity of the employee but decided not to publish his name as we could not confirm independently that the family back in California has been notified.  His hometown newspaper had since identified him in a news article as William E. Callahan Jr., 53, a prominent psychiatrist in Aliso Viejo, California.  He was the State Department’s Regional Psychiatrist covering West Africa. Below is an excerpt from OCRegister:

Callahan had left his private psychiatry practice in California last year to join the U.S. State Department as a Regional Medical Officer and Psychiatrist based out of the U.S. Embassy in Accra, Ghana, said Kenneth Dekleva, Director of Mental Health Services at the U.S. Department of State in Washington, D.C.

Dekleva said the news came as a shock to him and his department last Friday when he found out Callahan’s body had been recovered by South African authorities near the Table Mountain Range.

“His death has touched many people: my phone hasn’t stopped ringing since Friday…we lost one of our own,” Dekleva said. “It’s a huge loss for our organization. He represented the best in psychiatry in my opinion. We’re very proud to have known him and to have had him as part of our team.”

Dekleva said that the investigation surrounding the circumstances of Callahan’s death is ongoing in South Africa.

Memorial services are planned in Accra on Wednesday. Services in Greenfield, Mass. and Laguna Beach will occur in early 2014, the State Department said.


Dr. Callahan joined the State Department in July 2012.  Our source told us that “he was an avid outdoorsman and in great shape.  He was well-liked in Accra and at the other embassies he covered in West Africa.”

According to his online bio, he was a Special Forces flight surgeon turned psychiatrist.  “With the constant deployments in my military unit on clandestine missions, I observed how stress in a family member can jump from person to person and lead to physical illness as well.  After 5 years of active duty and 9 of total service, I left the military to get the training to become a board certified psychiatrist.”

He was previously the president of the Orange County Psychiatric Society.  For 15 years prior to joining the State Department, he  provided a two hour a week, free, open-to-the-public group for families dealing with a mental illness called Interactive Solutions.

Dr. Callahan’s service in the military included a general surgery internship at David Grant Medical Center at Travis AFB, CA followed by assignment to the 8th Special Operations Squadron as a flight surgeon, at Hurlburt Field, FL.  He served in both the First Gulf War and Panama Wars,  and received two Meritorious Service Medals. He was the 1988 Flight Surgeon of the Year within the First Special Operations Wing.

He graduated from Deerfield Academy (1978), Tufts University (1982), Tufts Medical School (1986) and did General Surgery Internship at Travis AFB, CA (1987), and his Residency in Psychiatry at UC Irvine (1994).


* * *










What to do when different voices start delivering multiple démarches in your head?

– By Domani Spero


Below is the State Department’s High Stress Assignment Outbrief Implementation Guide – the FSI/MED Model.

Background of the High Stress Outbrief Program via

The High Stress Assignment Outbrief program was developed after the first groups of employees began coming back from assignments to Iraq and Afghanistan in 2002 and 2003 – posts that would have beenin evacuation status in more normal times. Returnees asserted that coming back from those posts wasn’t at all like coming back from a regular foreign affairs community assignment – that theDepartment needed to help with this particular transition in some way. Med’s Office of Mental Health Services asked the Foreign Service Institute’s Transition Center to assist in the development of a prototype training event, which was piloted in 2003. MED/Mental Health convened an Iraq Out-briefing Conference on July 29 & 30, 2004 at the Foreign Service Institute. The Outbrief program was reviewedand discussed by the full cadre of RMO/Ps, Dr. Robert Ursano and Dr. James McCarroll, from theUniformed Services University for Health Sciences, Dr. Carol North, Washington University (St. Louis),with guest presentations by (then) Director General of the Foreign Service Amb. Robert Pearson and others.

The program was endorsed by MED leadership and has run as a partnership between the FSI’sTransition Center and MED/Mental Health Services since then. All subsequent Directors General of the Foreign Service have mandated that all returnees from Iraq (and later Afghanistan) who have served for 90 days or longer be required to attend either a group or individual Outbrief upon return to CONUS.The realities of the Foreign Service assignment system brought complications – many officers had TDY-ed to Iraq or Afghanistan and were returning directly to their former posts. Others PCS-ed directly to follow-on assignments around the world. Clearly, a purely Washington-based program would not be effective in providing the service to all of our employees. Furthermore, many participants did not fit traditional Foreign Service employee profiles – special hiring authority hires (3161s), civil service employees, and third country nationals all stepped up to serve in those war zones. RMO/Ps were instructed to deliver Outbriefs at posts or during post visits, and to communicate the name of the Outbrief participant, date, and place back to the Transition Center for entry into the Department’sofficial training registration database to certify compliance.

