MEMORANDUM OF CONSIDERATION

	IN THE CASE OF:      

	BOARD DATE:           15 JANUARY 2002
	DOCKET NUMBER:   AR2001060828

	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. Carl W. S. Chun		Director	
	Mr. Kenneth H. Aucock		Analyst	

  The following members, a quorum, were present:

	Ms. Irene N. Wheelwright		Chairperson	
	Mr. Hubert O. Fry, Jr.		Member	
	Mr. Donald P. Hupman, Jr.		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 receive a physical evaluation board (PEB).  

APPLICANT STATES:  In effect, that he had psychotic symptoms while on active duty which worsened within one week of being separated with a personality disorder. 

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

The applicant enlisted in the Army for four years on 31 August 2000.

An 18 December 2000 report of medical examination indicates that the applicant was medically qualified for separation with a physical profile serial of 1 1 1 1 1 1. In the report of medical history he furnished for the examination the applicant stated that his health was good.

On 5 January 2001 an NCO counseled the applicant because of his disregard for rules and regulations, disappearing on several occasions, and locking himself in his room.  The NCO indicated that the applicant stated that he did not want to remain in the Army.  He was also counseled for failing to follow instructions. He was informed that he was being referred to the community mental health activity.

On 5 January 2001 the applicant’s unit commander provided the community mental health activity with an evaluation of the applicant, stating that the applicant locks himself in his room, told his mother that he was injured and was confined to a wheel chair, disappears frequently, could not follow instructions, and laughed at things that were not funny.  He stated that the applicant appeared to be mentally dull, that he could not understand simple commands, and that his mind wandered off, and that the applicant wandered off.  He was defiant towards authority, disregarded rules, and exhibited peculiar actions.

A 10 January 2001 mental status form indicates that the applicant’s behavior was stubborn and disrespectful, his speech rambling, and his mood labile (unstable).  

An 11 January 2001 medical report from the Behavioral Medicine Division (BMD) shows that the applicant was assessed in order to complete his evaluation to be discharged from the Army.  It indicates that his drill sergeant talked about the problems they had with him in the unit about harassing a female soldier.  It indicates that the applicant had completed his psychological test, but it was not considered valid.  The report shows that the examining official had talked with the applicant’s mother, who stated that the applicant had a long pattern of not following directions and rules, and of being rebellious; and that appeared to have been a trend since basic training.  The report indicates that the applicant was acting his usual giddy self, wandering off, making jokes, and not following directions well.  He tended to not be able to discuss but one thing at a time.  He denied any psychosis, delusions, or hallucinations.  He talked a lot about a back injury.  He denied any suicidal ideation.  The examining official stated that the applicant needed to be administratively discharged.

An 11 January 2001 assessment of the applicant’s condition indicated that the applicant stated that he did not like being in the military and that he did not want anyone telling him what to do.  The applicant indicated that he underwent counseling for anger management before he came in the Army.  His condition was diagnosed as an Axis I adjustment disorder with disturbance of conduct, rule out bipolar disorder; an Axis II mixed personality disorder; an Axis III back injury; Axis IV occupational stressors; and a global assessment functioning of 55 under Axis V.  An assessment functioning of 55 (on a scale from 1 to 100) indicates some moderate symptoms (e.g., flat affect and circumstantial speech , occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers) of mental health-illness.

On 16 January 2001 an NCO counseled the applicant again, informing him that separation proceedings were being initiated based on the results of the community mental health clinic evaluation.  The NCO informed the applicant that he continued to wander around, and that no one could account for him; that he still could not follow simple instructions; and that he had total disregard for rules and regulations.

A 17 January 2001 BMD medical report shows that the applicant came in for a follow up, that the applicant stated that he had done well, and had not gotten into any trouble in the company; that he was ready to return to civilian life, understanding that he was not military material.  He denied any problems in the unit at that time, and denied any thoughts of homicide, suicide, or going AWOL. 

