IN THE CASE OF: BOARD DATE: 10 January 2017 DOCKET NUMBER: AR20150013744 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 IN THE CASE OF: BOARD DATE: 10 January 2017 DOCKET NUMBER: AR20150013744 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 to amend the decision set forth in Docket Number AR20140018068 on 17 March 2015. _____________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: 10 January 2017 DOCKET NUMBER: AR20150013744 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 reconsideration of her earlier request for correction of the narrative reason for her discharge from "Personality Disorder" to "Medical" and that her records be submitted to a medical evaluation board (MEB)/physical evaluation board (PEB) for consideration for a medical retirement. 2. The applicant states she served honorably and with distinction on active duty during combat operations in Iraq completing numerous convoy missions. She was the driver of the lead gun truck in the convoys. She witnessed numerous incidents involving forcing local national vehicles off the convoy route and forcing the local national drivers, owners and passengers/families to crash injuring themselves and destroying their property. She also witnessed numerous detonations of vehicle borne explosive devices and improvised explosive devices which injured or killed scores of people and destroyed and untold amount of equipment and property. a. She is disappointed with the Board’s response to her previous application. In that response it stated that her leaders stated she was always a problem Soldier. She plans to prove that incorrect. While in the Army, she attended a university thru eArmyU. She did well in her classes and when selected for the E-5 board, she had enough points to be an E-6. She was close to one Soldier and although he was injured in combat, his injury was not the reason for her return from theatre or the reason for her discharge from the military. b. She struggled during her first tour and sleep eluded her during that deployment. While stateside, she looked to the doctors for a solution to her lack of sleep. They prescribed her Benadryl and did not take her condition seriously. Six months later, she was on a second tour and as the threat level increased her level of sleep decreased. She began hearing and seeing things due to lack of sleep. She could not concentrate and sought help from theatre doctors. They offered no solution. As the deployment continued, she struggled more and more. The injury sustained by her partner was the breaking point for her: not the start of the problem. c. Not knowing what was best for her, she looked for the quickest way out. The medical board was never offered to her and the therapist she saw on base did not ask questions about how she was feeling, sleeping, eating, etc. She feels she was kicked out the back door and none of her problems were addressed. She feared everything. Not a normal thing for someone like her. She also sustained a broken leg in the combat theatre and injured her back on her second deployment. She now lives her days on medication to support her mood and her anxiety and has not slept a night without sleep medication. She receives weekly care from a chiropractor for her back and neck. She asks the Board to reconsider due to the new evidence provided by her therapist as well as her commander. 3. The applicant provides: * DD Form 214 (Certificate of Release or Discharge from Active Duty) * Previous Record of Proceedings * Statement from her former commander (57th Transportation Company) * Statement from a Department of Veterans Affairs (VA) medical doctor CONSIDERATION OF EVIDENCE: 1. Incorporated herein by reference are military records summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in AR20140018068 on 17 March 2015. 2. The applicant provides a statement from her former commander and a statement from a VA medical doctor that were not previously considered. This is considered new evidence that warrants consideration by the Board. 3. The applicant enlisted in the Regular Army on 2 October 2002 and she held military occupational specialty (MOS) 88M (Motor Transport Operator). She served in a variety of stateside or overseas assignments including Kuwait from August 2003 to April 2004 and Iraq from January to May 2005. 4. Her records contain a MEDCOM Form 699-R (Report of Mental Status Evaluation), dated 25 May 2005. The military psychiatrist stated: a. She was command-directed for an evaluation due to acute emotional crisis in the setting of her boyfriend being injured on a convoy. She was overwhelmed and distraught, and it was felt best that she sleep in the hospital for a couple of nights with the aid of medication. Upon further evaluation, it became apparent that this stressor was the culminating stressor of a series of difficulties she has had with her command and with her functioning in the military. Her reported history, and the history from the command, revealed a long-term pattern of interpersonal difficulties that have severely impacted her ability to perform adequately as a Soldier. Behaviors include inappropriate and intense outbursts of anger, affective instability, impulsivity, stress-related paranoid ideation, self-mutilating behavior, manipulation, and splitting." b. Her diagnoses for Axis I: adjustment disorder with mixed disturbance of emotion and conduct; and for Axis II: borderline personality disorder. This diagnosis, as shown, represents a personality disorder within the meaning of International Classification of Disease (ICD-9), Army Regulation (AR) 40-501 (Standards of Medical Fitness), AR 635-200 (Active Duty Enlisted Administrative Separations), and the Diagnostic and Statistical Manual – 5th Edition ( DSM V). c. The condition on Axis I does not represent a severe mental disease or defect for the purposes warranting a disposition through medical channels and meets the retention standards prescribed in Chapter 3 of AR 40-501. This Soldier was and is mentally responsible, able to distinguish right from wrong and to adhere to the right and has the mental capacity to understand and participate in administrative proceedings. 