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


IN THE MATTER OF:      DOCKET NUMBER:  01-02424
            INDEX CODE:  108.00

            COUNSEL:  NONE

            HEARING DESIRED:  NO


_________________________________________________________________

APPLICANT REQUESTS THAT:

Her general discharge be changed to a medical discharge.

_________________________________________________________________

STATEMENT OF FACTS:

On 2 Jan 02, the Board considered an  application  pertaining  to  the
applicant, in which  she  requested  that  her  general  discharge  be
changed to a medical discharge.  The Board noted  that  the  applicant
was  diagnosed  with  adjustment  and  personality  disorders,  but  a
determination was made by the  evaluator  that  she  did  not  have  a
psychiatric  disorder  that  warranted  disposition   by   a   medical
evaluation  board,  and  that  her  personality   disorder   did   not
significantly impair her ability to adapt to  military  service.   The
applicant was eventually  discharged  for  misconduct.   However,  the
Board was concerned about  the  close  proximity  of  the  applicant’s
discharge and her  diagnosis  with  schizophrenia.   Thus,  the  Board
determined that the most appropriate action in this case would be  for
the applicant to undergo a physical  examination  and  review  by  the
Medical Evaluation Board (MEB), the Physical  Evaluation  Board  (PEB)
and the Formal Physical Evaluation  Board  (FPEB),  if  necessary,  to
determine her medical condition as of the date of  her  discharge.   A
complete copy of the Record of Proceedings is at Exhibit F.

On 18  Apr  02,  an  MEB  convened  and  established  a  diagnosis  of
Schizophrenia, Paranoid Type, in Partial Remission (Existed  Prior  to
Service (EPTS)).  The MEB recommended that  the  applicant’s  case  be
referred to an Informal Physical Evaluation Board (IPEB).

On 25 Apr  02,  an  IPEB  convened  and  established  a  diagnosis  of
Schizophrenia,  Paranoid  Type,  EPTS  Without  Service   Aggravation,
Considerable Social and Industrial Adaptability Impairment.  The  IPEB
found that the applicant was unfit because of physical disability, and
that the disability was ratable under VA Diagnostic Code  9203  at  50
percent (Not Applicable), and that the disability was permanent.   The
IPEB recommended that the applicant be  discharged  under  other  than
Chapter 61, 10 United States Code (USC) (EPTS).

On  16  May  02,  the  applicant  disagreed  with  the  findings   and
recommended disposition of the IPEB and demanded a formal  hearing  of
the case.

On 17 Jun  02,  an  FPEB  convened  and  established  a  diagnosis  of
Schizophrenia,  Paranoid  Type,  EPTS  Without  Service   Aggravation,
Considerable Social and Industrial Adaptability Impairment.  The  FPEB
found that the applicant was unfit because of physical disability, and
that the disability was ratable under VA Diagnostic Code  9203  at  50
percent (Not Applicable), and that the disability was permanent.   The
FPEB recommended that the applicant be  discharged  under  other  than
Chapter 61, 10 United States Code (USC) (EPTS).  The applicant did not
agree with the findings and recommended disposition of the FPEB.

_________________________________________________________________

AIR FORCE EVALUATION:

SAF/MRBP  recommended  denial  indicating  that   they   conducted   a
retrospective  review  of  the  applicant’s  case   and   specifically
considered her post-discharge mental health evaluations.   They  noted
both the informal and formal medical evaluation boards determined  the
applicant  suffers  from  schizophrenia  which  makes  her  unfit  for
service.  Significantly, both  boards  found  the  applicant’s  mental
condition existed prior to service (EPTS).  Her condition was  dormant
and did not manifest  itself  during  her  brief  period  of  service.
Moreover, they did not find any evidence her condition was  aggravated
while she was  in  the  military.   Both  medical  boards  recommended
against retirement for medical reasons.

SAF/MRBP  noted  that  a  review  of  the  applicant’s   medical   and
disciplinary records revealed the applicant did not  manifest  any  of
the symptoms which are characteristic of her disorder.  In the  early,
or prodromal phase, persons suffering from  this  condition  typically
are withdrawn socially, lose interest in  work,  and  have  difficulty
concentrating.  The applicant’s actions during the  11 months  and  20
days  of  her  active  service  reveal  an  engaged,   involved,   but
manipulative airman who was able to  establish  goals  (sometimes  the
wrong goals) and take definitive steps in order to accomplish them.

