BOARD DATE:	  18 July 2013

		DOCKET NUMBER:  AR20120018254 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests, in effect, correction of his DD Form 214 (Certificate of Release or Discharge from Active Duty) to show his narrative reason for separation as physical disability for post-traumatic stress disorder (PTSD) in lieu of personality disorder.

2.  The applicant states the initial finding of personality disorder was hastily misdiagnosed.  Subsequent testing at the Buffalo and Rochester offices of the Department of Veterans Affairs (VA) shows he was diagnosed with PTSD.  He has been receiving PTSD counseling from those two VA facilities.  He was also awarded service-connected disability compensation at the rate of 70 percent for PTSD and major depressive disorder.

3.  The applicant provides:

* 2008 DD Form 214 for the period ending 8 August 2008
* 2008 VA Rating Decision, dated 16 December 2008
* VA psychiatric status report, dated 21 June 2012

CONSIDERATION OF EVIDENCE:

1.  Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice.  This provision of law also allows the Army Board for Correction of Military Records (ABCMR) to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so.  While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file.  In all other respects, there are insufficient bases to waive the statute of limitations for timely filing.

2.  The applicant's records show he enlisted in the Regular Army on 21 July 2005 and he held military occupational specialty 11B (Infantryman).  He served in Afghanistan from 26 January 2007 to 14 April 2008.

3.  On 29 July 2008, the unit received word that the applicant's father had contacted military police officials and advised them that the applicant had posted a suicide note on his Facebook page.  Upon following up, the applicant's roommate reported a 2-page letter left on his bed next to a bottle of pills.  The roommate also reported a missing handgun.  After several text chats with the applicant, he agreed to turn himself in and seek help.  The commander secured his weapon and escorted the applicant to the hospital for further evaluation.

4.  On 31 July 2008, he underwent a mental status evaluation at the Behavioral Health Clinic, Womack Army Medical Center, Fort Bragg, NC.  The Director of Inpatient Psychiatry stated:

	a.  His behavior was appropriate, he was fully alert, he had a mildly dysphoric mood with constricted range, his thinking process was linear and goal-oriented, and his memory was grossly intact.  He denied suicidal or homicidal ideation and he had no hallucinations.  He was diagnosed with:

* axis I – adjustment disorder with mixed disturbance of emotions and conduct
* axis II – personality disorder (not otherwise specified (NOS)) with cluster B traits

	b.  He had the mental capacity to participate in the proceedings and he was mentally responsible and able to distinguish between right and wrong.  He met the retention standards of Army Regulation 40-501 (Standards of Medical Fitness), chapter 3.  His condition was a deeply-ingrained maladaptive pattern of long-standing duration that interfered with his ability to effectively and consistently performing his duties.  He met the criteria for separation under paragraph 5-13 of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations).

5.  On 4 August 2008, the applicant's immediate commander notified the applicant of his intent to initiate separation action against him under the provisions of Army Regulation 635-200, paragraph 5-13, due to his adjustment disorder with depressive mood and personality disorder with cluster B traits.  He recommended an honorable character of service.

6.  The applicant acknowledged receipt of the notification of separation action.  He consulted with legal counsel and was advised of the basis for the contemplated separation and the rights available to him in connection with the action.  Subsequent to receiving legal counsel, the applicant elected not to submit statements in his own behalf.

7.  Subsequent to this acknowledgement, the immediate commander initiated separation action against the applicant under the provisions of Army Regulation 635-200, paragraph 5-13, by reason of personality disorder.  His intermediate commander recommended approval.

8.  On 5 August 2008, the separation authority approved the applicant's separation under the provisions of Army Regulation 635-200, paragraph 5-13, by reason of personality disorder and directed characterization of his service as honorable.  On 8 August 2008, the applicant was discharged accordingly.

9.  His DD Form 214 shows he was honorably discharged under the provisions of Army Regulation 635-200, paragraph 5-13.  He completed 3 years and 29 days of active service.  He was assigned a separation program designator code of "JFX."

10.  On 16 December 2008, the VA awarded him service-connected disability compensation for PTSD at the rate of 70 percent effective 9 August 2008.

