ADDENDUM TO RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER: BC-1999-01406-2 

						COUNSEL:  NONE
		
						HEARING DESIRED:  NO

APPLICANT REQUESTS THAT:

He receive a medical retirement.  

RESUME OF CASE:

On 23 February 2000, the Board considered and denied the applicant’s original request that he receive a medical retirement.  The applicant contends he was rated with three service connected conditions totaling 40 percent before the end of the first year after discharge so he should have received a medical retirement instead of a discharge.  However, evidence of record established beyond all reasonable doubt that the applicant was medically qualified for continued active duty and there was no documentation submitted to show he was unfit due to a physical disability at the time of his involuntary release from active duty.  He was involuntarily released from active duty due to his non-selection for promotion and the reason for his separation was proper.  For an accounting of the facts and circumstances surrounding the applicant’s original request and the rationale of the earlier decision by the Board, see the Record of Proceedings (ROP) at Exhibit E. 

On 4 November 2015, by virtue of a DD Form 149, Application for Correction of Military Record, the applicant requests reconsideration.  The applicant contends, he was diagnosed with the condition of dysthymia while in the military and it has progressed to post traumatic stress disorder (PTSD).  His initial diagnosis was incorrect and the Department of Veterans Affairs has since diagnosed him at 70 percent disability for PTSD.  He was misdiagnosed and separated for the convenience of the government.  However, he is currently 100 percent disabled which is a key indicator that his case is justified for review and warrants an upgrade to a medical retirement.  

The applicant’s complete submission, with attachments, is at Exhibit F.

AIR FORCE EVALUATION:

AFBCMR Medical Consultant recommends denial and defers to the opinion of the Mental Health Advisor.  

It is acknowledged that service-connection and disability ratings were granted to the applicant for a number of medical ailments by the Department of Veterans Affairs; to include the more recent inclusion of Post-Traumatic Stress Disorder (PTSD) among his disability ratings.  However, under Title 10, United States Code (U.S.C.), for a military medical separation or retirement, there must be evidence that one or more medical conditions interfered with or precluded the applicant’s ability to perform the duties of his office, grade, rank, and rating.  Stated differently, the medical condition(s) must be found unfitting by a Physical Evaluation Board (PEB).  

To obtain eligibility for a medical separation, the process begins by a credentialed medical provider identifying a condition which warrants a Medical Evaluation Board (MEB); either due to the disqualifying nature of the condition, in accordance with Air Force Instruction 48-123, Medical Examinations and Standards, the individual was under extended profile restrictions prohibiting worldwide qualification for 365 or more days, or a duty-limiting condition existed that was not expected to resolve after receiving maximal medical benefit.  Moreover, a unit commander may request an MEB review for members observed to be unable to properly perform his or her military duties due to a suspected physical or mental ailment.  An MEB may also be generated by HQ AFPC [AFMPC at the time], Medical Standards Division, if an individual’s PCS assignment has been cancelled due to a medical condition.  

In the case under review no such restrictions were imposed for any of the applicant’s systemic and somatic conditions of a sufficient level and duration that warranted MEB/PEB processing; notwithstanding the transient “S4” profile assigned for the applicant’s Adjustment Disorder, a disqualifying condition not eligible for disability evaluation processing at the time.  

In accordance with Department of Defense Instruction 1332.38, Physical Disability Evaluation [1996], and its contemporary 13323.18, Disability Evaluation System [2014], provides the following General Criteria for Making Unfitness Determinations. (a). “A Service member will be considered unfit when the evidence establishes that the member, due to disability, is unable to reasonably perform duties of his or her office, grade, rank, or rating, including those during a remaining period of Reserve obligation.” (b). “A Service member may also be considered unfit when the evidence establishes that:  (1) The Service member’s disability represents a decided medical risk to the health of the member or to the welfare or safety of other members; or (2) The Service member’s disability imposes unreasonable requirements on the military to maintain or protect the Service member.

Although the applicant’s had duties as a Security Forces member, his PRP status was terminated permanently principally due to financial concerns and likely due to his mental health assessment; which clearly impacted his retainability in his chosen career field and posed the vulnerability for denial of re-enlistment and possible denial of cross-training opportunities.  

The applicant was diagnosed with an Adjustment Disorder with Depressed Mood; a condition which was characterized as a non-compensable and unsuitable condition not qualifying for MEB processing under the DoD Instruction 1332.39, in effect at the time of the applicant’s separation, nor versions of AFI 36-3212.  Despite the possibility that the applicant’s emotional distress may have persisted greater than 6 months, he would not qualify for de facto consideration of the more recent Department of Defense posture recognizing that a Chronic Adjustment Disorder would qualify for MEB processing; made effective 10 April 2013.  

The Department of Veterans Affairs (DVA) is authorized to offer compensation for any medical condition determined service-incurred without regard to its proven or demonstrated impact upon a former service member’s retainability, fitness to serve, narrative reason for separation, or the length of time since date of separation.  The DVA is also empowered to conduct periodic re-evaluations for the purpose of adjusting the disability rating awards (increase or decrease) as the level of impairment from a given service connected medical condition may vary (improve or worsen, affecting future employability) over the lifetime of the veteran; as clearly demonstrated in the escalating disability ratings awards received since leaving military service.  

