RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:			DOCKET NUMBER:  BC-2015-03857
		
						COUNSEL:  NONE

						HEARING DESIRED:  YES

APPLICANT REQUESTS THAT:

He be brought back on active duty (AD) to have his records reviewed properly by a Medical Evaluation Board (MEB), and he get the medical assistance needed to get better.  

APPLICANT CONTENDS THAT:

He was discharged from AD for high-year of tenure (HYT) reduction in force (RIF)) on 16 Aug 15 without taking into account or treatment of his medical condition of Post-Traumatic Stress Disorder (PTSD) and Adjustment Disorder.  According to the USAF Medical Standards Directory, his medical condition meets criteria for an MEB with, at a minimum, the Q codes: Q17 (PTSD/ASD/Adjustment Disorder/other Specified Trauma and Stressor-Related Disorder that interferes with safety of flight/controlling/alert or if member is unable to return to full duty within 60 days of diagnosis (minor residual symptoms are acceptable), and Q18 (PTSD/Adjustment Disorder/other Specified Trauma and Stressor-Related Disorder if greater than 60 days, or if member experiences a recurrence of debilitating symptoms upon return to the operational environment.  

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

STATEMENT OF FACTS:

The applicant initially entered the Regular Air Force on 16 Aug 00.  

During the rating period 1 Apr 14 through 31 Jan 15, the applicant deployed to the Port Mortuary, Dover AFB, as a mortuary team member.  

On 16 Aug 15, the applicant was released from active duty with an honorable characterization of service, and was credited with fifteen years, and one day of active service.  The narrative reason for separation was “Reduction in Force.” 

On 27 Aug 15, the applicant submitted his DD Form 149, Application For Correction of Military Record Under the Provisions of Title 10, U.S. Code, Section 1552, with attachments.  One of the attachments was a copy of a 27 Aug 15 memo addressed to the AF Board for Correction of Military Records from the 96 MDOS/SGOW, Medical Director of Mental Health, disclosing that the applicant “meets full criteria for a full MEB.” 

The remaining relevant facts pertaining to this application are described in the memoranda prepared by the AFBCMR Medical Consultant and Psychiatric Advisor, which are included at Exhibits C and E.

AIR FORCE EVALUATION:

The AFBCMR Medical Consultant recommends granting partial relief, indicating sufficient evidence has been presented to demonstrate the existence of an error or injustice.  Specifically, after reviewing the applicant’s case file and the evidence, there was a clear intent to conduct an MEB, but it was missed in the “fog” of the applicant’s impending discharge.  Medical records reveal that on 6 May 14, the applicant was seen at the base Behavioral Health Clinic with a chief complaint of “sleep problems.”  This visit came three weeks after he found out he was being recommended for non-retention by the retention board.  Subsequently, he continued to receive episodic care and preventive health assessments during CY 14.  

On or about 9 Mar 15, the applicant was seen in the Family Health Clinic, McGuire AFB, for “anger issues and difficulty sleeping,” primary diagnosis: Adjustment Disorder and Sleep Disturbance.  The family physician suspected the applicant’s sleep issue was related to his PTSD-like symptoms.  This diagnosis came one month after his return from a six month deployment to the USAF Mortuary, Dover AFB, Delaware.  On 7 Apr 15, a medical entry at Joint Base McGuire-Dix shows the applicant “self-referred for trauma secondary to a mortuary affairs tasking.  The provider issued a diagnosis of PTSD, but at the time emphasized the “member IS cleared for mobility, PCS, TDY, and Deployment; no duty restrictions.”  The applicant had follow-up medical visits and/or telephone consults on 8 and 20 May 15, and 5 and 15 Jun 15.  On 16 Aug 15 the applicant was discharged from AD.  

