IN THE CASE OF:	  

		BOARD DATE:	  6 March 2015

		DOCKET NUMBER:  AR20140013445 


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 reconsideration of her request to change the narrative reason for her separation.

2.  The applicant states, in effect, that the narrative reason for her separation should be change to reflect that she was discharged by reason of "“Secretarial Authority."

3.  The applicant provides a three-inch binder containing 15 tabs.

COUNSEL'S REQUEST, STATEMENT AND EVIDENCE:

1.  Counsel requests that the Board reconsider its denial of the applicant’s request to change her narrative reason for separation to "Secretarial Authority" based on post-traumatic stress disorder (PTSD).

2.  Counsel states, in a nine-page brief, in effect, that the Army failed to follow its own regulations in diagnosing and discharging the applicant by reason of personality disorder.  Counsel goes on to state that a change in the narrative reason for discharge to "“Secretarial Authority" is a just result that is supported by the record and would preserve the Army’s discretion to honorably separate the applicant without causing difficult precedents for future service members and without further burdening the Board and the Army.  Counsel further states that the applicant suffered numerous service-connected injuries including a traumatic brain injury, foot conditions, knee and ankle injuries and was a victim of sexual assault.  Additionally, since her discharge, the applicant has been awarded service-connection by the Department of Veterans Affairs (VA) for PTSD, Traumatic Brain Injury (TBI), and other disabilities. 

3.  Counsel continues by stating that the applicant’s personality disorder diagnosis was never properly established and she was improperly discharged because she had numerous conditions that warranted consideration under the Physical Disability Evaluation System (PDES).  However, the Army chose to discharge her for a personality disorder and did not follow regulations which require that a medical review of the personality disorder diagnosis will consider whether PTSD, TBI and/or other comorbid mental illness may be significant contributing factors to the diagnosis.  Additionally, a Soldier will not be processed for administrative separation if PTSD, TBI, and/or other comorbid mental illness are significant contributing factors to a diagnosis of personality disorder, but will be evaluated under the PDES. 

4.  Counsel provides a nine-page brief explaining both the applicant’s and counsel’s position.

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20120019264 on 23 July 2013.

2.  The applicant enlisted in the Regular Army on 18 August 2004 for a period of 4 years and training as a mortuary affairs specialist.  She completed her basic training at Fort Jackson, South Carolina and her advanced individual training at Fort Lee, Virginia before being assigned to Fort Lee for her first and only permanent assignment.

3.  On 3 June 2005, she underwent a mental status evaluation and the clinical psychologlist noted that she was fully alert and oriented, she had a labile mood, clear thinking process, normal thought content, and good memory.  She was mentally responsible, had the capacity to understand and participate in proceedings, and she met the retention standards of chapter 3, Army Regulation 40-501 (Standards of Medical Fitness). She did not require a medical evaluation board (MEB). 

	b.  Her evaluation consisted of a clinical interview and/or psychometric testing and resulted in a diagnosis of:

* Axis I: Panic Disorder without Agoraphobia, Depressive Disorder Not Otherwise Specified (NOS) 
* Axis II: Personality Disorder NOS with Borderline features
* Axis III: Knee problem
  
   c.  She had developed a personality disorder, and consequently she was vulnerable to anxiety and depression, all of which are problems that began prior to service.  She did not appear to have developed any conditions while being in the military or as a result of her military service.  She would have likely had significant difficulties in the military and she was unlikely able to handle the stressors.  Because of her personality disorder, she met the criteria for an administrative separation.  She reported a knee problem that she stated started in basic combat training.  She should be examined to determine if her administrative separation should continue.

4.  On 27 June 2005, she underwent a complete separation physical.  She listed several of the conditions she now claims, but none were determined by medical authorities to be medically unfitting.  She was qualified for retention and separation.

5.  On 12 September 2005, the applicant's immediate commander notified the applicant of her intent to initiate separation action against her under the provisions of paragraph 5-13, Army Regulation 635-200 (Active Duty Enlisted Administrative Separations) because of personality disorder.  The immediate commander stated the reason for separation was that she had been diagnosed with a personality disorder, a depressive disorder, and a panic disorder without agoraphobia.  The immediate commander recommended an honorable character of service.

6.  On 13 September 2005, after 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. 

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.  The intermediate commander recommended approval.  A military attorney reviewed the separation packet and found it legally sufficient. 

8.  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 13 October 2005, the applicant was discharged accordingly.

9.  Her DD Form 214 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, 1 month, and 26 days of active service.  She was assigned separation code "JFX" to denote separation by reason of personality disorder under the provisions of Army Regulation 635-200, paragraph 5-13. 

10.  The applicant applied to the Board requesting that her narrative reason for separation be changed to reflect that she was discharged due to PTSD.  However, she provided no evidence showing that she was diagnosed with PTSD by competent authority.  On 23 July 2013, the Board determined that the applicant was properly discharged in accordance with the regulations in effect at the time based on her conditions as they existed at the time of her discharge and voted unanimously to deny her request.

