IN THE CASE OF:	  

		BOARD DATE:	  20 October 2015

		DOCKET NUMBER:  AR20150003535 


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 post-traumatic stress disorder (PTSD) in lieu of personality disorder.  He further requests referral to the Army Physical Disability Evaluation System (PDES) for possible medical retirement.

2.  The applicant states:

* he was discharged for personality disorder, but it should be for PTSD
* he is rated 100-percent permanently disabled for PTSD
* having his DD Form 214 list personality disorder as the narrative reason for separation suggests he was discharged due to prior issues
* his military and Department of Veterans Affairs (VA) records show PTSD as the correct reason

3.  The applicant indicates he provided VA paperwork; however, this documentation was not attached for review.

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 enlisted in the Regular Army on 4 February 2003 for a period of 4 years.  He completed his training and was awarded military occupational specialty 11B (infantryman).  He served overseas in Korea and later in Kuwait/Iraq from 1 August 2004 to 1 August 2005.

3.  On 4 November 2005, nonjudicial punishment was imposed against him for disobeying a lawful command not to travel outside a 50-mile radius of Fort Carson without a formal pass.

4.  On 23 January 2006, he underwent a mental status evaluation and the clinical psychologist diagnosed him with an anxiety and personality disorder.  He was psychiatrically cleared for any action deemed appropriate by his command.  Expeditious administrative separation was recommended under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), paragraph 5-13.  The mental status evaluation noted he received nonjudicial punishment three times (no other information is available).

5.  On 7 March 2006, he was notified of his pending separation for personality disorder under the provisions of Army Regulation 635-200, paragraph 5-13.  His commander stated he was initiating action to separate him for being diagnosed with an anxiety and personality disorder.

6.  On 7 March 2006, he acknowledged receipt of the notification of separation action.  He consulted with legal counsel and was advised of the basis for the contemplated separation and of the rights available to him in connection with this action.  Subsequent to receiving legal counsel, he elected not to submit statements in his own behalf.

7.  On 16 March 2006, 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 the issuance of an honorable discharge.  On 11 April 2006, he was discharged accordingly.


8.  His DD Form 214 shows in:

* item 25 (Separation Authority) – Army Regulation 635-200, 
Paragraph 5-13
* item 26 (Separation Code) – JFX
* item 28 (Narrative Reason for Separation) – Personality Disorder

9.  There is no evidence of record which shows he was diagnosed with PTSD prior to his separation.

10.  There is no evidence the applicant was processed through the Army PDES.

11.  In the processing of this case, a staff advisory opinion was obtained from the Director, Healthcare Delivery, U.S. Army Medical Command G-3/5/7, under the Office of the Surgeon General.  The opinion stated:

	a.  The applicant enlisted in the Army as an infantryman on 4 February 2003 and served a total of 2 years and 10 months.  He was deployed to Iraq from 1 August 2004 to 1 August 2005.  During his deployment, he received the Combat Infantryman Badge in addition to other overseas medals.  He reported exposure to traumatic events while deployed and subsequent symptoms consistent with PTSD, to include hypervigilance and anxiety.  He also had sleep disturbances and "significant war zone stress" according to the psychiatrist who evaluated him. He was given a diagnosis of anxiety disorder (not otherwise specified) and personality disorder.

	b.  He was command-referred to the Behavioral Health Clinic for concerns about his duty performance.  The behaviors that led to the referral were listed as "Article 15s, MH [mental health] issues."  The Article 15s were for not being at his appointed place of duty.  There was no information describing the "MH issues."  He was evaluated by a clinical psychologist who diagnosed him with personality disorder and he was recommended for administrative separation.  He was administratively separated under the provisions of Army Regulation 635-200, paragraph 5-13.

	c.  Despite several appointments with a psychiatrist and psychologist, the medical records do not provide a definitive diagnosis.  Furthermore, the diagnosis of personality disorder was given on the basis of a single psychological test and there was no psychological evaluation report that summarizes the finding or provides a diagnostic formulation.

	d.  The applicant states he was diagnosed with combat-related PTSD by the VA.  He affirms he was subsequently awarded service-connected disability of 100 percent for PTSD.

	e.  The review of the applicant's military records indicates there is sufficient evidence to conclude that the applicant qualified for a PTSD diagnosis and warranted referral into the Integrated Disability Evaluation System at the time of his discharge.

