RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER: BC-2014-01485 COUNSEL:
HEARING DESIRED:	NO

APPLICANT REQUESTS THAT:
His administrative separation be changed to a medical retirement because his medical condition meets the Department of Veterans Affairs (DVA) Schedule for Rating Disabilities (VASRD) criteria for a disability rating of 30%.

APPLICANT CONTENDS THAT:
He was wrongly discharged due to an adjustment disorder with depressed features. Further, he did not receive a mandatory separation physical he was entitled to because 1) his medical condition warranted it and 2) his separation was involuntary. He contends (at his separation physical) his chronic adjustment disorder is likely to result in his case being referred to a Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB), and not an administrative discharge. The DVA has recommended he request a change to his discharge based on new guidance to review all adjustment disorders and he should qualify for a disability rating. Alternatively, the applicant requests invitational travel orders for an MEB evaluation.

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

STATEMENT OF FACTS:
On 6 Mar 07, the applicant entered the Regular Air Force.
On 10 Dec 07, the applicant’s commander notified him that he was recommending him to be discharged under authority of AFI 36-3208, Administrative Separation of Airmen, for conditions that interfere with military service and that the resulting discharge would be characterized as honorable. The applicant acknowledged receipt of the notification the same day and waived his right to counsel and to submit statement on his own behalf.

On 17 Dec 07, the discharge authority approved the applicant’s administrative discharge.

On 18 Dec 07, the applicant was released from active duty, with an honorable character of service for Adjustment Disorder (no board entitlement), with uncharacterized service, an RE code of “2C,” and was credited with 9 months, and 13 days of active service.

On 14 Feb 13, the Discharge Review Board (DRB) denied the applicant’s request to change the narrative reason of his discharge and his Reenlistment (RE) code.

The remaining relevant facts pertaining to this application are contained in the memorandum prepared by the Air Force offices of primary responsibility (OPR), which are attached at Exhibits C and F.

AIR FORCE EVALUATION:
The AFBCMR Medical Consultant recommends denial indicating there is no evidence of an error or an injustice in the applicant’s discharge. The Medical Consultant’s objective is not to present obstacles to the applicant’s contentions, noting the decades that passed rarely making a distinction between Acute and Chronic Adjustment Disorder; and mischaracterizing some as a Personality Disorder. The false assumption was that whenever Adjustment Disorder was diagnosed, it universally qualified for administrative discharge if it significantly interfered with an individual’s ability to perform military duties. Distinguishing the two has since been addressed in DoD Instruction 1332.38 and by the Air Force Surgeon General in a policy memorandum. Indeed, one of the applicant’s principal arguments is that if he suffered from difficulties adjusting to military service during basic training, as shown in the mental health assessment of November 2007, then by the time the diagnosis of Adjustment Disorder appeared in his record, which is greater than the 6 months duration diagnostic of an Acute Adjustment Disorder, then, he met criteria for processing through the Disability Evaluation System (DES) for Chronic Adjustment Disorder. However, although there is a reference to engagement in “counseling service since basic training,” an official Air Force memo dated 22 Oct 14 from the Patient Advocate, Mental Health Service, 59th Medical Wing (MDW), indicates a review of the two existing electronic health records systems, the Composite Health Care System (CHCS) and the Armed Forces Health Longitudinal Technology Application (AHLTA), returned negative results for previous encounters of any kind in any Mental Health Clinic associated with the military,” concluding, “this is reflective of this member’s report he has never sought or received mental health care from the 59th MDW or other military sources.”

Thus, since the applicant was discharged on 16 Dec 07, the Consultant opines his November 2007 assessment falls well within the time-restricted diagnostic criteria for the Acute Adjustment Disorder that resulted in his involuntary discharge. Therefore, the Medical Consultant opines the applicant’s implicit assertion

that had he received a separation history and physical examination, he would have been processed through the military DES instead of the administrative discharge he received cannot be substantiated.

Addressing the applicant’s implicit assertion his diagnosis of Adjustment Disorder was issued in the effort to avoid processing his case through the DES, the Medical Consultant noted that the diagnostic terms Dysthymic Disorder and Depression appear at least once in the record prior to the diagnosis of Adjustment Disorder. However, diagnostic variance following an initial presentation is not unusual, particularly among mental disorders with overlapping signs and symptoms. It’s also noted that the aforementioned diagnoses were made by three different types of clinicians of variant levels of expertise, a psychologist, a clinical social worker, and a family practice provider; the former two issuing a diagnosis of Bereavement and latter issuing the diagnosis of Dysthymic Disorder. Prevailing DoD policy and Congressional mandates place greatest diagnostic authority to a psychiatrist or PhD-level psychologist.

The Medical Consultant also acknowledged the applicants implicit contention that he met criteria for an MEB since he had both an Axis I diagnosis [Adjustment Disorder] and an Axis II diagnosis [Negativistic, Schizoid and Avoidant Personality Traits], IAW AFI 48-123, paragraph 53.1.2. However, neither of these qualified for processing as a compensable disability through the military DES, IAW AFI 36-3208, Administrative Separation of Airmen, and DoDI 1332.38, Physical Disability Evaluation, in effect at the time of the applicant’s service.

Addressing the comment by one of the applicant’s providers, stating that his “adjustment disorder with depressed mood best describes his presentation and it is likely that this will be present in a chronic fashion for some time, the Consultant directs attention to the pivotal phrase, “likely that it will be.” The Consultant interprets this as a prognosis statement for possible future clinical status, which could not be determined at the “snap shot” time of evaluation.

