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


IN THE MATTER OF:                 DOCKET NUMBER:  BC-1996-02064

                             COUNSEL:  MR. A. W. WALLUK

                       HEARING DESIRED:  NO


_________________________________________________________________

APPLICANT REQUESTS THAT:

In the applicant’s request for reconsideration, she  requests  a  disability
retirement at a rating of 50 percent, as of the date of her separation.
_________________________________________________________________

STATEMENT OF FACTS:

The applicant’s Total Active Federal Military Service  Date  (TAFMSD)  is  9
May 74.  The applicant was  honorably  discharged  in  the  grade  of  staff
sergeant (E-5) on 10 May 88 under the provisions of  AFR  39-10  (Conditions
that Interfere with Military Service-Not Disability-Character  and  Behavior
Disorder).  She had completed a total of 14 years and 2 days of active  duty
service at the time of discharge.

In 1996, applicant  applied  to  the  Air  Force  Board  for  Correction  of
Military Records (AFBCMR) requesting a change to her  narrative  reason  for
separation and separation code.  Her application was considered  and  denied
by  the  Board  on  30  Sep  97.   For  an  accounting  of  the  facts   and
circumstances surrounding the applicant’s separation, and, the rationale  of
the  decision  by  the  Board,  see  the  Record  of  Proceedings  (ROP)  at
Exhibit H.

A similar appeal was considered and approved by  the  Board  on  21 Mar  00,
which changed her narrative  reason  for  separation  to  “Directed  by  the
Secretary of the Air Force” and her separation code.  For an  accounting  of
the facts and  circumstances  of  this  case,  and,  the  rationale  of  the
decision by the Board, see the Addendum to the ROP at Exhibit M.

In 2001, counsel, on behalf  of  the  applicant,  submitted  a  request  for
reconsideration of his client’s application.   The  reconsideration  request
was for a disability retirement at a rating of 50 percent, as  of  the  date
of her separation, based on an earlier Board decision.  Her  reconsideration
appeal was considered and denied by the Board on 28 Jan 02.   A  summary  of
the evidence considered by the Board and the rationale for its  decision  is
set forth in the Second Addendum to the ROP at Exhibit R.

In counsel’s most recent request for reconsideration,  submitted  on  behalf
of the applicant, he contends  that  his  client’s  diagnoses  of  unsuiting
conditions were erroneous and that her condition was  instead  an  unfitting
and ratable one that should have resulted in a  disability  retirement.   No
evidence  is  submitted  other  than  citing  the  Department   of   Defense
Instruction (DODI)  concerning  unsuiting  conditions.   Counsel’s  complete
submission is at Exhibit S.
_________________________________________________________________

AIR FORCE EVALUATION:

Pursuant to the Board’s request,  the  AFBCMR  Medical  Consultant  reviewed
counsel’s  most  recent  submission  and  stated   that   counsel   requests
consideration as to whether the applicant’s  adjustment  disorder  diagnosis
could be the basis of a disability discharge, citing Department  of  Defense
Instruction (DODI) 1332.38, paragraph E5.1.2.1 and E5.1.2.9.4, which  states
that an Adjustment Disorder cannot be the basis for a  disability  discharge
without a finding of another ratable causative  disorder.   He  argues  that
there was evidence of “considerable significant other  disorders  diagnosed”
in the applicant’s case.  In support of the contention, he cites the  mental
health evaluations from Aug 90 (depression diagnosis),  1  Jul  94  (opinion
that she had a disturbance of mood  while  on  active  duty  not  adequately
treated without specific opinion that the adjustment disorder diagnosis  was
in error), and the 1999 evaluation.  Counsel contends that  the  applicant’s
diagnoses were in error and her treatment was inadequate.

The AFBCMR Medical Consultant states that, in order  to  conclude  that  the
applicant’s symptoms actually  represented  an  unfitting  condition,  there
would have to be a preponderance of evidence to conclude that her  diagnosis
was something other than adjustment disorder.   Alternative  diagnoses  were
considered and the criteria for diagnosis were not met.  There is no  reason
to suspect that the different mental health professionals she was  evaluated
by while on  active  duty  were  all  incompetent  and  unable  to  properly
diagnose her symptoms.  Adjustment Disorder is considered to be  the  result
of constitutional weakness of coping skills and not a disease.  When  severe
enough, the condition  is  considered  “unsuiting”  for  continued  military
service and  cause  for  administrative  discharge  rather  than  disability
discharge.

