RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER: BC-2013-00990
	XXXXXXX	COUNSEL: LISA MARIE WINDSOR, ESQ.
		HEARING DESIRED: YES

________________________________________________________________

APPLICANT REQUESTS THAT:

His discharge with severance pay be changed to a permanent 
retirement with a 50 percent disability rating for Delusional 
Disorder and Post-Traumatic Stress Disorder (PTSD).

________________________________________________________________

APPLICANT CONTENDS THAT:

The applicant, thru counsel, contends that disagreements made by 
the mental health professionals in his case have made it 
virtually impossible for him to argue that both his disabilities 
are unfitting, ratable and compensable.  The applicant testified 
at the Formal Physical Evaluation Board (FPEB) that he had been 
suffering from symptoms of PTSD since he returned from 
deployment in 2006 and wanted to remain on active duty.  

He was afraid of the stigma associated with mental illness and 
did not seek treatment at the time.  The evidence supports that 
both Delusional Disorder and PTSD were present, unfitting and 
compensable at the time the applicant was placed on the TDRL.

He was given a battery of tests by a clinical social worker who 
diagnosed him with Delusional Disorder based on his unrequited 
love and unrealistic pursuit of a woman in his graduate school 
class.  The clinical social worker pursued his singular 
diagnosis of Delusional Disorder, despite his consistent 
complaints of PTSD symptoms as evidenced in the notes of other 
providers.  His treating physician acknowledges the possibility 
of Delusional Disorder but states that he has not personally 
observed any delusional behavior.

The has a history of family mental illness (schizophrenia), and 
a personal history of Traumatic Brain Injury (TBI).  He was in a 
vehicle that was hit by an Improvised Explosive Device and at 
another time he was in the vicinity of a suicide bomber attack 
and almost stepped on the bomber's severed head.  

He currently works at a job that he gained through vocational 
rehabilitation services.  The vocational rehabilitation 
counselor details the difficulty he has had due to post 
concussive syndrome and his struggles to improve memory, 
concentration and the ability to problem-solve.  His condition 
has not improved since 2009, and he still suffers from 
significant PTSD symptoms, including nightmares, sleep 
deprivation, hyper-vigilance, and recurrent intrusive thoughts.  
He acknowledges maintaining an isolated lifestyle, having no 
social life and rarely venturing out unless he is going to work.  
In Jul 2010, he received a 60 percent disability rating from the 
Department of Veterans Affairs (DVA), with 50 percent for "PTSD 
also claimed as Delusional Disorder and memory loss."

Medical opinions since 2008 have differed in mental health 
diagnosis, but agree that the applicant evidences a significant 
inability to function.  His history of reported memory loss, 
inability to concentrate, impaired thinking, motivational and 
mood disturbances and difficulty in establishing and maintaining 
effective work and social relationships fits the criteria 
according to the Veterans Administration Schedule for Rating 
Disabilities (VASRD) of at least a 50 percent disability rating.

In support of his request, the applicant provides copies of his 
AF Forms 356, Findings and Recommended Disposition of USAF 
Physical Evaluation Board; DVA Rating Decision; DD Form 214, 
Certificate of Release or Discharge from Active Duty; VA Form 9, 
Appeal to Board of Veterans’ Appeals; Standard Forms 600, 
Chronological Record of Medical Care, and various other 
documents associated with his request.

His complete submission, with attachments, is at Exhibit A.

________________________________________________________________

STATEMENT OF FACTS:

On 24 Jun 2009 the applicant was deemed unfit for military duty 
and was placed on the Temporary Disability Retirement List 
(TDRL) with a 50 percent disability rating for Delusional 
Disorder.

According to the 7 Jul 2010, DVA Rating decision provided by the 
applicant the DVA granted him a 50 percent rating for PTSD also 
claimed as Delusional Disorder with memory loss.

On 7 Feb 2012, the Informal Physical Evaluation Board (IPEB) 
rated the applicant’s “Delusional disorder, Erotomanic Type, in 
control off medication,” and recommended discharge with 
severance pay with a disability rating of zero percent.

