IN THE CASE OF: BOARD DATE: 20 September 2016 DOCKET NUMBER: AR20150006220 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ____X____ ____X____ ____X____ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ________ ________ ________ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 20 September 2016 DOCKET NUMBER: AR20150006220 BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined that the evidence presented was sufficient to warrant a recommendation for partial relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by directing that the Office of the Surgeon General review the available records to determine if he should have been referred to the Physical Disability Evaluation System (PDES). If it is determined that he should have been referred to the PDES prior to his separation, these proceedings serve as the authority to afford him that process. 2. Should a determination be made that the applicant should have been separated under the PDES, these proceedings will serve as the authority to void his administrative separation and to issue him the appropriate separation retroactive to his original separation date, with entitlement to all back pay and allowances and/or retired pay, less any entitlements already received. 3. The Board further determined that the evidence presented is insufficient to warrant a portion of the requested relief. As a result, the Board recommends denial of so much of the application that pertains changing his reason for separation without benefit of the review described above. _____________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. IN THE CASE OF: BOARD DATE: 20 September 2016 DOCKET NUMBER: AR20150006220 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 correction of his DD Form 214 (Certificate of Release or Discharge from Active Duty) by changing the narrative reason for separation from "condition, not a disability" to "medical disability." 2. The applicant states: * he was diagnosed with post-traumatic stress disorder (PTSD) and separated from the Army * he was never sent to a medical evaluation board (MEB) * the military did not provide the correct treatment for him * he was placed on medication after his deployment and went to mental health * he was told that he needed to take the "chapter" discharge rather than be provided appropriate mental health care 3. The applicant provides: * DD Form 214 * DA Form 3349 (Physical Profile) * DD Form 2648 (Separation Counseling Checklist For Active Component Service Members) * Enlisted Record Brief * Standard Form 600 (Chronological Record of Medical Care) * DA Form 3822-R (Report of Mental Status Evaluation) * DA Forms 4700 (Medical Record Supplemental Medical Data) * email CONSIDERATION OF EVIDENCE: 1. Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the Army Board for Correction of Military Records (ABCMR) to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file. In all other respects, there are insufficient bases to waive the statute of limitations for timely filing. 2. On 9 April 2003, the applicant enlisted in the Regular Army. After his initial training, he was awarded military occupational specialty 13P (Fire Direction Specialist). He served in Iraq from 14 January 2005 to 1 February 2006. 3. From June through September 2006, he had multiple mental health appointments related to PTSD while stationed at Fort Bliss, TX. In addition to PTSD, medical records from this period show adjustment disorder with anxiety and depressed mood listed among the applicant's identified problems. 4. On 10 August 2006, he underwent a mental status evaluation in conjunction with separation processing under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), paragraph 5-17 (condition, not a disability). He was diagnosed with adjustment disorder with depressed mood. The DA Form 3822-R he provides shows: a. His behavior was normal, he was fully alert, and he was fully oriented. His mood or affect was unremarkable, his thought content was normal, and his memory was good. * Axis I: Adjustment Disorder with depressed mood * Axis II: V61.09: No diagnosis b. The examining clinical psychologist noted the applicant had been treated by him due to post-deployment mental health issues. The psychologist noted clear evidence of symptoms of post-traumatic stress, especially uncontrollable genocidal thoughts related to insurgents that had not responded to medication or psychotherapy and that rendered the applicant unfit for military service. c. The psychologist recommended the applicant be discharged under Army Regulation 623-200, paragraph 5-17, and cleared the applicant for any administrative action deemed appropriate by his chain of command. 5. The complete facts and circumstances surrounding his discharge from active duty are not available for review with this case. However, his DD Form 214 shows he was honorably discharged on 3 November 2006, by reason of "condition, not a disability," with a separation code of "JFV." He completed 3 years, 6 months, and 25 days of active service. 6. The applicant provided an email, dated 9 August 2006, from an unknown individual who appears to be his supervisor, in which the author of the email stated, in effect, that the applicant should to be medically separated due to his unusual behavior. He provided examples of the applicant’s behavior and stated the psychologist (the same psychologist who conducted the 10 August 2006 mental status evaluation described above) appeared to support the member's medical separation. 7. An advisory opinion from the Office of the Surgeon General (OTSG), dated 22 July 2016, recommends approval of the applicant’s request, stating: a. In July 2006, an Army behavioral health (BH) provider diagnosed the applicant with PTSD, a diagnosis he carried until his separation. However, on a 10 August 2006 mental status evaluation conducted in preparation for administrative separation, the same provider recorded a diagnosis of adjustment disorder with depressed mood, noting that the applicant was unfit for military service. In further support of his impaired functioning, temporary profiles dated 10 November 2006 and 28 December 2006 indicate an “S3” profile (i.e., a psychiatric profile) with considerable duty limitations. b. The evidence clearly indicates that the applicant was diagnosed with PTSD while still in service at a level of severity not meeting retention standards. Therefore, he should have been referred to a MEB for consideration for a medical discharge. 