2.  The applicant requests, in effect, that her discharge due to physical unfitness, rated 10 percent disabled, be corrected to a medical retirement.

3.  She states that her psychiatric condition originated while she was on active duty and is permanently disabling, preventing her from being able to perform any form of work.

4.  The applicant’s military personnel and medical records show that she enlisted in the Regular Army on 2 October 1985 in pay grade E-1, was awarded the military occupational specialties of broadcast journalist and motor transport operator, had successfully completed the primary leadership development course in 1987, was promoted to pay grade E-5 on 1 August 1989, received above average noncommissioned officer evaluation reports, and completed an instructor training course in 1990.

5.  On 7 June 1994 the applicant referred herself to a military mental health clinic, reporting feelings of dread and impending doom.  She reported that since her return from Saudi Arabia, she would frequently awaken in the middle of the night as a result of bad dreams of being in Saudi Arabia.  She felt numb to things that should have caused her to feel various emotions, and she experienced prolonged blackouts.  During those blackouts she had been involved in an automobile accident, and had once started out to pick up her clothes from a local drycleaner, and inexplicably ended up in another state.  She reported a symptom complex consisting of recurrent and intrusive, depressing recollections of a particular event that occurred in Saudi Arabia.  The event in question was explosive debris falling on her unit with secondary explosions of ammunition (her unit was an ammunition supply unit).  She reported feeling intense panic when exposed to stimuli similar to that which she was exposed to in Saudi Arabia.  She was also experiencing consistently diminished interest in a variety of activities that she use to find pleasurable, significant feelings of detachment and estrangement from others, a very restricted range of affect, and a strong sense of a fore-shortened future.  Additional symptoms included irritability, concentration difficulty, hypervigilance, and exaggerated startle response.  During the examination, at least two well-formed and distinct personalities were identified, as well as several less fully formed personalities or personality states.  At various times, different personalities took full control of the applicant’s behavior.  Additional characterizations included significant memory gaps, internal conversations among different personalities, and markedly different interactional styles and modes of coping as a function of which personality appeared to be in control.  She was diagnosed as suffering from multiple personality disorder and Post-traumatic Stress Disorder (PTSD), with severe precipitating stress.  The psychiatrist continued that the applicant had no recall of any childhood trauma which is typically found in patients with multiple personality disorders, but stated that there was the possibility that the traumatic recall may not have been available to the personalities with whom the psychiatrist was interviewing.  The psychiatrist assessed her multiple personality disorder as being a marked impairment for further military duty, as being a definite impairment for social and industrial adaptability, and as existing prior to service but with permanent aggravation of the condition caused by military service.  In conjunction with her evaluation, she was given a permanent physical profile precluding her assignment to any area where psychiatric care is not available.

6.  The applicant was then referred to a medical evaluation board (MEB) which found that she suffered from multiple personality disorder, which was considered to have existed prior to service but was service aggravated, and PTSD, moderate degree.  The MEB referred the applicant to a physical evaluation board (PEB).

7.  On 29 July 1994 an informal PEB convened and determined that the applicant was physically unfit due to PTSD and multiple personality disorder under Veterans Administration Schedule for Rating Disabilities (VASRD) codes 9411 and 9401.  The PEB recommended that the applicant be discharged with severance pay, rated 10 percent disabled.  The applicant initially disagreed with that recommendation and demanded a formal hearing, but later withdrew her demand and concurred with the PEB’s recommendation.

8.  Subsequent to the applicant’s PEB, on 1 September 1994 she was given another psychiatric evaluation.  She was again diagnosed as suffering from PTSD and multiple personality disorder, stemming from SCUD missiles exploding over her head and destroying Deheron Air Force Base less than a mile from her sleeping quarters.  The symptoms she had exhibited during her MEB were still existent at that time, but she had since exhibited a phobic response to riding in the back seat of a car and in boarding a plane.  Depression was then evident, manifested by sleepless nights, a decrease in appetite, anxiousness, hopelessness, and worry about her future and present well-being.  She was prescribed prozac for those symptoms.  While the medication appeared to help those symptoms somewhat, she then began switching personalities, having blackouts, losing time, losing and finding objects that she could not account for, hearing internal voices, having imaginary friends, and having delusions.  She stated that the trauma of Operation Desert Storm shook her system to the point where she divided and became separate entities in order to survive the trauma of combat environment, and in order to deal with an attempted rape by a senior sergeant.  The psychiatrist then identified (mapped) nine different personalities (alter egos) within the applicant and found evidence of the possibility that she had a host of other personalities.  Treatment of her symptoms was said to be hampered by the personality receiving the counseling departing, leaving her other personalities without the memory of the therapy.  She developed a new phobic response to wearing a uniform, and experienced fatigue, poor motivation, crying spells and despair.  She continued receiving therapy and treatment for her conditions, making some progress, when she was raped by an ex-boyfriend, setting in motion suicidal ideations, fear, tearfulness, frustration, anger, shame and social withdrawal.  She became more dysfunctional occupationally and was placed on subsistence.  Her medication for depression also had to be increased.  The applicant’s marriage was reported to be in trouble, due to the strain of her PTSD symptoms and her therapy.  The psychiatrist concluded that the applicant’s condition continued to deteriorate despite continued therapeutic efforts and she was then functionally worse than at the time of her original PEB.

