ADDENDUM TO
                            RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:      DOCKET NUMBER:  90-01019
            INDEX NUMBER:  108.01, 108.10
            COUNSEL:  Mr. Victor Kelly

            HEARING DESIRED:  Yes

___________________________________________________________________

APPLICANT REQUESTS THAT:

His commission be reinstated and his name  be  placed  on  the  Temporary
Disability Retired List (TDRL) or, in the  alternative,  his  records  be
corrected to show that he received a medical discharge from the Air Force
with pay and benefits, retroactive to 2 August 1989.

___________________________________________________________________

APPLICANT CONTENDS THAT:

He  has  prepared  newly  discovered  relevant  evidence  which  was  not
considered by the Board at the time of the initial review of his case.

In further support of his appeal, he provided a  brief  by  counsel,  who
indicated that the injustice done to  the  applicant  has  been  revealed
slowly over a period of time.  The applicant's extreme paranoia  and  the
difficulty in gathering the necessary facts has made  investigation  into
and progress in his case very difficult.

After providing a chronology and a statement of facts pertaining  to  the
applicant's service and to his medical treatment during and subsequent to
his separation, counsel contended the fact that  the  applicant  did  not
receive a separation physical examination was contrary to the  provisions
of AFR 160-43.  It is the Air Force's position  that  the  applicant  was
separated in absentia.  Counsel notes that  the  applicant  was  informed
that his separation from the Air Force was effective  on  1  August  1989
and, on 2 August 1989, he was of the opinion that he had  been  separated
from the Air Force on the preceding  day.   Even  if  the  applicant  was
discharged  in  absentia,  the  discharge  was  not  valid  due  to   the
applicant's mental illness at the time.  He was not competent to  choose.
Furthermore, the record will show it was clear from the applicant's  duty
performance that he was drastically impaired and  that  his  fitness  for
duty could not be presumed.  The  evidence  will  also  show  that,  when
offered the opportunity to make  an  election  to  undergo  a  separation
physical examination, the applicant made no election.

In its earlier consideration of this appeal, the Board asked  for  recent
medical evidence other than the assertions  of  the  applicant's  family.
Counsel is now providing evidence  in  the  form  of  a  statement  by  a
physician, who has indicated that the applicant has a  "major  depressive
disorder with severe paranoid process."  This physician also stated that,
when the applicant was in the Air Force, he had  a  "medical  psychiatric
disorder."  He believes that a "behavioral disorder" is  a  misdiagnosis.
Amplifying  information  is  contained  in  a  letter   provided   by   a
representative of the Department of Veterans Affairs (DVA).

Counsel  asserts  all  of  the  information  provided  is  sufficient  to
demonstrate the applicant's claim is valid.

A complete copy of counsel's submission in behalf of the applicant is  at
Exhibit H.

___________________________________________________________________

RESUME OF THE CASE:

A similar appeal by the applicant was considered and denied by the  Board
on 5 February 1991.  For an accounting of that consideration, as well  as
a statement of the relevant facts of the case, see AFBCMR 90-01019, dated
21 February 1991, with Exhibits A through G.

___________________________________________________________________

AIR FORCE EVALUATION:

The  BCMR   Consultant,   AFMPC/DPMMMR,   reviewed   this   request   for
reconsideration and recommended no change be made to the medical records.
 DPMMMR stated that the applicant was thoroughly evaluated in March/April
1989 at the request of his commander and was diagnosed as having  marital
problems  and  an  obsessive-compulsive  personality  disorder.   He  was
considered not psychiatrically qualified for Flying Class II duties.  The
applicant then initiated requests for elimination from  upgrade  training
and for discharge.  Shortly after separation, he was diagnosed as  having
a delusional disorder, Axis I:  297.10, after his admission to a civilian
psychiatric ward.  These records also document a character  and  behavior
(personality) disorder.  (Personality disorders are lifelong patterns  of
maladjustment in the individual's personality  structure  which  are  not
medically disqualifying but may  render  the  individual  unsuitable  for
further military service and may be cause for  administrative  action  by
the individual's unit commander.) DPMMMR  stated  that  this  is  another
example  of  an  individual  who  demonstrated  classic  symptoms  of   a
personality disorder while on  active  duty.   The  reason  the  military
medical authorities are able to  diagnose  personality  disorders  easier
than their civilian counterparts is because the  military  has  available
accurate historical information on the individual's performance while  in
the service.   It  is  DPMMMR's  opinion  that  the  evidence  of  record
establishes beyond all  reasonable  doubt  that  no  error  or  injustice
occurred in this case.  At the time of discharge, the applicant  did  not
have any psychiatric or  mental  condition  which  would  have  warranted
consideration under the provisions of AFR 35-4.  Therefore, TDRL  is  not
appropriate since the applicant was not medically unfit at  the  time  of
discharge.  The TDRL provides a means for further  observation  of  unfit
members whose disability has not stabilized.