8. The applicant was provided a copy of the advisory opinion for an opportunity to respond. He did not respond. REFERENCES: 1. Army Regulation 635-200, paragraph 5-17 states commanders who are special court-martial convening authorities may approve separation 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, sufficiently severe that the Soldier's ability to effectively perform military duties is significantly impaired. 2. Army Regulation 635-5-1 (Separation Program Designator (SPD) Codes) provides the specific authorities (regulatory or directive), reasons for separating Soldiers from active duty, and the SPD code to be entered on the DD Form 214. It identifies the SPD of "JFV" as the appropriate code to assign to enlisted Soldiers administratively discharged under the provisions of Army Regulation 635-200, paragraph 5-17, based on a physical condition, not a disability. 3. Title 10, U.S. Code, chapter 61, provides the Secretaries of the Military Departments with authority to retire or discharge a member if they find the member unfit to perform military duties because of physical disability. The U.S. Army Physical Disability Agency, under the operational control of the Commander, U.S. Army Human Resources Command (HRC), is responsible for administering the physical disability evaluation system (PDES) and executes Secretary of the Army decision-making authority as directed by Congress in chapter 61 and in accordance with Department of Defense Directive 1332.18 and Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation). a. The objectives of the system are to: * maintain an effective and fit military organization with maximum use of available manpower * provide benefits for eligible Soldiers whose military service is terminated because of service-connected disability * provide prompt disability processing while ensuring that the rights and interests of the government and the Soldier are protected b. Soldiers are referred to the PDES when they: * no longer meet medical retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness), chapter 3, as evidenced in a medical evaluation board * receive a permanent medical profile, P3 or P4, and are referred by an MOS Medical Retention Board * are command-referred for a fitness-for-duty medical examination * are referred by the Commander, HRC c. The PDES assessment process involves two distinct stages: the MEB and the physical evaluation board (PEB). The purpose of the MEB is to determine whether the service member’s injury or illness is severe enough to compromise his/her ability to return to full duty based on the job specialty designation of the branch of service. A PEB is an administrative body possessing the authority to determine whether or not a service member is fit for duty. A designation of "unfit for duty" is required before an individual can be separated from the military because of an injury or medical condition. Service members who are determined to be unfit for duty due to disability are either separated from the military or are permanently retired, depending on the severity of the disability and length of military service. Individuals who are "separated" receive a one-time severance payment, while veterans who retire based upon disability receive monthly military retirement payments and have access to all other benefits afforded to military retirees. d. The mere presence of a medical impairment does not in and of itself justify a finding of unfitness. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier may reasonably be expected to perform because of his or her office, grade, rank, or rating. Reasonable performance of the preponderance of duties will invariably result in a finding of fitness for continued duty. A Soldier is physically unfit when a medical impairment prevents reasonable performance of the duties required of the Soldier's office, grade, rank, or rating. 4. Army Regulation 635-40 establishes the Army PDES and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. 5. Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement. Chapter 3 gives the various medical conditions and physical defects which may render a Soldier unfit for further military service and which fall below the standards required for the individuals in paragraph 3–2. These medical conditions and physical defects, individually or in combination, are those that significantly limit or interfere with the Soldier’s performance of their duties or may compromise or aggravate the Soldier’s health or well-being if they were to remain in the military Service. Once a determination of physical unfitness is made, the PEB rates all disabilities using the Veterans Affairs Schedule for Rating Disabilities (VASRD). Ratings can range from 0% to 100%, rising in increments of 10%. 6. Title 10, U.S. Code, section 1201, provides for the physical disability retirement of a member who has at least 20 years of service or a disability rating of at least 30 percent. Title 10, U.S. Code, section 1203, provides for the physical disability separation of a member who has less than 20 years of service and a disability rating at less than 30%. 7. 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." 8. 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. 9. 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. DISCUSSION: 1. The complete facts and circumstances surrounding the applicant's discharge are not available for review with this case. However, the available evidence shows the applicant entered active duty on 9 April 2003 and he was honorably discharged on 3 November 2006 under the provisions of Army Regulation 635-200, paragraph 5-17, by reason of a condition, not a disability. 2. The available evidence shows the applicant was consistently diagnosed with PTSD and adjustment disorder in the months following his return from a deployment to Iraq. He was eventually referred for a mental status evaluation in conjunction with administrative separation proceedings subsequent to exhibiting signs that it appears his chain of command perceived to be interfering with his ability to perform his duties. 3. Although the record clearly shows a diagnosis of PTSD and adjustment disorder, his 10 August 2006 evaluation diagnosed only adjustment disorder with depressed mood, while also describing evidence of symptoms of post-traumatic stress that rendered him unfit for military service. 4. The OTSG advisory opinion states it is clear the applicant should have been referred to an MEB based on his medical diagnosis of PTSD at a level of severity not meeting retention standards. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150006220 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150006220 9 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2