BOARD DATE:	  9 July 2013

		DOCKET NUMBER:  AR20130002666 


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, that her narrative reason for separation be changed from personality disorder to medical discharge – post-traumatic stress disorder (PTSD). 

2.  The applicant states she was discharged for a personality disorder which is incorrect.  She has been suffering from PTSD since she left Iraq.  She believes she should have been medically discharged due to PTSD and retired from the Army. 

3.  The applicant provides her Department of Veterans Affairs (VA) rating decision. 

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.  Having had prior enlisted service in the Army National Guard, the applicant enlisted in the Regular Army on 25 January 2006 and she held military occupational specialty 31B (Military Police).  She served in Kuwait/Iraq from 6 November 2006 to 9 May 2007. 

3.  On 14 July 2006, she accepted nonjudicial punishment (NJP) under the provisions of Article 15 of the Uniform Code of Military Justice (UCMJ) for violating a general regulation by wrongfully traveling outside of an authorized radius.  

4.  She was frequently counseled for various infractions, including being disrespectful and insubordinate, failing to follow instructions, a lack of motivation, substandard performance, a constant disregard for the mission, failing to be at her appointed place of duty at the time prescribed, and failing to obey orders.

5.  On 5 April 2007, as a result of her ongoing misconduct, she underwent a mental status evaluation at the Behavioral Health Clinic, Madigan Army Medical Center, WA.  Her behavior was passive and she was fully alert and partially oriented, had a flat mood, confused thinking process, normal thought content, and good memory.  The mental health provider stated she did not suffer from a psychiatric disease, defect, or personality disorder at the time.  However, she was unable to function at the necessary level for her job capabilities.  She was unable to focus or comprehend directives by this provider or by her chain of command.  These disorders led her to have poor discipline or to be unfit for duty. It was recommended that she seek additional professional help or be separated in accordance with chapter 5-13 of Army Regulation 635-200. 

6.  On 6 April 2007, she again accepted NJP under the provisions of Article 15 of the UCMJ for failing to go at the time prescribed to her appointed place of duty (twice), being disrespectful toward a noncommissioned officer (NCO) (twice), and for disobeying a lawful order. 

7.  On 31 May 2007, she underwent a command-directed mental status evaluation at the Behavioral Health Clinic, Madigan Army Medical Center, WA.  The clinical psychologist stated:  

	a.  The applicant was evaluated at the Behavioral Health Clinic, Madigan Army Medical Center for a Routine Command Referral for the following behavioral health concerns: "Soldier has refused to perform her job as directed by her section's supervisor and NCO's.  Soldier has completely disregarded all ranks and authority in the company; she has failed to comprehend what is expected of a Soldier; and she has had three rehabilitative transfers within unit and 9 NCOs as supervisor but still failed to adapt to any leadership style in the company."  Results are based on clinical interviews, psychological testing, collateral interviews, and review of the medical record.  The clinical psychologist opined the applicant had the mental capacity to understand and participate in the proceedings, and she was mentally responsible. 

	b.  She reported a history of interpersonal difficulties that began in her school years and she has been consistent across time and settings.  She indicated that she feels as though she has been targeted for problems with disrespect and not following instructions which has led to numerous counseling statements.  Current psychological problems include irritability, emotional lability that seems to be contingent on environmental problems, and problems with authority figures. Collateral data gathered from her rear detachment commander and a member of her unit confirmed a history of problems with disrespect.  Her interpersonal problems seem to be characterological in nature and have been well-documented and resistant to rehabilitation attempts by her unit.

	c.  Fitness and Suitability for Continued Service:  Based on results of this evaluation, she is recommended for administrative separation in accordance with chapter 5-13, Army Regulation 635-200.  Her personality disorder as described in paragraph 2 is sufficiently severe that her ability to effectively perform military duties is significantly impaired. 

	d.  Precautions:  Due to her history of emotional lability and interpersonal problems, she should be monitored for signs of increasing instability.  She does not report suicidal/homicidal ideation and has not indicated a history of self/other harm.  If command has concerns about her safety, or if she shows signs of suicidal or homicidal ideation, command is encouraged to take her to the local emergency room for evaluation.

	e.  Proposed Treatments:  She is currently attending weekly psychotherapy at the Behavioral Health Clinic with CPT Taraxxxxx.  It is advised that she be supported in continuing treatment while she remains in service.  Treatment will likely not produce desired effects in the short term.  However, positive contact with mental health may aid her in effectively coping with stress related to an administrative separation and may encourage her to seek care after separation to develop skills that will help her develop healthy relationships and improve emotional stability.