5. On 26 May 2005, while in Iraq the applicant’s immediate commander notified her of his intent to initiate action to separate her under the provisions of AR 635-200, paragraph 5-13, by reason of personality disorder. The commander stated the applicant had been diagnosed with an adjustment disorder with mixed disturbance of emotion and conduct and a borderline personality disorder. The commander recommended the applicant receive an honorable discharge. 6. On 26 May 2005, the applicant acknowledged receipt of the separation memorandum. She was advised of the basis for the contemplated separation action and its effect, of the rights available to her and the effect of any action taken by her in waiving her rights, and of the type of discharge and its effect on future enlistments or reenlistments. She waived her right to consult with counsel, and indicated she would not submit a statement in her own behalf. 7. Following this acknowledgement, her immediate commander initiated separation action against her in accordance with paragraph 5-13 of AR 635-200. Her intermediate commander recommended approval. 8. On 27 May 2005, consistent with the chain of command's recommendations, the separation authority approved the applicant's discharge and directed her service be characterized as honorable. She returned to the United States from Iraq. At Fort Drum, NY, she was honorably discharged on 24 June 2005, as a specialist/E-4. The narrative reason for her separation was personality disorder. She was not transferred to the U.S. Army Reserve, Individual Ready Reserve to complete her statutory commitment. 9. The DD Form 214 she was issued shows she was discharged under the provisions of AR 635-200, paragraph 5-13, by reason of personality disorder. She completed 2 years, 8 months, and 23 days of active service. This form also shows: * item 25 (Separation Authority) – AR 635-200, paragraph 5-13 * item 26 (Separation Code) – JFX * item 28 (Narrative Reason for Separation) – Personality Disorder 10. She previously provided Theater Medical Registry Records and a VA rating decision. She now provides a statement from her former commander and a statement from a VA medical doctor. The Board forwarded her documents to the Army Review Boards Agency (ARBA) staff psychiatrist for review. The psychiatrist rendered an advisory opinion on 6 October 2016. a. The staff psychiatrist summarized the applicant’s Regular Army service to include her two deployments in support of operations in Southwest Asia. She summarized the reason for the applicant’s request for reconsideration to include the applicant’s request for an MEB/PEB for possible consideration for medical retirement. b. The applicant?s VA disability award letter was reviewed. It indicates that the applicant is 100 percent service connected disabled for PTSD. The letter dated 24 July 2015 from Dr. G___, the applicant?s treating VA psychiatrist, was also reviewed. In the letter, Dr. G___ states the applicant’s primary diagnosis is PTSD and her secondary diagnosis is psychotic episodes due to sleep deprivation. Dr. G___ states the Army’s diagnosis of personality disorder is inaccurate and the applicant’s personality symptoms were, instead, due to undiagnosed PTSD. She asserts that the applicant’s personality symptoms have since resolved. c. A review of the available service records in the applicant’s file do not support the applicant’s contention that the behaviors which resulted in her discharge from the Army were due to PTSD and not due to a personality disorder. Reviewing the applicant’s record indicates that there is insufficient evidence to reasonably establish a diagnosis of in-service PTSD. The record, however, does support the diagnosis of personality disorder. The Report of Mental Status Evaluation (MEDCOM Form 699-R), performed by a psychiatrist, dated 25 May 2005, clearly states that the applicant meets military medical retention standards. He goes on to state that the applicant’s history and the history obtained from her command revealed a long-term pattern of interpersonal difficulties that severely impacted the applicant’s ability to function as a Soldier. d. The applicant also requested that her case be reviewed for potential military medical retirement. She provides her VA disability ratings letter and a letter from her VA psychiatrist as supporting evidence. While these documents do support the applicant’s post service diagnosis of PTSD, they do not provide evidence of an in-service PTSD diagnosis nor do they support the applicant’s assertion that a military medical discharge/retirement is warranted. It is important to understand that the VA operates under different rules, laws and regulations when assigning disability percentages than the Department of Defense (DOD). In essence, the VA will compensate for all disabilities felt to be unsuiting. The DOD, however, does not compensate for unsuiting conditions. It only