According  to  SAF/MRBP,  the  type  and  method  of  the  applicant’s
misconduct demonstrated she possessed a well-ordered  mind  while  she
was on active duty.  When confronted by the possible loss of high-cost
airline tickets because her supervisor declined to extend  her  leave,
the applicant  attempted  to  circumvent  her  supervisor  and  obtain
approval of the leave through subterfuge.  On  another  occasion,  the
applicant reacted with  understandable  (but  unjustified)  resentment
when her supervisor questioned her about failing to  attend  mandatory
physical training.  Similarly, the  applicant  demonstrated  a  linear
thought process when she attempted to avoid responsibility  for  being
late by lying to her supervisors.  During one  three-day  period,  the
applicant was late to work or  failed  to  show  up  for  bay  orderly
duties.  On one occasion, she timed her arrival to coincide to periods
when she knew her supervisor would not be able  to  assign  her  work.
Again, while her conduct was lamentable, it does not suggest a  defect
in her thought process.  Finally, the  applicant  became  romantically
involved with a male airman who ultimately proved unfaithful  to  her.
When she went to her  boyfriend’s  room,  she  discovered  her  rival.
After a brief  confrontation,  the  applicant  slapped  her  estranged
boyfriend across the face.  While there was no legal justification for
the applicant’s action, her decision to slap him across  the  face  is
certainly understandable (and showed remarkable restraint) considering
the circumstances in which she found herself.  Based on the foregoing,
the SAF/MRBP concurred with the findings of the  two  previous  boards
and did not find any evidence supporting service aggravation  in  this
case.

In summary, SAF/MRBP indicated that while the applicant may have  been
troubled emotionally and suffering from the very early stages  of  the
mental disease which now  afflicts  her,  there  was  nothing  in  her
military record  indicating  her  disease  impacted  her  performance,
played any role in her misconduct, or was in any way aggravated by her
service.

A complete copy of the SAF/MRBP evaluation is at Exhibit G.

The Medical Consultant recommended denial noting that schizophrenia is
a mental disorder characterized by a loss  of  contact  with  reality,
false perceptions (hallucinations, usually  auditory),  false  beliefs
(delusions),  abnormal  thinking,  restricted   range   of   emotions,
diminished  motivation,  and   disturbed   occupational   and   social
functioning.  Schizophrenia is believed  to  have  a  biologic  basis,
occurring in individuals  with  neurologically  based  vulnerabilities
when  exposed  to  stressful  life  events   (for   example:    ending
relationships, work stresses, military  service,  legal  difficulties,
etc).  The onset of this condition can be abrupt over days  to  weeks,
or  slow  and  insidious  over  several  years.    The   majority   of
schizophrenics experience a prodromal phase manifested by a  slow  and
gradual development of a  variety  of  signs  and  symptoms  including
social withdrawal, loss of interest in school or  work,  deterioration
in hygiene, outbursts of anger, and unusual  behavior.   Schizophrenia
shares features with  and  may  be  preceded  by  certain  personality
disorders including schizotypal,  schizoid,  or  paranoid  personality
disorder (e.g., paranoid ideation, magical thinking, social avoidance,
and  vague  and  digressive  speech).   An  additional  diagnosis   of
schizophrenia is appropriate when the symptoms are  severe  enough  to
satisfy  the   clinical   diagnostic   criteria   for   schizophrenia.
Schizophrenia is distinguished from a paranoid personality disorder by
the presence of persistent  psychotic  symptoms  (i.e.  delusions  and
hallucinations).  To give a diagnosis of personality disorder separate
from schizophrenia, the personality disorder must  have  been  present
before the onset of psychotic symptoms and must persist when psychotic
symptoms are in remission.   Personality  disorders  are  often  first
apparent in adolescence and young  adulthood  (as  may  the  prodromal
phase of schizophrenia).  The inability to maintain employment can  be
a  symptom  of  both  personality  disorder  and   the   prodrome   of
schizophrenia.   Whether  a  pre-morbid  personality  disorder  is   a
distinct entity  from  the  subsequent  schizophrenia,  or  represents
chronic mild symptomology of  the  neurobehavioral  disorder  that  is
called schizophrenia is not known for certain.  However,  their  close
clinical association in certain patients is consistent with  a  common
underlying  pathophysiology  in  those  patients.    Brief   psychotic
symptoms can be triggered by stress in  individuals  with  a  paranoid
personality disorder without  developing  schizophrenia.   Stress  can
also trigger an episode of schizophrenia in these individuals.