11.  In connection with the processing of this case, an advisory opinion was obtained from the Office of the Surgeon General (OTSG) Director of Health Care Delivery, dated 30 April 2013.  The OTSG states the applicant reported he was diagnosed with PTSD prior to his discharge for personality disorder.  Conclusions for this advisory opinion are drawn solely based on available documentation from his time in active service unless otherwise noted.

	a.  First seen for behavioral health issues during deployment, the applicant presented twice with sleep disturbances in the form of insomnia and night terrors judged to be either late onset sleep terror disorder or a side effect of mefloquine (orally-administered medication used in the prevention and treatment of malaria) since the onset coincided with first ingestion.  Upon redeployment, he received a neurological examination and treatment for a cognitive disorder NOS related to a traumatic brain injury.  He also received Celexa (citalopram) for his depressed and anxious mood.  During a 10 July 2008 Neurology Clinic appointment after block leave, he disclosed he experienced an emotional breakdown that "lasted for about 5 hours and could not talk or move his mouth, he just stared off into space almost 'catatonic.'"  Referred to Mental Health, he was assessed by a psychiatrist with the provisional diagnosis of depressive disorder NOS with symptoms of depressed mood, decreased energy, variable appetite, excessive sleeping, and general anxiousness.  That diagnosis was not continued in the records.  The psychiatrist noted, "SM [service member] has a significant characterological component as evidenced by his perceptions and means of conflict resolution," likely related to the applicant's description of a history of intermittent suicidal ideation and deceptively engaging women to form relationships to improve his mood.  About a week later, he attended an intake session with a psychologist and received the diagnosis of adjustment disorder with depressed mood, in retrospect judged to be acute, with a rule out of antisocial personality disorder with psychopathic features.   The applicant disclosed he had a long-standing desire to kill someone and joined the Army to have that opportunity without going to jail.  He reported preventing him from killing someone had been his desire to avoid getting caught and going to jail.

	b.  The applicant was hospitalized for 2 nights for suicidal ideation as he had decided it was better to kill himself than others.  He posted these thoughts using social media and then drove around with a rifle in his vehicle before reporting for his scheduled behavioral health appointment.  He completed a personality test while inpatient; however, the results were judged to not be valid given the endorsement of "an extremely large number and improbable combination of unusual beliefs, problems, and psychiatric symptoms."  The narrative summary generated during his hospitalization noted the applicant had related a 15-year history of a desire to kill and that those feelings were present at all times, increasing during times of stress.  Further, he reported a "perpetual state of lack of emotion, and that he goes in and out of sadness and neutrality."  While this report was not congruent with other portions of his records noting a range of emotions including "high irritability," anxiety, and feeling "really happy," it is consistent with other information suggesting feelings of emptiness.  For instance, he mentioned searching for a purpose and feelings of "nothingness." The described sleep terrors were noted to not meet the criteria for the disorder.  He also reported suicidal ideation beginning 2 to 3 years prior.  His discharge diagnoses were adjustment disorder with mixed disturbance of emotions and conduct, in retrospect judged to be acute, and personality disorder NOS with cluster B traits, which refer to a grouping where individuals with those disorders or aspects of those disorders often appear dramatic, emotional, or erratic.  This evaluation led to a recommendation for administrative separation in accordance with Army Regulation 635-200, paragraph 5-13.  The records supported the personality disorder diagnosis with a long-standing desire to kill people with considerable time spent contemplating ways, manipulative behaviors in interpersonal relationships, reported lack of emotion implying emptiness, emotional lability when not experiencing a lack of emotion, and a multi-year history of suicidal ideation.

	c.  Within a month of his discharge, he was seen at the VA and hospitalized for psychiatric treatment.  The close proximity in time suggests the information is important to consider.  As on active duty, he was hospitalized for suicidal and homicidal ideations.  He reported having the urge to kill and eat people since he was very young and, at the time of that visit, still had "a very strong urge of killing people and then mutilating them."  He cited two instances of identified victims and means of killing them.  This theme was consistent until about a month and a half later when he began to report he had few, if any, homicidal thoughts in childhood, followed a week later by his report that, in retrospect, he thought his homicidal ideation did not start until joining the military.  Approximately a month after that, he reported recurring nightmares related to a traumatic event during deployment – and it is noted that he expressed an interest in compensation for PTSD several times and the provider wrote, "this motivation for BH [treatment] cannot be ruled out."  Further, the psychologist noted a PTSD diagnosis did not appear warranted at that time and diagnosed him with anxiety disorder NOS in addition to having cluster B traits on axis II.  According to the record, the nightmares were not reported during his time in the service.