While the applicant has been able to justify service-connection and compensation for the diagnosis of PTSD, albeit made effective several years since discharge, PTSD was not an unfitting medical condition at the time of the applicant’s service and that it was not and should not have been the cause for career termination.  The applicant’s alleged traumatic event in 1990 was not disclosed as a factor during at least two military mental health MEB summaries, wherein the focus of his distress was predominantly upon his responses to receiving PCS orders to Turkey.  

There are noted opposing clinical diagnostic opinions among the VA mental health providers.  In April 2004, a provider opined the applicant’s diagnosis of Adjustment Disorder to be Dysthymia and his mood symptoms were “mild and chronic” and “persistent at least 9 years.”  Then a VA provider expressed, on 10 May 2010, the applicant is not diagnosed with PTSD.  The provider, instead, issued an Axis I diagnosis of Anxiety Disorder, NOS and Dysthymia.  Finally, an evaluation conducted on 21 April 2015, facilitated by an Initial PTSD Disability Benefits Questionnaire (DBQ), resulted in confirmation of a diagnosis of PTSD. 

There are several reasons why there may be diagnostic disparities among mental health professionals which may cause a change in a person’s diagnosis.  However, the applicant was indeed diagnosed with a mental disorder during military service and his appeal is related to a mental health issue; therefore, an opinion by a psychiatrist or PhD-level psychologist is advised, IAW provisions of the National Defense Authorization Act, 2015, Section 521.

A complete copy of the AFBCMR Medical Advisor’s evaluation is at Exhibit G.

AFBCMR Psychiatric Consultant recommends denial.  There is insufficient evidence to warrant the desired change of the record.  

The DVA and the military work under separate laws.  The DVA operating under Title 38, United States Code (U.S.C.), is empowered to offer compensation for any medical condition with an established nexus with military service, without regard to is impact upon a member’s fitness to serve, the narrative reason for release from service, or the length of time transpired since the date of discharge.  The DVA may also conduct periodic reevaluations for the purpose of adjusting the disability rating awards as the level of impairment from a given medical condition may vary [improve or worsen] over the lifetime of the veteran.

To the contrary, according to Title 10, U.S.C., the Disability Evaluation System (DES) was established to set policy to maintain a fit and vital force, and provide procedures for referral, evaluation, return to duty, separation, or retirement of service members for disability.  The standards for all determinations will be consistently and equitably applied and are based on a determination of fitness to perform the duties of a member’s office, grade, rank or rating.  This determination is done as a “snap shot” in time, when all the conditions whether singly or together result in a state of unfitness for duty.  

A diagnosis of Dependent Personality Disorder makes him unsuitable for military service, meaning that this condition is an innate part of the individual and not a condition that developed as a result of military service.  For the same reason this condition is not compensable.  

The MEB diagnosis should be considered.  According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) DSM 5, and Adjustment Disorder is the development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).  These symptoms or behaviors are clinically significant.  The stress-related disturbances does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.  Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months.  

Thus, it is clear that the applicant was not discharged for a compensable mental health condition, and although he was not discharged for Dependent Personality Disorder, it does fit his presentation more aptly.  But even more evident is that he does demonstrate the symptoms of an Adjustment Disorder.  However, an adjustment disorder has been, for decades listed in the Air Force and Department of Defense policies as a medical condition not considered a compensable disability by the military Disability Evaluation System (DES).  

In summary, the rating that the applicant received from the DVA is based on a different set of conditions than the Air Force rules.  A medical retirement is based solely on the extent to which the applicant can perform his/her duties.  It is clear that this applicant has successfully held a job for over ten years since he left the military and reported that he was functional in the job market as well as on an interpersonal level.  In consideration of the 8 years of good performance, the applicant was given the honorable discharge.  

A complete copy of the AFBCMR Psychiatric Advisor’s evaluation is at Exhibit H.

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

Copies of the evaluations were forwarded to the applicant on 9 June 2017 for review and comment within 30 days (Exhibit I).  As of this date, no response has been received by this office.  

THE BOARD CONCLUDES THAT:

After again reviewing this application and the evidence provided in support of his appeal we remain unpersuaded the evidence presented demonstrate the existence of an error or injustice. Therefore, we are in agreement with the BCMR Medical Consultant and BCMR Psychiatric Consultant recommendation the applicant has not been a victim of an error or injustice.  In the absence of evidence to the contrary, we find no basis to recommend granting the requested relief.

THE BOARD DETERMINES THAT:

The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application.

The following members of the Board considered AFBCMR Docket Number BC-1999-01406-2 in Executive Session on 12 September 2017 under the provisions of AFI 36-2603:

The following documentary evidence pertaining to AFBCMR Docket Number «DocketNumber» was considered:

	Exhibit E.  Record of Proceedings, dated 7 March 2000
                 w/exhibits A through D. 
	Exhibit F.  DD Form 149, dated 4 November 2015, w/atchs.
Exhibit G.  Memorandum, AFBCMR Medical Advisor, dated 
            17 March 2017. 
	Exhibit H.  Memorandum, AFBCMR Psychiatric Advisor, dated  
                 22 May 2017. 
	Exhibit I.  Letter, AFBCMR Letter to Applicant, dated 9  
                 June 2017.