On 24 Apr 2012, the FPEB upheld the IPEB decision.

On 24 Sep 2012, the applicant was separated from active service 
for physical disability under the provisions of 10 United States 
Code (USC) § 1203, with severance pay and a disability rating of 
10 percent.  He had 19 years, 3 months and 23 days of active 
duty.

The remaining relevant facts pertaining to this application are 
contained in the letters prepared by the appropriate offices of 
the Air Force and the BCMR Medical Consultant at Exhibits C and 
D.

________________________________________________________________

AIR FORCE EVALUATION:

AFPC/DPFD recommends denial.  DPFD states that the preponderance 
of evidence reflects that no error or injustice occurred during 
the disability process or at the time of separation.  In 
accordance with DoDI 1332.38, Physical Disability Evaluation, 
E3.P6.2.4. Compensability of New Diagnoses, when there is a new 
condition for which the service member was not placed on the 
TDRL, the PEB may find the condition ratable and compensable if 
the condition was caused by the condition for which the member 
was placed on the TDRL, or directly related to its treatment, or 
the evidence of record establishes that the condition was an 
unfitting disability at the time the member was placed on the 
TDRL.

The applicant testified he did not miss any work due to his PTSD 
while in service.  DVA evaluation notes dated 22 Jan 2009, state 
that he reported symptoms of “flashbacks, nightmares, and at 
times he emotionally withdraws,” but states that these 
occurrences “do not hinder his current life.”  Since being 
placed on the TDRL, the applicant has maintained a full time 
position with the Department of Treasury.  He takes no 
medications for his condition but continues to function 
adequately without it.  He reported that he did not feel he 
needed any medications for his mental health condition.  
Although he testified he works from home an average of 1-2 days 
a week due to distress, he related this distress to PTSD 
symptoms, not to his Delusional Disorder.  The FPEB found the 
applicant’s Delusional Disorder does not interfere with 
occupational and social functioning which decrease work 
efficiency and ability to perform tasks.  However, his condition 
continues to be unfitting for military service as routine 
military duty and deployment stressors could exacerbate his 
condition with deterioration in functioning.

Although the applicant submitted a copy of his DVA disability 
rating, the FBEB opines this disability rating, awarded on 
initial separation from service, is insufficient for purposes of 
determining the most appropriate current disability rating and 
thus refers to the recent TDRL evaluation and more recent DVA 
and medical treatment notes for rating determination purposes. 
The FPEB recommended discharge with severance pay with a 
disability rating of zero percent in accordance with the VASRD 
guidelines.  The Department of Defense and the DVA disability 
evaluation systems operate under separate laws.  The Air Force 
disability boards must rate disabilities based on the member's 
condition at the time of evaluation.  It is the charge of the 
DVA to pick up where the Air Force must, by law, leave off.  
Under Title 38, the DVA may rate any service-connected condition 
based upon future employability or reevaluate based on changes 
in the severity of a condition.

The complete DPFD evaluation is at Exhibit C.

The BCMR Medical Consultant recommends denial of the applicant's 
request for inclusion of PTSD as unfitting at the time of his 
initial placement on the TDRL.  The Medical Consultant 
alternatively recommends consideration for permanent retirement 
with a 30 percent disability rating due to Delusional Disorder, 
effective the established date of his removal from the TDRL.

Existing Department of Defense policies prohibit the inclusion 
as unfitting any newly diagnosed medical condition or a 
previously diagnosed condition that was not determined unfitting 
or was not caused by the condition found unfitting at the time 
of initial placement on the TDRL.  The applicant's service 
treatment record indicates he reported signs and symptoms that 
can be attributed to PTSD prior to his placement on the TDRL.  
Even though the military provider believed that the applicant 
did not meet the criteria for the diagnosis of PTSD, in order 
for the condition to be included in the disability rating 
computation, it would have to be determined unfitting for 
further military service at the time of initial TDRL placement; 
or found to be secondary to or the direct result of the 
Delusional Disorder.  Despite the clinical history provided to 
the DVA examiner, the applicant's supplied service evidence of 
record does not reflect the applicant's PTSD was the condition 
that resulted in his referral to the military Disability 
Evaluation System (DES). 