8.  On 8 August 2007, the applicant's immediate commander notified the applicant of his intent to initiate separation action against her under the provisions of paragraph 5-13, Army Regulation 635-200 because of personality disorder, chronic maladaptive behavior that significantly impaired her ability to adapt and function in a military environment.  The recommendation was an honorable character of service.   

9.  On 13 August 2007, the applicant acknowledged receipt of the notification of separation action.  She consulted with legal counsel and was advised of the basis for the contemplated separation and of the rights available to her in connection with the action.  Subsequent to receiving legal counsel, the applicant elected not to submit statements in her own behalf. 

10.  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.  Her intermediate commander recommended approval. 

11.  On 15 August 2007, the separation authority approved the applicant's separation under the provisions of paragraph 5-13, Army Regulation 635-200, by reason of personality disorder, and directed the applicant be issued an honorable characterization of service.  On 7 September 2007, the applicant was discharged accordingly.  

12.  Her DD Form 214 (Certificate of Release or Discharge from Active Duty) shows she was discharged under the provisions of chapter 5-13 of Army Regulation 635-200 with an honorable character of service.  She completed 
1 year, 7 months, and 13 days of active service.  She was assigned a separation code of "JFX." 

13.  She submitted a copy of her VA rating decision, dated 27 August 2008, which shows she was awarded service-connected disability compensation for PTSD at the rate of 30% and tinnitus at the rate of 10%. 

14.  In connection with the processing of this case, on 9 May 2013, an advisory opinion was obtained from the Office of The Surgeon General (OTSG), Director of Health Care Delivery.  The OTSG official stated the applicant requested the personality disorder be changed to PTSD, as she reported she suffered with PTSD during and following her deployment to Iraq.  Conclusions for this advisory opinion are drawn solely based on available documentation from the applicant's active service unless otherwise noted:

	a.  After serving in the Army National Guard for 2 years, she was transferred to the Regular Army in 2006 and deployed twice, once to Bosnia and the second time to Iraq.  She reported having interpersonal difficulties while serving in the Army National Guard.  During active service, she demonstrated difficulty accepting authority and following rules, as shown by her reduction in rank to E-1 from a career high of E-4.  She overstayed a 3-day weekend prior to deployment and received disciplinary action.  A counseling statement 1 month into her deployment referred to a 6-month history of various counseling statements. During deployment, she continued to exhibit interpersonal difficulties and behavior not conducive to military service, receiving numerous additional counseling statements.  Despite three transfers within the unit and nine different supervisors, she proved unable to adapt and acclimate to any of the different leadership styles.  During her deployment, she also sought help for attention problems, reporting a history of Attention Deficit Disorder in childhood with medication and behavioral counseling through junior high school.  The duration of her pre-enlistment treatment is uncertain as 2 days later she reported taking medication for only 2 months.  The deployed provider gave her the diagnosis of Attention Deficit Disorder with Hyperactivity, the symptoms of which are supported in the record, and referred her for a medication evaluation, resulting in a Concerta prescription.  At that appointment, she further reported a history of frequently being in trouble at school for getting out of her seat and for fighting, in addition to discipline problems at home.  Additionally, she reported thinking many of her disciplinary problems were related to her attention problems.