11.  The applicant now provides a VA Rating Decision which shows that she was granted 30% service-connection for PTSD effective 14 October 2005 which was increased to 70% on 22 December 2009.  She has received a combined service-connected disability rating of 90%.

12.  Army Regulation 635-200 prescribes the policy for the administrative separation of enlisted personnel.  

   a.  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.

   b.  Paragraph 5-3 states, in pertinent part, that the separation of enlisted personnel is the prerogative of the Secretary of the Army and will be effected only by his authority.  Except as delegated by these regulations or by special Department of the Army directives, the discharge or release of any enlisted member of the Army for the convenience of the Government will be at the Secretary’s discretion and with the type of discharge as determined by him.  Such authority may be given either in an individual case or by an order applicable to all cases specified in such order.

13.  Army Regulation 40-501 governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement).  It outlines medical conditions which may render an individual unfit or which may preclude enlistment and notes that both personality and adjustment disorders will be dealt with through administrative and not medical channels.  Paragraph 3-35 of this regulation states that a history of or current manifestations of personality disorders render an individual administratively unfit.  These conditions render an individual administratively unfit rather than unfit because of physical illness or medical disability.  These conditions will be dealt with through administrative channels, including Army Regulation 635-200.

14.  PTSD can occur after someone goes through a traumatic event like combat, assault, or disaster.  The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and it provides standard criteria and common language for the classification of mental disorders.  In 1980, the APA added PTSD to the third edition of its DSM-III nosologic classification scheme.  Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice.
From an historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis).  The key to understanding the scientific basis and clinical expression of PTSD is the concept of "trauma." 

15.  PTSD is unique among psychiatric diagnoses because of the great importance placed upon the etiological agent, the traumatic stressor.  In fact, one cannot make a PTSD diagnosis unless the patient has actually met the "stressor criterion," which means that he or she has been exposed to an event that is considered traumatic.  Clinical experience with the PTSD diagnosis has shown, however, that there are individual differences regarding the capacity to cope with catastrophic stress.  Therefore, while most people exposed to traumatic events do not develop PTSD, others go on to develop the full-blown syndrome.  Such observations have prompted the recognition that trauma, like pain, is not an external phenomenon that can be completely objectified.  Like pain, the traumatic experience is filtered through cognitive and emotional processes before it can be appraised as an extreme threat.  Because of individual differences in this appraisal process, different people appear to have different trauma thresholds, some more protected from and some more vulnerable to developing clinical symptoms after exposure to extremely stressful situations.

16.  The DSM fifth revision (DSM-5) was released in May 2013.  This revision includes changes to the diagnostic criteria for PTSD and Acute Stress Disorder.  The PTSD diagnostic criteria were revised to take into account things that have been learned from scientific research and clinical experience.  The revised diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters:  intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.  The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

	a.  Criterion A, stressor:  The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required) 

		(1)  Direct exposure. 

		(2)  Witnessing, in person.

		(3)  Indirectly, by learning that a close relative or close friend was exposed to trauma.  If the event involved actual or threatened death, it must have been violent or accidental.

		(4)  Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

	b.  Criterion B, intrusion symptoms:  The traumatic event is persistently re-experienced in the following way(s): (one required) 

		(1)  Recurrent, involuntary, and intrusive memories. 

		(2)  Traumatic nightmares. 

		(3)  Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. 

		(4)  Intense or prolonged distress after exposure to traumatic reminders. 

		(5)  Marked physiologic reactivity after exposure to trauma-related stimuli. 

	c.  Criterion C, avoidance:  Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required)

		(1)  Trauma-related thoughts or feelings.

		(2)  Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
	d.  Criterion D, negative alterations in cognitions and mood:  Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

		(1)  Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).

		(2)  Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").

		(3)  Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.

		(4)  Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).

		(5)  Markedly diminished interest in (pre-traumatic) significant activities.
Feeling alienated from others (e.g., detachment or estrangement).

		(6)  Constricted affect: persistent inability to experience positive emotions. 

	e.  Criterion E, alterations in arousal and reactivity:  Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

		(1)  Irritable or aggressive behavior

		(2)  Self-destructive or reckless behavior

		(3)  Hypervigilance

		(4)  Exaggerated startle response

		(5)  Problems in concentration

		(6)  Sleep disturbance

	f.  Criterion F, duration:  Persistence of symptoms (in Criteria B, C, D, and E) for more than one month. 

	g.  Criterion G, functional significance:  Significant symptom-related distress or functional impairment (e.g., social, occupational).
	h.  Criterion H, exclusion:  Disturbance is not due to medication, substance use, or other illness. 

