IN THE CASE OF: BOARD DATE: 11 July 2013 DOCKET NUMBER: AR20120019639 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records (with supporting documents provided, if any). 2. Military Personnel Records and advisory opinions (if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests, in effect, change of her narrative reason for separation from personality disorder to medical discharge – post-traumatic stress disorder (PTSD). 2. The applicant states she has been diagnosed with PTSD and she would like her discharge to reflect it. 3. The applicant provides: * Department of Veterans Affairs (VA) rating decision, dated 23 February 2005 * Report of Mental Health Evaluation, dated 10 March 2004 * DD Form 214 (Certificate of Release or Discharge from Active Duty) CONSIDERATION OF EVIDENCE: 1. Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the Army Board for Correction of Military Records (ABCMR) to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file. In all other respects, there are insufficient bases to waive the statute of limitations for timely filing. 2. The applicant enlisted in the Regular Army on 7 March 2002 and she held military occupational specialty 54B (Chemical Operations Specialist). She served in Kuwait/Iraq from 22 January to 26 August 2003. 3. On 20 October 2003, at Fort Stewart, GA, she accepted nonjudicial (NJP) punishment under the provisions of Article 15, Uniform Code of Military Justice (UCMJ) for failing to go at the time prescribed to her appointed place of duty. 4. On 10 March 2004, she underwent a mental status evaluation in relation to the possibility for separation for misconduct. She was presented at the Division Mental Health, based on a request by her commander. The Division Psychiatrist stated: a. Her behavior was normal, she was fully alert and oriented with an unremarkable mood, clear thinking process, normal thought content, and good memory. She was mentally responsible, had the capacity to understand and participate in proceedings, and she met the retention standards of Army Regulation 40-501 (Standards of Medical Fitness), chapter 3. She did not require a medical evaluation board (MEB). b. She had been previously referred on 9 June 2003 for counseling concerning workplace relational problems. Her pattern of unstable and intense interpersonal relationships and reactivity of mood over a prolonged period placed in doubt the likelihood of benefiting from therapy of a reasonable duration. Her symptoms were more consistent with a personality disorder, not suitable for continued active service. Her evaluation consisted of a clinical interview and/or medical records review and resulted in a diagnosis of: * Axis I: None * Axis II: Borderline Personality Disorder * Axis III: Chronic back pain * Axis IV: Occupational problems c. The conditions and problems presented by the applicant were not amenable to future hospitalization, treatment, disciplinary action, training, or reclassification. Efforts to rehabilitate her into a satisfactory or productive member of the military were likely to be unsuccessful. Fitness for duty and suitability for continued service were unlikely. She met the criteria for an administrative separation via Army Regulation 635-200 (Personnel Separations – Active Duty Enlisted Administrative Separations), paragraph 5-13, by reason of personality disorder. 5. On 24 March 2004, she again accepted NJP under the provisions of Article 15, UCMJ for making a false official statement, with intent to deceive; and twice failing to go at the time prescribed to her appointed place of duty. 6. On 30 March 2004, the applicant's immediate commander notified her of the intent to initiate separation action against her under the provisions of Army Regulation 635-200, paragraph 5-13 because of a personality disorder. The commander stated the reason for separation was that the applicant had been diagnosed with a personality disorder. She recommended an honorable character of service. 7. On 30 March 2004, after the applicant acknowledged receipt of the notification of separation action, she consulted with legal counsel and she was advised of the basis for the contemplated separation and of the rights available to her in connection with the action. Subsequent to receiving legal counsel, the applicant elected not to submit statements in her own behalf. 8. Subsequent to this acknowledgement, the immediate commander initiated separation action against the applicant under the provisions of Army Regulation 635-200, paragraph 5-13, by reason of personality disorder. The intermediate commander recommended approval. A military attorney reviewed the separation packet and found it legally sufficient. 9. The separation authority approved the applicant's separation under the provisions of Army Regulation 635-200, paragraph 5-13, by reason of personality disorder and directed the applicant be issued an honorable discharge. 10. On 15 April 2004, the applicant was discharged accordingly. The DD Form 214 she was issued shows she was discharged under the provisions of Army Regulation 635-200, paragraph 5-13, with an honorable character of service. She completed 2 years, 1 month, and 9 days of creditable active service. Item 26 (Separation code) shows the entry "JFX." 11. On 23 February 2005, the VA awarded her service-connected disability compensation for PTSD at the rate of 30 percent, effective 16 April 2004. 