MEMORANDUM OF CONSIDERATION

	IN THE CASE OF

	BOARD DATE:  29 March 2000
	DOCKET NUMBER:   AR1999027691

	I certify that hereinafter is recorded the record of consideration of the Army Board for Correction of Military Records in the case of the above-named individual.

	Mr. Paul A. Petty		Analyst	

  The following members, a quorum, were present:

	Mr. Robert G. Hinkle		Chairperson	
	Mr. James P. Stueve		Member	
	Mr. Mark D. Manning		Member	

	The Board, established pursuant to authority contained in 10 U.S.C. 1552, convened at the call of the Chairperson on the above date.  In accordance with Army Regulation 15-185, the application and the available military records pertinent to the corrective action requested were reviewed to determine whether to authorize a formal hearing, recommend that the records be corrected without a formal hearing, or to deny the application without a formal hearing if it is determined that insufficient relevant evidence has been presented to demonstrate the existence of probable material error or injustice.

	The applicant requests correction of military records as stated in the application to the Board and as restated herein.

	The Board considered the following evidence:

	Exhibit A - Application for correction of military 
                records
	Exhibit B - Military Personnel Records (including
	            advisory opinion, if any)

APPLICANT REQUESTS:  That he be granted a medical discharge due to him having a Bipolar disorder.

APPLICANT STATES:  In effect, due to a psychiatric report from a forensically qualified civilian doctor, the Army was aware of his Bipolar condition and should have considered and granted him a medical discharge.  The applicant submits a copy of his discharge from active Air Force duty in 1979; his discharge from Active Guard/Reserve duty in 1994; a 3 February 1994 Occupational Therapy Discharge Summary Note; a 1 February 1994 Dwight D. Eisenhower Army Medical Center inpatient summary; a 3 March 1994 civilian doctor examination summary; a 6 January 1997 letter of endorsement from the Disabled American Veterans Department of Colorado; a 7 April 1997 and a 9 September 1999 VA Rating Decisions; a 27 March 1987 National Agency Security check; and a 
27 November 1976 military medical consultation sheet requesting evaluation of the applicant for a possible diagnosis of depression (the form does not show the consultation report or final diagnosis).

EVIDENCE OF RECORD:  The applicant's military records show:

That he enlisted in the U.S. Air Force on 29 May 1974.  He served on active duty in the Air Force until he was honorably released from active duty and transferred to the U.S. Air Force Reserve (USAFR) on 11 January 1979 as an E-5.  He was honorably discharged from the USAFR on 13 March 1980.

On 24 January 1987, the applicant enlisted as an E-4 in the Louisiana Army National Guard and participated in Troop Program Units (TPU).  On 13 June 1990, he transferred to a TPU in the Florida Army National Guard.  On 
1 September 1990, he was ordered to active duty as a full-time Active Guard/Reserve soldier as a personnel administrative specialist.  On 31 October 1993, he was promoted to E-5.  

In December 1993, the applicant exhibited a vocal and emotional outburst at his supervisor when the supervisor refused to accept long distance telephone charges at the TPU facility from the applicant’s girl friend.  The applicant believed that his girl friend, with whom he had lived, was a law enforcement agent undercover in the Mafia and that the call may have been a matter of life or death. The applicant’s command directed that he have a medical and mental evaluation. He was evaluated at the Naval Training Center Hospital (NTCH) in Orlando, Florida, on or about 13-14 January 1994.  A Report of this evaluation is not available to the Board.  Evidence from another medical report states that the applicant was diagnosed as having an adjustment disorder with disturbance of emotions and conduct which was resolved, and as having a personality disorder with passive - aggressive features and narcissistic features (excessive interest in one’s personal features or inflated opinion of one’s self importance).  Administrative separation was recommended if the problem was to reoccur.  

The applicant was medevaced to the Dwight D. Eisenhower Army Medical Center (DDEAMC) at Fort Gordon for further evaluation where he was admitted on 16 January 1994.  He was tested physically, mentally, and psychiatrically until release from the hospital on or about 4 February 1994 and returned to his TPU unit.  From the medical record and the applicant’s information, the applicant was found to have a been treated with the drug Paxil, 20 mg per day, for depressive symptoms from May – October 1993 and again for 20 days in December 1993 as a result of his relationship with his girl friend.  There was also a record of a suicide gesture in 1990 secondary to his divorce (the patient cut his underarm with a razor and was hospitalized for three days).  At the DDEAMC, the applicant was diagnosed on Axis I as having Adjustment Disorder with mixed disturbance of emotions and conduct – resolved, historically demonstrated by patient’s inappropriate expressions of anger, to include threatening statements to his command, precipitated by the patient’s unstable relationship with his girl friend.  He was diagnosed on Axis II as having a Borderline Personality Disorder demonstrated by the patient’s unstable relationships, labile emotions, intense anger, history of suicidal gestures, feeling of emptiness, impulsiveness, and frantic efforts to avoid abandonment.  The recommended disposition was, “This service member meets the retention standards described in chapter 3, 
AR 40-501 (Standards of Medical Fitness), and there is no psychiatric defect which warrants disposition through medical channels (medical discharge).  This individual was and is mentally sound and able to participate in administrative proceedings.  He will be discharged (from the hospital) to return to duty.  However, this Axis II diagnosis represents a deeply ingrained maladaptive pattern of behavior which interferes with this individuals ability to perform duty.  Therefore, it is strongly recommended that he be administratively separated as expeditiously as possible.”