Opinions as to whether the  applicant  had  maladaptive  personality  traits
that met the threshold  for  diagnosing  a  personality  disorder  (Axis  II
diagnosis) have varied among the various  mental  health  professionals  who
have evaluated her.  The Jan 88 VA  psychiatry  hospitalization  rendered  a
diagnosis of Histrionic Personality  Disorder.   Multiple  other  evaluators
who saw  her  only  one  time  without  the  benefit  of  other  sources  of
historical information made “no  diagnosis”  in  the  Axis  II  (personality
disorder).  However, other evaluators have clearly  noted  the  presence  of
maladaptive personality traits contributing to her  reduced  coping  skills.
A specific description of her traits as borderline is  consistent  with  the
previous impression of histrionic traits since both  fall  into  the  larger
classification of “Cluster B traits” which includes Borderline,  Histrionic,
Antisocial   and   Narcissistic   Personality   Disorders.     A    detailed
psychological evaluation in 1999 that included  formal  personality  testing
was reported to have not identified the presence of a personality  disorder.
 This apparent discrepancy  does  not  fully  contradict  the  diagnosis  of
personality disorder 11 years before as some types of personality  disorder,
especially Cluster B disorders, tend to become less  evident  over  time  or
remit with age.   Histrionic  personality  disorder  is  associated  with  a
higher risk for depressive disorders and the coexisting  presence  of  other
Cluster B traits or disorders.  The applicant’s previous  several  years  of
good duty performance and lack of apparent  mental  health  difficulties  is
evidence that argues against the presence of a severe personality  disorder,
but not the presence of maladaptive traits that do not  meet  the  threshold
for diagnosis.  The  presence  of  her  adjustment  disorder  aggravated  by
personality traits  not  meeting  the  threshold  for  personality  disorder
diagnosis may better account  for  the  difficulties  at  the  time  of  her
discharge.  The applicant’s post-service experience of  depression  in  1990
and subsequent normal  examinations  and  finding  of  Posttraumatic  Stress
Disorder (PTSD) and Adjustment Disorder  do  not  contradict  her  diagnoses
while in the service.  The difficulties the applicant demonstrated with  her
externship in 1989 and 1990 are consistent with the findings of  maladaptive
personality traits and personality disorder.

The  AFBCMR  Medical  Consultant  concludes  that  evidence  of  the  record
supports the original  diagnoses  of  Adjustment  Disorder  and  Personality
Disorder that led to the applicant’s discharge and that  no  change  in  the
records is warranted.  Action and disposition in this case  are  proper  and
equitable reflecting compliance with Air  Force  directives  that  implement
the law.  A complete copy of this evaluation is at Exhibit T.
_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Having been  provided  the  advisory  opinion,  the  applicant  submitted  a
personal  statement  indicating  that  her  counsel  would  be  preparing  a
response to the advisory opinion (Exhibit V).

The applicant, through congressional channels, has apparently submitted  her
response to the advisory opinion for  the  Board’s  review.   She  does  not
believe that the AFBCMR Medical  Consultant  is  fully  cognizant  that  the
Board removed personality disorder from her records.  She  would  also  like
to note that he is not a psychiatrist.   Since  then,  she  has  obtained  a
letter from a psychologist (Dr. H---)  and  a  letter  from  a  psychiatrist
(Dr. G--).  She indicated that they both agreed with  the  Board’s  decision
to remove the diagnosis of Personality Disorder from her  records  and  that
her release from active duty was due to emotional problems due to  a  mental
condition (Axis I disorder), diagnosed a generalized Anxiety Disorder  on  5
Nov 87.  She has been unemployed since her discharge.

The congressional inquiry and the applicant’s submission, with  attachments,
are at Exhibit W.