A 31 January 2001 report of mental status evaluation indicates that the applicant was evaluated by the BMD on various occasions due to his inability to concentrate and follow directions.  He had a pattern of not following directions, wandering off, disobeying rules, and becoming angry quite easily.  He assaulted another soldier during basic training.  His episodes of disobeying, wandering off and not following orders since arriving at Redstone Arsenal had occurred daily.  His thinking was odd and he did not appear to be adapting to a military regimen.  He was not motivated to complete training.  He had a personality disorder.  The examining medical personnel recommended that he be separated from the Army due to his inability to adapt.  They evaluated his behavior as bizarre, his level of alertness dull mood labile, thinking process confused, thought content abnormal, and memory fair.  He was fully oriented, and had the mental capacity to understand and participate in proceedings.  He was diagnosed as having a mixed personality disorder, not otherwise specified. 

On 11 February 2001 the applicant was counseled for failure to perform corrective training.  

On 20 March 2001 the applicant received nonjudicial punishment under           Article 15, UCMJ, for failure to go to his place of duty on two occasions, for being disrespectful to a commissioned officer, and for striking an NCO.

A 29 March 2001 BMD evaluation shows that the application was referred to the clinic for acting out behavior, that he had a great deal of difficulty adjusting to the military, following rules, and respecting authority.  The applicant stated that his main concern was getting out of the military, and that he did not see himself as anxious or depressed.  The evaluation indicated that the applicant’s reporting of his history was somewhat questionable, and that the applicant stated that he only started having these kind of problems when he joined the Army. 

On 30 March 2001 the applicant’s commanding officer notified the applicant that he was initiating action to separate him from the Army under the provisions of Army Regulation 635-200, paragraph 5-13, for a personality disorder.

The applicant stated that he had been afforded the opportunity to consult with counsel, that he had been advised of the basis for the contemplated action, its effect, the rights available to him, and the effect of any action taken by him in waiving his rights.  He declined to submit a statement in his own behalf and waived representation by counsel.

On 4 April 2001 the applicant’s commanding officer recommended to the separation authority that the applicant be discharged because of a mixed personality disorder with a characterization of service as honorable.  The separation authority approved the recommendation and directed that the applicant’s service be characterized as honorable.  The applicant was discharged on 13 April 2001.  He had 7 months and 13 days of service. 

The applicant was interviewed by doctors at the Naval Medical Center at San Diego and 2 May 2001 notes from that interview show that while the applicant was cooperative, caution should be exercised in accepting his history as presented by him; and that given that he was discharged from the Army for a personality disorder two weeks ago, additional psychiatric history might be forthcoming.  The notes indicate that the rapidity of onset of his symptoms as reported by him was suspicious and concerning.  The mental status evaluation was notable for disorganized thought process as well as disturbed (paranoid) thought content, mildly pressured speech, and affect and the presence of both auditory and visual hallucinations.  The auditory hallucinations were telling the applicant to do bad things.  

The applicant was admitted to the Naval Medical Center on 1 May 2001 and discharged from that facility on 7 May 2001.  The examining physician indicated that the applicant was in need of outpatient care and certain medications.  He stated that a letter would be sent to the Army Review Boards Agency requesting correction of the applicant’s records.  He stated that the applicant’s condition at the time he was separated warranted a physical evaluation board rather than an administrative separation.  He indicated that the applicant had an acute worsening of his symptoms after his separation and those symptoms had been present to a lesser degree while he was in the Army.

The physician went on to describe the applicant’s history, stating that the applicant was brought to the emergency department by his mother for increasingly bizarre and aggressive behavior, to include demonstrated violent behavior towards herself and his 11-year old brother – that his behavior was unusual for him, and that while he had discipline problems, he always [had appropriate behavior] towards his family.  The mother reported that the family was afraid of him.  The applicant stated that he had been hearing voices for a couple of months telling him to do bad things and to kill himself, but that he had not provided that information to the mental health professionals in Alabama, as he felt that he could control it.  The applicant stated that those voices had worsened, telling him to kill himself, his sister, or to do criminal things.  The applicant stated that he was afraid people were trying to kill him and believed that the police were trying to stop him from obtaining a driver’s license.  He stated that he was confused and frustrated.  He stated that his problems over the last week was due to the medication he was taking for chronic back pain.  He stated that if he could just play soccer everything could be all right.

