BOARD DATE: 17 August 2017 DOCKET NUMBER: AR20160000200 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 BOARD DATE: 17 August 2017 DOCKET NUMBER: AR20160000200 BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined the evidence presented is sufficient to warrant amendment of the ABCMR's decision in Docket Number AR2000041727, dated 12 September 2000. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by reissuing his DD Form 214 to show the character of his service as general under honorable conditions. 2. The Board further determined 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 to upgrading his character of service to fully honorable. __________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: 17 August 2017 DOCKET NUMBER: AR20160000200 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 an earlier request to upgrade his discharge under other than honorable conditions (UOTHC) to honorable. 2. The applicant states: a. Post-traumatic stress disorder (PTSD) affected his mental health and caused him to be absent without leave (AWOL). b. On 3 September 2014, the Secretary of Defense issued a memorandum providing guidance to the Military Department Boards for Correction of Military/Naval Records regarding discharge upgrades by veterans claiming PTSD. 3. The applicant provides numerous civilian mental health records, dated June 1984 to June 1987. CONSIDERATION OF EVIDENCE: 1. Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR2000041727 on 12 September 2000. 2. The medical records provided by the applicant are new evidence that was not previously considered by the Board and warrants consideration at this time. 3. The applicant enlisted in the Regular Army on 17 February 1983 for a period of 4 years. He completed his training and was awarded military occupational specialty 62J (general construction equipment operator). 4. He was AWOL from 17 September 1983 to 16 November 1983. On 18 November 1983, charges were preferred against him for the AWOL period. 5. On 18 November 1983, he consulted with counsel and voluntarily requested discharge for the good of the service in lieu of trial by court-martial under the provisions of Army Regulation 635-200 (Personnel Separations – Enlisted Personnel), chapter 10. He acknowledged that by submitting his request for discharge, he was guilty of a charge against him that authorized the imposition of a bad conduct or dishonorable discharge. He indicated he understood he might be discharged under conditions other than honorable and given a discharge UOTHC, he might be ineligible for many or all benefits administered by the Veterans Administration, he might be deprived of many or all Army benefits, and he might be ineligible for many or all benefits as a veteran under both Federal and State laws. He acknowledged he might expect to encounter substantial prejudice in civilian life because of a discharge UOTHC. He elected not to make a statement in his own behalf. 6. On 31 January 1984, the separation authority approved his voluntary request for discharge and directed the issuance of a discharge UOTHC. 7. On 17 February 1984, he was discharged for the good of the service in lieu of trial by court-martial under the provisions of Army Regulation 635-200, chapter 10. He completed 10 months and 2 days of creditable active service during this period with 60 days of lost time. His service was characterized as UOTHC. 8. There is no evidence of record showing he was diagnosed with PTSD or any behavioral or mental health condition prior to or subsequent to his discharge. 9. He provided: a. A psychiatric intake from the Southeastern Regional Mental Health Center of Lumberton, North Carolina, dated 5 June 1984, documenting the applicant was actively psychotic with paranoia and strange behaviors. According to the intake, the applicant's mother reported the applicant had his first psychotic break during basic training and was hospitalized for this. His mother states she saw the applicant's military medical records when he came home while AWOL and saw the diagnosis of schizophrenia. b. A diagnostic report from the North Carolina Division of Mental Health/Mental Retardation and Substance abuse Services, dated 16 July 1984, showing he was diagnosed with chronic undifferentiated schizophrenia. c. A termination summary from the North Carolina Division of Mental Health/Mental Retardation, dated 1 May 1986, showing he was diagnosed with schizophrenic disorder, undifferentiated, unspecified. 10. On 27 February 1987, the Army Discharge Review Board denied his request for a discharge upgrade. 11. On 12 September 2000, the ABCMR denied his request for a general discharge. 12. An advisory opinion was rendered by the Army Review Boards Agency Psychiatrist, dated 25 May 2017, wherein she stated: a. The applicant's military personnel records are void of any information regarding his behavioral health. His mother reported to his healthcare providers that the applicant developed psychotic symptoms during basic training and was hospitalized. The mother stated she saw military medical records diagnosing the applicant was schizophrenia. This documentation, however, is not present in the applicant's military personnel records. No military medical records are available for review. b. There is no evidence in the applicant's military records that he failed to meet retention standards. c. In conclusion, review of the military personnel record indicates no evidence of any behavior health condition, to include schizophrenia. A review of the civilian medical records, however, indicates indisputably that the applicant was diagnose with schizophrenia four months after being discharged from the Army. Given the proximity of his date of diagnosis to his date of discharge, it is almost certain the applicant was psychotic and suffering from the effects of schizophrenia while serving on active duty. The fact he was AWOL with no obvious explanation further supports this contention. Psychotic individuals are prone to illogical thinking and impulsive behaviors. Additionally, oftentimes these individuals have paranoid delusions regarding governmental organizations such as the military. The combination of these paranoid delusions, irrational thinking and impulsivity could quiet easily result in the psychotic individual taking flight (i.e., being AWOL) in order to protect himself. d. The available records do support a boardable diagnosis at the time of his discharge – chronic undifferentiated schizophrenia. e. There is no evidence in the applicant's military records that he failed to meet retention standards. f. His diagnosis of chronic undifferentiated schizophrenia is a mitigating factor in his misconduct. Schizophrenia can lead to