DEPARTMENT OF THE NAVY

BOARD FOR CORRECTION OF NAVAL RECORDS

2 NAVY ANNEX

WASHINGTON DC 20370-5100

Docket No: 117601
21 January 2003

This is in reference to your application for correction of your naval record pursuant to the
provisions of title 10 of the United States Code, section 1552.

A three-member panel of the Board for Correction of Naval Records, sitting in executive
session, considered your application on 16 January 2002. Your allegations of error and
injustice were reviewed in accordance with administrative regulations and procedures
applicable to the proceedings of this Board. Documentary material considered by the Board
consisted of your application, together with all material submitted in support thereof, your
naval record and applicable statutes, regulations and policies. In addition, the Board
considered the advisory opinion furnished by a designee of the Specialty Advisor for
Psychiatry dated 27 September 2002, a copy of which is attached.

After careful and conscientious consideration of the entire record, the Board found that the
evidence submitted was insufficient to establish the existence of probable material error or
injustice. In this connection, the Board substantially concurred with the comments contained
in the advisory opinion.
responsibility when you committed the offenses for which you received nonjudicial
punishment. Accordingly, your application has been denied. The names and votes of the
members of the panel will be furnished upon request.

In addition, it was not persuaded that you lacked mental

It is regretted that the circumstances of your case are such that favorable action cannot be
taken. You are entitled to have the Board reconsider its decision upon submission of new and
material evidence or other matter not previously considered by the 
In this regard, it is
important to keep in mind that a presumption of regularity attaches to all official records.

Board.

Consequently, when applying for a correction of an official naval record, the burden is on the
applicant to demonstrate the existence of probable material error or injustice.

Sincerely,

W. DEAN PFEIFFER
Executive Director

Enclosure

NATIONAL NAVAL MEDICAL CENTER

ADULT 

OUTI ’ATIENT BEHAVIORAL  

BEALTIICABE CLINIC

8901 WISCONSIN 

AVENUE

BETHESDA, 

MARYLAND  20889-5600

CAPT&MC ,
 USAF

CAP- MC, USN
Specialty Advisor for PSYCHIATRY
Naval Medical Center
San Diego, CA 92 134

27 September 2002

*

Service Chief, Outpatient Behavioral Healthcare Clinic, NNMC

/
&

FROM:

TO :

VIA:

SUBJECT:

REF:

ENCL:

1.

(a) 10 U.S.C. 1171

(b)

Board for Correction of Naval Record letter of 7 August 200 1

(1) BCNR File
(2) Service record
(3) Medical records
(4) VA records

Per your request for review of the subject
response to reference
documentation of the charges that led to non-judicial punishment was provided in this packet.

(b), I thoroughly reviewed enclosures (1) through (4). Of note, no
 

’s petition for a correction of his Navy records, and in

I
cannot comment on the patient
’s mental status at the time of the alleged offenses and therefore
cannot render any opinion as to whether the Board should set aside his non-judicial punishment on
the basis of a mental disorder.

2. Review of available service records revealed:

a. Active duty service in the USMC 

from 7 October 1997 through 20 October 2000. He

was a Rifleman for the majority of that time.
Deployment Ribbon, a Letter of Appreciation and a Rifle Sharpshooter Badge during his
service. He was discharge with a General Discharge under Honorable Conditions.

The patient earned a Sea Service

3. Review of available Navy medical records revealed:

a.

b.

In

 

“Have you ever had or

” “depression or

“frequent trouble sleeping,

” “nervous trouble of any sort,

” he checked the column labeled 

SFS8, Report of Medical History, signed and dated by the patient 25 August 1997.
section 11, which asked the patient to respond to the question 
have you now, ” under the statements 
excessive worry, ” “loss of memory or amnesia,
“periods of unconsciousness,
of a waiver for any prior mental health treatment accompanying the SF88.
The above statements contradicted information found in several other places in the
medical record. For example, an SF600, Chronological Record of Medical Care, &ted
3 1 March 1998 from 
mood and irritability ” but also a significant previous psychiatric history. The psychiatric
history included  “depression at age 9-10 with a three to four month hospitalization at
‘Bedford Meadows ’,” in Texas, and outpatient follow-up. Involvement with counseling
at age 14-15 for problems related to the patient
The patient failed to report either the hospitalization or the counseling on SF88.

3/7 MCAGCC 29 Palms documented not only current 

“No. ”There is no record

’s family was also documented in the note.

