RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-03637 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: His narrative reason for separation of “Personality Disorder” and corresponding separation code “JFX” be changed to a medical retirement. ________________________________________________________________ APPLICANT CONTENDS THAT: He should have been medically retired for a bipolar disorder. He was recently diagnosed with a bipolar disorder. The Department of Veterans Affairs (DVA) rated his condition at 70 percent. He only signed the recommendation for discharge for personality disorder because he trusted the doctor’s diagnosis. At the time, he thought it was the right diagnosis but now has evidence to support he has a bipolar disorder. The military has a history of discharging veterans with a diagnosis of personality disorder. Consequently, veterans are unable to get the proper treatment. He is one of these veterans and requests his records be corrected. In support of his request, the applicant provides a personal statement, copies of his DD Form 214, Certificate of Release or Discharge from Active Duty; medical information, DVA rating decision and discharge proceedings. The applicant’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: On 30 Mar 2009, the applicant entered active duty. On 5 Jan 2010, the applicant’s commander notified him that he was recommending that he be discharged from the Air Force for conditions that interfere with military service, specifically, mental disorders - personality disorders In Accordance With (IAW) AFI 36-3208, Administrative Separation of Airmen. The specific reasons include the applicant’s diagnosis with an adjustment disorder with mixed disturbance of emotions and conduct and borderline personality disorder. The severity of the personality disorder affected the applicant’s ability to function effectively in the military environment. Although he denied any suicidal or homicidal ideations, he had a history of recurrent suicidal ideations and threats. Due to the personality disorder, he was recommended for permanent disqualification from weapon bearing, Personnel Reliability Program (PRP), Sensitive Compartmented Information (SCI) and other sensitive duty access. Other factors considered in the discharge recommendation include a Letter of Counseling (LOC) for reporting late for duty and failure to go to his appointed place of duty and a Letter of Reprimand (LOR) for damage to government property. On 5 Jan 2010, the applicant acknowledged receipt of the discharge notification. On 8 Jan 2010, he consulted counsel and waived his right to submit statements in his own behalf. On 11 Jan 2010, the Staff Judge Advocate (SJA) found the case legally sufficient to support the separation. On 12 Jan 2010, the separation authority approved the recommendation for discharge. On 20 Jan 2010, the applicant was honorably discharged with a narrative reason for separation of “Personality Disorder” and a corresponding separation code of “JFX.” He served 9 months and 21 days on active duty. _____________________________________________________________ AIR FORCE EVALUATION: AFPC/DPSOS recommends denial. Based on the documentation on file in the applicant’s master personnel records, the discharge to include his narrative reason for separation was consistent with the procedural and substantive requirements of the discharge instruction and was within the discretion of the discharge authority. The administrative discharge package clearly indicates the applicant was counseled on numerous occasions regarding his conduct and was afforded an opportunity to meet Air Force standards prior to the initiation of his discharge. The applicant was diagnosed with an adjustment disorder with mixed disturbance of emotions, conduct and borderline personality disorder. The medical report indicates the applicant demonstrated unstable mood patterns, repeated relationship problems, anger outbursts, acting out behaviors, inpatient hospitalization and verbalized suicidal threats when under stress. The applicant did not have a psychiatric disorder that required action through medical channels, his ongoing work and personal problems strongly suggest he was temperamentally and emotionally unsuited for continued service in the Air Force. The complete DPSOS evaluation is at Exhibit C. The BCMR Medical Consultant recommends denial. The Medical Consultant is aware and sensitive to allegations of diagnostic errors [particularly mental health conditions] which result in administrative discharge which are followed by service connection by the DVA for a completely different diagnosis. Policies have been established for use within the DVA to address diagnostic changes in the implicit effort to render the most appropriate disability rating decisions. The diagnostic nomenclature assigned to a given set of psychiatric symptoms as reported by a patient at a given point in time may change over time or may be reported differently at a subsequent point in time. Therefore, with disclosure of a different clinical history or set of symptoms [as noted in the distinctly different symptoms reported in the civilian evaluation of 4 Mar 2013, when compared with the supplied service evidence] a new mental health provider may legitimately reach different diagnostic conclusions. Furthermore, a change in diagnosis may occur following a greater period of observation and treatment; individuals may also experience symptoms that concurrently overlap one or more other clinical diagnosis. Yet two or more mental disorders may even co-exist as co-morbid mental disorders Axis I and/or Axis II diagnosis, often times making it difficult to attempt to separate the two due to their close association or shared clinical features. Thus, the fact that the applicant was given a different diagnosis by a civilian provider three years after leaving military service and has been granted DVA