BOARD DATE: 5 September 2017 DOCKET NUMBER: AR20160002216 BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ___x_____ __x______ ___x___ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration BOARD DATE: 5 September 2017 DOCKET NUMBER: AR20160002216 BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. ___________x_______________ CHAIRPERSON I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. BOARD DATE: 5 September 2017 DOCKET NUMBER: AR20160002216 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records (with supporting documents provided, if any). 2. Military Personnel Records and advisory opinions (if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests, in effect, correction of her DD Form 214 (Certificate of Release or Discharge from Active Duty) to show she was separated by reason of medical disability with an honorable character of service. Additionally, she requests a personal hearing before the Board. 2. The applicant states her situation resulted from unique and unusual circumstances brought on by post-traumatic stress disorder (PTSD). Her mental and physical disabilities were caused during her enlisted service period. She claims she would not have mental or physical disabilities if she had not enlisted. 3. The applicant provides documents labeled 1 through 10, consisting of a DD Form 149 (Application for Correction of Military Record under the Provisions of Title 10, U.S. Code, Section 1552) and the following: * progress notes from Dr. Ritky C. Dy Medical Clinic LLC, dated 22 May 2014 * three Fort Jackson (FJ) Forms 689-R (Initial Military Training (IMT) Sick Slip (BCT)), dated between 14 July and 22 July 2014 * two identical DD Forms 689 (Individual Sick Slip), dated 12 July 2014 * affidavit, dated 24 July 2014 * self-authored note, dated 4 January 2016 * Prattville Baptist Hospital Emergency Department Patient Summary, dated 30 December 2014 CONSIDERATION OF EVIDENCE: 1. The applicant's DD Form 2807-1 (Report of Medical History) and DD Form 2808 (Report of Medical Examination), both dated 28 February 2014, show she was in good health, with no health issues, and she was deemed qualified for service by the examining physician at the military entrance processing station. 2. The applicant enlisted in the Regular Army on 30 June 2014. She was assigned to Fort Jackson, SC for initial entry training. 3. The applicant's record contains four DA Forms 4856 (General Counseling Form), dated between 22 and 28 July 2014. She received counseling for the below deficiencies, which resulted in a recommendation for her separation from military service: * unwillingness to subordinate herself to the mission and fellow Soldiers * inability to understand, accept, and live by the Army Values and Warrior Ethos * lack of motivation * failure to adapt to the social and emotional rigors of the military lifestyle and the lack of physical and mental toughness necessary to complete basic combat training * unsatisfactory performance and conduct * failure to meet initial entry training standards * failure to pass the Army Physical Fitness Test (APFT) * stating she was unable to continue training due to her feelings toward the Army and her training environment. 4. A DA Form 3822 (Report of Mental Status Evaluation), dated 22 July 2014, shows the applicant was self-referred for evaluation. The examining official determined she had no obvious impairments and was cooperative and normal in thinking. She was unlikely to be impulsive or dangerous. She was psychiatrically cleared to return to her unit, with no training restrictions, and was scheduled for a follow-up visit. She was diagnosed with adjustment disorder with mixed anxiety and depressed mood. The examining official determined she would not likely respond to command efforts at rehabilitation and that if her command decided she was failing to adapt to Army standards, they could pursue separation under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations, Chapter 11 (Entry Level Performance and Conduct). 5. The applicant's immediate commander recommended the applicant's separation from the Army under the provisions of Army Regulation 635-200, chapter 11, for unsatisfactory performance and conduct due to lack of motivation, and her inability to complete mandatory training events required for successful completion of initial entry training. The applicant was further advised that her service would be characterized as "uncharacterized." 6. The applicant acknowledged receipt of the separation notification memorandum on 5 August 2014. She waived her right to consult with counsel and elected not to make any statements in her own behalf. 7. The separation authority reviewed the proposed separation action on 6 August 2014, waived further rehabilitative efforts, and approved an entry-level separation with uncharacterized service in accordance with Army Regulation 635-200, chapter 11. 8. The applicant was discharged on 14 August 2014. The DD Form 214 she was issued shows she completed 1 month and 15 days of net active service. It further shows in: * Item 23 (Type of Separation) – Discharge * Item 24 (Character of Service) – Uncharacterized * Item 25 (Separation Authority) – Army Regulation 635-200, chapter 11 * Item 28 (Narrative Reason for Separation) – Entry Level Performance and Conduct 9. The applicant provides: a. A clinic note from Ri_ C. D_ Medical Clinic LLC, dated 22 May 2014 (prior to service), which shows the applicant was seen for pain in her left hand. b. Three initial military training sick slip forms, dated between 14 July through 22 July 2014, showing the applicant complained of swollen knees, sore knees and shin pain. An individual sick slip form, dated 12 July 2014, shows she was returned to duty with no running, marching, or jogging for 24 hours. c. An individual statement affidavit, dated 24 July 2014, which states, in pertinent part, "I feel so out of place here. I don't know if I can take this feeling of being trapped any longer. Mentally and physically I am not ready for [basic combat training]. I do not want to train any longer and I understand my chapter 11 discharge." d. A self-authored statement, dated 4 January 2016, wherein she states she does not agree with her discharge and that she was denied medical care by the Department of Veterans Affairs (VA). e. A patient summary from Prattville Baptist Hospital, dated 30 December 2014, showing she was evaluated for pleurodynia (painful breathing) and chest pain. 10. The applicant's record does not contain, nor does she provide any evidence that shows she was diagnosed or treated for any unfitting medical condition(s) during her period of service. Her record does not contain, nor does she provide any evidence that shows she was diagnosed with PTSD or PTSD-like symptoms during her period of military service. 