Although the Medical Consultant and the Board have been 
confronted with "dueling doctors" opinions, the preponderance of 
evidence reflects it was the applicant's Delusional Disorder and 
not his PTSD that significantly interfered with his duties 
resulting in his release from active military service. 
Nevertheless, the Board’s attention is also directed to the 
matter of the TDRL narrative summary, which clearly states the 
applicant's level of impairment in social and industrial 
adaptability for his Delusional Disorder was "Definite."  Such a 
designation by a mental health provider is generally accepted by 
adjudicating bodies as consistent with a 30 percent disability 
rating.  The applicant's self-report of full-time work and his 
lack of need for medications to control his condition, likely 
led to the reduced rating decision of "0 percent" by the IPEB 
and FPEB; although subsequently increased to 10 percent by 
SAFPC.  Moreover, although the DVA appears to have discarded 
Delusional Disorder as the primary diagnosis, as noted in its 
rating description of the condition as "PTSD also claimed as 
Delusional Disorder," it does not change the fact that 
Delusional Disorder was the condition that cut short the 
applicant's career at the "snap shot" time of his placement on 
the TDRL.  Indeed, the rationale for the DVA rating decision for 
PTSD acknowledges the Delusional Disorder, but in no way 
illustrates a causal relationship between the two in the 
following: "Service connection for PTSD also claimed as a 
Delusional Disorder and memory loss has been established as 
directly related to military service.  The DVA examination 
revealed a diagnosis of PTSD which the examiner linked to the 
applicant’s military service.

The reader is reminded that, operating under Title 38, USC, the 
DVA is authorized to offer compensation for any medical 
diagnosis of record with a nexus to military service, without 
regard to and independent of its relationship with a member's 
retainability or fitness to serve.  The Medical Consultant found 
no causal relationship between the applicant's PTSD and the 
performance of his duties nor as a cause for terminating his 
career.  However, in order to remedy a possible injustice to the 
applicant, the Medical Consultant recommends amending the record 
to reflect that the applicant was permanently retired with a 30 
percent disability rating due to the definite impairment caused 
by his Delusional Disorder.  Conversely, if the argument stands 
that the applicant no longer has symptoms or a functional 
impairment due to Delusional Disorder, then the 10 percent 
rating reissued by SAFPC should stand.  The Board should also be 
aware that a Delusional Disorder diagnosis is considered a 
thought disorder that could be a comparative occupational 
detriment [although not presently] to the applicant, as opposed 
to PTSD, a mood disorder, albeit a factual diagnosis in the 
record.

The complete Medical Consultant’s evaluation is at Exhibit D.

________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Regarding the diagnosis of PTSD, counsel states that no matter 
how severe his condition became it does not appear the applicant 
sought out mental health treatment and may not have ever done so 
absent the command referral.  From his first visit to mental 
health he complained of symptoms associated with combat-related 
PTSD and was referred to a psychologist or psychiatrist for an 
evaluation.  The psychologist communicated to the social worker 
who referred him that he had made a diagnosis of combat-related 
PTSD.  As PTSD is a severe mental condition and potentially 
service-unfitting, the condition should have been assessed and 
considered by the MEB.  Counsel agrees that the determination of 
unfitness is a snapshot of the applicant’s condition at the time 
of separation, but it must also be an accurate snapshot.  Any 
potentially unfitting condition should be evaluated by a 
military physician for possible referral to a MEB, if it is 
known.  The determination of whether the applicant’s combat-
related PTSD rendered him unfit was not accomplished at the time 
of his placement on the TDRL, and it is within the Board's 
authority to make that determination now based on the medical 
reports he received at the time.