This evaluation is at Exhibit I.

The Physical Disability Division, AFMPC/DPMAD, reviewed this  appeal  and
stated that, prior to a case being considered by the Physical  Disability
Evaluation System, it must be forwarded by  a  Medical  Evaluation  Board
(MEB).  Whether  an  MEB  is  conducted  is  a  medical  standards  issue
determined under the provisions of AFR 160-43, Chapter 3.   According  to
DPMMMR, the applicant's condition did not warrant MEB action or  referral
to the disability system.   DPMAD  deferred  to  DPMMMR  on  the  medical
standards issue.

DPMAD  further  indicated  that  only  those  members  who  qualify   for
disability retirement but whose permanent degree of impairment cannot yet
be determined are temporarily retired.  The names  of  such  members  are
placed on the Air Force Temporary Disability Retired  List  (TDRL).   The
TDRL is used as a "pending list" for those unfit members whose conditions
may be permanent; however, a final decision  cannot  be  made  concerning
ultimate disposition because their conditions have not stabilized.  Since
the applicant was not found medically unfit at the time of his separation
from the military, he did not qualify for  placement  on  the  TDRL.   In
addition, in order to  qualify  for  disability/medical  retirement,  the
applicant  must  have  at  least  20  years  of  service  creditable  for
retirement or a disability rating of 30 percent or more.  In the  opinion
of DPMAD, the applicant does not qualify under either of these criteria.

In view of  the  above,  DPMAD  recommended  denial  of  the  applicant's
requests (see Exhibit J).

The Separations Branch, AFMPC/DPMARS1, also reviewed this application and
recommended  denial.   DPMARS1  stated  that  the   applicant   requested
separation under the provisions of AFR 36-12, Table 2-6, Rule  3.   On  1
August 1989, his request was approved under the provisions of AFR  36-12,
Table 2-6, Rule 15 (Miscellaneous Reasons) because of a  one-year  active
duty service commitment based  on  his  self-initiated  elimination  from
formal  training.   The  application   processing   was   delayed   until
termination of a Flying Evaluation Board  action.   Based  on  the  facts
provided,  DPMARS1  finds  no  error  or  injustice  in  the   separation
processing and recommended the applicant's request for  reinstatement  be
denied (Exhibit K).

___________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Counsel reviewed the additional  advisory  opinions  and  disagreed  with
DPMMMR's position that the applicant was not unfit for duty at  the  time
of his separation.   Counsel  indicated  that  DPMMMR's  conclusions  are
contrary to significant matters contained in the basic  petition  and  in
the following comments.

Statements provided by of the applicant's physicians would show that  the
applicant was hospitalized from 15  November  1992  to  28 January  1993.
These opinions, observations  and  conclusions  are  indicated  that  the
applicant had a personality disorder.  However,  counsel  points  to  the
opinion of a physician (at Exhibit H,  Enclosure  10),  in  which  it  is
indicated that the diagnosis in  the  applicant's  case  was  "depressive
disorder, chronic, since 1986, with severe paranoid features of psychotic
proportions and obsessive-compulsive features."  The evidence  will  also
show that the applicant was "incapable of being open and honest with  the
Air Force officials and physicians because of  his  delusional  beliefs."
and  that  "In  spite  of  these  Delusional  beliefs,   he   ...remained
cognitively intact and (was) able to conceal them when  he  (chose)  to."
The  applicant's  attending  physician  has  stated  that  the  applicant
resigned  his  commission  while  under  the  influence  of  a   Paranoid
Delusional Disorder and as  a  direct  result  of  this  disorder.   This
physician was of  the  opinion  that  the  applicant  suffered  from  any
personality or development disorder.