12.  A copy of the advisory opinion was forwarded to the applicant for comment and possible rebuttal.  He responded and concurred with the advisory official's recommendation that he qualified for a PTSD diagnosis and should have been referred to the PDES at the time of his discharge.

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.

14.  Army Regulation 635-5-1 (Separation Program Designator (SPD)) Codes), in effect at the time, provided the specific authorities (regulatory or directive), reasons for separating Soldiers from active duty, and the SPD codes to be entered on the DD Form 214.  It stated that SPD code JFX was the appropriate code to assign to Soldiers being separated under the provisions of Army Regulation 635-200, paragraph 5-13, by reason of personality disorder.

15.  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 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 nosologic classification scheme.  Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice.  From a 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."

16.  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.

17.  The fifth edition of the DSM 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 criterion 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; or

		(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; or

		(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 or

		(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); and

		(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; and

		(6)  sleep disturbance.

	f.  Criterion F – Duration:  Persistence of symptoms (in Criteria B, C, D, and E) for more than 1 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.

18.  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 (UOTHC) 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 Soldiers' 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 a 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.

19.  On 3 September 2014 in view of the foregoing information, 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 applicants' service.

20.  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?

21.  Although DOD acknowledges that some Soldiers who were administratively discharged UOTHC 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 records 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.  BCM/NRs 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.  BCM/NRs will also exercise caution in weighing evidence of mitigation in all cases of misconduct by carefully considering the likely causal relationship of symptoms to the misconduct.

22.  Department of Defense Instruction 1332.38 provides for medical evaluation boards (MEBs) which are convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status.  A decision is made as to the Soldier's medical qualifications for retention based on the criteria in Army Regulation 40-501, chapter 3.  If the MEB determines the Soldier does not meet retention standards, the board will recommend referral of the Soldier to a physical evaluation board (PEB).

23.  PEBs are established to evaluate all cases of physical disability equitability for the Soldier and the Army.  It is a fact-finding board to investigate the nature, cause, degree of severity, and probable permanency of the disability of Soldiers who are referred to the board; to evaluate the physical condition of the Soldier's against the physical requirements of the Soldier's particular office, grade, rank or rating; to provide a full and fair hearing for the Soldier; and to make findings and recommendations to establish eligibility of a Soldier to be separated or retired because of physical disability.

24.  Title 10, U.S. Code, chapter 61, provides disability retirement or separation for a member who is physically unfit to perform the duties of his or her office, rank, grade, or rating because of disability incurred while entitled to basic pay.

DISCUSSION AND CONCLUSIONS:

1.  The evidence of record shows the applicant was discharged on 11 April 2006 for personality disorder.

2.  There is no evidence to show that his narrative reason for separation was not administratively correct and in conformance with applicable regulations at the time of his separation.

3.  The applicant contends he should have been referred into the PDES due to his PTSD.

4.  There is no evidence the applicant was processed through the PDES.

5.  Based on the advisory opinion from the Office of the Surgeon General, it appears that an MEB is warranted because there is sufficient evidence to conclude applicant qualified for a PTSD diagnosis and warranted referral into the PDES at the time of his discharge.

6.  He should be issued invitational travel orders for the purpose of undergoing an MEB and, if appropriate, a PEB.  He should be directed to report for a medical evaluation at the nearest available medical treatment facility to his current residence.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

____X____  ___X_____  ___X_____  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

1.  The Board determined the evidence presented is sufficient to warrant a recommendation for partial relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by:

	a.  issuing him invitational travel orders for the purpose of undergoing an MEB and, if appropriate, a PEB, to include directing him to report for medical evaluation at the nearest available military medical treatment facility to his current residence; and

	b.  providing him the MEB and/or PEB findings and recommendations for further action, as appropriate.

2.  The Board further determined the evidence presented is insufficient to warrant a portion of the requested relief.  As a result, the Board recommends denial of so much of the application that pertains to amending his narrative reason for separation or showing he was medically retired at this time.



      _____________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)                                         AR20150003535



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ABCMR Record of Proceedings (cont)                                         AR20150003535



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