RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:				DOCKET NUMBER:  BC-2012-02157

								COUNSEL:  NONE

								HEARING DESIRED:  NO

________________________________________________________________

APPLICANT REQUESTS THAT: 

Her narrative reason for separation be changed from adjustment 
disorder to medically retired. 

________________________________________________________________

APPLICANT CONTENDS THAT:

She should have been medically boarded and in turn, medically 
retired.  She received a letter from the Air Force Personnel 
Center regarding personality disorder separations.  While she 
does not believe her disability is related to post-traumatic 
stress disorder (PTSD), she does believe she should have 
received a medical board. 

In support of the appeal, the applicant provides her DD Form 
214, Certificate of Discharge or Release from Active Duty and 
her rating from the Department of Veterans Affairs (DVA).

The applicant’s complete submission, with attachments, is at 
Exhibit A.

________________________________________________________________

STATEMENT OF FACTS:

The applicant enlisted in the Regular Air Force on 31 July 1996.  
On 21 May 2009, she was notified of her commander’s intent to 
discharge her from the Air Force for Conditions that Interfere 
with Military Service:  Mental Disorder – Personality Disorder 
and Adjustment Disorder.  Specifically, she was diagnosed with 
Adjustment Disorder with Mixed Anxiety and Depressed Mood and a 
Personality Disorder, as contained in the Diagnostic and 
Statistics Manual of Medical Disorders.  Additionally, she had 
shown an inability to cope with her duties and instability to 
cope with interpersonal issues in her workplace.  

The applicant acknowledged her right to present her case to an 
administrative discharge board, to be represented by military 
counsel and to submit matters on her behalf to be considered by 
the discharge board.  She waived her rights to a board hearing 
and counsel.  She also declined to submit matters on her behalf.  
The staff Judge Advocate found the discharge legally sufficient 
on 27 May 2008.  On 27 May 2008, the commander approved the 
discharge and directed she be separated with an honorable 
discharge.  Her narrative reason for separation is listed as 
Adjustment Disorder.

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AIR FORCE EVALUATION:

The BCMR Medical Advisor recommends denial.  The applicant had 
excellent enlisted performance reports throughout her 12 years 
of service, except for a referral report in April 2008 due to 
her involvement in an off-base driving while under the influence 
incident.  She was seen by a mental health provider on several 
occasions between 18 December 2007 and 6 March 2008.  She 
repeatedly noted to the professionals that her emotional issues 
were directly related to her service.  She was given an Axis I 
diagnosis of Adjustment Disorder with Mixed Anxiety and 
Depressed Mood.  Her Axis II diagnosis was Personality Disorder.

Despite a poor response to therapy, the applicant had no signs 
or symptoms of a diagnosable disqualifying medical condition 
warranting a Medical Evaluation Board under AFI 48-123, Medical 
Examinations and Standards, or further processing as a 
compensable disability.  Adjustment Disorder is listed among 
mental disorders not considered a disability under AFI 36-3208, 
Administrative Separation of Airmen, and Department of Defense 
Instruction 1332.38.  The fact that the applicant has been 
subsequently issued a different diagnosis after leaving military 
service does not invalidate the accuracy or appropriateness of 
the diagnostic conclusion reached by equally competent mental 
health authority, which was based on the applicant’s complaints 
and demonstrated pattern of behavior at the time of her military 
service.  

The applicant should be aware that the DVA operates under a 
different set of laws and is authorized to offer compensation 
for any medical condition for which it establishes a nexus with 
military service, without regard to its proven or demonstrated 
impact upon a service, nor the intervening period since release 
from service.  This is why individuals may be discharged from 
military service for one reason, yet receive a compensation 
rating for one or more service connected medical conditions that 
were not military unfitting at the time of release from service. 

The applicant has not met the burden of proof of an error or 
injustice that warrants the desired change of record.

The BCMR Medical Advisor’s complete evaluation is at Exhibit C.

________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant does not deny stating she wanted out of the Air 
Force, however, she was not in the right state of mind and spoke 
out of frustration.  She was diagnosed with Adjustment Disorder 
and Personality Disorder.  She was also diagnosed with Major 
Depressive Disorder in June 2000, Dysthymic Disorder and Anxiety 
Disorder in February 2008 and Depression in April 2008.  