Again, in view of the medical evidence provided,  counsel  requests  that
the Board grant the requested relief.

Counsel's complete review is at Exhibit M.

___________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

Pursuant  to  the  Board’s  request  (Exhibit  N),  the  Chief,  Physical
Disability Division, AFPC/DPPD, reviewed this application and recommended
denial.  Upon review, DPPD stated that the  applicant  never  received  a
psychiatric diagnosis that would have been eligible for presentation to a
Medical Evaluation Board (MEB).  While on active duty, he did receive  an
Axis I  (psychiatric  diagnosis  of  marital  problems  and  an  Axis  II
(personality) diagnosis of an obsessive-compulsive  personality  disorder
but these are not eligible for disability processing.  At the time of his
separation, the applicant was not diagnosed with a mental condition  that
would have been properly adjudicated under AFR 35-4, Physical  Evaluation
for  Retention,  Retirement  and  Separation.   When  the  applicant  was
involuntarily hospitalized after his discharge, he was diagnosed with  an
“Adjustment disorder with mixed emotional features”  and  this  diagnosis
was confirmed by a  subsequent  evaluation  a  few  weeks  later  by  the
Veterans’ Administration.

DPPD stated that, in psychiatric terms,  an  adjustment  disorder  occurs
when a person develops significant emotional or behavioral symptoms  when
responding to identifiable stressors and those symptoms are in excess  of
what would be expected.   The  diagnosis  requires  identification  of  a
subtype(s), some of which are:

      With depressed mood (including feelings of hopelessness
      With anxiety (nervousness, worry, jitteriness)
      With mixed anxiety and depressed mood (combination of the above
         types)
      With disturbance of conduct (violation of age-appropriate
         societal norms)
      With mixed disturbance of emotions and conduct (combination of
         all the above)
      Unspecified (maladaptive reactions that don’t meet any of the
     above areas)

However, DPPD further stated the diagnosis of “Adjustment  disorder  with
depressed mood” is the only type of adjustment disorder that  may  result
in a finding of unfitness and assignment of  a  disability  rating.   Any
other diagnoses of “adjustment disorder” are considered to be personality
disorders which may make a member unsuitable  for  military  service  and
subject the member to administrative discharge proceedings.

DPPD indicated that the applicant had an extensive history  of  physical,
psychological,  and  psychiatric  evaluations  while  on   active   duty.
However, he never  received  a  psychiatric  diagnosis  that  raised  the
question of his fitness for continued military  service.   DPPD  believes
that the 21 March 1990 advisory by the BCMR  Section,  Medical  Standards
Division, clearly  explained  the  applicant’s  medical  conditions,  the
treatment received, the evaluations conducted and the diagnoses rendered.
 The consultant further delineated why the applicant was not eligible for
presentation to an MEB nor referral to a Physical Evaluation Board (PEB).

The PEB reviewed the entire case, as the Board requested, and stated that
the applicant was not unfit according to the directives in effect at  the
time of his separation.  The PEB stated that at  that  time,  they  would
have  issued  a  recommended  finding  of   “Return   to   Duty.”    This
recommendation means that there was not sufficient  medical  evidence  in
the file to find the member was unfit  for  continued  military  service.
This recommendation did not mean that the applicant did  not  have  other
conditions which rendered him unsuitable for continued military service.

As they have stated in their  previous  advisories  in  this  case,  DPPD
affirms that the applicant was not eligible for disability processing and
recommends denial of the application.

This evaluation is at Exhibit O.