According to the Medical Consultant, the preponderance of the evidence
supports the presence of a  pre-morbid  condition  existing  prior  to
service, variably diagnosed as a personality disorder or the  prodrome
of   schizophrenia   (manifested   by    marked    job    instability,
suspiciousness, and other features).   There  was  no  evidence  of  a
history  of  psychotic  symptoms  existing  prior  to  service.    The
Diagnostic  and  Statistical  Manual  of  Mental   Disorders   clearly
indicates that certain personality disorders are predisposing or are a
pre-morbid antecedent to schizophrenia.  The applicant’s diagnoses  of
personality disorder and adjustment disorder were proper at  the  time
they were made.  A diagnosis of schizophrenia was proper at  the  time
she manifested psychotic symptoms.  The misconduct  exhibited  by  the
applicant was not clearly attributable to hallucinations or delusional
thinking of schizophrenia, but was consistent with the presence  of  a
personality  disorder,  the  prodromal  phase  of   schizophrenia   or
schizophrenia.  There was no evidence of psychotic  symptoms  existing
while on active duty that can be found in the available records.   The
only evidence that the applicant fully manifested schizophrenia  while
on active duty was her statement and her  mother’s  statement  a  year
following discharge that she had delusional thinking in Mar 01.

The  applicant’s  misconduct  did  not  reflect  defects  in   thought
processes.  She attempted  to  circumvent  her  direct  supervisor  to
extend her leave when faced with the potential loss of  a  high-  cost
airline ticket.  She attempted to avoid responsibility by lying  about
her tardiness.  She became romantically involved with  another  airman
whom she  confronted  regarding  unfaithfulness  and  slapped  him,  a
behavioral response exhibited by many without mental  illness.   There
was no evidence that she was behaving in response to voices commanding
her to do certain things,  or  in  response  to  delusional  thoughts.
Further, her pattern of tardiness,  and  difficulties  while  at  work
appears to be a continuation of behavior reported prior to service.

In the Medical Consultant’s view, had  the  applicant  been  diagnosed
with schizophrenia while on active duty, it is likely that  she  would
have been referred into the disability evaluation system and  had  her
case evaluated at the Secretary of the Air Force Personnel Council  as
a “dual action” to determine if discharge should be for misconduct  or
for disability.  It is likely that with an  established  diagnosis  of
schizophrenia (while on active duty), the Council would  have  granted
disability discharge.  In  view  of  the  fact  that  the  applicant’s
symptoms were very mild at the time of her mental  health  evaluation,
and the presence of a pre-morbid  personality  disorder  or  prodromal
phase  of  schizophrenia,  the  PEB  would  likely  have   recommended
disability  discharge  either  due  to  an  EPTS   condition   without
compensation, or at most, separation with severance pay at 10 percent.
 Aggravation  of  mental  health  conditions  due  to  the  stress  of
discharge from the military is not a reason for compensation rating at
a higher level.

The Medical Consultant was of  the  opinion  that  no  change  in  the
records was warranted  based  on  the  evidence  of  the  medical  and
personnel records.  The action  and  disposition  in  this  case  were
proper and equitable reflecting compliance with Air  Force  directives
that implement the law.  However, he indicated that the  AFBCMR  could
consider the applicant’s testimony that she was manifesting delusional
thinking while on active duty that would have resulted in a  diagnosis
of schizophrenia and altered the outcome of her discharge.

A complete copy of the Medical Consultant’s evaluation is  at  Exhibit
H.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the Air Force evaluations were forwarded to applicant  on  6
Dec 02 for review and response.  As of this date, no response has been
received by this office (Exhibit I).