On 24 February 1994, the applicant obtained a civilian doctor’s mental and psychiatric evaluation.  The evaluation was conducted through an office interview with the doctor, a mental test, and through the doctor’s review of the some medical reports: the 1994 medical evaluations from the NTCH and the DDEAMC; a doctor’s office notes from May to December 1993 when the applicant was treated with the drug Paxil, 20 mg per day, for depression related to his relationship with his girl friend; and the office notes of another doctor who had treated the applicant with Valium in 1974 for depression related to schooling and in 1984 for an episode of anxiety and depression.  The applicant reported to this civilian doctor in interview that he had a 20 year history of depression and gave other incidents.  (A number of the applicant’s assertions were not documented and therefore not verifiable by the civilian doctor according to his write up in the report.)  The civilian doctor gave his opinion that the applicant suffered from a Bipolar Spectrum Disorder (Bipolar I – depression, and Bipolar III – cyclomthymic; and Personality Disorder not otherwise specified, with 
passive -aggressive, narcissistic, and borderline personality traits.

According to AR 40-501, Personality Disorders and Adjustment Disorders (which include depressive episodes and are transient, situational maladjustments due to acute special stress) are not physically unfitting warranting medical discharge, but they may be the basis for administrative separation if these disorders cause interference with performance of effective military duty.  Bipolar Disorder may be an organic mental disorder which could be referred to a Medical Evaluation Board and possible medical separation.  However, suspected Bipolar Disorders may only be Adjustment Disorder caused by cyclic situational stress and anxiety. A more in depth documented medial history of disorder incidents and long term effects of various chemical and drug treatments would be necessary to categorize a disorder as an organic mental Bipolar condition subject to medical processing.

The applicant’s submitted evidence was reviewed in detail by the Board’s senior medical advisor who is forensically qualified.  He concluded from the medical and psychiatric evidence available, that the applicant’s condition most closely fit the Diagnostic and Statistical Manual of Mental Disorders IV criteria for Adjustment Disorder at the time of his discharge.  Adjustment Disorders are not physically unfitting and are not subject to medical discharge consideration.

In about 1996, following the applicant’s 1994 discharge, the Veterans Administration (VA) determined that enough evidence had accumulated to then properly diagnose the applicant with organic mental Bipolar condition and granted him a 30 percent disability.  His status has periodically been reevaluated by the VA and was increased to 70 percent disability in 1999.

Title 38, United States Code, sections 310 and 331, permits the VA to award compensation for disabilities which were incurred in or aggravated by active military service.  However, an award of a VA rating does not establish error or injustice in the Army determination of disability. The Army rates only conditions determined to be physically unfitting at the time of discharge, thus compensating the individual for loss of a career; while the VA may rate any service connected impairment including those that are detected after discharge, in order to compensate the individual for loss of civilian employability.  Accordingly, it is not unusual for the two agencies of the Government, operating under different policies, to arrive at a different determinations of disability.  Furthermore, unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency’s examinations and findings.

DISCUSSION:  Considering all the evidence, allegations, and information presented by the applicant, together with the evidence of record, applicable law and regulations, and advisory opinion, it is concluded

1.  At the time of discharge from the Army on 15 June 1994, the applicant’s military medical records and his record of conduct demonstrated that the applicant had an Adjustment Disorder and a Personality Disorder, neither of which may serve as a basis for medical discharge according the AR 40-501.  These disorders may serve as the basis for administrative discharge if these disorders cause interference with performance of effective military duty.  The applicant was so discharged based on the lack of effectiveness of the performance of his military duties.

2.  According to AR 40-501, Adjustment Disorders and Personality Disorders are not physically unfitting and are therefore not a basis for medical discharge.  Medical discharge is given to compensate soldiers for the ending of their military careers due to physically unfitting condition that prohibits them from performing their military duties.

3.  The civilian doctor who evaluated the applicant on 3 March 1994 gave it as his opinion that the applicant had a Bipolar Disorder.  That opinion was based in part on historical statements made by the applicant that the doctor himself said he could not verify for lack of documentation.  That opinion was also based on a one-day office interview, test, and review of only some medical reports according to the doctor’s statement.  On the other hand, the Army’s diagnosis at the time of discharge was based on three weeks of inpatient hospital medical, mental, neurological, and psychiatric testing and observation by a full medical and psychiatric staff as well as a review of the applicant’s full military medical record as it applied to the performance of his military duties.  The fact that the civilian doctor’s opinion was filed in the military medical record does not change the more thorough evaluation findings by the Army.  A review of the evidence and medical records by the Board’s senior medical advisor also concludes that at the time of discharge, the proper diagnosis was Adjustment Disorder.

4.  The VA’s later diagnosis of a Bipolar Disorder for the applicant was based on further evaluation and additional medical history since the applicant’s discharge.  Their later finding does not have bearing on the Army’s diagnosis at the time of discharge or the type of discharge.

5.  In view of the foregoing, there is no basis for granting the applicant's request.

DETERMINATION:  The applicant has failed to submit sufficient relevant evidence to demonstrate the existence of probable error or injustice.

BOARD VOTE:

________  ________  ________  GRANT

________  ________  ________  GRANT FORMAL HEARING

__RH___  __JS___  ___MM___  DENY APPLICATION

					Karl F. Schneider
			    Director, Army Review Boards Agency

INDEX

CASE ID	AR1999027691	
SUFFIX		
RECON	YYYYMMDD	
DATE BOARDED	20000329	
TYPE OF DISCHARGE	(HD, GD, UOTHC, UD, BCD, DD, UNCHAR)	
DATE OF DISCHARGE	YYYYMMDD	
DISCHARGE AUTHORITY	AR .  .  .  .  .  	
DISCHARGE REASON		
BOARD DECISION	DENY	
REVIEW AUTHORITY		
ISSUES         1.144.31	Discharge for Physical Disability	
2.		
3.		
4.		
5.		
6.