On 17 Aug 15, a medical entry indicates the applicant was “now separated from military, and listed as dependent husband.” His clinical history of exposures and responses to those exposures are continued.  On 20 Aug 15, the medical provider reflected upon the applicant’s prior exposures and his responses to those exposures; of which there are many affecting himself and interactions with family members.  The provider indicated the applicant “would have needed and would have benefited from an MEB at that time, but that it was probably “overshadowed by the timing and terminal leave and the transition from TAFS.”  At the time, the applicant’ was characterized as “very labile in his mood and very tearful, unable to keep it all together in the session.”  The provider opined the applicant met criteria for PTSD as well as Major Depressive Disorder with Psychotic Features.  Interactive email traffic from 20 and 21 Aug 15, between an official at HQ APFC/DPANM and the applicant’s servicing medical treatment facility [96 MDOS/SGOW/Mental Health Clinic] discloses the applicant meets criteria for the diagnosis of PTSD and Adjustment Disorder.   However, since the applicant had already been separated, the HQ AFPC/DPANM representative recommended the only recourse would be for the applicant to seek a remedy via the AFBMCR.  

A 27 Aug 15 memo addressed to the AFBCMR from the 96 MDOS/SGOW, Medical Director of Mental Health, discloses that the applicant “meets full criteria for a full MEB, that the condition was expected to and did cause duty impairment, and that the condition will require psychoactive medications beyond one year.  The provider also opined “from a psychiatry perspective he is clearly impaired in all aspects of life function and will need intensive psychopharmacology and psychotherapy management with a very guarded prognosis.”  The Medical Consultant adopted the implicit recommendation of the Director of Mental Health that the applicant be entered into the Disability Evaluation System (DES) to undergo MEB.  He advises the Board that a diagnosis does not automatically warrant MEB processing and a medical separation or retirement.  However, in this case under review, although the applicant’s clinical symptoms arose roughly four to five months prior to his mandatory date of separation, he was not retirement eligible and, thus, the Presumption of Fitness rules did not apply in his case.  He also notes the Department of Defense policy is that mental impairment caused by the prospect of a separation or occupational/employment concerns will not be considered in quantifying the degree of compensable impairment, or words to that effect.  

The Medical Consultant recommends the record be changed to reflect the applicant was not released from service due to a Reduction in Force, but that he was found physically unfit and placed on the Temporary Disability Retired List (TDRL) under Authority of AFI 36-3212, by reason of Disability, that his condition was PTSD rated at 50%, under Veterans Affairs Schedule for Rating Disabilities (VASRD) code 9411, and that he should receive a reassessment of his condition as soon as practicable to determine if there should be a change in the disability rating and disposition.  He advises the Board to dispense with returning the applicant to active duty to conduct an MEB, as the existing medical evidence of record is sufficient to serve as a proxy MEB narrative summary reflective of the applicant’s PTSD and depressive symptoms at or about the time of his release from military service.  Accordingly, a de facto assessment of his fitness to serve can be made along with assignment of an appropriate initial disability rating and disposition, in compliance with 38 C.F.R., Section 4.129.  The reassessment must conclude with a statement addressing the applicant’s level of stability or control and his level of impairment in civilian social and industrial/or occupational adaptability.  A permanent or subsequent disposition would require more current evidence.  The applicant may alternatively supply a copy of any evaluations conducted by the Department of Veterans Affairs or a credentialed civilian health care professional, provided that it was conducted at or about 6 months, but not greater than 12 months after discharge.  All requested medical evidence should then be forwarded to attention of AFBCMR Medical Consultant for a recommended final disposition.  

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

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 13 Jun 16 for review and comment within 30 days (Exhibit D).  As of this date, no response has been received by this office.

ADDITIONAL AIR FORCE EVALUATION:

The AFBCMR Psychiatric Advisor recommends granting partial relief, indicating sufficient evidence has been presented to demonstrate the existence of an error or injustice.  She agreed with the review of the evidence and resultant conclusions reached by the Medical Consultant to find the applicant unfit and to place him on the Temporary Disability Retired List (TDRL) with a 50 percent disability rating under VASRD for PTSD code 9411.  However, the Psychiatric Advisory recommends not to return any new medical evidence to the BCMR Medical Consultant for subsequent disposition, but, rather, the applicant’s condition be reassessed by the Integrated Disability Evaluation System (IDES) at the appropriate intervals of time until his condition, functional capacity, both socially and occupational, stabilizes.  This will allow the applicant to avail himself of all of the benefits of subsequent appellate review and options he is entitled to receive.  

