DEPARTMENT OF THE NAVY
 NAVAL DISCHARGE REVIEW BOARD (NDRB)
                     DISCHARGE REVIEW
                   DECISIONAL DOCUMENT

FOR OFFICIAL USE ONLY

  ex-PCSA, USN
Docket No. ND05-00896

Applicant’s Request

The application for discharge review was received on 20050427.  The Applicant requests the Discharge Characterization of Service received at the time of discharge be changed to general (under honorable conditions).  The Applicant requests a documentary record discharge review.  The Applicant did not designate a representative on the DD Form 293.  

Decision

A documentary discharge review was conducted in Washington, D.C. on 20051215.  After a thorough review of the records, supporting documents, facts, and circumstances unique to this case, no impropriety or inequity in the characterization of the Applicant’s service was discovered by the NDRB.  The Board’s vote was unanimous that the character of the discharge and reason for discharge shall not change.  The discharge shall remain Under Other Than Honorable Conditions by reason of misconduct due to drug abuse.

PART I - APPLICANT’S ISSUES AND DOCUMENTATION

Issues, as stated

Applicant’s issues, as stated on the application and attached document/letter: 

“To whom it may concern:

I am requesting a review of my discharge because of my medical condition.  In December of 2003, I was diagnosed with Bipolar II Disorder with Mixed MRE.  In November of 2003, I started to seek professional formal help for my depression that I had been suffering for several months.  I was put onto the medication Wellbutrin XL.  This medication was supposed to help me feel better, instead in sent me into hypomania.  Since I am bipolar this was not a good thing.  The last Saturday in November, which was the 29th, I was at my apartment with my brother, my boyfriend, and my son.  My boyfriend, D_, had brought into my apartment some cocaine.  Under normal circumstances I would have asked him to leave when I had discovered that he had it with him.  I was not in a way to where I would have done so.  I had been up for several days, and I wanted a rush, so when he offered me some I did not say NO.  Before this incident I had never been around the drug nor had I ever seen any.  He showed me how to do a line; then before I knew it I had done four lines, drank three bottles of hard liquor and I was in a bathroom with a knife to my wrist.  This was not the effect I had sought so I asked D_ to get it out of the apartment before I did some real harm to myself.

This had been my first time ever doing the drug I know it is hard to tell by how much was in my system, but I was also on a medication that altered my senses.  So to me what seemed like three big lines may have been more.  All I know is that between the cocaine and a prescription medication that was supposed to help me I was not of a sound mind to make sensible judgments.  I could have taken the medical discharge when Lt. C_ offered it to me but I honestly was not looking for a way out of the military.

I therefore submit that while I did commit the act of using a controlled substance had I not been on a medication that altered my mental state of mind; I would never have used said controlled substance and have had to be discharged from the military.  Thank you for your time.

[Signed by Applicant]
S_ S_ H_ (Applicant)
[SSN deleted]”

Documentation

In addition to the service record, the following additional documentation, submitted by the Applicant, was considered:

Applicant’s medical record documents (30 pages)
Applicant’s DD Form 214 (Member – 4)

PART II - SUMMARY OF SERVICE

Prior Service (component, dates of service, type of discharge):

	Inactive:  USNR (DEP)	20020607 - 20030224		COG
	Active:    None

Period of Service Under Review:

Date of Enlistment:  20030225		Date of Discharge:  20040322

Length of Service (years, months, days):

	Active:    01  00  28  
	Inactive:  None

Time Lost During This Period (days):

	Unauthorized absence:	None
	Confinement:			None

Age at Entry:  21

Years Contracted:  4 (24 month extension)

Education Level:  15				AFQT:   86

Highest Rate:  PCSN

Final Enlisted Performance Evaluation Averages (number of marks):

Performance:  NA*		Behavior:  NA*		OTA:  NA*

Decorations, Medals, Badges, Citations, and Campaign Ribbons Awarded or Authorized, (as listed on the DD Form 214):  National Defense Service Medal

* Not Available

Character, Narrative Reason, and Authority of Discharge (at time of issuance):

UNDER OTHER THAN HONORABLE CONDITIONS/MISCONDUCT, authority: MILPERSMAN, Article 1910-146, formerly 3630620.

