APPLICANT REQUESTS:  In effect, the applicant requests physical disability retirement.    

APPLICANT STATES:  She was discharged through administrative channels, and the Army Discharge Review Board agrees that if her condition had been properly diagnosed, she would have received a physical disability retirement or separation.

COUNSEL CONTENDS:  Counsel supports the applicant’s request (COPY ATTACHED) and states that he strongly disagrees with the advisory opinion from the Office of the Surgeon General. Counsel notes that Army medical examinations reflect findings of depression, reduction in ability to get along with co-workers and suicidal ideation.  The applicant was referred to civilian rape crisis sources for care and counseling and received a diagnosis of rape trauma syndrome. Counsel states that the military evaluations did not reflect the PTSD/rape trauma because they did not want to recognize this problem.

The advisory opinion continues this attitude, discounting not only the diagnosis of rape trauma, as an aspect of PTSD, but does not consider the guilt factor leading to suicidal ideation.  Counsel notes that many factors point to a personality disorder, however, because of the diagnosis of rape trauma they also support a diagnosis of PTSD.  Counsel notes that the VA has awarded the applicant a 30 percent disability rating for PTSD.  Counsel feels that the military too often diagnoses a soldier with personality disorder, but if it would take the time to be more thorough, the diagnosis would be different.  Counsel states that this is borne out by the fact that the VA has often disagreed with the evaluation of personality disorder by the military, and relied not only on service medical records, but follow-up examinations by the VA and private medical personnel.  

Counsel states that the manifestations of PTSD were of record and disregarded by military personnel.  Counsel states that full relief is warranted.


EVIDENCE OF RECORD:  The applicant's military records show:

The applicant enlisted in the Army on 2 July 1981 and had served on continuous active duty until her discharge in 1989.  She achieved the rank of Sergeant and was awarded the Army Commendation Medal, two awards of the Joint Service Commendation Medal, the Army Good Conduct Medal, and the Army Achievement Medal, among other awards.  The applicant served in Belgium and the Netherlands.  She received a permanent P3 profile for chronic low back pain with disc degenerative change on 1 March 1986.  In June 1986 she was assigned to Key West, Florida.

A 8 December 1986 clinical resume from the Florida Keys Memorial Hospital indicated that the applicant was referred by a doctor from the Naval Clinic because she was expressing suicidal ideation.  The examining physician stated that it was planned to medically evacuate the applicant to a military psychiatric facility for further evaluation.  Her condition was diagnosed as an adjustment disorder with depressed mood.

A 9 December 1986 psychiatric report indicates that the applicant had filed a formal complaint charging unfair treatment because of her sex, harassment because she was overweight as well as because of her smoking.  Her complaints were determined to be unfounded.  The examining psychiatrist indicated that she showed no gross psychiatric disturbance, however her mood was one of frustration, anger and dissatisfaction with her job, mainly with the people she works for.  She projected blame and responsibility onto a Major and a Sergeant Major, and felt she was being treated unfairly.  A great deal of preoccupation and histrionics with manipulative features in her attempt at dealing with the perceived injustice was verbalized.  The psychiatrist diagnosed her condition as a mixed personality disorder with passive-aggressive histrionic and narcissistic features, and stated that she was temperamentally and emotionally unsuited for continued service and administrative separation should be strongly considered on the basis of a personality disorder.

On 11 June 1987 a MOS (Military Occupational Specialty/Medical Retention Board (MMRB) determined that the applicant’s permanent medical condition did not preclude her satisfactory performance in her MOS in a worldwide field environment, and that she would be retained in her current primary MOS (PMOS). 

In July 1988 the applicant was assigned to the Defense Language Institute at Monterey, California.

A November 1988 medical report indicates that the applicant had an adjustment disorder with depressed mood, manifested by problems coping and suicidal thoughts.

The applicant underwent therapy from psychologists at the Fort Ord community hospital on numerous occasions from November 1988 to March 1989.  During these sessions she revealed that she felt that she was victimized.  She stated that she was traumatized because of sexual harassment while stationed overseas, she was raped, she married an alcoholic and suffered numerous episodes of domestic violence, and she attempted suicide.  The examining psychologist opined during the early sessions that the applicant suffered from PTSD.

An undated medical evaluation from the Fort Ord, California Army Medical Department Activity psychology service, indicates that the applicant had been seen for five sessions beginning on 3 January 1989.  That evaluation indicated that therapy was established following a brief, self-referred hospitalization, which at that time she was severely depressed with accompanying suicidal depression precipitated by a recent separation in a turmoil laden marriage.  There was no report or known previous psychiatric history.  She showed no evidence of mental defect, emotional illness, or psychiatric disorder of sufficient severity to warrant disposition through military medical channels.  The diagnostic impression was major depressive episode.  Clinical evaluation at that time indicated that she did not suffer from psychiatric disease, defect, or personality disorder that would cause significant defects in judgment or reliability, or preclude adequate performance of duties.  She was psychiatrically cleared for any administrative action deemed appropriate. 
On 17 February 1989 the applicant’s commanding officer requested that the applicant undergo a psychiatric evaluation, stating that the applicant was a chronic complainer, had an excessive desire to be discharged, was under stress and depressed, with unusual behavior.  That official stated that the applicant might commit suicide if there were no other options.