“depressed

” and

” He

“the USMC was not what [he] expected.

SF 5 13, Consultation Sheet completed 28 April 1998 from Mental Health Department,
Naval Hospital 29 Palms contained further details.
The patient was referred to Mental
Health approximately six months after coming on active duty, with five weeks at his duty
station, with a chief complaint that 
endorsed transient homicidal ideation toward his company commander because of the
“degree to which he [pushed]
” the unit during “humps.”The patient indicated that he had
been on medication during and after his hospitalization at age 10, but discontinued it
under his mother ’s direction.He also indicated that he was involved in counseling until
approximately one year prior to enlistment. During this evaluation, the patient denied
of the evaluation
childhood physical or sexual abuse Mental status evaluation at the time 
was significant for tearfulness and for a 
would not be worth living if he [could not] get an honorable or general discharge from
the USMC. ” No symptoms of elevated mood, euphoria or grandiosity were noted, and
the depressive symptoms were judged not severe enough to warrant a diagnosis of major
depression. He was diagnosed with Adjustment Disorder with mixed emotional features,
and returned to duty with restrictions for dangerous equipment and firearms and a
temporary 1: 
of making the diagnosis.

1 watch. The note also indicated possible Personality Disorder, but fell short

“pessimistic outlook and the position that it

d. A follow-up note dated 6 May 1998 indicated that the patient was doing much better than

C.

e.

f.

’s next available

from 4 August 2000, documented a psychiatric admission for

homicidal@. It was signed by LT Loomis, staff psychiatrist, and

on initial assessment, was looking forward to a deployment to Kuwait, and that the
suicide risk was  “acceptable. ” As a result, the 1: 1 watch was discontinued, and the
patient was returned to full duty with instruction to take the provider
appointment. The patient was a no-show to an appointment scheduled for 29 May 1998.
The treating psychiatrist documented that he notified the patient
’s command about the
no-show. No further psychiatric outpatient visits were documented in the chart. Of note,
the patient presented to the Batallion Aid Station for evaluation of knee pain on 25 June
1998.
SF504, Clinical History, 
suicidality and 
documented that in January of 2000, the patient and his wife of 2 months underwent
Per the record, the patient
marriage counseling and were later divorced in May of 2000.
also participated in individual counseling and anger management classes around the same
further indicated that a  “pill overdose ” prompted the psychiatric
time. The record 
hospitalization at age 10. As in the previous documents cited above, the patient became
suicidal and homicidal in the context of stressors, at this time his stressors included
failure to be promoted to 
legal charges. Of note, the patient tested positive for cannabinoids on a routine urine
drug screen at the time of psychiatric admission. He also endorsed a history of at least
two episodes of childhood sexual abuse, but declined to provide any 
The Mental Health Services Narrative Summary dated 9 August 2000 indicated a
discharge diagnosis of cyclothymic disorder based on his history of mood swings and
depressed mood, not ever fully meeting criteria for either mania or major depression.
Therapy with Lithium was initiated to assist with mood swings.
Personality Disorder NOS with antisocial and narcissistic features was also given at the
time of discharge. The patient was recommended for expeditious 
separation on the basis of personality disorder.

B4, his ex-wife ’s refusal to communicate with him, and several

A diagnosis of

f$-ther  details.

adm@@rative

g. An outpatient clinic note dated 5 September 2000 indicated that the

 
pat&m ’s mother, a
ab@&disability
registered nurse, was calling the clinic to question the diagnosis and ask 
benefits. After listening to her concerns and description of some behaviors he exhibited
while on leave (including reckless driving, borrowing and 
to anger) the diagnosis of cyclothymic disorder was reconsidered

spending, being quick

unchanged.

4. Review
a.

b.

C.

d.

e.

f.

5. Discuss
a.

b.

G.