The physician stated that the applicant had been seen briefly for depression by a therapist prior to entering the Army, and that he had a longstanding history of dysthymic behavior as a teenager, and would frequently get in trouble with authority figures at school.  

The physician stated that the applicant was voluntarily admitted to the locked psychiatry ward for further evaluation, treatment, and crisis intervention.  He was started on medication.  A review of his clinical history and current symptoms led to a working diagnosis of psychotic disorder not otherwise specified, rule out bipolar disorder, mixed type, rule out schizophreniform disorder.  

The physician stated that the applicant’s medication was changed and he responded well to the new medication.  On the second day, he began attending group therapy, had difficulty staying organized initially, but was much more functional on his discharge date.  The physician contacted the applicant’s Army mental health provider, and opined that the applicant’s symptoms [while in the Army] were more consistent with a psychotic disorder than a personality disorder, and that a disservice would be done to the applicant if a medical board was not conducted.

The physician stated that the applicant’s mood gradually improved and on the third day he requested to leave the hospital; however, because he was felt to be a high risk and his family was still concerned about him coming home, he stayed over the weekend.  The increase in medication appeared to work well.  At the time of his discharge, the applicant denied any suicidal or homicidal ideation, plan, or intent.  The applicant was diagnosed as having a psychotic disorder, not otherwise specified; rule out bipolar disorder, mixed type; rule out schizophreniform disorder (Axis I).  Axis II diagnosis was deferred and there was no diagnosis in Axis III.  Axis IV diagnosis indicated occupational problems.  He had a global assessment functioning of from 11-20 in Axis V upon admission to the hospital and of 50 upon discharge.

Army Regulation 635-200 sets forth the basic authority for the separation of enlisted personnel.  Paragraph 5-13 establishes policy and prescribes procedures for  separating members for personality disorder (not
amounting to a disability under Army Regulation 635-40), a deeply-ingrained maladaptive pattern of behavior which interferes with the individual's ability to perform.  Prior counseling with a view to correcting deficiencies is mandatory.
The service of a soldier separated for a personality disorder will be characterized as honorable.   

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) offers specified diagnostic criteria for each mental disorder as guidelines for making diagnoses.  The purpose of DSM-IV is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders.  

A multiaxial system involves an assessment on several axes, each of which refers to a different domain of information, that may help the clinician plan treatment and predict outcome.  There are five axes included in the DSM-IV multiaxial classification:

Axis I refers to clinical disorders and other conditions that may be a focus of clinical attention.  Axis II refers to personality disorders and mental retardation.  Axis III refers to general medical conditions.  Axis IV refers to psychosocial and environmental problems.  Axis V refers to the global (overall) assessment of functioning. 

Psychotic disorder not otherwise specified is an Axis I clinical disorder which includes psychotic symptomatology (i.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific psychotic disorder.  Examples include brief psychotic disorder, psychotic symptoms that have lasted for less than 1 month but that have not yet been remitted, and persistent auditory hallucinations in the absence of any other features.

The essential feature of an adjustment disorder is the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stress or stressors.  This category should not be used if the disturbance meets the criteria of another specific Axis I disorder or is merely an exacerbation of a preexisting Axis I or II disorder.  However, an adjustment disorder may be diagnosed in the presence of another Axis I or Axis II disorder if the latter does not account for the pattern of symptoms that have occurred in response to the stressor.  Adjustment disorders are coded according to the subtype that best characterizes the predominant syndrome.  An adjustment disorder with disturbance of conduct is used when the predominant manifestation is a disturbance in conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy, vandalism, fighting). 