11. The applicant applied to the Army Discharge Review Board (ADRB) for an upgrade of her discharge on 4 December 2015. The ADRB determined that her reason for discharge and characterization of service were both proper and equitable and denied her request for a discharge upgrade. 12. In the processing of this case, an advisory opinion was obtained on 13 February 2017, from the Army Review Boards Agency (ARBA) Senior Medical Advisor, a medical doctor. The advisory official noted and opined: a. The applicant's medical conditions were duly considered during her separation processing. She did not meet the diagnostic criteria for PTSD, major depression, or anxiety disorder at the time of her service. She met the medical retention standards for behavior and mental health. b. A review of the available documentation found no evidence of a medical disability or condition that would support a change to the character or reason for the applicant's discharge in this case. She met medical retention standards for bilateral shin splints and adjustment disorder. c. It is unclear why the applicant states she is unable to get medical care from the VA; the VA has no record of the applicant having made contact as of 13 February 2017. (The medical advisor accessed the VA electronic medical records through the Joint Legacy Viewer.) 13. The applicant was provided a copy of the advisory opinion on 14 February 2017, to provide her an opportunity to comment and/or submit a rebuttal. However, she did not respond. REFERENCES: 1. Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. The regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. It is not an investigative body. The ABCMR may, in its discretion, hold a hearing. Applicants do not have a right to a hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. 2. Army Regulation 635-200 prescribes policies, standards, and procedures to ensure the readiness and competency of the force while providing for the orderly administrative separation of Soldiers for a variety of reasons. a. Chapter 3 states a separation will be described as entry level with uncharacterized service if the Soldier has less than 180 days of continuous active duty service at the time separation action is initiated. b. Paragraph 3-7a provides that an honorable discharge is a separation with honor and entitles the recipient to benefits provided by law. The honorable characterization is appropriate when the quality of the member's service generally has met the standards of acceptable conduct and performance of duty for Army personnel, or is otherwise so meritorious that any other characterization would be clearly inappropriate. c. Chapter 5 states unless the reason for separation requires a specific characterization, a Soldier being separated for the convenience of the government will be awarded a character of service of honorable, under honorable conditions, or an uncharacterized description of service if in an entry-level status. d. Paragraph 5-17 provides that commanders, who are special court-martial convening authorities, may approve separation actions under this paragraph on the basis of other physical or mental conditions not amounting to disability that potentially interfere with assignment to, or performance of, duty. A recommendation for separation must be supported by documentation confirming the existence of the physical or mental condition. Members may be separated for physical or mental conditions not amounting to disability which is sufficiently severe that the Soldier's ability to effectively perform military duties is significantly impaired. e. Chapter 11 provides for the separation of personnel because of unsatisfactory performance or conduct (or both) while in an entry-level status. When separation of a Soldier in an entry-level status is warranted by unsatisfactory performance or minor disciplinary infractions (or both) as evidenced by inability, lack of reasonable effort, or failure to adapt to the military environment, he or she will normally be separated per this chapter. Service will be uncharacterized for entry-level separation under the provisions of this chapter. 3. PTSD can occur after someone goes through a traumatic event like combat, assault, or disaster. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and it provides standard criteria and common language for the classification of mental disorders. In 1980, the APA added PTSD to the third edition of its DSM-III nosologic classification scheme. Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice. From an historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis). The key to understanding the scientific basis and clinical expression of PTSD is the concept of "trauma." 4. PTSD is unique among psychiatric diagnoses because of the great importance placed upon the etiological agent, the traumatic stressor. In fact, one cannot make a PTSD diagnosis unless the patient has actually met the "stressor criterion," which means that he or she has been exposed to an event that is considered traumatic. Clinical experience with the PTSD diagnosis has shown, however, that there are individual differences regarding the capacity to cope with catastrophic stress. Therefore, while most people exposed to traumatic events do not develop PTSD, others go on to develop the full-blown syndrome. Such observations have prompted the recognition that trauma, like pain, is not an external phenomenon that can be completely objectified. Like pain, the traumatic experience is filtered through cognitive and emotional processes before it can be appraised as an extreme threat. Because of individual differences in this appraisal process, different people appear to have different trauma thresholds, some more protected from and some more vulnerable to developing clinical symptoms after exposure to extremely stressful situations. 