	d.  Taking into consideration the available records during his active duty service and his early VA visits, it does not appear he qualified for a PTSD diagnosis at the time of his discharge.  His post-deployment health assessment a month prior to discharge further reinforced this finding as his PTSD screen was negative.  Further, the records supported the personality disorder diagnosis at that time given his reports of his history, behaviors, and pattern of thinking.  In terms of the cognitive disorder NOS, the record reflected improvement; however, the last related note prior to his discharge indicated further treatment was planned.  The records do not reflect whether his impairment would have been to a level to meet a medical evaluation board, though his improvement suggested there would be no limiting effects.

12.  On 7 June 2013, the applicant was provided a copy of the OTSG advisory opinion to have the opportunity to respond to or rebut its contents.  He responded on 8 July 2013 by providing the following documents:

	a.  a memorandum issued by Headquarters, U.S. Army Medical Command, Fort Sam Houston, TX, dated 10 April 2012, subject:  Policy Guidance on the Assessment and Treatment of PTSD;

	b.  an excerpt of testimony before the Committee on Veterans' Affairs, House of Representatives, titled, "Status of Efforts to Address Lack of Compliance with Personality Disorder Separation Requirements";

	c.  a medical statement from a VA psychiatrist, dated 21 June 2012, who states the applicant's psychiatric diagnosis is PTSD stemming from multiple traumatic exposures incurred while serving in the military.  He opines that although he did not evaluate the applicant while he was in the military, based on his history and clinical assessment, administrative separation for personality disorder may not have been the appropriate vehicle for departure from the military;

	d.  page 2 of the 6-page DD Form 2807-2 (Medical Prescreen of Medical History Report), dated 31 August 2004, prior to his enlistment;

	e.  a U.S. Army Recruiting Command Form 1101-R-E (Enlistment Eligibility), dated 15 September 2004;

	f.  a Report of Mental Status Evaluation, dated 31 July 2008; and

	g.  multiple Standard Forms 600 (Chronological Record of Medical Care) related to an adjustment disorder, personality disorder, and depressed mood.

13.  Army Regulation 635-200 prescribes the policy for the administrative separation of enlisted personnel.  Paragraph 5-13 provides for separating members by reason of personality disorder not amounting to disability that interferes with assignment or with performance of duty.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's request to change the narrative reason for his separation has been carefully considered.  However, there is insufficient evidence to support this claim.

2.  The applicant underwent a mental status evaluation that led to a diagnosis of a personality disorder.  Accordingly, his chain of command initiated separation action against him.  His separation processing was accomplished in accordance with the applicable regulation.  All requirements of law and regulation were met and the rights of the applicant were fully protected throughout the separation process.

3.  The evidence of record contains a mental status evaluation completed on the applicant that confirmed a diagnosis of personality disorder not amounting to disability was made by proper medical authority.  The record is void of any clear indication that the applicant was suffering from an unfitting PTSD condition at the time of his discharge.  As confirmed by the OTSG advisory opinion, while it is possible that he may have developed PTSD at a later date, there is no evidence he met the full criteria for PTSD at the time of his separation and that diagnosis is not recorded in his available record during his time of active service.  There is insufficient medical evidence to support an unfitting PTSD finding at the time of his discharge.

4.  In view of the foregoing and absent any evidence of error or injustice in the separation process or medical evidence confirming the applicant was suffering from an unfitting PTSD condition at the time of his discharge, there is an insufficient evidentiary basis to support granting the requested relief.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

____X____  ___X_____  __X__  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.



      __________X_______________
                 CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.

ABCMR Record of Proceedings (cont)                                         AR20120018254



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ABCMR Record of Proceedings (cont)                                         AR20120018254



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