The Medical Consultant also acknowledged the mental health assessment dated 7 Feb 12, in which the applicant sought a re- evaluation due to his interest in re-enlisting in the Air National Guard. Although the applicant was given a diagnosis of Major Depressive Disorder, it is noted the provider concluded it was a “single episode” and this was “in remission.” Noting the five years that passed since the applicant’s discharge date, the Medical Consultant could not establish a clear nexus between this post-service diagnosis, which was in remission at the time of evaluation, and the reason for his release from military service.

The Medical Consultant opines the applicant’s evidence better supports a change in Re-enlistment Eligibility Code than a medical retirement. Thus a recommendation is made to deny the applicant’s petition to change his administrative discharge to a medical retirement and to deny invitational orders to conduct a Medical Evaluation Board.

A complete copy of the AFBCMR Medical Consultant evaluation is at Exhibit C.

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:
In response to the BCMR Medical Consultant advisory opinion, the applicant’s counsel contends the applicant’s unfitting conditions should have been rated at 50% disabling; but not less than 30%. Further, he clarifies/amends two points regarding the applicant’s original request. First, the applicant is seeking disability retired pay because he was wrongfully discharged. Second, regardless of the DVA representative’s recent advice to apply for an upgrade to his discharge (based on new guidance regarding adjustment disorders, the applicant’s chronic adjustment disorder was compensable at the time of discharge. At the core of the applicant’s rebuttal is the stark contrast in opinions between the BCMR Medical Consultant’s position [the applicant’s condition did not exist for the (6-month) time-requirement for processing via the DES], and the applicant’s position [he has met the burden of proof his diagnosis of chronic adjustment disorder existed for more than six months; therefore, he should have been processed via the DES]. The applicant’s counsel closes by asserting the Medical Consultant failed to state the correct issues and erroneously shifts the burden of proof to the applicant, when the error is clearly on the part of the government (Exhibit E).

ADDITIONAL AIR FORCE EVALUATION:
The AFBCMR Clinical Psychology recommends denial indicating there is no evidence of an error or an injustice in the applicant’s discharge. The applicant’s initial presentation for mental health intervention, as documented in his medical record, occurred when he was in technical school. The Clinical Psychology Consultant observes part of the applicant’s argument in favor of the chronicity of his adjustment disorder is the 28 Nov 2007 memorandum recommending his separation from military  service states he was engaged in counseling services during basic military training. The absence of documentation in the applicant’s medical record showing that he was assessed or treated for a mental health issue at any point prior to the mental health encounter in technical school leads this Consultant to opine that it is reasonable to conclude the memorandum recommending him for administrative separation was referring to the mental health services he received during technical school.

The applicant’s first diagnosis in the clinical record is bereavement, a condition described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV; in use at the time of his discharge) as depressive symptoms that occur in reaction to the loss of a loved one. He was later diagnosed with an adjustment disorder, which is used when an individual’s emotional and/or behavioral reaction to a stressor is determined to be out of proportion or excessive in the context of the given stressor. As pointed out by the applicant, through counsel, in a letter to the BCMR, dated
16 Dec 14, the DSM-IV states an adjustment disorder diagnosis does not apply when symptoms represent bereavement.			Therefore, this Consultant does not assume symptoms of bereavement early in his course of therapy equate to a diagnosis of adjustment disorder. The Clinical Psychology Consultant concedes, however, symptoms of bereavement can progress to meet criteria for a major depressive episode.			Alternatively,		a	different		stressor		may	overcome	a bereaved	person’s	already		taxed		coping	skills		resulting		in		the emergence of a comorbid adjustment disorder.		In DSM-IV a chronic specifier		was	applied		when	the		adjustment	disorder	lasted		six months or longer.	In this case, the applicant was first seen in mental health to discuss the death of his sister on 31 Aug 2007. Within		three	and	a	half	months		he	was		separated	from	military service.		His first diagnosis of adjustment disorder appeared 15 Nov	[07].		 He		was	recommended	for		discharge	approximately		two weeks	later	and	was	separated		just	over	30		days	after	this diagnosis first appeared.		Thus, regardless of whether one starts the “clock” on 31 Aug 07 or 15 Nov 07 the applicant’s condition did not meet criteria for a chronic adjustment disorder and this Consultant finds no error or injustice in the diagnoses applied to his case.

Additionally, the applicant contends he was not provided an opportunity for a separation physical and that had he been allowed this opportunity he would have been found unfit and submitted for a medical evaluation board. The applicant’s medical record contains documentation of his separation physical from 13 Dec 07. His mental health symptoms were noted and he was approved for separation.

The Clinical Psychology Consultant found no error or injustice in this case and recommends denying the applicant’s requests.

A complete copy of the AFBCMR Medical Consultant evaluation is at Exhibit F.

A copy of the AFBCMR Clinical Psychology evaluation was forwarded to the applicant on 30 Jun 15 for review and comment within 30 days (Exhibit G). As of this date, no response has been received by this office.

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 an error or injustice. We took notice of the applicant’s complete submission, including his rebuttal response, in judging the merits of the case; however, we agree with the opinions and recommendations of the BCMR Medical Consultant and BCMR Clinical Psychologist, and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice. Additionally, the Board denies applicant’s request for invitational travel orders to participate in a Medical Evaluation Board. Therefore, 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-2014-01485 in Executive Session on 26 Aug 15 under the provisions of AFI 36-2603:

, Panel Chair
, Member
, Member
The following documentary evidence was considered:
Exhibit A. DD Form 149, dated 3 Apr 14, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Memorandum, SAF/MRBC, dated 3 Nov 14. Exhibit D.  Letter, SAF/MRBR, dated 17 Nov 14.
Exhibit E.	Letter, Applicant, dated 12 Dec 14. Exhibit F.	Memorandum, SAF/MRBR, dated 15 Jun 15. Exhibit G.	Letter, SAF/MRBR, dated 30 Jun 15.