He was admitted

of available VA records revealed:
Initial Outpatient evaluation on 18 December 2000 at the VA North Texas Health Care
System. He presented with pressured speech and request for refill of Lithium, and was
referred for further evaluation of mood disorder and evaluation for participation in a
research protocol.
The next note, dated 27 December 2000 indicated that he presented a day late for
participation in a research protocol, did not meet criteria for emergency referral or
evaluation and was sent home with instructions to return the next day.
on December 28 2000 for hypomanic symptoms and to participate in a research study on
bipolar disorder being conducted at that time. His lithium was discontinued and he was
started on the study medication as per the protocol.
Of note, during the intake evaluation,
he denied any previous psychiatric hospitalizations prior to the year 2000, and also
denied a history of childhood sexual abuse. He did endorse that his long-standing
personal and family practice of Wicca, currently at odds with his mother ’s practice of
Christianity.
Hospital course was marked by overall cooperation with protocol and 
staff, with
“immature, child-like behavior ” noted on several occasions. Diagnostically, the
attending psychiatrist noted onset of mild PTSD symptoms related to experiences the
patient had while on active duty. Also, the attending psychiatrist performed a Structured
Clinical Interview for the DSM (SCID), which, according to the note,  “confirmed the
diagnosis of Bipolar Disorder. ”
During outpatient follow-up while on the study medication, the patient endorsed a
previous history of head injury with loss of consciousness while playing football.
age at the time of injury was not indicated in the note.
While on the study medication, the patient developed waxing and waning manic and
depressive symptoms, often related to psychosocial stressors (social isolation, conflict
with parents, and 
hospitalized for depressive symptoms, including suicidal ideation with plan to shoot
himself with a gun he owned. Though there was no diagnostic test to confirm it, the
notes indicated that he may have used marijuana in the days prior to the onset of his
depressed mood. He was discharged from the research protocol as a result of his
hospitalization, and his medications were changed to depakote 1000 mg po qhs, celexa 20
mg po qd and 
pm insomnia. He was discharged on 14 March 2001.
A.tter discharge, the patient continued to be depressed, and his celexa was increased to 30
mg po qd, and he was given clonazepam 0.5 to 1 mg po qhs pm insomnia.

difftculty finding employment). On 8 March 2001, the patient was

ativan 2 mg po qhs 

The

lion:

was formally evaluated by several different mental health providers on

several occasions during his military career. Based on the data available at the time of
these evaluations, he was never found to have an Axis I psychiatric condition of
sufficient severity to disqualify him from continued service in the USMC.
Despite his
initial hospitalization at the VA (to participate in a VA sponsored research protocol), his
e from the USMC was for depressed mood and
history of chronic dysphoria, mood swings 

ed for the same reasons while he was on active duty.

suicidal ideation
By history, he met criteria for an Axis II diagnosis of Personality Disorder Not Otherwise
Specified, with Antisocial and Narcisisstic traits. This Axis II diagnosis led to a finding
of not fit for continued military service, and he was discharged from the USMC on that
basis. Based on my evaluation of the records, I 
that the administrative discharge was appropriate.
traits consistent with borderline personality disorde
this diagnosis was appropriately considered during his psychiatric hospitalization while

be1

and

falsified his entry SF88 by failing to disclose his previous
mpt at age 10, as well his history of head injury and loss of

consciousness. Had this information been disclosed as required by law, it is unlikely that
d have met enlistment standards, or been able to obtain a waiver for
bling, in the context of attempting to obtain disability benefits, he

on, the VA physician made the

ginated during active duty service. By
asive

quality beginning in
case, his poor coping and
hood. Again, I concur with the

selectively omitted his history of suicide attempt or his previous hospitalization and
treatment with medi
erroneous 
conclusio
definition, personali
adolescence or early a
vulnerability to stressors was evide
diagnosis of Cyclothymic Disorder, but feel that it is appropriate to
“Existed Prior to Enlistment,
to seek mental health treatment prior to enlistment.
Per the record, despite severe interpersonal and religious conflicts,
mother has been intimately involved in helping him to obtain help
According to the record, she supervised his discontinuation of medication within two
months of his hospitalization when he
knowledge of his involvement with cou
sexual abuse. She figured prominently
VA, ie., it was a phone call from her that prompted a same-day hospitalization over
concerns that he was beginning to exhibit manic

may have had prior
of his history of childhood
initial hospitalization at the

” to capture the mood disturbance that

’symptoms.

d.

a.

b.

6. Opinion and Recommendations:

I concur with the diagnosis of Cyclothymic Disorder, but feel that the specifier, 
Prior to Enlistment, ” should be added.The condition, by definition, is not severe enough
al Evaluation Board proceeding, and none should be undertaken now.
persists in his pursuit of service connected disability, I recommend

that he also be investigated for fraudulent enlistment based on the abundant evidence in
the medical record.

“Existed

POC for this BCNR evaluation is