A 17 February 1989 report of mental status evaluation shows that the applicant was diagnosed as having a mixed personality disorder (passive dependent/passive aggressive/borderline), severe.  Her condition was a deeply ingrained, maladaptive pattern of behavior of long duration which interfered with her ability to perform duty; and so severe that her ability to function effectively in the military environment was significantly impaired.  The examining psychologist did indicate that the applicant had the potential to meet mobilization requirements under conditions of full mobilization, and recommended that the applicant be transferred to the Reserve.

On 23 February 1989 the applicant’s commanding officer initiated action to discharge the applicant under the provisions of Army Regulation 635-200, paragraph 5-13, for a personality disorder.  The applicant consulted with counsel, and stated that she understood the basis for the contemplated action, its effects, and of the rights available to her.  She waived consideration of her case by an administrative separation board and declined to submit a statement in her own behalf.

A 2 March 1989 report of medical examination indicates that the applicant was medically qualified for separation with a physical profile serial of 1 1 1 1 1 1.  In the report of medical history she furnished for the examination, the applicant indicated that she had withdrawn from a course in Russian because of acute PTSD, and that she had attempted suicide in October of 1988.


The applicant’s commanding officer recommended to the separation authority that the applicant be separated.  On 
3 March 1989 the separation authority approved that recommendation and directed that the applicant be issued an honorable discharge certificate.

The applicant was discharged on 10 March 1989.  She had 
7 years, 11 months, and 26 days of service. 

A 17 March 1989 medical record indicates the applicant was seen by a clinical psychology service at Fort Ord, California for anxiety and personal problems.  Her condition was diagnosed as a personality disorder.

A 17 August 1990 report from a marriage, family, and child counselor, indicates that the applicant was referred through the Monterey Rape Crisis Center in November 1988 to a group that this counselor ran for survivors of sexual assault.  That counselor stated that the applicant’s history included an untreated attempted rape and assault in February 1986, sexual harassment, rape, and spousal abuse; and that the applicant still displayed many symptoms of PTSD which affected her daily life.

A 11 June 1991 VA rating decision awarded the applicant a 
10 percent service connected disability rating for post traumatic stress disorder (PTSD) from 11 March 1989, an increase from the zero percent awarded on 20 November 1989.
A 12 October 1993 VA decision continued the 10 percent rating for PTSD.

On 8 June 1994 the Army Discharge Review Board (ADRB) granted the applicant’s request to change the reason for her discharge from personality disorder to one directed by the Secretary of the Army.  That board determined that the applicant’s excellent service record and accomplishments were not compatible with the diagnosis of personality disorder, and that the applicant was treated, and was still being treated for PTSD.  The board felt that had the applicant been properly diagnosed, she would have been separated through medical channels instead of administrative channels.  This Board notes that the above determination by the ADRB was made without benefit of medical advice. 
A 17 April 1995 VA rating decision increased the applicant’s disability rating for PTSD to 30 percent.

In the processing of this case an advisory opinion was obtained from the Office of the Surgeon General (COPY ATTACHED).  The psychiatrist reviewing the applicant’s case provided a background history on her various psychiatric evaluations, attempted rape in 1986, rape in 1988, and suicide attempt later that year.  That official stated that the applicant had received extensive mental health care during her active duty service, and that her difficulties were attributed to adjustment disorders and various combinations of personality features and personality disorder, that when taken together support the diagnosis of a personality disorder.  He stated that there was no evidence in the available medical and personnel records that PTSD was ever present during her active duty service.  She met the medical standards for retention in the Army.  That official recommended that the applicant’s claim be denied.

Army Regulation 635-200 sets forth the basic authority for the separation of enlisted personnel.  Paragraph 5-13 establishes policy and prescribes procedures for  separating members for personality disorder (not amounting to a disability under Army Regulation 635-40), a deeply-ingrained maladaptive pattern of behavior which interferes with the individual's ability to perform.  Prior counseling with a view to correcting deficiencies is mandatory.

PTSD, an anxiety disorder, was not recognized as a
psychiatric disorder until 1980 with the publishing of
the Diagnostic and Statistical Manual of Mental
Disorders (DSM) III.  The condition is described in the
current DSM-IV, pages 424 through 427.  While PTSD
has only been categorized by psychiatrists as a distinct
diagnosis since 1980, it has, as early as the Civil War,
been described in psychological literature, variously
labeled as shell shock, soldier's heart, effect
syndrome, combat fatigue and traumatic neurosis.  During
the period of time in question, similar psychiatric
symptomatology was categorized as hysterical neurosis. 
Although the current label of PTSD is of rather recent
acceptance, the idea that catastrophes and tragedies can
result in persistent emotional and psychological
symptoms is common even among the lay public.  While
PTSD was not recognized as a specific illness at the
time of the applicant's separation from the service, the
fact that an individual might not be fit for further
military service because of psychosis, psychoneurosis,
or neurological disorders was outlined in Army
Regulation 40-501 which was in effect at the time of his
separation.  The Army here established standards and
procedures for determining fitness for retention and
utilized those procedures and standards in evaluating
individuals at that time.  The specific diagnostic label
given to an individual's condition a decade or more
after her discharge from the service may change, but any
change does not call into question the application of
then existing fitness standards.

