RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-03241 XXXXXXX COUNSEL: XXXXXXX HEARING DESIRED: YES ________________________________________________________________ APPLICANT REQUESTS THAT: 1. Her administrative discharge be changed to a medical retirement with a 30 percent disability rating. 2. Her narrative reason for separation be changed to reflect a less inflammatory reason for discharge than “Personality Disorder.” 3. On 5 Feb 2014, the applicant amended her request to change her administrative discharge to a medical retirement with a 60 disability rating rather than 30 percent. ________________________________________________________________ APPLICANT CONTENDS THAT: In a 9-page statement the applicant’s counsel presents the following major contentions: 1. The applicant was incorrectly diagnosed with a Personality Disorder. Her diagnosis of Personality Disorder is in error. By definition a Personality Disorder is a pattern of inner experience and behavior that deviates from the expectations of an individual's culture. Personality Disorders are not fleeting in nature and are not associated with temporary stressors but instead are a long-lasting impairment in social, occupational, or other areas of functioning. If she in fact suffers from a Personality Disorder then she would have had some symptoms prior to Apr 2010. In Apr 2010, she was forty-three years old and had completed two Bachelor's degrees and a Master's degree with a 3.9+ grade point average. Prior to her military career, she led a perfectly normal life with an impeccable work history and maintained healthy and lasting relationships. Beginning in 2010, she started seeing a clinical psychologist, in light of the command's insistence that she suffers from a Personality Disorder. According to her treating physician, she does not meet any of the criteria for a Personality Disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). As set forth by her clinical psychologist, an individual with a Personality Disorder must meet at least two of the following conditions to be diagnosed with a Personality Disorder: a. A problematic pattern of behavior which has its beginnings in at least adolescence or early adulthood; b. In appropriate affectivity, such as intense or labile affect, abnormal emotional response, etc.; c. Difficulties in interpersonal relations, social situations; and, d. Lack of impulse control. When one considers the stark contrast between her work ethic, commitment, and drive to succeed prior to her terminal diagnosis of idiopathic pulmonary fibrosis, it is quite clear that her change in behavior is solely attributable to that diagnosis and not an enduring maladaptive pattern of behavior and cognition consistent with a Personality Disorder. 2. She should have been processed through the Disability Evaluation System (DES). She should have been permanently retired from the Air Force due to her diagnosis of idiopathic pulmonary fibrosis. Her health has repeatedly declined and will continue to decline in years to come. In Jun 2010 she was informed by her physician that she would likely require a lung transplant within three to five years. The Physical Evaluation Board (PEB) correctly determined that her conditions were service connected and that she should have been retired with a permanent rating of 30 percent. The only reason she was not permanently retired was due to the incorrect separation based on Personality Disorder. When one considers the fact that immediately after she was released from the military she received a combined rating of 100 percent from the Department of Veterans Affairs (DVA), it becomes abundantly clear that she should have been processed through the DES system. Notably the DVA assigned a 60 percent disability rating for her diagnosis of idiopathic pulmonary fibrosis effective 3 Dec 2011. Regardless of the percentage difference between the DVA and the Medical Evaluation Board (MEB), it cannot be ignored that both departments viewed her pulmonary fibrosis as service connected. Clearly, she should have been separated through the DES system and not separated under the auspices of "Personality Disorder." 3. Characterizing her as having a Personality Disorder is inequitable. Since her separation on 2 Dec 2011, she has been unable to find employment. The characterization of Personality Disorder carries with it a negative stigma that unfairly jeopardizes her future employment prospects, particularly in her career as a social worker. The Mental Health Evaluation is an inaccurate, cursory review of her mental health history; counsel respectfully requests that the narrative reason of discharge be changed to reflect a less inflammatory reason for discharge than Personality Disorder. In support of her request, the applicant provides copies of her AF Form 356, Findings and Recommended Disposition of USAF Physical Evaluation Board; DVA Rating Decision; medical documents, memorandums, and various other documents associated with her request. Her complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: On 28 Jun 2009, the applicant entered active duty. On 28 Jul 2009, the applicant was notified by her commander that she was considering she be disenrolled from Commissioned Officer Training (COT) for lack of adaptability. On 31 Jul 2009, the Staff Judge Advocate found the COT disenrollment legally sufficient. In a 19 Aug 2009 electronic communiqué, COT leadership and the career filed manager provided the applicant a second opportunity at COT beginning on 24 Aug 2009. On 1 Feb 2010, she received