5. The DSM fifth revision (DSM-5) was released in May 2013. This revision includes changes to the diagnostic criteria for PTSD and acute stress disorder. The PTSD diagnostic criteria were revised to take into account things that have been learned from scientific research and clinical experience. The revised diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition. a. Criterion A, stressor: The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required) (1) Direct exposure. (2) Witnessing, in person. (3) Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental. (4) Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures. b. Criterion B, intrusion symptoms: The traumatic event is persistently re-experienced in the following way(s): (one required) (1) Recurrent, involuntary, and intrusive memories. (2) Traumatic nightmares. (3) Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. (4) Intense or prolonged distress after exposure to traumatic reminders. (5) Marked physiologic reactivity after exposure to trauma-related stimuli. c. Criterion C, avoidance: Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required) (1) Trauma-related thoughts or feelings. (2) Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations). d. Criterion D, negative alterations in cognitions and mood: Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required) (1) Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs). (2) Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous"). (3) Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences. (4) Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame). (5) Markedly diminished interest in (pre-traumatic) significant activities. Feeling alienated from others (e.g., detachment or estrangement). (6) Constricted affect: persistent inability to experience positive emotions. e. Criterion E, alterations in arousal and reactivity: Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required) (1) Irritable or aggressive behavior. (2) Self-destructive or reckless behavior. (3) Hypervigilance. (4) Exaggerated startle response. (5) Problems in concentration. (6) Sleep disturbance. f. Criterion F, duration: Persistence of symptoms (in Criteria B, C, D, and E) for more than one month. g. Criterion G, functional significance: Significant symptom-related distress or functional impairment (e.g., social, occupational). h. Criterion H, exclusion: Disturbance is not due to medication, substance use, or other illness. 6. As a result of the extensive research conducted by the medical community and the relatively recent issuance of revised criteria regarding the causes, diagnosis and treatment of PTSD the Department of Defense (DoD) acknowledges that some Soldiers who were administratively discharged under other than honorable conditions may have had an undiagnosed condition of PTSD at the time of their discharge. It is also acknowledged that in some cases this undiagnosed condition of PTSD may have been a mitigating factor in the Soldier's misconduct which served as a catalyst for their discharge. Research has also shown that misconduct stemming from PTSD is typically based upon a spur of the moment decision resulting from temporary lapse in judgment; therefore, PTSD is not a likely cause for either premeditated misconduct or misconduct that continues for an extended period of time. 7. In view of the foregoing, on 3 September 2014 the Secretary of Defense directed the Service Discharge Review Boards (DRBs) and Service Boards for Correction of Military/Naval Records (BCM/NRs) to carefully consider the revised PTSD criteria, detailed medical considerations and mitigating factors when taking action on applications from former service members administratively discharged under other than honorable conditions and who have been diagnosed with PTSD by a competent mental health professional representing a civilian healthcare provider in order to determine if it would be appropriate to upgrade the characterization of the applicant's service. 8. BCM/NRs are not courts, nor are they investigative agencies. Therefore, the determinations will be based upon a thorough review of the available military records and the evidence provided by each applicant on a case-by-case basis. When determining if PTSD was the causative factor for an applicant's misconduct and whether an upgrade is warranted, the following factors must be carefully considered: * Is it reasonable to determine that PTSD or PTSD-related conditions existed at the time of discharge? * Does the applicant's record contain documentation of the occurrence of a traumatic event during the period of service? * Does the applicant's military record contain documentation of a diagnosis of PTSD or PTSD-related symptoms? * Did the applicant provide documentation of a diagnosis of PTSD or PTSD-related symptoms rendered by a competent mental health professional representing a civilian healthcare provider? * Was the applicant's condition determined to have existed prior to military service? * Was the applicant's condition determined to be incurred during or aggravated by military service? * Do mitigating factors exist in the applicant's case? * Did the applicant have a history of misconduct prior to the occurrence of the traumatic event? * Was the applicant's misconduct premeditated? * How serious was the misconduct? DISCUSSION: 1. The applicant's request for correction of her DD Form 214, to show she was separated by reason of medical disability with an honorable character of service, was carefully considered. 2. The applicant entered active duty on 30 June 2014 and was discharged on 14 August 2014. Her record shows she entered initial entry training but she did not complete basic training. During basic training, she was counseled several times for her inability to adapt to the military environment and failure to pass the APFT. She self-referred to the mental health clinic for an evaluation and was diagnosed with an adjustment disorder with mixed anxiety and depressed mood. Based on her failure to attain training standards, her chain of command initiated separation proceedings against her. 3. The applicant was in an entry-level status at the time of her separation for she had not completed training nor had she served for more than 180 days of active service. As a result, her service was appropriately described as "uncharacterized" in accordance with governing regulations. All requirements of law and regulation were met and her rights were fully protected throughout the separation process. 4. A review of the available documentation found no evidence of a medical disability or condition that would support a change to the character or reason for her discharge in this case. 5. 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. 6. The applicant's request for a personal appearance hearing was carefully considered. By regulation, an applicant is not entitled to a hearing before the ABCMR. Hearings may be authorized by a panel of the ABCMR or by the Director of the ABCMR. In this case, the evidence of record and independent evidence provided by the applicant are sufficient to render a fair and equitable decision at this time. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160002216 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160002216 11 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2