_________________________________________________________________

THE BOARD CONCLUDES THAT:

Sufficient relevant evidence has been  presented  to  demonstrate  the
existence of error or injustice.  In an earlier finding in this  case,
because of the applicant's diagnosis with schizophrenia so soon  after
her discharge for misconduct, the  Board  concluded  that  she  should
undergo an evaluation to determined her medical condition  as  of  the
date of her discharge, and that  the  results  of  the  evaluation  be
provided for the Board’s  review.   In  accordance  with  the  Board’s
request, the applicant was evaluated and an  IPEB  and  an  FPEB  were
conducted.  Both boards determined that  the  applicant  suffers  from
schizophrenia which makes her unfit for service.  They also found that
her condition existed prior to service.  The IPEB and FPEB recommended
discharge without compensation.  Based on the evidence  presented,  to
include the Medical Consultant's assessment, a majority of  the  Board
is persuaded that had the applicant been diagnosed with  schizophrenia
while on active duty, she would have in all likelihood  been  referred
into the disability evaluation system and discharged by  reason  of  a
physical  disability  rather  than  for   misconduct.    The   Medical
Consultant has indicated that because the applicant's  symptoms  would
have  been  considered  very  mild  at  the  time,   the   recommended
disposition would have been a disability discharge either  due  to  an
EPTS condition without  compensation,  or  at  most,  separation  with
severance pay at 10 percent.  After an exhaustive review  of  all  the
facts and circumstances of this case, a majority is inclined to  agree
with the latter.  Accordingly, a majority of the Board recommends that
the applicant's records be corrected to the extent set forth below.

_________________________________________________________________

THE BOARD RECOMMENDS THAT:

The pertinent military records of the  Department  of  the  Air  Force
relating to APPLICANT, be corrected to show that:

      a.  On 3 May 01, she was found unfit to perform  the  duties  of
her office, grade, rank, or rating by reason of a physical  disability
incurred while entitled to basic pay; that the diagnosis in  her  case
was for schizophrenia, VASRD Code 9203, rated at 10 percent; that  the
degree of impairment was permanent; that the disability was not due to
intentional misconduct or willful neglect; that the disability was not
incurred during a period of unauthorized absence; and  the  disability
was not received in line of duty as a direct result of armed  conflict
or caused by an instrumentality of war.

      b.  On 4 May 01, she was honorably discharged from  active  duty
under the provisions of AFI 36-3212 and Title 10, USC,  Section  1203,
Disability, Entitled to Disability Severance Pay, with  a  10  percent
disability rating, and was issued a separation program designator code
of “JFL” rather than “JKN,” and a  reenlistment  eligibility  code  of
“2Q,” rather than “2B.”

_________________________________________________________________

The following members of the Board considered AFBCMR Docket Number BC-
2001-02424 in Executive Session on 1 Apr 03, under the  provisions  of
AFI 36-2603:

      Mr. Gregory H. Petkoff, Panel Chair
      Mr. Thomas J. Topolski, Member
      Mr. Clarence D. Long III, Member

By a majority vote,  the  Board  voted  to  correct  the  records,  as
recommended.  Mr. Topolski voted to deny the appeal but did  not  wish
to submit a minority report.   The  following  additional  documentary
evidence was considered:

     Exhibit F.  Record of Proceedings, dated 8 Feb 02, w/atchs.
     Exhibit G.  Letter, SAF/MRBP, dated 13 Nov 02.
     Exhibit H.  Letter, Medical Consultant, dated 25 Nov 02.
     Exhibit I.  Letter, AFBCMR, dated 6 Dec 02.




                                   GREGORY H. PETKOFF
                                   Panel Chair










AFBCMR BC-2001-02424




MEMORANDUM FOR THE CHIEF OF STAFF

      Having received and considered the recommendation of the Air
Force Board for Correction of Military Records and under the authority
of Section 1552, Title 10, United States Code (70A Stat 116), it is
directed that:

      The pertinent military records of the Department of the Air
Force relating to , be corrected to show that:

            a.  On 3 May 01, she was found unfit to perform the duties
of her office, grade, rank, or rating by reason of a physical
disability incurred while entitled to basic pay; that the diagnosis in
her case was for schizophrenia, VASRD Code 9203, rated at 10 percent;
that the degree of impairment was permanent; that the disability was
not due to intentional misconduct or willful neglect; that the
disability was not incurred during a period of unauthorized absence;
and the disability was not received in line of duty as a direct result
of armed conflict or caused by an instrumentality of war.

            b.  On 4 May 01, she was honorably discharged from active
duty under the provisions of AFI 36-3212 and Title 10, USC, Section
1203, Disability, Entitled to Disability Severance Pay, with a 10
percent disability rating, and was issued a separation program
designator code of “JFL” rather than “JKN,” and a reenlistment
eligibility code of “2Q,” rather than “2B.”






    JOE G. LINEBERGER

    Director

    Air Force Review Boards Agency