Army Regulation 40-501, paragraph 3-3b(1), as amended, provides that for an individual to be found unfit by reason of physical disability, she must be unable to perform the duties of her office, grade, rank or rating.

Army Regulation 635-40, paragraph 2-2b, as amended, provides that when a member is being separated by reason other than physical disability, her continued performance of duty creates a presumption of fitness which can be overcome only by clear and convincing evidence that she was unable to perform her duties or that acute grave illness or injury or other deterioration of physical condition, occurring immediately prior to or coincident with separation, rendered the member unfit.

Army Regulation 635-40 was changed by Department of the Army message, dated 27 February 1973, to provide that when a
member is undergoing evaluation because of a referral arising during processing for separation for reasons other than physical disability, her continued performance of duty until she is scheduled for separation creates a presumption that the member is fit for duty.

Title 38, United States Code, sections 310 and 331, permits the VA to award compensation for a medical condition which was incurred in or aggravated by active military service.  The VA, however, is not required by law to determine medical unfitness for further military service.  The VA, in accordance with its own policies and regulations, awards compensation solely on the basis that a medical condition exists and that said medical condition reduces or impairs the social or industrial adaptability of the individual concerned.  Consequently, due to the two concepts involved, an individual's medical condition, although not considered medically unfitting for military service at the time of processing for separation, discharge or retirement, may be sufficient to qualify the individual for VA benefits based on an evaluation by that agency.

DISCUSSION:  Considering all the evidence, allegations, and information presented by the applicant, together with the evidence of record, applicable law and regulations, and advisory opinion(s), it is concluded:

1.  Notwithstanding the opinion by the Army Discharge Review Board (ADRB), service medical records do not indicate any medical condition incurred while entitled to receive basic pay which was so severe as to render the applicant medically unfit for retention on active duty.  Contrary to the ADRB opinion, the applicant was properly diagnosed.  At the time of the separation physical examination, competent medical authority determined that the applicant was then medically fit for retention or appropriate separation.  Accordingly, the applicant was separated from active duty for reasons other than physical disability.  

2.  The applicant did not have any medically unfitting disability which required physical disability processing.  Therefore, there is no basis for physical disability retirement or separation.

3.  The Board notes that the applicant received comprehensive medical and mental health care during her Army service.  Contrary to counsel’s contentions, the diagnosis of her condition as a personality disorder was not hastily conducted, sketchy or incomplete, but thorough and definite. The applicant was diagnosed on four different occasions over a two year period as having a personality disorder.  Although counsel takes exception to the advisory opinion from the office of the Surgeon General, that agency emphatically states that there was no clear descriptions of the symptoms and findings consistent with PTSD - the applicant made no complaints of nightmares, flashbacks of the alleged assaults, or dissociative phenomena, hallmarks of PTSD. 

4.  The applicant's continued performance of duty raised a presumption of fitness which she has not overcome by evidence of any unfitting, acute, grave illness or injury concomitant with her separation.

5.  Records provided by the VA indicate that the applicant has been awarded compensation for medical conditions which that agency has determined to be related to military service.

6.  The fact that the VA, in its discretion, has awarded the applicant a disability rating is a prerogative exercised within the policies of that agency.  It does not, in itself, establish physical unfitness for Department of the Army purposes.

7.  The award of VA compensation does not mandate disability retirement or separation from the Army.  The VA, operating under its own policies and regulations, may make a determination that a medical condition warrants compensation. The VA is not required to determine fitness for duty at the time of separation.  The Army must find a member physically unfit before she can be medically retired or separated.

8.  An award of a VA rating does not establish entitlement to medical retirement or separation.  The VA is not required to find unfitness for duty.  Operating under its own policies and regulations, the VA awards ratings because a medical condition is related to service, i.e., service-connected.  Furthermore, the VA can evaluate a veteran throughout his lifetime, adjusting the percentage of disability based upon that agency's examinations and findings.  The Army must find unfitness for duty at the time of separation before a member may be medically retired or separated.
9.  Neither the applicant nor counsel has submitted  probative evidence or a convincing argument in support of her request. 

10.  In order to justify correction of a military record the applicant must show to the satisfaction of the Board, or it must otherwise satisfactorily appear, that the record is in error or unjust.  The applicant has failed to submit evidence that would satisfy the aforementioned requirement.

11.  In view of the foregoing, there is no basis for granting the applicant’s request.

DETERMINATION:  The applicant has failed to submit sufficient relevant evidence to demonstrate the existence of probable error or injustice.

BOARD VOTE:

                       GRANT          

                       GRANT FORMAL HEARING

                       DENY APPLICATION




						Karl F. Schneider
						Acting Director