impulsive, irrational, paranoid thinking which can result in the affect individual fleeing in order to protect himself. As such, there is a nexus between the applicant's schizophrenia and the misconduct of being AWOL. 13. A copy of the advisory opinion was provided to the applicant for comment and/or rebuttal. He responded and stated he doesn't have any Department of Veterans Affairs medical records because his family didn't know he qualified for such support with a discharge UOTHC. Therefore, his mother used the public mental health system. He was admitted at the first available appointment. He is not sure what happened to his military medical treatment records. The copy they sent him didn't have anything in his records about seeing doctors about mental behavior even though his mother received a call stating he might be medically discharged. He was treated with shots in his eye at the Fort Leonard Wood medical treatment facility and that wasn't in the copy of medical records sent to him. REFERENCES: 1. Army Regulation 635-200 sets forth the basic authority for separation of enlisted personnel. a. 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. b. Paragraph 3-7b provides that a general discharge is a separation from the Army under honorable conditions. When authorized, it is issued to a Soldier whose military record is satisfactory, but not sufficiently meritorious to warrant an honorable discharge. c. Chapter 10 provides that a member who has committed an offense or offenses for which the authorized punishment includes a punitive discharge may submit a request for discharge for the good of the service in lieu of trial by court-martial. The request may be submitted at any time after charges have been preferred and must include the individual's admission of guilt. Although an honorable or general discharge is authorized, a discharge UOTHC is normally considered appropriate. 2. The Diagnostic and Statistical Manual of Mental Disorders (DSM), chapter 7, addresses trauma and stress or related disorders. The DSM is published by the American Psychiatric Association (APA) and provides standard criteria and common language for classification of mental disorders. In 1980, the APA added PTSD to the third edition of its DSM nosologic classification scheme. Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice. From a 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." 3. 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. 4. The fifth edition of the DSM 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 criterion 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; or (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; or (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 or (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); and (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, and (6) sleep disturbance; f. Criterion F – Duration: Persistence of symptoms (in Criteria B, C, D, and E) for more than 1 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. 5. 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 UOTHC 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 Soldiers' 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 a 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. 6. On 3 September 2014 in view of the foregoing information, 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 UOTHC 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 applicants' service. 7. 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? 8. Although DOD acknowledges that some Soldiers who were administratively discharged UOTHC may have had an undiagnosed condition of PTSD at the time of their discharge, it is presumed that they were properly discharged based upon the evidence that was available at the time. Conditions documented in the records that can reasonably be determined to have existed at the time of discharge will be considered to have existed at the time of discharge. In cases in which PTSD or PTSD-related conditions may be reasonably determined to have existed at the time of discharge, those conditions will be considered potential mitigating factors in the misconduct that caused the UOTHC characterization of service. BCM/NRs will exercise caution in weighing evidence of mitigation in cases in which serious misconduct precipitated a discharge with a characterization of service of UOTHC. Potentially mitigating evidence of the existence of undiagnosed combat-related PTSD or PTSD-related conditions as a causative factor in the misconduct resulting in discharge will be carefully weighed against the severity of the misconduct. PTSD is not a likely cause of premeditated misconduct. BCM/NRs will also exercise caution in weighing evidence of mitigation in all cases of misconduct by carefully considering the likely causal relationship of symptoms to the misconduct. DISCUSSION: 1. The applicant's voluntary request for separation for the good of the service in lieu of trial by court-martial under the provisions of Army Regulation 635-200, chapter 10, was administratively correct and in conformance with applicable regulations. The type of discharge directed and the reason for discharge were appropriate considering all the facts of the case. 2. Although the applicant contends PTSD affected his mental health and caused him to be AWOL, there is no evidence and he provided no evidence showing he was diagnosed with PTSD. However, the evidence shows he was diagnosed with schizophrenia 4 months after his discharge from the Army on 6 June 1984. 3. A clinical psychiatrist reviewed his records and determined: a. Given the proximity of his date of diagnosis of schizophrenia (June 1984) to his date of discharge (February 1984), it is almost certain the applicant was psychotic and suffering from the effects of schizophrenia while serving on active duty. b. The available records do support a boardable diagnosis at the time of discharge – chronic undifferentiated schizophrenia. c. His diagnosis of chronic undifferentiated schizophrenia is a mitigating factor in his misconduct. 4. As a matter of clemency, this nexus may serve as a basis for a recommendation to upgrade the characterization of his service to general under honorable conditions. 5. A general discharge is a separation from the Army under honorable conditions. When authorized, it is issued to a Soldier whose military record is satisfactory but not sufficiently meritorious to warrant an honorable discharge. 6. His overall service did not rise to a fully honorable character of service. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160000200 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160000200 10 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2