Having been provided the advisory opinion,  counsel  submits  his  statement
indicating that the point of  this  reconsideration  is  that  the  previous
advice  that  the  Board  adopted  was  incorrect.   All  three  Air   Force
evaluations contain axis one diagnoses that qualify  for  the  exception  in
the DoD Instruction.  The applicant’s medical problems were well  documented
while she was on active duty and they continued causing  her  problems  from
immediately following her discharge to the present day.  She served over  13
years and was improperly discharged, as the Board earlier  determined,  with
no  benefits.   She  should  have  been  processed  through  the  Air  Force
disability system that would have resulted in a retirement of  at  least  30
percent, but more likely 50 percent.

Counsel’s submission, with attachments, is at Exhibit W.

_________________________________________________________________

THE BOARD CONCLUDES THAT:

1.  After  reviewing  the  documents  presented  for  our  review  with  the
applicant’s request for reconsideration along with  the  prior  evidence  of
record,  we  are  unconvinced  that,  at  the  time  of  her  administrative
separation, the  applicant  had  a  medical  condition  that  warranted  her
referral to the Disability Evaluation System for processing.   We  therefore
believe the earlier decision in this case should be affirmed  based  on  the
following considerations.

2.  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.  While the  applicant’s  behavior  was  case  for  referral  for
mental  health  evaluations,  it  was  the  determination  of  health   care
providers that her condition at that time was  not  unfitting,  but  rather,
was cause for the initiation of administrative separation action.

3.  This Board has been presented with the assertion that the applicant  had
conditions  that  were  unfitting  in  accordance  with  the  governing  DoD
Instruction.  We disagree.  Prior to her separation,  it  appears  that  the
applicant underwent extensive evaluation and treatment, including  a  period
of inpatient hospitalization at a VA medical facility.   In  the  main,  her
condition was diagnosed as an Adjustment Disorder.  Beginning  approximately
two years after the applicant’s separation, she  was  diagnosed,  variously,
as having Major Depression,  Generalized  Anxiety  Disorder  and  Depressive
Neuroses, Adjustment Disorder,  and  PTSD.   Notwithstanding  the  views  of
various mental health specialists who have  evaluated  her  over  the  years
since her separation, we remain unpersuaded  that  the  assessments  of  her
condition prior to her discharge were erroneous, contrary to  sound  medical
principles or based on factors other than the  state  of  her  condition  at
that time.  It is interesting to note that the DVA has determined  that  she
does not possesses a psychiatric disability that is  compensable  under  the
VASRD.  The applicant’s case has undergone an exhaustive review by the  BCMR
Medical Consultant  and there is nothing in the  evidence  provided  by  the
applicant that would overcome his assessment of the case.

4.  Accordingly, in view of the above and based on our  finding  that  there
is no evidence in the available record that establishes to our  satisfaction
that the applicant’s separation from the Air Force in 1988, as corrected  by
this Board, is erroneous or unjust, we have no basis to  favorably  consider
the applicant’s request for additional relief in the form  of  a  retirement
because of physical disability.

_________________________________________________________________

THE BOARD DETERMINES THAT:

The applicant be notified that the evidence presented  did  not  demonstrate
the existence of 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 11 September 2003 under the provisions of AFI 36-2603:

                 Mr. Richard A. Peterson Panel Chair
                 Ms. Brenda L. Romine, Member
                 Ms. Carolyn B. Willis, Member

The following documentary evidence was considered:

      Exhibit R. Second Addendum to the Record of Proceedings,
                 dated 15 February 2002, with Exhibits.
      Exhibit S. Counsel’s letter, dated 19 August 2002, with
                 with attachments.
      Exhibit T. Letter, BCMR Medical Consultant, dated
                 14 November 2002.
      Exhibit U. Letter, AFBCMR, dated 15 November 2002.
      Exhibit V. Applicant’s letter, dated 5 December 2002.
      Exhibit W. Letter from a Member of Congress, dated
                 28 July 2003, with Applicant’s 30 June 2003
                 letter, with attachments, and Counsel’s
            letters, dated 18 August 2003,
            with attachments, and 5 September 2003.





                                   RICHARD A. PETERSON
                                   Panel Chair