	b.  She returned early from deployment for a commander-directed evaluation. Prior to redeployment, she completed a Post-Deployment Health Assessment (PDHA) with a positive PTSD screen and some depressive symptoms.  Before the date of her evaluation, she was seen in the Behavioral Health Clinic stating, "I have nightmares of mass destruction, torture and people dying."  She also indicated she had problems sleeping and jumping at loud noises.  She appeared to attribute her behavioral problems to an "uncaring chain of command and bad luck."  She described sleep disturbances, loss of interest in her usual activities, energy problems, low self-esteem, and feelings of guilt.  She was noted to have depressed and anxious mood and received the diagnoses Depressive Disorder Not Otherwise Specified (NOS), Anxiety Disorder NOS, and Occupational Problems (which is not a disorder).  At a follow up session with a different provider, moderate post-traumatic symptoms were noted, such as increased arousal, nightmares, anxiety, and irritability.  The provider wrote, "SM denied any particular identifiable traumatic event, but expressed common reactions to post-deployment," which is interesting given in her PDHA she endorsed seeing wounded, killed or dead and feeling she was in great danger of being killed.  On her PDHA she also responded affirmatively to symptoms related to a frightening, horrible, or upsetting experience.  In a VA note after her discharge, she reported a friend was killed by an improvised explosive device and she saw his body soon thereafter.  Taking all her symptoms into account, it does appear she may have had PTSD at this point in time.  This psychologist dropped the Depressive Disorder NOS diagnosis, and while the reason is not noted, it made sense given an appropriate application of Anxiety Disorder NOS is for mixed anxiety and depressive clinical picture.

	c.  A third provider conducted her commander-directed evaluation, and she completed psychological testing and a clinical interview.  Results supported the diagnosis of Paranoid Personality Disorder.  She reported a history starting in school of a pattern of behaviors and thinking characterized by pervasive distrust and thinking others' treatment of her is motivated by malevolence leading to significant interpersonal challenges.  Her challenges persisted across multiple settings and relationships, affecting her work and social functioning.  No other diagnosis was given despite symptoms described in the two previous notes and test results indicating anxiety-related arousal and depressive concerns.  Around this time, she was prescribed Nortriptiyline for sleep, though it also can function as an anti-depressant.

	d.  While her discharge was processed, the applicant continued to be seen in therapy to reduce her anxiety and learn skills to cope more effectively with her anger and relationships.  Her 2 July 2007 therapy termination note stated her anxiety disorder symptoms appeared to be alleviated at that time, and her symptoms had resolved with the exception of decreased energy.  Her diagnoses at termination were Occupational Problems and the personality disorder.  She engaged in supportive sessions with Soldier Readiness Services and her anxiety disorder diagnosis again appeared, though in the initial note there were no symptoms to support the diagnosis.  The next session notes included sleep disturbances, loss of interest in usual activities, energy problems, and, the night before, suicidal ideation.  She was seen the next day in the medical clinic; she received Celexa in response to a psychology referral for anxiety and depression medication.  During her final session the next month, she reported having nightmares when not taking her medication as the only issue, and stated when she takes her medicine she does not have sleep problems or nightmares. Sessions were ended at that time since her mood and sleep had improved.

	e.  The record supported her Paranoid Personality Disorder diagnosis based on her self report, collateral information, and testing, which supported a pervasive pattern of difficulties beginning in adolescence, prior to joining the military.  Her personality disorder significantly interfered with her ability to function effectively in the military.  In addition, she appeared to experience traumatic events during her deployment.  While PTSD could have been a legitimate diagnosis during her treatment, the diagnosed anxiety disorder and her PTSD symptoms resolved over the course of her therapy, and any lingering symptoms appeared well controlled with medication.  This therapeutic result, however, does not preclude the possibility she developed symptoms meeting criteria for PTSD at some future time.
15.  On 18 June 2013, the applicant provided a rebuttal to this advisory opinion.  She did not make any statements but provided the same VA rating decision she originally provided with her application to this Board. 

16.  Army Regulation 635-200 (Active Duty Enlisted Administrative Separations) 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 requests to change her narrative reason for 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 personality disorder.  Accordingly, her chain of command initiated separation action against her.  Her 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 two mental status evaluations 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 indication that the applicant was suffering from an unfitting PTSD condition at the time of discharge.  As confirmed by the OTSG advisory opinion, there is insufficient medical evidence to support an unfitting PTSD finding at the time of discharge.  

4.  In view of the foregoing, 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 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 that 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)                                         AR20130002666



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