`                       RECORD OF PROCEEDINGS
         AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2003-03834

	XXXXXXX	COUNSEL:  NONE

	XXXXXXX	HEARING DESIRED: YES

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APPLICANT REQUESTS THAT:

His diagnoses of Anxiety Disorder and Narcissistic Personality Traits for separation be removed from his records in order to allow him to be eligible to return to active duty.

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APPLICANT CONTENDS THAT:

His prior psychologist stated that his condition was corrected more than two months prior to his medical evaluation board (MEB) meeting.  The psychologist at the VA Medical Center in XXXXX, WY stated after his evaluation, he should had never been diagnosed with an Anxiety Disorder.  He is currently attending a graduate school full time.  He would like to return to active duty and/or allowed to serve in the active Reserves or Air National Guard.  Please note his outstanding final OPR and comments from his squadron commander.  

In support of his appeal, the applicant has provided copies of OPRs, training reports, Findings and Recommendation Disposition of USAF Physical Evaluation Boards, MPT Training Report Reviews, USAF Fitness Program Reports, Award Submissions, Letters of Appreciation, Statement of Medical Condition, Field Observations, Formal Evaluation Board Reports, Medical Evaluation Board Reports, MEB audio tapes, and letters of support.

Applicant’s complete submission, with attachments, is at Exhibit A.

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STATEMENT OF FACTS:

The applicant completed ROTC, was commissioned, entered active on September 25, 1999, and served as missile combat crew in the grade of 2nd lieutenant.  In April 2002, he presented with complaint of increasing anxiety resulting in decertification from the Personnel Reliability Program (PRP) and subsequent disability discharge.  The applicant was disability discharged with severance pay on May 2, 2003 after 3 years, 7 months and 8 days on active duty.  

While an ROTC Cadet, the applicant worked with the Air Force Tops in Blue tours over the course of two years prior to his graduation and commissioning.  Following his commissioning, the applicant attended missile training and was assigned to F.E. Warren Air Force Base beginning July 2000. His excellent work with Tops In Blue resulted in an invitation for him to continue to participate with Tops In Blue tours while on active duty, however, his requests to participate with Tops In Blue were denied in 2000 and 2001.  On an August 14, 2001 periodic health assessment questionnaire, the applicant wrote, “Anxious to cross train into Tops in Blue.”  The applicant’s request to participate with the tour in 2002 was again denied around April 2002 (according to a letter dated December 10, 2002 in the discharge package).

The applicant was seen initially in the Life Skills Clinic (mental health clinic) on April 16, 2002 and given a preliminary diagnosis of anxiety disorder.  There was no prior history of psychiatric illness.  He was temporarily decertified from missile duty and entered into psychotherapy. Personnel records show he performed his non-missile duties in an exemplary fashion and did well in training (a simulator ride and 2 tests). His diagnosis in the April 24, 2002 entry was listed as “Adjustment Disorder with Anxiety, R/o anxiety disorder.”  The applicant’s duty limiting symptoms persisted through June and he was referred by his psychologist for further evaluation with psychological testing and evaluation by a psychiatrist. The psychiatrist evaluated the applicant on July 22, 2002 and rendered diagnoses of Anxiety Disorder not otherwise specified, and narcissistic personality traits, commenting,” Patient has manifested clear symptoms of anxiety in the face of mild to moderate job stress.  It seems that his narcissistic personality traits may interfere with his ability to accept a job that he feels is ill-suited to his nature.”  On a July 31, 2002 health questionnaire, the applicant endorsed symptoms of being bothered by feeling down, helpless, panicky or anxious.  On July 31, 2002, the mental health clinic recommended permanent decertification from the Personnel Reliability Program (and therefore missile duty) subsequently triggering a Medical Evaluation Board.  

The Medical Evaluation Board (MEB) narrative summary dated   August 18, 2002 indicated that the applicant reported difficulties with job stress while performing missile duties since his arrival and reported “angered and resentment over “doing wrong job” and being “better suited elsewhere in USAF.”  His symptoms had worsened markedly in the month preceding his April 2002 presentation to the mental health clinic.  His symptoms included depressed mood, insomnia, generalized anxiety associated with nervousness, sweaty palms, increased heart rate, shortness of breath, and white knuckles.  He reported feeling trapped inside the missile capsule.  Following removal from missile duty, his symptoms improved.  The narrative report noted personality traits (not to the level of a personality disorder) that were felt to have contributed significantly to his difficulty adapting to the job he found very distressing and anxiety provoking.  The formal diagnoses were, Anxiety Disorder not otherwise specified, and Narcissistic personality traits with a social and industrial impairment of mild.  The narrative summary concluded.  

An October 6, 2002 update to the narrative summary, states, “His condition remains unchanged since the MEB began.  His anxiety symptoms resolved completely with his withdrawal from his stressful job environment.  Psychological testing was consistent with the diagnosis of an anxiety disorder.  He would likely deteriorate again if reassigned to missileer duties.  Job stress and frustration were central to the etiology of his psychiatric symptoms and poor work performance. He will likely experienced significant problems in any situation in which he was stressed over his military job assignment.”  The psychiatrist recommended disability discharge from the military.  