12. In connection with the processing of this case, on 20 May 2013, an advisory opinion was obtained from the Office of The Surgeon General (OTSG), Director of Health Care Delivery. The advisory official states conclusions for this advisory opinion are drawn solely based on available documentation from her time in service unless otherwise indicated. The records available for this review are extremely limited as the applicant's service pre-dated consistent use of electronic records. The available medical record does not include any behavioral health notes. The official added: a. There were a few documents referring to behavioral health issues. One consultation report around the time of her discharge referred to "chronic tremors, anxiety disorder, and newly reported grand mal seizure." Her VA examination, dated 21 December 2004, referred to a review of available records and recorded a progress note on 8 June 2003 that indicated [Applicant] was seen by the combat stress team when members of her team were killed. It is unclear if she was seen by the combat stress team on 8 June 2003, or if the note referred to a prior visit. The document further indicated the Report of Medical History, dated 19 March 2004, stated she was treated while in the military for anxiety, depression, and borderline personality disorder. Her VA Rating Decision stated [Applicant's] separation examination showed a need for her to follow up with psychiatry and psychology. b. The 10 March 2004 memorandum for the commander addressing her mental health evaluation stated the applicant self-referred to Mental Health on 9 June 2003 for "counseling concerning workplace and relational problems." The initiation of treatment began while deployed and no further information was provided regarding her course of treatment. The report noted a “pattern of unstable and intense interpersonal relationships and reactivity of mood over a prolonged period,” thought to be consistent with a personality disorder and incompatible with continued active duty service. Borderline personality disorder was the only diagnosis given. c. At the end of January through early March 2004, [Applicant] filled prescriptions for Ambien, Klonopin, Trazodone, Paxil, Ativan, and Xanax, medications that typically address sleep problems, anxiety, and depressive symptoms. These medications appear to have been during a discrete period of time of approximately one month and did not appear earlier on her medication list. d. In terms of PTSD, [Applicant] completed a Post-Deployment Health Assessment (PDHA) on 5 August 2003, the date she left the Theater of Operations. She endorsed traumatic events and feeling in "great danger of being killed during deployment, having in the past month been constantly on guard, watchful, or easily startled, and feeling down some." At that time, she did not screen positive for PTSD. It is conceivable her condition changed between that time and the date of her discharge. Her VA examination in December 2004, approximately 8 months following her discharge, resulted in a diagnosis of PTSD and the available summary supported that diagnosis. e. There are insufficient records available to review for this advisory opinion. It is not possible to ascertain during-service support for diagnoses retrospectively referenced in other documents, including those provided on her administrative separation paperwork. If additional records were submitted pertaining to her behavioral health treatment and diagnosis during the time of her service, those could be taken into consideration. 13. On 20 May 2013, a copy of the advisory opinion was forwarded to the applicant for information and to allow her the opportunity to submit comments or a rebuttal. She did not respond. 14. Army Regulation 635-200 prescribes the policy for the administrative separation of enlisted personnel. Paragraph 5-13 provides for separating members by reason of personality disorder (not amounting to disability) that interferes with assignment or with performance of duty. DISCUSSION AND CONCLUSIONS: 1. The applicant's requests to change the narrative reason for separation to a medical discharge – PTSD, has been carefully considered. However, there is insufficient evidence to support this claim. 2. The available evidence shows the applicant underwent a mental status evaluation that led to a diagnosis of a personality disorder. Accordingly, her chain of command initiated separation action against her. Her separation processing was accomplished in accordance with the applicable regulation. All requirements of law and regulation were met and the rights of the applicant were fully protected throughout the separation process. 3. The available evidence of record contains the applicant's mental status evaluation that confirmed a diagnosis of personality disorder not amounting to disability was made by proper medical authority. The record is void of any indication she was suffering from an unfitting PTSD condition at the time of her discharge. As confirmed by the OTSG advisory opinion, there are limited medical records for review. These limited records do not confirm the existence of PTSD at the time of her separation and such diagnosis is not recorded in her available record during her time of active service. There is insufficient medical evidence to support an unfitting PTSD finding at the time of her discharge. 4. In view of the foregoing, absent any evidence of error or injustice in the separation process or medical evidence confirming the applicant was suffering from an unfitting PTSD condition at the time of her discharge, there is an insufficient evidentiary basis for granting the applicant's requested relief. BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ____X____ ____X____ ____X____ DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. ____________X___________ CHAIRPERSON I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. ABCMR Record of Proceedings (cont) AR20120019639 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20120019639 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1