Read more below:


I’ve requested help in understanding the usefulness of the Outbrief session and received a few responses below:

Comment #1: (from a twice-deployed employee)

“I have taken that half-day course twice in 2009 and 2013.  The class was almost the exact same.  They basically tell you to get sleep and try to adjust back and if needed, see someone.  The class I took in 2013 was 8 months after I returned because HR would not pay to send me to DC before home leave then I was in language training for six months.  If it was really important, HR would allow people to take it as early as possible otherwise, it must not be that important.”

Comment #2 (a State Department employee who served in Iraq and Pakistan)

“The description of the outbrief program seems reasonably accurate – although it’s been a while since I attended (in 2008 after Iraq, but not subsequently after Pakistan).  There’s a certain value to spending a bit of time (three hours?) with people that have been through similar experiences – probably including someone that you knew or at least shared acquaintances with.  It gives you a chance to talk with people who better understand your experiences.   It’s possible that some of our feedback made it back to decision makers in aggregated form.  For example, one of the themes of our discussion was that the Department (USG?) was doing itself no favors by sending warm bodies that lacked core qualifications (e.g. basic competence and a desire to be there.)  I think that the Department is now requesting 360s [360 degree feedback] for everyone that they send – although that may just be part of the general trend towards requesting 360s.  My memory is a bit hazy, but I think a key element was describing what other resources (e.g. clinical/therapeutic) might be available for those that needed them.”

Comment #3 (somebody once posted in Iraq— added at 6:48 am PST)
The high stress outbrief  is, as you noted, just an example of CYA– look, we have a program! A couple of voluntary hours with some contractor at cozy FSI with no follow-up, and especially no mandatory individual session is worthless. Many symptoms of PTSD evolve over time, and many returning-to-DC-stresses only become apparent after you have in fact returned to work and gotten the lay of the land in a new office. Speaking out in front of a group is not a core FS trait, and not something any person with real problems does easily. Imperfect as it is, the military does require formal screening and a brief one-on-one session with a counselor. Follow up care (imperfect) is available. At State, you’re told to “get help” without much help in getting it. After all, MED is not responsible for healthcare in the U.S.
Still not sure? Check with officers who were MEDEVACed for anything, not necessarily PTSD, and see if any of them got any follow-on from MED other than a new, career-crushing clearance status.

One of our readers commenting on mental health support suggested the following:

“While I know it wouldn’t solve everything, I think that anyone coming out of a post with danger pay should have some sort of mandatory sessions with some sort of licensed therapist. That would take away the stigma of the therapy and maybe get some people some help before they take out their PTSD on themselves or someone else.”


Remember the US Embassy Malta road rage meltdown that made the news? (US Embassy Malta Gets a Viral Video But — Not the Kind You Want).  We don’t know this individual nor his story, or which post he previously came from. But assignments to European posts like Malta have typically gone to employees who did tours in Iraq, Afghanistan and Pakistan.   We don’t know if this individual came from an AIP posts. Even if he did, it’s not an excuse for such a behavior, but it might help us understand his demeanor.  American diplomats normally do not go around looking for a fight.

Our concern is simple. We are sending people out to the war/danger zones.  The State Department touts its mandatory High Stress Outbrief, an educational program that only requires presentation/delivery skills from whoever delivers the program.  Less than 60 percent of returnees attend the program, and there are no consequences for non-compliance.  Who does the follow-up? Anybody?

Is it fair to say that the State Department does no follow-up beyond the Outbrief session and expects employees to simply self-report any mental health issue? And because no one fears the social stigma of seeking mental health help and nobody suffers from the fear of losing one’s security clearance over a mental health issue, everyone in the Service can be counted on to self-report if/when different voices start delivering multiple démarches in one’s head?


USAID’s First War-Zone Related Suicide – Michael C. Dempsey, Rest in Peace

— By Domani Spero

On September 5, Gordon Lubold writing for Foreign Policy reported on USAID’s first known war-zone-related suicide and asks if America is doing enough to assist its relief workers. Excerpt below:

On Aug. 15, the U.S. Agency for International Development announced that one of its employees had died suddenly. The agency didn’t mention that Michael C. Dempsey, a senior field program officer assigned as the leader of a civilian assistance team in eastern Afghanistan, killed himself four days earlier while home on extended medical leave. However, the medical examiner in Kent County, Michigan, confirmed to Foreign Policy that Dempsey had committed suicide by hanging himself in a hotel-room shower. His death is USAID’s first known suicide in a decade of work in the war zones of Afghanistan and Iraq. And what makes the suicide particularly striking is that it came a year and three days after Dempsey’s close friend and colleague was killed in an improvised-explosive-device attack in Afghanistan.