compensates for unfitting conditions. The applicant’s condition was not felt to be unfitting when she was on active duty as indicated by the fact she was found to meet military medical retention standards. e. It is also important to note that the DOD does not compensate service members for anticipated future severity or potential complications of conditions that were incurred during active military service. This is a role reserved for the VA. f. Based on the information available for review at this time, there is insufficient evidence to support changing the applicant’s narrative reason for discharge from "Personality Disorder" to "Medical." Additionally, review of the applicant’s available service treatment records indicates that the applicant did not suffer from a medically unfitting condition and met medical retention standards while on active duty. Accordingly, a referral of her record for consideration of military medical discharge/retirement under the Army Physical Disability Evaluation System is not warranted. 11. The applicant was provided with a copy of this advisory opinion to give her an opportunity to submit a rebuttal or additional comments. She did not respond. 12. As evidence to support her request for reconsideration, she provides a letter from her former company commander dated 15 April 2015. The commander acknowledges the applicant served under his command in Iraq in 2005. He asserts it was a very difficult time for U.S. Soldiers who operated "outside the wire." He reports his company had three Soldiers killed-in-action and 23 Soldiers were seriously injured. a. The applicant was a gun-truck driver serving as a crew-served weapons operator (machine guns and automatic grenade launchers) supporting the Marine Expeditionary Force. b. He states the applicant?s experiences in Iraq were absolutely traumatic. She and her peers were exposed to extreme situations which tested the limits of one?s psychological resilience. Members of the applicant’s platoon were wounded by improvised explosive devices. She also was personally involved in the escalation of force incidents involving local national civilians. In addition, her friend lost his right hand during an attack. He states the applicant’s demeanor changed and she was visibly shaken. She was distressed and understandably angry. Due to increased mission requirements, her chain of command was not able to adequately address her combat stressors. She was referred to mental health professionals to help her chain of command develop more proactive ways to help her and other Soldiers suffering from combat stress. c. He was diagnosed with PTSD. He now believes he misinterpreted the applicant’s signs and symptoms in Iraq. As her commander he expedited her return to Fort Drum, NY, with a recommendation that she be chaptered out of the Army. His main focus in 2005 was maintaining operations and combat readiness in Iraq. He asserts that prior to the unit’s deployment, the applicant was a competent and dedicated Soldier. Her perceived behavioral problems did not start until combat operations were escalated by direct enemy attack incidents and their use of improvised explosive devices. He found the situation difficult himself and can only imagine how a young Soldier must have felt in the chaos of combat. He asks the Board to favorably review her application and change her narrative reason for discharge. REFERENCES: 1. AR 635-200 provides the basic authority for the separation of enlisted personnel. Paragraph 5-13 states a Soldier could be separated for personality disorder (as determined by medical authority), not amounting to disability under AR 635-40 (Physical Evaluation for Retention, Retirement, or Separation), provided the personality disorder interfered with assignment to or performance of duty. The regulation required that the condition be a deeply ingrained maladaptive pattern of behavior of long duration that interfered with the Soldier's ability to perform duty. The diagnosis must have concluded that the disorder was so severe that the Soldier’s ability to function in the military environment was significantly impaired. 2. AR 635-5-1 (Separation Program Designator (SPD) Codes) states that the SPD codes are three-character alphabetic combinations which identify reasons for and types of separation from active duty. The SPD code JFX is the correct code for Soldiers separating under paragraph 5-13 of AR 635-200 because of a personality disorder. 3. AR 635-40 establishes the Army disability system 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 or her office, grade, rank, or rating. It provides for medical evaluation boards, which are convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status. A decision is made as to the Soldier's medical qualifications for retention based on the criteria in AR 40-501. Paragraph 3-1 provides that the mere presence of impairment does not, of itself, justify a finding of unfitness because of physical disability. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier reasonably may be expected to perform because of their office, grade, rank, or rating. To ensure all Soldiers are physically qualified to perform their duties in a reasonable manner, medical retention qualification standards have been established in AR 40-501, chapter 3. 