a Letter of Admonishment for dereliction of duties, attempting to deceive superior officers and providing false information. In a “Mental Health Evaluation date 1 Apr 2010, the applicant was seen for a non-emergent Commander Directed Evaluation (CDE) on 23 Mar 2010, 25 Mar 2010, 29 Mar 2010 and 31 Mar 2010. The applicant was referred by her commander for an evaluation due to a pattern of lying, undue anxiety in dealing with patients and not benefiting from supervision. On 29 Jul 2010, the applicant’s commander initiated separation action under the provisions of AFI 36-3206, Administrative Discharge for Commissioned Officers. The specific reason for his action was the applicant was diagnosed with an Adjustment Disorder with anxiety and with a Personality Disorder with borderline paranoid and compulsive features by a clinical psychologist. On 19 Jul 2011, the applicant was referred to the Informal Physical Disability Evaluation Board (IPEB) for “Interstitial Lung Disease NOS, likely Idiopathic Pulmonary Fibrosis.” The IPEB recommended permanent retirement with a disability rating of 30 percent. On 1 Aug 2011, the applicant concurred with the medical recommendation for permanent retirement. On 4 Aug 2011, the applicant's case was forwarded to the Secretary of the Air Force Personnel Counsel (SAFPC) for review of her dual action case. On 14 Nov 2011, SAFPC directed the applicant be discharged by execution of the approved AFI 36-3206, Administrative Discharge Procedures for Commissioned Officers, action and terminated the action under the provisions of AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation. On 2 Dec 2011, the applicant was honorably discharged from the Air Force after serving 2 years, 5 months and 5 days of active service. Her narrative reason for separation is “Personality Disorder.” On 29 Nov 2012, the DVA granted the applicant a 60 percent service connected rating effective 3 Dec 2011, for “Sarcoidosis, Unusual Interstitial Pneumonia (UIP), Idiopathic Pulmonary Fibrosis, and Sleep Apnea.” Her overall combined rating is 100 percent. ________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPFD recommends denial. DPFD states that the preponderance of evidence reflects that no error or injustice occurred during the disability process or the rating applied at the time of the board. In accordance with AFI 36-3212, when a case is being processed with a final recommendation of unfit and administrative action is pending, the case is processed as a dual action and forwarded to SAFPC for finalization. Once SAFPC reviewed the case as a dual action they had the option to retain the applicant on active duty, direct the medical retirement or uphold the administrative discharge. On 14 Nov 2011, SAFPC directed the applicant be discharged by execution of the approved AFI 36-3206 action and terminated the action under the provisions of AFI 36-3212. After reviewing all the facts and evidence SAFPC noted "...the Board determined there was no causal relationship between the member's medical condition and her misconduct, and that there were insufficient mitigating factors to disregard the disciplinary action. Therefore, the Board determined that execution of the previously approved AFI 36-3206 action is appropriate.” The complete DPFD evaluation is at Exhibit C. The BCMR Medical Consultant recommends granting the applicant alternative relief by changing the reason for discharge to “Secretarial Authority.” The Medical Consultant states that he found sufficient evidence of an alternative choice available to the applicant's commander in selecting the narrative reason for administrative discharge, which would remedy the injustice caused by the stigma of the diagnosis of Personality Disorder. It should be noted that the applicant's CDE predated the 1 Apr 2010 medical narrative explaining her diagnosis and prognosis. Thus, while the applicant may have experienced some symptoms of her disease, the Medical Consultant does not link her performance difficulties to her knowledge of the diagnosis or prognosis for recovery. Instead, the applicant's demonstrated performance difficulties and the multiple documented observations of co-workers collectively resulted in the CDE. Noting the recurrent reference to the applicant's poor or difficult adaptability to the Air Force, her Axis I Adjustment Disorder with anxiety could have and should have taken precedence when selecting the administrative reason for discharge. Choosing this route would have been both legal and appropriate, with the added benefit of a much less adverse occupational stigma when compared to her co-morbid diagnosis of Personality Disorder; notwithstanding the plausible diagnostic challenge by the applicant's legal counsel. Re-addressing the applicant's desire for a medical separation/retirement, the military DES, established to maintain a fit and vital fighting force, can by law, under Title 10, United States Code (USC), only offer compensation for those service incurred diseases or injuries which specifically rendered a member unfit for continued active service and were the cause for career termination; and then only for the degree of impairment present at the time of separation and not based on future occurrences. Although the applicant was found unfit due her pulmonary condition, because she was concurrently the subject of an approved and unrelated administrative discharge, the SAFPC acted within its authority to execute the administrative discharge and to set aside the medical discharge. SAFPC found no causal or