Chronological Listing of Significant Service Events: 

031028:	Medical Officer Appointment (Follow-up):  Probable Dx is Bipolar, scheduled to see Dr .C_ for further eval and possible meds.

031126:	Naval Medical Center Portsmouth, Outpatient Psychiatry Clinic:  This is the 1st NMC Portsmouth psychiatric eval for this 22 year old single, white, female, AD/USN with 9 months continuous active duty.  Her current command is aboard the USS MOUNT WHITNEY where she is an E-3 in PC.  Dr S_, from ship’s medical referred her for eval for possible Bipolar disorder.
	Pt here because of “mood swings.”  Per her report, her symptoms started when she was 15-16 years old and have persisted since that time.  She reports episodes of depression (irritability, social isolation, hypersomnia, crying spells, depressed mood), elevated moods (increased pleasure seeking behavior, increased psychomotor activity, racing thoughts, multiple tasks going at once, drive to be always on the move/busy, decreased need for sleep) and period of feeling “normal” (where nothing bothers her and she has no worries).  Since she has joined the Navy, the episodes have become more frequent.  She is still coping with them because she knows that they are self-limited, but her COC is worried.  She reports that her depressed times last 2-3 weeks, her normal times can last between 3 weeks to 2 months and her up times last about 1 week.  There is no recurrent pattern, but the cycles are evident to her.  She got worried when she started “snapping” at first classes – she is afraid that, during her down time, she might snap at a CPO or an officer and get in trouble.  Her ship’s document saw her and diagnosed bipolar disorder (he did an organic w/u including Basic Met, Hepatic Panel, TFT and CBC – all within normal limits).  She denies any thoughts of suicide, ever.
	DIAGNOSIS:
	Axis I:   Cyclothymic Disorder (301.13)
	Axis II:  Deferred
	Axis III: DeQuervain’s tendonitis
	Axis IV: Mild to Moderate – routine military, separation from child, 
financial
	Axis V:  Current GAF=70
	RECOMMENDATIONS/PLAN:
	1) Pt is fit for full duty and may return to parent command.
	2) To target the symptoms of depression, will start Wellbutrin XL.  Wrote Rx for Wellbutrin XL 150mg po qam #30 w/no refills.  Risks, benefits, alternatives to treatment (including no treatment) and side effects (including but not limited to seizures, headache, heart palpitations, dizziness, allergic and idiopathic reaction) of this medication have been discussed with pt and she voiced understanding and willingness to take medication.
	3) Pt to follow-up with Dr. C_ in 2 weeks and 4 weeks; pt may call and pt returns as necessary.
	4) Should an emergency arise, pt has been instructed to call 911 or go to the ER.

031210:	Naval Medical Center Portsmouth Outpatient Psychiatry Clinic 
(Follow-up):  Patient not tolerating the Wellbutrin XL at all it is precipitating her migraine HAs and now her ups are REALLY up.  No thoughts of suicide.  
Diagnostic Impression:  
Axis I;  Cyclothymic Disorder (310.13)
Axis II:  Deferred
Plan:
1.  Pt is fit for full duty and may return to parent command.

031224:	Naval Medical Center Portsmouth Outpatient Psychiatry Clinic 
(Follow-up):  Per her report, patient has been going to a number of people to get help w/finances and such, but she has not gotten any answers.  Then, in a moment of desperation to feel better, she tried cocaine (for the first time).  Then, she got caught.  Now, she is off medication and scheduled for Captain’s Mast.  
Diagnostic Impression:
Axis I:  Major Depressive Disorder – Single, Moderate to Severe
Axis II:  Deferred
Plan:  To be admitted to inpatient for stabilization and to ensure her safety.  I do not believe that this is an attempt to get out of Mast…She has clearly deteriorated from my initial evaluation.