9.  On 14 September 1994 the applicant was honorably discharged due to physical disability, with severance pay, rated 10 percent disabled.  Her awards include the Army Commendation Medal, the Army Achievement Medal (two awards), and the Good Conduct Medal (two awards).  She had completed 8 years, 11 months and 13 days of continuous active duty.

10.  The VASRD codes 9401 and 9411 are both classified as psychoneurotic disorders.  For individuals who exhibit symptoms within these classifications, a 30 percent rating is to be assigned when the ability to establish or maintain effective or wholesome relationships with people is definitely impaired; by reason of psychoneurotic symptoms the initiative, reliability, flexibility and efficiency levels are so reduced as to result in definite industrial impairment.  A 10 percent rating is to be assigned for less than the criteria of the 30 percent rating, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment.

11.  In the processing of this case the staff of the Board found it necessary to contact the Physical Disability Agency (PDA).  The PDA was furnished a copy of the applicant’s 1 September 1994 treatment summary, which was not in her PEB packet.  The PDA stated that it appears that the applicant’s PEB did not see this summary, and the PDA definitely did not see it when it approved the PEB’s recommendation.  The PDA recommended that the applicant be placed on the Temporary Disability Retired List (TDRL), rated 30 percent disabled, and have her scheduled for another MEB as soon as possible.

12.  Guidance provided to the Board from the PDA specifies that a disability or injury is considered to be a “direct result of armed conflict” if the injury or disease was incurred while the soldier was engaged in armed conflict, an operation or incident, involving armed conflict or the likelihood of armed conflict, while interred as a prisoner of war or detained against their will in the custody of a hostile or belligerent force, or while escaping or attempting to escape from such prisoner of war or detained status.  The disability must also be based upon a direct causal relationship between the armed conflict, operation, prisoner of war, or detained status and the injury.  This is not a casual connection or just having something occur to the soldier while in an area of armed conflict or hostilities.  Normally, soldiers who sustain injuries while assigned to administrative, supply, or other support duties in the rear area are not considered to be in the area of combat operations unless the injury is actually incurred during an enemy attack in the immediate area.  There must be a direct cause and effect between the “armed conflict” and the disability.

CONCLUSIONS:

1.  The applicant was an outstanding soldier for over 7 years of active duty, being promoted to noncommissioned officer rank in good order, receiving above average evaluation reports, and receiving three medals for achievement.

2.  The applicant’s psychiatric record depicts a soldier of outstanding potential who experienced battle trauma, an experience which precipitated PTSD and, as a result, multiple personality disorder.

3.  The applicant’s conditions were obviously severe while she was still on active duty, well beyond the emotional tension or other evidence of anxiety productive of mild social and industrial impairment required for a 10 percent disability rating.

4.  In addition, her psychiatric condition was said to be deteriorating at the time of her discharge.  Therefore, her condition does not appear to have been stable enough to assign a permanent rating at that time.

5.  Therefore, the Board agrees with the PDA that the applicant should have had her name placed on the TDRL rated 30 percent disabled, not discharged rated 10 percent disabled with severance pay.

6.  Although the applicant was assigned to support duties in a rear area in Saudi Arabia, her disabilities were incurred during an enemy attack in her immediate area.  Therefore, there is a direct cause and effect between the “armed conflict” and the applicant’s disabilities.  Therefore, her disabilities should be classified as a direct result of armed conflict.

7.  In view of the foregoing, the applicant’s records should be corrected as recommended below.

RECOMMENDATION:

1.  That all of the Department of the Army records related to this case be corrected:

	a.  by correcting the DA Form 199, Physical Evaluation Board (PEB) Proceedings, dated 29 July 1994, of the individual concerned, to show VASRD codes 9411 and 9401, rated 30 percent disabled;

	b.  by showing that she was placed on the TDRL rated 30 percent disabled effective 14 September 1994 and that she receive all appropriate pay resulting from that increase in disability rating; and

	c.  that her placement on the TDRL be shown to be as a result of a disability incurred as a direct result of an armed conflict.

2.  That the applicant be scheduled for a periodic medical examination to determine whether her psychiatric conditions have stabilized to the extent that they can be rated and, if so, that she either be returned to duty or medically separated, rated disabled, as appropriate.  If the applicant’s condition is not determined to be stable enough to rate, she will be maintained on the TDRL until her conditions stabilize or 14 September 1999, whichever occurs first.

BOARD VOTE:  

                       GRANT AS STATED IN RECOMMENDATION

                       GRANT FORMAL HEARING

                       DENY APPLICATION




		                           
		        CHAIRPERSON