According to AFI 48-123, 5.3.12.2, mental conditions requiring 
Medical Evaluation Boards (MEB) include conditions that are 
expected to have persistent duty impairment, more than one year 
despite treatment; conditions associated with recurrent duty 
impairment, two or more episodes of impairment in 12 months and 
conditions which require continuing psychiatric support beyond 
one year.  Not only did she have recurring episodes of 
depression with duty impairment, but she also required 
psychiatric support beyond one year.  She continues to receive 
medical treatment as she still struggles with both conditions to 
this day.

She explains that she felt she could not trust the Mental Health 
Clinic due to the adverse effects of the prescribed medication.  
She also explains the references to alcohol abuse and dependence 
in her medical records.  She contends she self-identified to her 
first sergeant and was referred to a 30-day in-residence 
rehabilitation program in 2000.  She also states that after her 
driving under the influence incident, the initial evaluation 
found that she did not meet the criteria for alcohol dependence.

In her 12 years of military service, she had five duty stations 
and six deployments.  She volunteered for each deployment, to 
include a remote tour to Alaska.  She never complained and never 
attempted to get out of these deployments.  She had an overall 
excellent career and loved being part of the military until 
depression and anxiety got in the way.  Although she wanted to 
get out of the military, she feels she should have been 
diagnosed with Depression and Anxiety at the time of her 
discharge which would have prompted an MEB. 

The applicant’s complete response, with attachments, is at 
Exhibit E.

________________________________________________________________

ADDITIONAL AIR FORCE EVALUATION:

The BCMR Medical Advisor recommends denial.  After reviewing the 
new medical evidence submitted by the applicant, the Medical 
Consultant identified evidence of alternative diagnosis, twice 
by the same provider, in which the applicant was diagnosed with 
potentially compensable Axis I diagnosis.  However, the Medical 
Consultant opines that although the applicant has received 
compensation by the DVA, this fact does not invalidate the 
accuracy of the findings and recommendation of the military 
department, particularly in the context of the applicant’s 
emphatic requests for administrative separation and the 
declination of further treatment.  

Under the Title 38 Code of Federal Regulations (CFR), Section 
4.13, Effect of change of diagnosis, it provides that when a 
change is made of a previously assigned diagnosis or etiology 
the aim should at the reconciliation and continuance of the 
diagnosis or etiology upon which service connection for the 
disability had been granted.  The relevant principle 
enunciated in Section 4.125, entitled "Diagnosis of Mental 
Disorders," should have careful attention in this connection.  
When any change in evaluation is made, the rating agency 
should assure that there has been an actual change in the 
conditions, for better or worse, and not merely a difference in 
thoroughness of the examination or in use in descriptive 
terms.  

This will not preclude the correction of erroneous ratings, nor 
will it preclude assignment of a rating in conformity with 
Section 4.7.  Section 4.70, Inadequate Examinations, reads:  If 
the report of examination is inadequate as a basis for the 
required consideration of service connection and evaluation, 
the rating agency may request a supplementary report from the 
examiner giving further details as to the limitations of the 
disabled person's ordinary activity imposed by the disease, 
injury, or residual condition, the prognosis for return to, or 
continuance of, useful work.  When the best interests of the 
service will be advanced by personal conference with the 
examiner, such conference may be arranged through channels.

Section 4.125, Diagnosis of Mental Disorders, reads:  (a) If 
the diagnosis of a mental disorder does not conform to DSM-IV 
or is not supported by the findings on the examination report, 
the rating agency shall return the report to the examiner to 
substantiate the diagnosis.  (b) If the diagnosis of a mental 
disorder is changed, the rating agency shall determine whether 
the new diagnosis represents progression of the prior 
diagnosis, correction of an error in the prior diagnosis, or 
development of a new and separate condition. If it is not clear 
from the available records what the change of diagnosis 
represents, the rating agency shall return the report to the 
examiner for a determination."   

While these rules are useful when considering ratings and 
accuracy of the diagnoses within the DVA, it does not have 
relevance when determining whether a condition was unfitting 
during military service; or the cause for career termination.  
The fact that another federal agency has utilized criteria 
under Section 4.129 (used in rating PTSD) in assigning the 
applicant's post-service disability rating, illustrates the 
latitude given to examiners and rating officials in applying 
the law.