031224:	Admission to Naval Medical Center, Portsmouth, Psychiatry ward:  This is the first admission for this active duty female, attached to the USS MOUNT WHITNEY.  Pt was admitted by her outpatient psychiatrist, Dr. C_, after evaluation of suicidal.  History of present illness was obtained from the pt and available records, and is considered reliable.  Pt is having worsening thoughts of suicide in the context of captain’s mast on 30 Dec 2003.  Pt was positive on a drug screen at her command, and she is uncertain as to what she will be awarded at captain’s mast.  Pt has lengthy history of hippomanic episodes, involving decreased need to sleep, increased goal-directed activity, feeling full of energy, having racing thoughts and pressured speech.  The length of time for these episodes is approximately three days.  She additionally, and sometimes simultaneously, has depressive symptoms, including thoughts of suicide and hopelessness.  Pt denied homicidally or hallucinations.  She denied homicidally or hallucinations.  She denied symptoms or paranoia, schizophrenia, or anxiety disorders.  Pt is an outpatient of Dr. C_ at NMCP.  Prior to this, the pt was not seen by a psychiatrist.
	DIAGNOSES:
	Axis I  Bipolar II Disorder MRE mixed, Rule out Cocaine Abuse
	Axis II  Borderline personality traits
	Axis III Tendonitis of wrist and knees
	Axis IV Upcoming captain’s mast, poor primary support system
	Axis V  GAF 65
	DISPOSITION:  Discharge to her command.
	DISCHARGE MEDICATIONS:  None
	DISCHARGE INSTRUCTIONS:
	1.  Pt to return to full duty.  Psychiatrically fit for same.
2.  Pt is to follow up with Dr. C_, outpatient psychiatrist at NMCP psychiatry, on 5 Jan 2004.
		3.  Pt is to report to her command DAPA for evaluation of substance use.
		4.  Pt to abstain from using any substances
		5.  Point of contact at NMCP is Dr. C_.

040102:	Discharged from Naval Medical Center, Portsmouth, Psychiatry ward and returned to full duty.

040108:	NJP for violation of UCMJ, Article 112a:  Wrongful use of Cocaine.
	Award:  Forfeiture of $670 pay per month for 2 months, restriction and extra duty for 45 days, reduction to E-2.  No indication of appeal in the record.

040116:	Naval Medical Center Portsmouth Outpatient Psychiatry Clinic 
(Follow-up):  Pt is a 22 year old white female, AD/USN, 1st seen by NMC Portsmouth Psychiatry on 26 Nov 03 and diagnosed with Cyclothymia.  She was started on Wellbutrin XL.  She became hypomanic on the Wellbutrin XL so that was discontinued.  She did not do well after the discontinuation so she was admitted to Inpatient Psychiatry for 10 days and received PsychoDiagnostic Testing.  The results were valid and were c/w Bipolar II disorder and suggestive of some personality disorder traits (Borderline).  A trial of Neurontin was initiated but she did not tolerate it.  She was discharged on no medications.  A trial of Depakote was initiated.
Pt here for f/u.  She is here today late because the ship had difficulty getting her a ride here.  I am seeing her anyway because she does not look good.  She relates to me that she is stressed out and feeling quite out of control.  She is tearful and notes that she has been vomiting for the past 2 days after eating (medical w/u negative).  She is tolerating the Depakote ER well.  I had spoken w/her SMO and we had increased the dose to 1000mg qhs.  She has not had any up episodes since starting the Depakote, and that is good.  However, these down times are beginning to take their toll.  I would like to switch the pt from Trazodone to Ambien to assist w/the “hangover” effect.  The pt is in agreement.  There have been some thoughts of suicide but she is attentive enough to get help when those occur.  She had thoughts of suicide this morning but none right now.
DIAGNOSTIC IMPRESSION:
AXIS I:  Bipolar II Disorder – MRE Mixed
AXIS II:  Borderline Traits
PLAN:
1) Pt is fit for full duty and may return to parent command.
2) Continue Depakote ER at current dose; wrote Rx for Depakote ER 500mg t-tab po qhs #60 w/no refills.
3) Discontinue Trazodone.
4)  To target the symptom of insomnia, will start Ambien.  Wrote Rx for Ambien 5-10mg po qhs prn for sleep #15 w/no refills.  Risks, benefits, alternatives to treatment (including no treatment) and side effects (including but not limited to sedation, dizziness, allergic and idiopathic reaction) of this medication have been discussed with pt and she voiced understanding and willingness to take medication.
5) Pt to f/u w/Dr. C_ in 2 weeks and 3 weeks, pt may call/returns as necessary.
5) Should an emergency arise, pt has been instructed to call 911 or go to the ER.