Related posts:

More from Mr. Lobold’s A Death in the Family:

Shah left unspoken the issue of suicide that USAID must now confront. With Dempsey’s death as the first known suicide from either of USAID’s Afghanistan or Iraq programs, the suicide forces the agency to deal with an inescapable problem: how to help its employees who deploy to the same war zones as the military but who don’t always have access to the same kind of assistance. Civilian culture may not have the military’s taboo against seeking mental-health assistance, but unlike the Defense Department, which has struggled to arrest the vast suicide problem within its ranks, civilian agencies such as USAID and the State Department are governed by different privacy rules that hamstring those agencies as they try to help employees who may be suffering from post-traumatic anxiety, depression, or worse.
USAID has deployed more than 2,000 “direct hires” through Iraq and Afghanistan since 2003. Many of them, like Dempsey, are considered “foreign service limited” (FSL) officers. That means they enjoy many of the same benefits of Foreign Service officers, but can’t be promoted or moved to other offices or departments. About 150 FSL officers are in Afghanistan currently. After each deployment, each one gets a “high-stress outbrief,” but due to privacy concerns, USAID isn’t able to contact any of them after they leave federal service to ensure that they aren’t suffering from deployment-related issues or other maladies, like alcohol abuse or depression. After a deployment, supervisors may only hear about those kinds of problems unofficially, through the bureaucratic grapevine, because of the way privacy regulations govern civilian agencies. And even then, if a problem is identified, USAID, unlike the Defense Department, can’t force an employee to undergo treatment.

Click here for the memorial page of Michael Cameron Dempsey (May 26, 1980  –  August 11, 2013) where you may leave a note or share a photo with his family.

* * *

Something about that “each one gets a “high-stress outbrief,” but due to privacy concerns, USAID isn’t able to contact any of them …” seem odd.

According to the State Department, Foreign Service and Civil Service employees from the State Department and USAID who have spent more than 90 days in Afghanistan, Iraq, Pakistan, Yemen, or Libya are required to attend its High-stress Assignment Outbriefing Program. Any State employee serving at any high stress post is also highly encouraged to attend.

However, a review of the program by State/OIG in July 2010 indicates that fewer than 60 percent of returnees from Iraq and Afghanistan for whom this is mandatory attend the High Stress Assignment Outbrief.   Apparently, very few employees from other high stress posts for whom it is voluntary take it.  State/OIG also stated that “If efforts to increase attendance fail, the Department will need to adopt stronger measures and a follow-up mechanism.”  Now, why would State/OIG propose the adoption of stronger measures to increase the Outbrief attendance if there were “privacy concerns?”

In any case, the Outbrief is mandatory but more than 40% of returnees mandated to attend it do not take it. FSI’s Transition Center admits that “compliance remains a difficult issue:”

“Compliance remains a difficult issue. While the program has received support and validation from a number of internal and external stakeholders, the unique requirement of a post-deployment “de-brief” coupled with a cultural reluctance in the workforce to deal with mental health or stress related issues mitigate against full participation. Since the essence of the program is to provide help to returning employees – and their family members – more rigorous measures to ensure compliance were seen as undesirable (e.g., holding up onward assignments or limiting or temporarily suspending clearances) and counterproductive.”

In a recent document published in conjunction with a solicitation for a High Stress Assignment Outbrief provider also states that the Outbrief “is a two-way educational program” and it is “not a clinical session or intervention.”  Asked by potential provider about “sources/citations for the interviewing methodologies utilized in the High Stress Assignment Outbrief”, the official response is as follows:

“The interview methodology was developed by trainers and psychiatrists working for the Foreign Service Institute and the Office of Medical Services of the Department of State. The interview protocol is not designed as a therapeutic intervention; it’s purpose is to have participants reflect on their experiences, offer advice to the Department, and to provide a conduit for such aggregated information for Department decision makers.”

The Outbrief implementation guide posted by FSI’s Transition Center at also states that “the Department is responsible for keeping track of compliance” and that there is a need (for the selected provider) to make sure that “accurate records are kept of who attended, when, and where.”

In short —

The Outbrief is not/not a clinical session.

It is not/not a therapeutic intervention.

It is mandatory but not everyone attends it.

The Department kept accurate records of who attended it, where and when.

But due to “privacy concerns” USAID isn’t able to contact any of them to ensure that they are not suffering from deployment-related issues.

Also a new contract was awarded to a new Outbriefer in May 2013 for $46,400 (Base and Option Years Estimate).

You know, I’ve lost my brain today. I just don’t get this. If you’ve been through the Outbrief session would you kindly write me and help me understand how this is helpful to returnees from high stress-high threat assignments.