___________________________________________________________________
APPLICANT’S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

Copies of the additional advisory opinion were forwarded to  counsel  for
review and comment (Exhibit P).  Counsel submits that the issues in  this
case are clear.  Counsel noted DPPD’s observation  that  the  applicant’s
“decompensation  and  involuntary  hospitalization  within  days  of  his
separation … clearly raised questions about his mental  status  while  he
was on active duty.”  Counsel opined that  these  “questions”  have  been
resolved beyond any doubt from the statements and enclosures appended  to
the basic petition.  The cited evidence offers irrefutable proof  of  the
validity of the applicant’s petition.

DPPD’s  statement  that  the  applicant  never  received  a   psychiatric
diagnosis which raised the question of his fitness for continued  service
bespeaks the clear evidence that  the  applicant’s  illness  was  clearly
manifested and diagnosed within days of his military discharge.   Counsel
asserts  that  a  proper  separation  physical  examination  would   have
discovered that the applicant was clearly unfit for service at  the  time
of his separation.  The nature of  his  illness  was  such  that  he  was
incompetent to waive his discharge physical.

Counsel stated that the evidence in the record before the Board leads one
to the correct conclusion that the  applicant  was  unfit  for  continued
military service.  The opinions in the advisories  are  contrary  to  the
evidence.  The applicant is most deserving of the modest relief which  he
claims and which is within the Board’s authority to grant.

Counsel’s review and a copy of 27 January 1997 decision by the Department
of Veterans Affairs, increasing the applicant’s  compensable  rating  for
his condition to 100%, effective 15 August 1991, is at Exhibit Q.

___________________________________________________________________

THE BOARD CONCLUDES THAT:

1.  In earlier findings in this case it was determined that the  evidence
presented had not demonstrated the applicant was physically unfit at  the
time of his separation from the Air Force, that his decisions  to  tender
his  resignation  and  disqualify  himself  for  aviation  service   were
involuntary, or that he was incompetent to make these  decisions  at  the
time his requests were submitted.  After reviewing all the  evidence,  we
believe the original decision of the Board should be affirmed.   We  have
reached  our  decision  in   this   matter   based   on   the   following
considerations.

2.  The evidence before us in this case has been difficult to  reconcile.
It cannot be disputed that less than two weeks following his release from
active duty, the applicant’s unusual behavior caused  his  family  enough
alarm that he was referred for mental health  assessment  at  a  civilian
facility.  His condition was diagnosed as a “Delusional Disorder” and  he
was discharged on medication during the  following  month.   The  primary
question which must be answered is, was the applicant unfit at  the  time
of his separation, within the meaning of the governing  regulation  which
implements  the  law.   Air  Force  military  medical  authorities   have
consistently stated that the answer to  the  question  is  “no.”   Having
deliberated over this matter for some time, we are inclined to agree.

3.  It should be noted that then, as now, an  individual’s  condition  at
the time of separation or final disposition governs whether  or  not  the
member is referred for disability processing.  In order  to  be  referred
for disability processing, the member’s fitness for worldwide  duty  must
be seen as questionable.  Decisions of this nature are based on  accepted
medical principles.  With the benefit of hindsight, this Board  has  been
presented with the assertion that the applicant’s condition  should  have
been evident when his service was ending.  We are  aware  that  it  is  a
generally accepted principle there is a progression to conditions such as
the applicant’s, i.e., before the condition  manifests  to  a  degree  of
severity by which a firm diagnosis may be made, some symptoms  may  occur
which, in and of themselves, do not lead medical authorities to  question
the individual’s ability to function in  society.   Therefore,  while  in
retrospect, it may be determined that  symptoms  of  the  condition  were
evident before the disease reaches a severity which  would  allow  for  a
definitive diagnosis, the exact nature and  seriousness  of  the  disease
cannot be diagnosed with any certainty.  It appears to us that  this  was
the situation here.