040118:	Naval Medical Center Portsmouth – Outpatient Progress Note:  Pt was evaluated by the ER psychiatry service.  She was brought in her command after they learned of her making superficial lacerations to her left wrist two days ago.  She reports being “frustrated and bored” at the time and adamantly denies this was a suicide attempt.  She denies any previous self-mutilation.  She is being followed by Dr. C_ as an outpatient, diagnosed with Bipolar II and Borderline traits.  She currently takes Depakote ER 1000mg ghs and Ambien 5-10mg qhs for sleep.  She describes her mood as “down” and has had a decrease in sleep and appetite recently.  She states she feels frustrated by being restricted to the ship and is bored because there “s nothing to do but work.”  She is pending a separation due to a drug change (positive UDS for cocaine).  She denies any further use.  She denies any alcohol use.  She is not currently suicidal, homicidal, nor is she displaying symptoms of mania, psychosis.  She denies audio/visual hallucinations.  She is contracting for safety and feels safe returning to the ship.  
	ASSESSMENT:
Bipolar II Disorder
Borderline Traits
PLAN:
Return to command, fit for full duty/restriction.
Continue Depakote ER 1000mg qhs as prescribed.
Follow up w/Dr. C_ on 30 Jan as scheduled.  Recommend calling clinic to move appointment to this week if available.
Pt understands to contact medical/chaplain/shipmate if conditions worsens.
Discussed with command medical representative.
Discussed with Dr. D_, staff psychiatrist, who agrees.  

040130:	Naval Medical Center Portsmouth Outpatient Psychiatry Clinic 
(Follow-up):  Pt here for f/u.  She made a visit to the ER second after our last visit because she was “angry” and took it out on herself by cutting on her both arms (L>R).  She adamantly denied then and denies now any thoughts of suicide at the time – she was just “pissed.”  Her mood was relatively stable until last weekend when she had an “up” episode that lasted from Thursday to Monday.  She reports that she made it though that without getting in trouble because of the medication.  I reviewed her dose, and she is where she should be based on her weight (15mg/kg).  And, the Ambien is not helping her sleep.  Lastly, she notes that she occasionally has sharp pains in her right side that last 5 min or so.  She has an appointment w/DAPA at SRP for the 5th of FEB and they are recommending treatment.  After she finishes that, she will be out (likely 21 FEB 04).
DIAGNOSTIC IMPRESSION:
AXIS I:  Bipolar II Disorder – MRE Mixed
AXIS II:  Borderline Traits
PLAN:
1) Pt is fit for full duty and may return to parent command.
2) Continue Depakote ER at current dose; wrote Rx for Depakote ER 500mg t-tab po qhs #60 w/1 refills.
3) Discontinue Ambien.
4)  LABS today – CBC w/d/p, Hepatic Profile, GGT, VPA.
5) Pt to f/u w/Dr. C_ in 2 weeks and 3 weeks, pt may call/returns as necessary.
5) Should an emergency arise, pt has been instructed to call 911 or go to the ER.

040301:	Naval Medical Center Portsmouth Outpatient Psychiatry Clinic 
(Follow-up):  Pt here for f/u.  She has two main complaints today – she is not sleeping and she is gaining weight.  And, she reports, nothing has changed.  Her mood has been good – stable, no ups or downs.  No cutting or thoughts of self-harm/suicide.  No visits to the ER.  It has been brought to her attention that she is being VERY flirtatious, and that bothers her somewhat.  So, we are talking about options.  For now, she is still AD because the earliest SARP appointment (Level 1) was 15 Mar.  After that, 2 weeks then she is on her way out (probably another week or so after that).
DIAGNOSTIC IMPRESSION:
AXIS I:  Bipolar II Disorder – MRE Mixed
AXIS II:  Borderline Traits
PLAN:
1) Pt is fit for full duty and may return to parent command.
2) Continue Depakote ER at current dose; wrote Rx for Depakote ER 500mg t-tab po qhs #120 w/no refills.
3) Suggest, when pt has secured f/u after d/c, a trial of Topamax to assist w/weight loss.
4) Pt to f/u w/Dr. C_, pt returns as necessary.
5) Should an emergency arise, pt has been instructed to call 911 or go to the ER.

040303:	Commander, Amphibious Group Two directed the Applicant's discharge under other than honorable conditions by reason of misconduct due to drug abuse.

040322:	Applicant discharged under other than honorable conditions by reason of misconduct due to drug abuse.