A complete copy of the AFBCMR Psychiatric Advisor evaluation is at Exhibit E.

APPLICANT'S REVIEW OF THE ADDITIONAL AIR FORCE EVALUATION:

A copy of the additional Air Force evaluation was forwarded to the applicant on 20 Dec 16, for review and comment within 30 days (Exhibit F).  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 timely filed.

3.  Insufficient relevant evidence of an error or injustice has been presented regarding the applicant’s request he be brought back on active duty (AD) to have his records reviewed properly by a Medical Evaluation Board (MEB).  Based on the available evidence of record, it appears the “high-year of tenure (HYT) reduction in force (RIF))” discharge was consistent with the substantive requirements of the discharge regulation and within the commander's discretionary authority.  All the same, we took notice of the applicant's complete submission in judging the merits of the case and we agree with the opinion and recommendation of the AFBCMR Medical Consultant and the Psychiatric Advisor that the Board dispense with returning the applicant to active duty to conduct an MEB, as the existing medical evidence of record is sufficient to serve as a proxy MEB narrative summary reflective of the applicant’s PTSD and depressive symptoms at or about the time of his release from military service.  Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting this portion of the requested relief.

4.  Notwithstanding our findings above, we believe sufficient relevant evidence has been presented to warrant partial relief.  In this regard, we note the AFBCMR Medical Consultant and Psychiatric Advisor comments that after reviewing the applicant’s case file and the evidence suggesting a clear intent to conduct an MEB and the Director of Mental Health’s recommendation that the applicant be entered into the DES to undergo MEB processing, favorable consideration should be made in response to the applicant’s petition to have his records reviewed properly by an MEB, and receive the medical assistance needed to get better.  We are in agreement with their recommendation that the applicant’s record be changed to reflect he was not released from service due to a Reduction in Force, but that he was found physically unfit and placed on the Temporary Disability Retired List (TDRL).  Additionally, we agree with the AFBCMR Psychiatric Advisor’s recommendation that new medical evidence go directly to the IDES for subsequent disposition.  Therefore, we recommend the applicant’s 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 issues 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 the APPLICANT be corrected to show that:

a.  On 15 August 2015, he was found unfit to perform the duties if his office, rank, grade or rating by reason of physical disability incurred while he was entitled to receive basic pay; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not the direct result of armed conflict or caused by an instrumentality of war.

b.  On 16 August 2015, he was not discharged from active duty, but rather, effective 17 August 2015, his name was placed on the Temporary Disability Retired List with a disability rating of 50 percent due to a diagnosis of Post-Traumatic Stress Disorder (PTSD), under Veterans Affairs Schedule for Rating Disabilities (VASRD) code 9411, rated at 50 percent.  

c.  The applicant should be evaluated as soon as practical for assessment of his fitness to serve via the Integrated Disability Evaluation System (IDES).

The following members of the Board considered AFBCMR Docket Number BC-2015-03857 in Executive Session on 18 Aug 16 and 6 Mar 17 under the provisions of AFI 36-2603:

All members voted to correct the records as recommended.  The following documentary evidence pertaining to AFBCMR Docket Number BC-2015-03857 was considered:

	Exhibit A.  DD Form 149, dated 27 Aug 15, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Memorandum, AFBCMR Medical Consultant, 
  dated 7 Mar 16.
	Exhibit D.  Letter, SAF/MRBR, dated 13 Jun 16.
	Exhibit E.  Memorandum, AFBCMR Psychiatric Advisor, dated
			  13 Dec 16.
	Exhibit F.  Letter, SAF/MRBR, dated 20 Dec 16.  

Pursuant to paragraph 1 of AFI 36-2603 (Title 32 Code of Federal Regulations, Part 865.1), it is certified that a quorum was present at the Board's review and deliberations, and the foregoing is a true and complete record of the Board's proceedings in the above entitled matter.