RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-00679 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: His narrative reason for separation be changed to medical. APPLICANT CONTENDS THAT: He was discharged due to a medical disability. The Board should find it in the interest of justice to consider his untimely application. He states that since his discharge he has been in constant physical and mental rehabilitation at the Department of Veterans Affairs (DVA) Hospital. The applicant’s complete submission is at Exhibit A. STATEMENT OF FACTS: On 29 Mar 00, the applicant initially entered the Regular Air Force. On 4 May 09, the applicant's commander notified him that he was recommending him for discharge from the Air Force for a condition that interfered with military service, specifically for mental disorders. The specific reason for this action was on 7 Apr 09, the applicant was diagnosed by the mental health clinic, with Axis I: Adjustment Disorder with Mixed Anxiety and Depressed Mood; Axis II: Narcissistic Personality Disorder. The report was further certified by a Licensed Psychologist and a Licensed Psychiatrist. This condition was deemed unsuitable for continued military service and was so severe that the applicant's ability to function effectively in the military environment was significantly impaired. It was determined that discharge was deemed to be in the best interest of the United States Air Force. The applicant acknowledged receipt of the notification of discharge and was advised of his right to consult with legal counsel and submit statements on his own behalf. The applicant submitted an unconditional waiver of his right to present his case to an administrative discharge board. On 27 May 09, the staff judge advocate reviewed the package and found it legally sufficient to support separation. The discharge authority accepted the unconditional waiver, approved the separation and directed the applicant be discharged with an honorable discharge. On 12 Jun 09, the applicant was honorably discharge, with a reason for separation of personality disorder. He was credited with 9 years, 2 months, and 14 days of active duty service. AIR FORCE EVALUATION: AFPC/DPSOR recommends denial. Based on the documentation on file in the master personnel records, the discharge to include the separation code, the narrative reason for separation and character of service was consistent with the procedural and substantive requirements of the discharge instruction and was within the discretion of the discharge authority. DPSOR found no evidence of an error or injustice in the processing of the applicant's discharge. DPSOR notes the report, from the mental health clinic, dated 7 Apr 09, states the applicant's negative pattern of interactions with others both at work and outside of work indicated that he was likely to continue to have difficulties that affect his duty performance. Further, there was no evidence of mental defect, emotional illness, or psychiatric disorder, as defined by AFI 48- 123, Medical Examinations and Standards, of sufficient severity to warrant disposition through military medical channels. Furthermore, the report stated the applicant was deemed unsuitable for continued military service on the basis of the Narcissistic Personality Disorder. Finally, his difficulties were so severe as to significantly impair his ability to function in a military environment and it was recommended that administrative separation be pursued. As a result of the conclusions made in the report, the applicant was processed for immediate discharge. Therefore, the SPD code, the narrative reason for separation, and character of service as indicated on the applicant's DD Form 214 are correct. The complete DPSOR evaluation is at Exhibit C. The BCMR Medical Consultant recommends denial of the applicant’s request to change his narrative reason for separation to a medical discharge. Despite this advisory recommendation, the Board is clearly empowered to assert its wisdom and executive authority if an error or injustice exists in its opinion; bearing in mind that what may not be an error in procedure, may yet present an injustice. It should first be noted that both the Military Department [2009] and the DVA examiner [2013 gave the applicant an Axis II diagnosis of Personality Disorder. Thus, while the applicant was also given an Axis I diagnosis of Anxiety Disorder, a ratable and compensable condition, the Military Department found the Personality Disorder to be the primary diagnostic impediment to duty and the reason for discharge. This analysis, although sound, does not tell the full story. The Military Department also issued an Axis I diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood; which by definition is a diagnosis limited to a period of six months, following which resolution is expected to have occurred upon removal or resolution of the precipitating stressor. Otherwise, symptoms that persist beyond six months [presumably beyond the applicant's discharge date] the condition is either characterized as chronic, or may be more appropriately characterized under different diagnostic nomenclature based on an enduring stressor. Therefore, it would not be usual for the applicant's service Axis I diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood to then change to Anxiety Disorder; particularly after disclosure of a new set of significant stressors since leaving military service and considering that features of the disorder were present and acknowledged during the applicant's military service. Addressing a common allegation of arbitrary and capricious separations for Personality Disorder, the Medical Consultant has no scientific way to validate whether this occurred in the applicant's case. However, directing attention to the totality of his performance reports, other than that which is disclosed in the mental health assessments, there is, otherwise, no written explanation for the relative sudden downturn in performance; as one would expect a developmental Personality Disorder to have manifested sooner and more consistently as maladaptive behavior throughout or earlier in his service history; lending credence to probable external precipitating sources influencing his mental functioning, hence the co-morbid Adjustment Disorder diagnosed by his military provider. The applicant and the Board are also advised that assigning diagnostic nomenclature is dependent upon the predominant disclosed or presenting symptoms, as reported through interview with the patient at a given point in time [e.g., during a military evaluation versus a subsequent post-service VA examination]; as these may vary along a continuum of time. Additionally, a psychiatric diagnosis may even differ among different clinicians evaluating the same patient during the relative same period of time, which, again, depends upon the predominant clinical presentation, observations made, or symptoms disclosed. Yet, as in the case under review, two or more mental disorders [Axis I and/or Axis II diagnoses] may even co-exist concurrently, as co-morbid mental disorders in the same subject, often times making it difficult to attempt to separate the two due to their close association or shared clinical features; or which to attribute causation for a particular event. Thus, the fact the applicant was given an additional diagnosis of Anxiety Disorder, by the VA examiner in 2013, does not invalidate the accuracy or appropriateness of the Axis II [Personality Disorder] diagnostic conclusions also reached the DVA, which resulted in the disposition chosen by the Military Department, IAW AFI 36-3208, Administrative Separation of Airmen. Unlike the Military Department, which operates under Title 10, United States Code (U.S.C.), the DVA, operating under Title 38 U.S.C., is authorized to offer compensation for any diagnosed medical condition that it finds a nexus with military service, without regard to whether it was the predominant diagnostic presentation at the time of release from service, the cause for release from service, or the length of time that has transpired since discharge. The DVA is also empowered to conduct periodic evaluations for the purpose of adjusting the disability ratings [decrease or increase) as the level of impairment for a given medical condition may vary [improve or worsen) over the lifetime of the veterans. The complete BCMR Medical Consultant evaluation is at Exhibit D. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Copies of the Air Force evaluations were forwarded to the applicant on 27 Oct 14 for review and comment within 30 days (Exhibit E). As of this date, no response has been received by this office. THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was not timely filed; however, it is in the interest of justice to excuse the failure to timely file. 3. Insufficient relevant evidence has been presented to demonstrate the existence of an error or injustice. We took notice of the applicant’s complete submission in judging the merits of the case; however, we agree with the opinion and recommendation of the Air Force office of primary responsibility (OPR) and the BCMR Medical Consultant, and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the requested relief. THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. The following members of the Board considered AFBCMR Docket Number BC-2014-00679 in Executive Session on 9 Dec 14 under the provisions of AFI 36-2603: , Panel Chair , Member , Member The following documentary evidence was considered: Exhibit A. DD Form 149, dated 9 Feb 14. Exhibit B. Pertinent Excerpts from Personnel Records. Exhibit C. Letter, AFPC/DPSOR, dated 8 Aug 14. Exhibit D. Letter, BCMR Medical Consultant, dated 9 Oct 14. Exhibit E. Letter, SAF/MRBR, dated 27 Oct 14.