mitigating relationship between the reason for the applicant's administrative discharge and the medical condition for which she was found unfit for further military service and, thus, recommended execution of the previously approved administrative discharge. On the other hand, operating under a different set of laws (Title 38, USC.), with a different purpose, the DVA is authorized to offer compensation for any medical condition determined service incurred, without regard to [and independent of] its demonstrated or proven impact upon a service member's fitness to serve or the narrative reason for separation. So, the fact that the DVA assigned the applicant's disability rating effective so close to her date of release from service is not relevant to the administrative action executed by the Air Force; unless there was a convincing and proven cause and effect relationship between the two. ? The complete Medical Consultant’s evaluation is at Exhibit D. ________________________________________________________________ APPLICANT'S REVIEW OF THE AIR FORCE EVALUATION: The advisory opinion incorrectly characterizes the applicant’s arguments on appeal and further fails to address her arguments as to why her request for relief should be granted. Furthermore, it should be noted that the Medical evaluation was prepared by a general medical practitioner as opposed to a psychologist who would recognize the inadequacies in her diagnosis. As set forth in the Medical evaluation, and reflected in the Mental Health Evaluation, the only factual basis for supporting her diagnosis is her "lack of adaptability" to military service. There is absolutely no information establishing a "problematic pattern of behavior" which began in adolescence or early adulthood. Furthermore there is no information establishing any of the other three conditions set forth by the DSM-IV. The only basis appears to be "several minor disciplinary infractions" and her failure to adapt during COT. Instead, she has offered significant documentation which proves she does not have a Personality Disorder, but instead was responding to a major life stressor that occurred after joining the military. As corroborated by an outside physician, the applicant was diagnosed with Adjustment Disorder with Mixed Anxiety as a result of being diagnosed with a terminal condition in early 2010. Counsel further expounded on her previous contentions that the applicant should have been processed through the DES and characterizing her as having a Personality Disorder is inequitable. Moreover, should the Board grant the relief requested, she should be medically retired from the Air Force with a rating of at least 60 percent based on the DVA's rating shortly after her discharge. Counsel’s complete response is at Exhibit F. ________________________________________________________________ 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 an error or injustice to warrant changing her administrative discharge to a medical retirement with a 60 percent disability rating. We took notice of the applicant's complete submission in judging the merits of the case and do not find that it supports a determination that she should be medically retired. While the applicant’s response to the BCMR Medical Consultant is noted, she has provided no evidence which, in our opinion, successfully refutes the assessment of her case by the BCMR Medical Consultant. Therefore, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt his rationale as the basic for our conclusion that the applicant has not been the victim of an error or injustice. In view of the above and in the absence of evidence to the contrary, we find no basis to favorably consider this portion of the applicant’s request. 4. Notwithstanding the above sufficient relevant evidence has been presented to demonstrate the existence of error or injustice warranting a degree of relief. In coming to our determination we reviewed the complete evidence of record, in particular, the advisory prepared by the BCMR Medical Consultant who recommends changing the applicant’s records to reflect that her narrative reason for separation be changed to “Secretarial Authority.” Accordingly, we agree with the opinion and recommendation of the BCMR Medical Consultant and adopt the rationale expressed as the basis for our decision that the applicant has been the victim of either an error or an injustice. Therefore, in the interest of justice, we recommend her records be corrected to the extent indicated below. 5. 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 issue(s) involved. Therefore, the request for a hearing is not favorably considered. ________________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to APPLICANT, be corrected to show that at the time of her 2 Dec 2011 discharge, the narrative reason for her separation was Secretarial Authority with a separation code of JFF. ________________________________________________________________ The following members of the Board considered this application in Executive Session on 6 May 2014, under the provisions of AFI 36-2603: , Panel Chair , Member , Member ? All members voted to correct the record as recommended. The following documentary evidence was considered in AFBCMR BC-2013- 03241: Exhibit A. DD Form 149, dated 28 Jun 2013, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPFD, dated 25 Jul 2013. Exhibit D. Letter, BCMR Medical Consultant, dated 2 Jan 2014. Exhibit E. Letter, SAF/MRBC, dated 6 Jan 2014. Exhibit F. Letter, Counsel, dated 5 Feb 2014. Panel Chair 1