Given his current level of impairment and self-reports of 
combat-related PTSD symptoms, the likelihood that he would have 
eventually been separated from the service for combat-related 
PTSD is probable and counsel argues that combat-related PTSD 
should be added as a service unfitting medical condition for the 
purposes of a disability rating.  Counsel agrees with the BCMR 
Medical Consultant’s recommendation regarding the diagnosis of 
Delusional Disorder.  Therefore, counsel requests the Board 
disregard the AFPC/DPFD advisory opinion and adopt the rationale 
of the BCMR Medical Advisor.  In the hope that the Board will 
have a better understanding of the complexities of combat-
related PTSD and Delusional Disorder; counsel guides the Board 
to review the Diagnostic and Statistical Manual of Mental 
Disorders, Fifth Edition (DSM-V). 

In further support of his request, counsel provided copies of 
the DVA rating decision for TBI, progress notes and DSM-V

The complete response, with attachments, is at Exhibit F.

________________________________________________________________

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 took 
notice of the applicant's complete submission in judging the 
merits of the case and do not find that it supports a 
determination that the applicant should have received a 
50 percent disability for PTSD and Delusional Disorder.  The 
applicant has provided no evidence which, in our opinion, 
successfully refutes the assessment of his case by the BCMR 
Medical Consultant.  Therefore, we agree with the recommendation 
of the BCMR Medical Consultant and adopt his opinion as our 
findings in this case.  In the absence of evidence to the 
contrary, we find no basis to recommend granting this portion of 
his application.

4.  Notwithstanding the above, sufficient relevant evidence has 
been presented to demonstrate the existence of an error or 
injustice warranting partial relief.  The thorough analysis 
performed by the BCMR Medical Consultant has raised sufficient 
doubt as to whether the applicant's 10 percent disability rating 
for his Delusional Disorder was correct.  As pointed out by the 
BCMR Medical Consultant, the applicant’s level of impairment in 
social and industrial adaptability for his Delusional Disorder 
was “Definite,” is generally accepted by adjudicating bodies as 
consistent with a 30 percent disability rating.  As such, we 
believe the applicant's medical condition may not have been 
rated properly at the time of his separation.  Therefore, in the 
interest of equity and justice, we recommend the applicant’s 
records be corrected to reflect that he was medically retired 
from the Air Force by reason of a physical disability rather 
than “Disability, Severance Pay.”  Accordingly, we recommend his 
records be corrected to the extent indicated below.

5.  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 issue(s) 
involved.  Therefore, the request for a hearing is not favorably 
considered.

________________________________________________________________

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 23 Sep 2012, he was found unfit to perform the duties 
of his office, rank, grade, or rating by reason of physical 
disability, first incurred while he was entitled to 
receive  basic pay; that the diagnosis in his case was 
"Delusional Disorder, VASRD Code 9208, that the degree of 
impairment in social and occupational adaptability was definite; 
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 that the disability was 
not received in the line of duty as a direct result of armed 
conflict or caused by an instrumentality of war.

    b. On 24 Sep 2012, the applicant was not separated by reason 
of Physical Disability with a compensable rating of 10 percent, 
but, on that date he was removed from the Temporary Disability 
Retirement List and permanently retired with a 30 percent 
disability rating.

    c. The election of Survivor Benefit Plan option will be 
corrected in accordance with the member's expressed preferences 
and/or as otherwise provided for by law or the Code of Federal 
Regulations.

________________________________________________________________

The following members of the Board considered this application 
in Executive Session on 5 Dec 2013, under the provisions of AFI 
36-2603:

, Panel Chair
, Member
, Member

All members voted to correct the record as recommended.  Due to 
the unavailability of Mr. Janosov, Mr. Pollock will sign as 
Acting Panel Chair.  The following documentary evidence was 
considered in AFBCMR BC-2013-00990:

   Exhibit A.  DD Form 149, dated 15 Feb 2013, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, AFPC/DPFD, dated 23 Apr 2013.
   Exhibit D.  Letter, BCMR Medical Consultant, dated 6 May 2013.
   Exhibit E.  Letter, SAF/MRBC, dated 7 May 2013.
   Exhibit F.  Letter, Counsel, dated 5 Jun 2013, w/atchs.




								
								Acting Panel Chair

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FOR OFFICIAL USE ONLY – PRIVACY ACT OF 1974