RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 	DOCKET NUMBER: BC-2014-00679
					COUNSEL:  NONE
		HEARING DESIRED:  NO 


APPLICANT REQUESTS THAT:

His narrative reason for separation be changed to medical.


APPLICANT CONTENDS THAT:

He was discharged due to a medical disability.  

The Board should find it in the interest of justice to consider 
his untimely application.  He states that since his discharge he 
has been in constant physical and mental rehabilitation at the 
Department of Veterans Affairs (DVA) Hospital.

The applicant’s complete submission is at Exhibit A.


STATEMENT OF FACTS:

On 29 Mar 00, the applicant initially entered the Regular Air 
Force.

On 4 May 09, the applicant's commander notified him that he was 
recommending him for discharge from the Air Force for a condition 
that interfered with military service, specifically for mental 
disorders.  The specific reason for this action was on 7 Apr 09, 
the applicant was diagnosed by the mental health clinic, with Axis 
I:  Adjustment Disorder with Mixed Anxiety and Depressed Mood; 
Axis II:  Narcissistic Personality Disorder.  The report was 
further certified by a Licensed Psychologist and a Licensed 
Psychiatrist.  This condition was deemed unsuitable for continued 
military service and was so severe that the applicant's ability to 
function effectively in the military environment was significantly 
impaired.  It was determined that discharge was deemed to be in 
the best interest of the United States Air Force.

The applicant acknowledged receipt of the notification of 
discharge and was advised of his right to consult with legal 
counsel and submit statements on his own behalf.

The applicant submitted an unconditional waiver of his right to 
present his case to an administrative discharge board.

On 27 May 09, the staff judge advocate reviewed the package and 
found it legally sufficient to support separation.  

The discharge authority accepted the unconditional waiver, 
approved the separation and directed the applicant be discharged 
with an honorable discharge.

On 12 Jun 09, the applicant was honorably discharge, with a reason 
for separation of personality disorder.  He was credited with 
9 years, 2 months, and 14 days of active duty service.   


AIR FORCE EVALUATION:

AFPC/DPSOR recommends denial.  Based on the documentation on file 
in the master personnel records, the discharge to include the 
separation code, the narrative reason for separation and character 
of service was consistent with the procedural and substantive 
requirements of the discharge instruction and was within the 
discretion of the discharge authority.  DPSOR found no evidence of 
an error or injustice in the processing of the applicant's 
discharge.  

DPSOR notes the report, from the mental health clinic, dated 7 Apr 
09, states the applicant's negative pattern of interactions with 
others both at work and outside of work indicated that he was 
likely to continue to have difficulties that affect his duty 
performance.  Further, there was no evidence of mental defect, 
emotional illness, or psychiatric disorder, as defined by AFI 48-
123, Medical Examinations and Standards, of sufficient severity to 
warrant disposition through military medical channels.  
Furthermore, the report stated the applicant was deemed unsuitable 
for continued military service on the basis of the Narcissistic 
Personality Disorder.  Finally, his difficulties were so severe as 
to significantly impair his ability to function in a military 
environment and it was recommended that administrative separation 
be pursued.

As a result of the conclusions made in the report, the applicant 
was processed for immediate discharge.  Therefore, the SPD code, 
the narrative reason for separation, and character of service as 
indicated on the applicant's DD Form 214 are correct.

The complete DPSOR evaluation is at Exhibit C.

The BCMR Medical Consultant recommends denial of the applicant’s 
request to change his narrative reason for separation to a medical 
discharge.  Despite this advisory recommendation, the Board is 
clearly empowered to assert its wisdom and executive authority if 
an error or injustice exists in its opinion; bearing in mind that 
what may not be an error in procedure, may yet present an 
injustice.

It should first be noted that both the Military Department [2009] 
and the DVA examiner [2013 gave the applicant an Axis II diagnosis 
of Personality Disorder.  Thus, while the applicant was also given 
an Axis I diagnosis of Anxiety Disorder, a ratable and compensable 
condition, the Military Department found the Personality Disorder 
to be the primary diagnostic impediment to duty and the reason for 
discharge.  This analysis, although sound, does not tell the full 
story.