17.  As a result of the extensive research conducted by the medical community and the relatively recent issuance of revised criteria regarding the causes, diagnosis and treatment of PTSD the Department of Defense (DoD) acknowledges that some Soldiers who were administratively discharged under other than honorable conditions may have had an undiagnosed condition of PTSD at the time of their discharge.  It is also acknowledged that in some cases this undiagnosed condition of PTSD may have been a mitigating factor in the Soldier's misconduct which served as a catalyst for their discharge.  Research has also shown that misconduct stemming from PTSD is typically based upon a spur of the moment decision resulting from temporary lapse in judgment; therefore, PTSD is not a likely cause for either premeditated misconduct or misconduct that continues for an extended period of time.

18.  In view of the foregoing, on 3 September 2014 the Secretary of Defense directed the Service Discharge Review Boards (DRBs) and Service Boards for Correction of Military/Naval Records (BCM/NRs) to carefully consider the revised PTSD criteria, detailed medical considerations and mitigating factors when taking action on applications from former service members administratively discharged UOTHC and who have been diagnosed with PTSD by a competent mental health professional representing a civilian healthcare provider in order to determine if it would be appropriate to upgrade the characterization of the applicant's service.

19.  BCM/NRs are not courts, nor are they investigative agencies.  Therefore, the determinations will be based upon a thorough review of the available military records and the evidence provided by each applicant on a case-by-case basis.  When determining if PTSD was the causative factor for an applicant's misconduct and whether an upgrade is warranted, the following factors must be carefully considered:

* Is it reasonable to determine that PTSD or PTSD-related conditions existed at the time of discharge?

* Does the applicant's record contain documentation of the occurrence of a traumatic event during the period of service?
* Does the applicant's military record contain documentation of a diagnosis of PTSD or PTSD-related symptoms?
* Did the applicant provide documentation of a diagnosis of PTSD or PTSD-related symptoms rendered by a competent mental health professional representing a civilian healthcare provider?
* Was the applicant's condition determined to have existed prior to military service?
* Was the applicant's condition determined to be incurred during or aggravated by military service?
* Do mitigating factors exist in the applicant's case?
* Did the applicant have a history of misconduct prior to the occurrence of the traumatic event?
* Was the applicant's misconduct premeditated?
* How serious was the misconduct?

20.  Although the DoD acknowledges that some Soldiers who were administratively discharged under other than honorable conditions may have had an undiagnosed condition of PTSD at the time of their discharge, it is presumed that they were properly discharged based upon the evidence that was available at the time.  Conditions documented in the record that can reasonably be determined to have existed at the time of discharge will be considered to have existed at the time of discharge.  In cases in which PTSD or PTSD-related conditions may be reasonably determined to have existed at the time of discharge; those conditions will be considered potential mitigating factors in the misconduct that caused the UOTHC characterization of service.  Corrections Boards will exercise caution in weighing evidence of mitigation in cases in which serious misconduct precipitated a discharge with a characterization of service of UOTHC.  Potentially mitigating evidence of the existence of undiagnosed combat-related PTSD or PTSD-related conditions as a causative factor in the misconduct resulting in discharge will be carefully weighed against the severity of the misconduct.  PTSD is not a likely cause of premeditated misconduct.  Corrections Boards will also exercise caution in weighing evidence of mitigation in all cases of misconduct by carefully considering the likely causeal relationship of symptoms to the misconduct.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's discharge proceedings for personality disorder were conducted in accordance with law and regulations in effect at the time.  The characterization of the applicant's discharge was commensurate with the reason for discharge and overall record of military service in accordance with the governing regulations in effect at the time.

2.  Soldiers who suffered from PTSD and were separated solely for personality disorder subsequent to a traumatic event warrant careful consideration for the possible change to the narrative reason for separation.

3.  A review of the applicant's record and the evidence that she provided shows that she was subjected to a traumatic event while serving on active duty that may have caused her PTSD.

4.  Subsequent to these experiences, medical evidence shows the applicant was diagnosed with PTSD/PTSD-related symptoms by a competent mental health professional.  Therefore, it is reasonable to believe the applicant's PTSD condition may have existed at the time of discharge.

5.  While the Board does not accept counsel’s contention that the applicant’s discharge was not conducted in accordance with Army regulations as the available evidence shows that she was diagnosed at the time by competent medical authorities and that the available evidence shows she underwent a medical exam in conjunction with her separation and she was found medically qualified for retention/separation.  She was subsequently diagnosed with PTSD that appears to be increasing in severity based on the VA evaluations.

6.  Therefore, in the interest of equity, the applicant’s discharge should be corrected to show that she was discharged under the provisions of Army Regulation 635-200, paragraph 5-3, due to Secretarial Authority, with a separation code of “JFF.”

BOARD VOTE:

___x____  ___x____  ___x____  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION












BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant amendment of the ABCMR’s decision in Docket Number AR20120019264, dated 23 July 2013.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by issuing her a new DD Form 214 showing she was discharged under the authority of Army Regulation 635-200, paragraph 5-3, Secretarial Authority, with a separation code of "JFF."



      __________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)                                         AR20140013445



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ABCMR Record of Proceedings (cont)                                         AR20140013445



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