The diagnostic nomenclature assigned to a given set of 
psychiatric symptoms and stressors, as reported by a patient at 
a given point in time, not uncommonly may change over time; or 
may be reported differently at subsequent points in time. 
Therefore, with disclosure or presentation of a different 
clinical history or set of symptoms, a new mental health 
provider may reach a different final diagnostic conclusion, as 
was likely in the case under review.  Professional diagnostic 
opinions may even vary between two different providers when 
given the same set of clinical symptoms from the same patient; 
and during the approximate same period of time, as also noted 
in the different diagnoses reached by a licensed clinical 
social worker and the psychologist.  Furthermore, a change in 
diagnosis may legitimately occur following a greater period of 
observation and treatment; notwithstanding the fact that 
individuals may also experience symptoms that are shared by one 
or more other clinical diagnoses, for instance, the 
depressed mood seen in Adjustment Disorder, Major Depressive 
Disorder, Dysthymic Disorder, Anxiety Disorder, PTSD, or 
secondary to Alcohol Dependence; and the mood swings seen in 
Bipolar Disorder and Borderline Personality Disorder. 

Adjustment Disorder is generally considered a diagnosis for at 
least 6 months, following which, other diagnostic 
considerations would be made if symptoms persist or further 
evolve.  Yet two or more mental disorders [Axis I and/or Axis 
II diagnoses] may even coexist concurrently, as co-morbid 
mental disorders in the same subject, often times making it 
difficult to attempt separation of the two due to their close 
association and shared clinical features.  

Thus, the fact that the applicant has been given compensation 
for a different diagnosis by the DVA provider is insufficient 
to invalidate the accuracy or appropriateness of the 
conclusions reached by equally competent military mental health 
authorities and the applicant's commander, who is most familiar 
with her expressed pattern of behavior at the time of her 
military service; notwithstanding her expressed desire to leave 
military service.

The Board is reminded that, operating under Title 10 United 
States Code (U.S.C.), the military department can only, by law, 
offer compensation for the illness or injury which is the cause 
for career termination; and then only to the degree of 
impairment present at the "snap-shot" time of release from 
service.  Whereas, operating under a different set of laws with 
a different purpose [Title 38 U.S.C.], the DVA is authorized to 
offer compensation for any medical diagnosis/condition for 
which it establishes a nexus with military service.  Moreover, 
the DVA may conduct periodic reevaluations for the purpose of 
adjusting the disability rating compensation.  The fact that 
the DVA has assigned a disability compensation for Depression 
does not invalidate the personnel action taken by the military 
department, is not determinative that this diagnosis was 
unfitting at the time of release from service, and thus, does 
not warrant a de facto Medical Evaluation Board and further 
processing through the military Disability Evaluation System.

The BCMR Medical Consultant regrettably recommends denial of the 
applicant’s request to supplant her administrative discharge 
with a medical retirement.

The BCMR Medical Consultant’s complete evaluation is at 
Exhibit F.


________________________________________________________________

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the 
applicant on 24 September 2013, for review and comment within 
30 days (Exhibit H).  As of this date, this office has received 
no response.

________________________________________________________________

THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by 
existing law or regulations.

2.  The application was timely filed.

3.  Insufficient relevant evidence has been presented to 
demonstrate the existence of an error or injustice.  We 
carefully considered the available evidence of record; however, 
the Board majority found no indication the actions taken to 
effect the applicant’s discharge were improper or contrary to 
the provisions of the governing instructions.  Therefore the 
majority of the Board agrees with the opinion and recommendation 
of the BCMR Medical Consultant and adopts his rationale as the 
basis for our conclusion that the applicant has not been the 
victim of an error or injustice.  Therefore, in the absence of 
evidence to the contrary, the Board majority finds no basis to 
recommend granting the relief sought in this application.

________________________________________________________________

RECOMMENDATION OF THE BOARD:

A majority of the Board finds insufficient evidence of error or 
injustice and recommends the application be denied.

________________________________________________________________

The following members of the Board considered AFBCMR Docket 
Number BC-2012-02157 in Executive Session on 21 February 2013 
and 26 March 2013, under the provisions of AFI 36-2603:


By a majority vote, the Board recommended denial of the 
application.  XXXX XXXX voted to correct the record and submits 
a Minority Report.  The following documentary evidence was 
considered:

    Exhibit A.  DD Form 149, dtd 23 May 12, w/atchs.
    Exhibit B.  Applicant’s Master Personnel Record.
    Exhibit C.  Letter, BCMR Medical Consultant, dtd 22 Jan 13.
    Exhibit D.  Letter, SAF/MRBR, dtd 22 Jan 13.
    Exhibit E.  Letter, Applicant’s Response, undated, w/atchs.
    Exhibit F.  Letter, BCMR Medical Consultant, dtd 20 Mar 13.
    Exhibit G.  Minority Report, dtd 15 Apr 13.
    Exhibit H.  Letter, SAF/MRBR 24 Sep 13.