The Military Department also issued an Axis I diagnosis of 
Adjustment Disorder with Mixed Anxiety and Depressed Mood; which 
by definition is a diagnosis limited to a period of six months, 
following which resolution is expected to have occurred upon 
removal or resolution of the precipitating stressor.  Otherwise, 
symptoms that persist beyond six months [presumably beyond the 
applicant's discharge date] the condition is either characterized 
as chronic, or may be more appropriately characterized under 
different diagnostic nomenclature based on an enduring stressor.  
Therefore, it would not be usual for the applicant's service Axis 
I diagnosis of Adjustment Disorder with Mixed Anxiety and 
Depressed Mood to then change to Anxiety Disorder; particularly 
after disclosure of a new set of significant stressors since 
leaving military service and considering that features of the 
disorder were present and acknowledged during the applicant's 
military service.  Addressing a common allegation of arbitrary and 
capricious separations for Personality Disorder, the Medical 
Consultant has no scientific way to validate whether this occurred 
in the applicant's case.  However, directing attention to the 
totality of his performance reports, other than that which is 
disclosed in the mental health assessments, there is, otherwise, 
no written explanation for the relative sudden downturn in 
performance; as one would expect a developmental Personality 
Disorder to have manifested sooner and more consistently as 
maladaptive behavior throughout or earlier in his service history; 
lending credence to probable external precipitating sources 
influencing his mental functioning, hence the co-morbid Adjustment 
Disorder diagnosed by his military provider.

The applicant and the Board are also advised that assigning 
diagnostic nomenclature is dependent upon the predominant 
disclosed or presenting symptoms, as reported through interview 
with the patient at a given point in time [e.g., during a military 
evaluation versus a subsequent post-service VA examination]; as 
these may vary along a continuum of time. Additionally, a 
psychiatric diagnosis may even differ among different clinicians 
evaluating the same patient during the relative same period of 
time, which, again, depends upon the predominant clinical 
presentation, observations made, or symptoms disclosed.  

Yet, as in the case under review, two or more mental disorders 
[Axis I and/or Axis II diagnoses] may even co-exist concurrently, 
as co-morbid mental disorders in the same subject, often times 
making it difficult to attempt to separate the two due to their 
close association or shared clinical features; or which to 
attribute causation for a particular event.  Thus, the fact the 
applicant was given an additional diagnosis of Anxiety Disorder, 
by the VA examiner in 2013, does not invalidate the accuracy or 
appropriateness of the Axis II [Personality Disorder] diagnostic 
conclusions also reached the DVA, which resulted in the 
disposition chosen by the Military Department, IAW AFI 36-3208, 
Administrative Separation of Airmen.  

Unlike the Military Department, which operates under Title 10, 
United States Code (U.S.C.), the DVA, operating under Title 
38 U.S.C., is authorized to offer compensation for any diagnosed 
medical condition that it finds a nexus with military service, 
without regard to whether it was the predominant diagnostic 
presentation at the time of release from service, the cause for 
release from service, or the length of time that has transpired 
since discharge.  The DVA is also empowered to conduct periodic 
evaluations for the purpose of adjusting the disability ratings 
[decrease or increase) as the level of impairment for a given 
medical condition may vary [improve or worsen) over the lifetime 
of the veterans.  

The complete BCMR Medical Consultant evaluation is at Exhibit D.


APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the Air Force evaluations were forwarded to the 
applicant on 27 Oct 14 for review and comment within 30 days 
(Exhibit E).  As of this date, no response has been received by 
this office.


THE BOARD CONCLUDES THAT:

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

2.  The application was not timely filed; however, it is in the 
interest of justice to excuse the failure to timely file.

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; however, we agree with the opinion and 
recommendation of the Air Force office of primary responsibility 
(OPR) and the BCMR Medical Consultant, and adopt their rationale 
as the basis for our conclusion the applicant has not been the 
victim of an error of injustice.  Therefore, in the absence of 
evidence to the contrary, we find no basis to recommend granting 
the requested relief.



THE BOARD DETERMINES THAT:

The applicant be notified the evidence presented did not 
demonstrate the existence of material error or injustice; the 
application was denied without a personal appearance; and 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 AFBCMR Docket Number 
BC-2014-00679 in Executive Session on 9 Dec 14 under the 
provisions of AFI 36-2603:

	, Panel Chair
	, Member
	, Member

The following documentary evidence was considered:

	Exhibit A.  DD Form 149, dated 9 Feb 14.
	Exhibit B.  Pertinent Excerpts from Personnel Records.
	Exhibit C.  Letter, AFPC/DPSOR, dated 8 Aug 14.
	Exhibit D.  Letter, BCMR Medical Consultant, 
	            dated 9 Oct 14.
Exhibit E.  Letter, SAF/MRBR, dated 27 Oct 14.