Service Record contains a partial Administrative Discharge package.
Service Record was missing elements of the Summary of Service.

PART III – RATIONALE FOR DECISION AND PERTINENT REGULATION/LAW

Discussion

The Applicant was discharged on 20040322 by reason of misconduct due to drug abuse (A) with a service characterization of under other than honorable conditions.  After a thorough review of the available records, supporting documents, facts, and circumstances unique to this case, the Board found that the discharge was proper and equitable (B and C).  The Board presumed regularity in the conduct of governmental affairs (D).

Normally, to permit relief, an impropriety or inequity must have existed during the period of enlistment in question.  No such impropriety or inequity is evident during the Applicant’s enlistment.  There is credible evidence in the record that the Applicant used illegal drugs.  The Applicant was awarded nonjudicial punishment (NJP) for a violation of UCMJ Article 112a, wrongful use of cocaine.  Regulations permit relief on equitable grounds if the Applicant’s discharge is inconsistent with standards of discipline of the Naval service.  Mandatory processing for separation is required for sailors who abuse illegal drugs.  Separation under these conditions generally results in characterization of service under other than honorable conditions.  The Applicant was properly notified, processed and discharged under other than honorable conditions by reason of misconduct due to drug abuse.  Based upon available records, nothing indicates that the Applicant’s discharge was in any way inconsistent with the standards of discipline in the United States Navy.  Relief denied.

The Applicant contends that her discharge should be upgraded because she was suffering from a mental condition while on active duty.  A mental condition will not automatically excuse a servicemember from legal liability for her misconduct.  The Applicant must show a lack of mental responsibility by virtue of being unable to appreciate the nature and quality or the wrongfulness of her acts.  The Applicant’s record contains substantial evidence that she suffered from a bipolar disorder while on active duty.  However, despite the presence of this condition, the psychiatrist consistently proclaimed the Applicant fit to return to full duty.  In contrast, the Board could find no evidence in the record to support the Applicant’s contention that this mental condition was of such severity to relieve her from legal responsibility for her misconduct.  Thus, the preponderance of the evidence supports a finding that the Applicant was legally responsible for her actions.  The Board concluded that the severity of the Applicant’s mental condition was not of such a nature to relieve her of responsibility for her misconduct and found the discharge proper and equitable as issued.  Relief denied.

The Applicant remains eligible for a personal appearance hearing, provided an application is received, at the NDRB, within 15 years from the date of discharge.  Representation at a personal appearance hearing is recommended but not required.

Pertinent Regulation/Law (at time of discharge)

A.  The Naval Military Personnel Manual, (NAVPERS 15560C), re-issued October 2002, effective 22 Aug 2002 until 28 April 2005, Article 1910-146 (formerly 3630620), Separation by Reason of Misconduct - Drug Abuse.

B.  Secretary of the Navy Instruction 5420.174D of 22 December 2004, Naval Discharge Review Board (NDRB) Procedures and Standards, Part V, Para 502, Propriety.

C.  Secretary of the Navy Instruction 5420.174D of 22 December 2004, Naval Discharge Review Board (NDRB) Procedures and Standards, Part V, Para 503, Equity.

D.  Secretary of the Navy Instruction 5420.174D of 22 December 2004, Naval Discharge Review Board (NDRB) Procedures and Standards, Part II, Para 211, Regularity of Government Affairs.

PART IV - INFORMATION FOR THE APPLICANT

If you believe that the decision in your case is unclear, not responsive to the issues you raised, or does not otherwise comport with the decisional document requirements of DoD Directive 1332.28, you may submit a complaint in accordance with Enclosure (5) of that Directive.  You should read Enclosure (5) of the Directive before submitting such a complaint.  The complaint procedure does not permit a challenge of the merits of the decision; it is designed solely to ensure that the decisional documents meet applicable requirements for clarity and responsiveness.  You may view DoD Directive 1332.28 and other Decisional Documents by going online at “http://Boards.law.af.mil”.

The names, and votes of the members of the Board are recorded on the original of this document and may be obtained from the service records by writing to:

		Secretary of the Navy Council of Review Boards
		Attn:  Naval Discharge Review Board
		720 Kennon Street SE Rm 309
		Washington Navy Yard DC  20374-5023