Personality disorder not otherwise specified is an Axis II disorder.  The essential feature of a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture and is manifested in at least two of the following areas:  cognition, affectivity, interpersonal functions, or impulse control.  This enduring pattern is inflexible and pervasive across a broad range of personal and social situations and leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.   
Many of the specific criteria for the personality disorders describe features (e.g., suspiciousness, dependency, or insensitivity) that are also characteristic of episodes of Axis I mental disorders.  A personality disorder should be diagnosed only when defining characteristics appeared before early adulthood, are typical of the individual’s long-term functioning, and do not occur exclusively during an    Axis I disorder.  For the three personality disorders that may be related to the psychotic disorders (i.e., paranoid, schizoid, and schizotypal), there is an exclusion criterion stating that the pattern of behavior must not have occurred exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder.   

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

1.  The applicant’s behavior while in the Army was indeed bizarre, in addition to being defiant towards authority, disregarding rules, and not following orders, the same behavior that the applicant’s mother indicated that he had [prior to joining the Army].  The applicant apparently had a problem with his anger, both before and after he joined the Army; had a longstanding history of depression as a teenager and got in trouble with authority figures at school.  

2.  The applicant stated at various times that he wanted to get out of the Army as evidenced by a 5 January 2001 counseling report, an 11 January 2001 evaluation, and a 20 March 2001 BMD evaluation.  He denied any psychosis, delusions, or hallucinations as evidenced by an 11 January 2001 medical report. 
He also indicated on 17 January that he had not gotten into trouble in the company and was ready to return to civilian life, denying any problems in his unit at that time.  He denied any thoughts of homicide, suicide, or going AWOL.  On 29 March 2001 the applicant denied being depressed or anxious, and stated that he only started having problems when he joined the Army.   

3.  While there is no information concerning the applicant’s military service prior to his assignment to Redstone Arsenal in November 2000, it is assumed that he did go to basic training after his enlistment in August of that year and did complete basic training prior to his assignment to Redstone.  However, the applicant appeared to do what he wanted to do while stationed at Redstone.  An assumption could be made that his conduct did not warrant any action, disciplinary or otherwise, during basic training; but that his acting out occurred after his assignment at Redstone.    

4.  The applicant has been diagnosed as having a mixed personality disorder, not otherwise specified, which led to his discharge from the Army; and a psychotic disorder, not otherwise specified, two weeks after his discharge.  However, the  doctors at the Naval Medical Center did indicate that the onset of his symptoms soon after his discharge was suspicious and concerning. The applicant’s reporting of his history to the BMD in March 2001 was also questionable.  

5.  The Board recognizes that at times there will be an honest difference of opinion among physicians as to a diagnosis, and does not dispute the post-discharge diagnosis given by the physicians at the Naval Medical Center.  Nonetheless, the Board notes that the applicant’s behavior (anger, rebellious, disregard for rules and authority, etc.) did exist prior to his entry into the Army, and that he was assessed and evaluated by competent medical personnel at least on four different occasions during a three month period prior to his discharge.  He was determined to have a personality disorder and was medically qualified for separation.  The applicant himself stated that his health was good.    Consequently, and notwithstanding the diagnosis provided by the Naval Medical Center in May 2001, the applicant has not convinced the Board that his discharge for a personality disorder was improper, incorrect, or unjust.  His request for a PEB is not warranted.
       
6.  The applicant has submitted neither probative evidence nor a convincing argument in support of his request.   

7.  In order to justify correction of a military record the applicant must show to the satisfaction of the Board, or it must otherwise satisfactorily appear, that the record is in error or unjust.  The applicant has failed to submit evidence that would satisfy that requirement.

8.  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

__INW __  __HOF __  __DPH__  DENY APPLICATION

		    Carl W. S. Chun
		    Director, Army Board for Correction
    of Military Records

INDEX

CASE ID	AR2001060828	
SUFFIX		
RECON	YYYYMMDD	
DATE BOARDED	20020115	
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.	108.00	
2.	177	
3.		
4.		
5.		
6.