compensation is insufficient to invalidate the appropriateness of the diagnostic conclusions reached by equally competent military mental health authorities who were at least as familiar with the applicant’s observed pattern of behavior at the “snap-shot” time of his military service. The Medical Consultant is keenly aware of the shared clinical features of borderline personality disorder and bipolar disorder and the vulnerability for error in making either diagnosis by equally competent clinicians at a given time. Given the fact that the applicant has a family history of bipolar disorder and considering its known familial/genetic predisposition, the Medical Consultant opines the odds lean towards a condition which was possibly present but not fully clinically manifested at the time of his military service. However, given the relative short interval of military service from the applicant’s entry into military service to his first documented manifestation of a negative pattern of behavior, it is difficult to now presume that his medical condition was service incurred or permanently aggravated by military service despite the decision of the DVA. The Board is reminded that, operating under Title 38, the DVA is authorized to offer compensation for any medical diagnosis that it independently finds a nexus with military service without regard to its proven or demonstrated impact upon a service member’s fitness to serve, retainability, the narrative reason for release from military service or the intervening period since release from service, in this case over three years after his release from military service. The action by the DVA does not automatically rule erroneous or invalidate any clinical decision making based upon presenting signs and symptoms during a service interview and the resultant conclusions reached by competent medical authorities; particularly in the fluid and evolving range of behavior changes that may occur over time. This is the reason why an individual may be legitimately separated from military service for one reason but sometime thereafter receive a compensation rating from the DVA for a medical condition that was either or not diagnosed or not militarily unfitting at the time of release from military service. Nevertheless, in view of the applicant’s co-morbid service diagnosis of adjustment disorder, the Board may elect to remove the lifelong label of “Personality Disorder” with consideration of a change to “Secretarial Authority.” The complete BCMR Medical Consultant’s evaluation is at Exhibit D. _____________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: He disagrees with the decision to deny his application and provides new evidence to support his request, to include his hospitalization records from when he was in the Air Force and a complete diagnosis from his civilian psychiatrist. He was admitted to Trinity Hospital in Minot, ND where he was diagnosed with Axis I Major Depressive Disorder and Axis 2 Narcissistic Personality Disorder traits which were not included in his official Air Force documentation. These records should have been included since his prescription for Zoloft was increased. His medical provider admitted that he had difficulty making a diagnosis and he believes this new evidence proves that the Air Force diagnosis was incorrect. Although he wasn’t diagnosed with bipolar disorder at the time, he was at least diagnosed with major depressive disorder. He believes this new evidence proves that he should have been medically discharged or retired. The applicant’s complete submission, with attachments, 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 not timely filed; however, it is in the interest of justice to excuse the failure to timely file. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice warranting changing his discharge to a medical retirement or medical separation. 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 the applicant was improperly separated from active duty in 2010. The applicant has provided no evidence which, in our opinion, successfully refutes the assessment of his case by the BCMR Medical Consultant. Therefore, we agree with the recommendation of the BCMR Medical Consultant and adopt his opinion as our findings in this case. In view of the above, 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 an injustice to warrant changing the applicant’s narrative reason for separation. After carefully reviewing the evidence of record, it appears that his separation was proper and in compliance with the appropriate regulations in effect at the time. However, in view of the applicant’s co-morbid service diagnosis of adjustment disorder and to prevent a further burden with the stigma associated with the narrative reason of “Personality Disorder” we find it is in the interest of justice to change it to "Secretarial Authority" with the corresponding separation code of "JFF." Accordingly, we recommend his record be corrected to the extent indicated below. ________________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to the APPLICANT be corrected to show that at the time of his discharge on 20 Jan 2010, the narrative reason for his separation was Secretarial Authority with a separation code of “JFF.” _________________________________________________________________ The following members of the Board considered Docket Number BC- 2013-03637 in Executive Session on 27 May 2014, under the provisions of AFI 36-2603: , Panel Chair , Member , Member All members voted to correct the records as recommended. The following documentary evidence was considered: Exhibit A. DD Form 149, dated 13 Jun 2013, w/atchs. Exhibit B. Applicant’s Master Personnel Records. Exhibit C. Letter, AFPC/DPSOS, dated 13 Sep 2013. Exhibit D. Letter, AFBCMR Medical Consultant, 16 Jan 2014. Exhibit E. Letter, SAF/MRBC, dated 22 Jan 2014. Exhibit F. E-mail, Applicant, dated 13 Feb 2014. Panel Chair