The commander’s letter to the Physical Evaluation Board (undated), states that since April 2002, the applicant had been assigned various jobs within the wing.  “He has the capability to be an average crewmember, but his negative attitude towards that duty holds him back.  His inability to cope with stress of crew duty causes him to question his ability to deal with any situation or career field he doesn’t like.  The training difficulties we’ve had with the applicant and his inability to deal with the stress of a job he doesn’t like cause him to question his ability to succeed as an Air Force officer.”  

The applicant requested retention on active duty with cross training into another career field and submitted several letters of support including coworkers, trainers, and supervisors attesting to his character and excellent qualities desirable of an Air Force officer.  Also present are two letters from Air Force Tops In Blue civilian officials extolling his abilities and performance while working with that organization.  A November 13, 2002 memorandum for the Medical Evaluation Board by the applicant’s psychologist indicated complete resolution of symptoms and estimated his prognosis for continuing health as good.  

The Informal Physical Evaluation Board recommended discharge with severance pay stating, “Member’s medical condition is not compatible with the rigors of military service as evidenced by his susceptibility to relatively minor stressors which may be present even in other career fields.”  The applicant appealed to the Formal Physical Evaluation Board (FPEB).  The FPEB, on January 10, 2003 found the applicant unfit and recommended discharge with severance pay (10%) for Anxiety Disorder Not Otherwise Specified.  

The decision of the FPEB was upheld by the Secretary of the Air Force Personnel Council on March 12, 2003, citing the opinion of mental health professionals indicating a high likelihood of recurrence of symptoms, under similar stressful situations.  

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AIR FORCE EVALUATION:

The BCMR Medical Consultant recommended denial and stated action and disposition in this case is proper and equitable reflecting compliance with Air Force directives that implement the law.  The applicant was disability discharged with severance pay for Anxiety Disorder not otherwise specified that developed in the setting of job stress and dissatisfaction with the career field that the Air Force had assigned him.  Following the disappointment of being denied the opportunity to tour with Tops In Blue, he presented to the mental health clinic and reported a 2 year history of symptoms that had recently worsened.  Based on the applicant’s report of symptoms, severity and duration, he was properly diagnosed by his psychologist and psychiatrist.  Although his symptoms improved gradually following removal from missileer duties, both his psychologist and psychiatrist attributed the development of his symptoms to characterological features and expressed the opinion that recurrent symptoms were highly likely under similar circumstances of occupational dissatisfaction and stress.  Based on these opinions the Physical Evaluation Boards and the Secretary of the Air Force Personnel Council determined the applicant was not fit for continued military service.  

The situational and transient nature of the applicant’s symptoms diagnosed as anxiety disorder also suggested the earlier diagnosis of Adjustment Disorder.  Members diagnosed with Adjustment Disorder that interferes with duty are considered unsuited for military duty and are subject to administrative discharge by their commanders.  Although the symptoms of Adjustment Disorder improve with relief of the stressors, recurrence under similar stressful circumstances is likely especially with the co-morbid maladaptive coping associated with narcissistic personality traits. Regardless of which diagnosis was the most accurate, Adjustment Disorder or Anxiety Disorder, past experience is predictive of an increased risk for recurrence of duty limiting anxiety and or Adjustment Disorder if re-exposed to the unique demands of military training and service.  
BCMR Medical Consultant’s complete evaluation is at Exhibit C.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 21 May 2004 for review and comment within 30 days.  As of this date, no response has been received by this office.

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THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by existing law or regulations.

2.  The application was timely filed.

3.  Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice.  We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the BCMR Medical Consultant’s recommendation and adopt his rationale that the applicant has not been the victim of an error or injustice and the narrative reason for separation in this case is appropriate.  In this respect, we noted the findings of the MEB and PEB that indicated the applicant’s medical condition is not compatible with the rigors of military service as evidenced by his susceptibility to relatively minor stressors, which may be present even in other career fields.  Accordingly, in the absence of persuasive evidence to the contrary, we find no basis to recommend granting the relief sought in this application.

4.  The applicant's case is adequately documented and it has not been shown that a personal appearance with or without counsel will materially add to our understanding of the issues involved.  Therefore, the request for a hearing is not favorably considered.

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THE BOARD DETERMINES THAT:

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

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The following members of the Board considered AFBCMR Docket Number BC-2003-03834 in Executive Session on 14 September 2004, under the provisions of AFI 36-2603:

The following documentary evidence was considered:

    Exhibit A.  DD Form 149, dated 10 Nov 03, w/atchs. 
    Exhibit B.  Applicant's Master Personnel Records.
    Exhibit C.  Letter, BCMR Medical Consultant, dated 17 May 04.
    Exhibit D.  Letter, SAF/MRBR, dated 21 May 04.