4.  In April 1989, approximately three and  one-half  months  before  his
separation, the applicant underwent a mental  health  evaluation,  having
been referred because of marital problems.  He was  no  stranger  to  the
mental health clinic, having undergone a number of such  assessments  for
several years.  Following interview and evaluation, the examiner rendered
diagnoses of “marital  problems”  and  “obsessive-compulsive  personality
disorder.”  Notwithstanding the subsequent course of his illness, we have
seen nothing in the evidence which would cause us  to  believe  that  the
1989 diagnoses were erroneous or, based on accepted  medical  principles,
contrary to the symptoms the applicant exhibited at that  time.   Shortly
before undergoing  this  evaluation,  the  applicant  had  submitted  his
request to withdraw from training and had tendered his  resignation.   On
their face, his reasons for submitting these personnel actions seem to us
to be reasonable and  any  concern  his  behavior  may  have  caused  his
superiors was assuaged by the mental health evaluation indicating he  did
not, at that time, appear to have a condition which  caused  his  fitness
for  continued  service  to  be  questionable,  even  though  they   were
disqualifying for the limited purpose of performing aviation service.  He
was, at that time, medically cleared for administrative separation.

5.  After his request for separation had been approved and prior  to  its
execution, it appears  the  applicant  changed  his  mind  and  requested
retention.  This sequence of events is  not  so  unusual  as  some  would
believe and would not normally cause deciding officials to  question  the
individual’s mental capacity to choose.  It is our experience  that  such
requests are approved or denied based  primarily  on  the  needs  of  the
service.  As to the assertion that the Air Force erred by  not  referring
the applicant for a physical examination, as a matter of course, one  was
not required unless requested by the member.  In view of this and because
there was apparently no indication in the applicant’s behavior subsequent
to his evaluation in April  which  caused  his  superiors  to  believe  a
further assessment was warranted, we are not persuaded that the Air Force
erred in this matter.

6.  In view of the above, we  are  unable  to  conclude  with  sufficient
certainty on the basis of the evidence provided that the point  at  which
the  applicant’s  condition  became   unfitting   occurred   before   his
separation, thereby warranting approval of the requested relief.  Whether
the course  of  applicant’s  illness  was  gradually  progressive  and/or
triggered by the trauma associated with his separation combined with  his
existing personal problems, we are unconvinced that the evaluation of his
case by his commanders and military medical authorities was  improper  or
not based on accepted medical principles.  We are  not  unsympathetic  to
the applicant’s situation.  However, after  reviewing  all  the  evidence
provided, we agree with the Air Force offices who have reviewed this case
and believe the actions by Air Force authorities  were  appropriate,  the
applicant’s condition became unfitting and ratable after his  separation,
and, as the law requires, he is now being properly compensated by the DVA
for his service-connected condition.

7.  The applicant's case is adequately documented and  it  has  not  been
shown that a personal appearance with or without counsel will  materially
add to our understanding of the issues involved.  Therefore, the  request
for a hearing is not favorably considered.

___________________________________________________________________

THE BOARD DETERMINES THAT:

The applicant be notified that the evidence presented did not demonstrate
the  existence  of  probable  material  error  or  injustice;  that   the
application was denied  without  a  personal  appearance;  and  that  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  this  application  in
Executive Session on 27 April 1999, under the provisions of AFI 36-2603:

      Ms. Patricia J. Zarodkiewicz, Panel Chair
      Ms. Olga M. Crerar, Member
      Ms. Dorothy P. Loeb, Member

The following additional documentary evidence was considered:

    Exhibit H.  DD Form 149, dated 14 August 1992, with
                attachments.
    Exhibit I.  Letter, AFMPC/DPMMMR, dated 15 October 1992.
    Exhibit J.  Letter, AFMPC/DPMAD, dated 3 November 1992.
    Exhibit K.  Letter, AFMPC/DPMARS1, dated 6 January 1993.
    Exhibit L.  Letter, AFBCMR, dated 4 February 1993.
    Exhibit M.  Counsel’s letter, dated 2 April 1993, with
                attachments.
    Exhibit N.  Letter, AFBCMR, dated 16 October 1995.
    Exhibit O.  Letter, AFPC/DPPD, dated 8 May 1996.
    Exhibit P.  Letters, SAF/MIBR and AFBCMR, dated 20 May and
                20 June 1996, respectively.
    Exhibit Q.  Counsel’s Letters, dated 11 July 1996 and 31 July
                1997, with attachments.




                                   PATRICIA J. ZARODKIEWICZ
                                   Panel Chair