4. AR 40-501 governs medical fitness standards for enlistment, induction, appointment (including officer procurement programs), retention, and separation (including retirement). It outlines medical conditions which may render an individual unfit or which may preclude enlistment and notes that both personality and adjustment disorders will be dealt with through administrative and not medical channels. Paragraph 3-32.1 stated an individual with a history of or current manifestations of personality disorder effecting duty did not render an individual unfit because of physical disability. Paragraph 3-32.2 stated adjustment disorders (transient, situational maladjustments due to acute or special stress) also did not render an individual unfit because of physical disability. Those conditions at the time rendered an individual administratively unfit for continued military service. Such conditions would be dealt with through administrative channels, including process in accordance with procedures outlined in AR 635-200 5. Title 10, U.S. Code, chapter 61, provides disability retirement or separation for a member who is physically unfit to perform the duties of her office, rank, grade or rating because of disability incurred while entitled to basic pay. 6. Title 38, U.S. Code, sections 310 and 331, permit the VA to award compensation for a medical condition which was incurred in or aggravated by active military service. The VA, however, is not required by law to determine medical unfitness for further military service. The VA, in accordance with its own policies and regulations, awards compensation solely on the basis that a medical condition exists and that said medical condition reduces or impairs the social or industrial adaptability of the individual concerned. Consequently, due to the two concepts involved, an individual's medical condition, although not considered physically unfit for military service at the time of processing for separation, discharge, or retirement, may be sufficient to qualify the individual for VA benefits based on an evaluation by that agency. DISCUSSION: The applicant served on active duty from 2 October 2002 to 24 June 2005. During her second deployment to Iraq, she exhibited an emotional crisis following the serious combat incurred injury of her friend. Concerned with her behavior, her commander referred her for a mental status evaluation. a. The mental status evaluation yielded a personality disorder diagnosis. This diagnosis did not amount to a disability under AR 635-40 though it interfered with the applicant's ability to perform her military duties. Because this mental status evaluation determined she was diagnosed with a personality disorder that affected her ability to function effectively in a military environment, her chain of command initiated separation action against her under the provisions of paragraph 5-13 of AR 635-200. b. Her administrative discharge under the provisions of paragraph 5-13 of AR 635-200 for a personality disorder appears proper and in compliance with pertinent regulations. Her discharge was administratively correct and in conformance with applicable regulations with no indication of any violations of her rights or procedural errors. Accordingly, the type of discharge directed and the reasons therefore appear appropriate under the circumstances. c. A review of her records, and the evidence she submitted, does not support her contention that she should have been given a medical discharge. That review determined there was no evidence that, at the time of separation, she met the criteria for a mental or a behavioral health condition that did not meet medical retention standards or was found unfitting. d. In order to be separated for disability, the Army has a process that begins with entry into the disability evaluation system. Referral to this system requires a designation of unfitness before an individual can be separated from the military because of an injury or medical condition. In the applicant's case, there is no evidence to show she had: * a permanent physical profile * a diagnosis that a medical condition failed medical retention standards * a diagnosis of a disabling condition that rendered her unable to perform the duties required of her MOS or former grade * a medical examination that warranted her entry into the disability evaluation system e. Whenever there is a disability, 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 the Soldier’s office, grade, rank, or rating. 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. This does not appear to be the case here. f. The Army diagnosis of personality disorder is a reflection of her condition and its impact on her military duties at the time of service and/or separation. Her diagnosis in 2005 was personality disorder, which was a basis for administrative separation. g. A diagnosis of a mental or behavioral health condition post-service and the subsequent award of a VA rating does not establish entitlement to medical retirement or separation from the Army. Operating under its own policies and regulations, the VA which has neither the authority nor the responsibility for determining medical unfitness for military duty, awards ratings because a medical condition is related to service and affects the individual's civilian employability. h. The VA evaluates a member throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. The Army must find that a service member is physically unfit to reasonably perform his or her duties and assign an appropriate disability rating before he or she can be medically retired or separated. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150013744 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150013744 10 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2