IN THE CASE OF: BOARD DATE: 31 October 2017 DOCKET NUMBER: AR20160004900 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: 31 October 2017 DOCKET NUMBER: AR20160004900 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. IN THE CASE OF: BOARD DATE: 31 October 2017 DOCKET NUMBER: AR20160004900 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 his record to show he was separated for medical reasons in lieu of discharge at his expiration of term of service (ETS) date. 2. The applicant states, in effect, he suffers from post-traumatic stress disorder (PTSD), which started in 1966 while he was in the service. He thought it was his way of life; he drank a lot and was a loner. He started receiving counseling in 1996 from the Department of Veterans Affairs (VA) in Tucson, Arizona, and has been granted a 100% disability rating for his ears, PTSD, diabetes, and his right hand. He became an alcoholic and is depressed and has nightmares. His wife attends a ladies support group for PTSD. He witnessed a lot of combat in the Republic of Vietnam and believes the government owes him for what happened. 3. The applicant provides a certified copy of his DD Form 214 (Armed Forces of the United States Report of Transfer or Discharge). 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. The applicant was inducted into the Army of the United States on 8 June 1966. Upon completion of his initial entry training, he was awarded military occupational specialty (MOS) 11B (Light Weapons Infantryman). 3. The applicant's DA Form 20 (Enlisted Qualification Record) shows he served in the Republic of Vietnam from on or about 4 December 1966 through on or about 30 November 1967. 4. The applicant was honorably released from active duty and transferred to the U.S. Army Reserve (USAR) on 7 June 1968. His DD Form 214 shows he was discharged under the provisions of Army Regulation 635-200 (Personnel Separations – Enlisted Personnel) upon reaching his ETS date. 5. The Director, Case Management Division, Army Review Boards Agency (ARBA) sent a letter to the applicant on 17 June 2016, requesting medical documentation in support of his PTSD as alleged in his application. In response, the applicant provided approximately 120 pages of medical progress notes from the Southern Arizona VA Health Care System in Tucson, Arizona. These medical documents, dated between 2004 and 2011, show the applicant was diagnosed and treated for PTSD and depression, along with other ailments. 6. In connection with the processing of this case, an advisory opinion was obtained on 13 January 2017 from an ARBA Medical Advisor/Psychologist, who opined: a. The request for a medical opinion review of this case specifically requested consideration of the following referral questions: (1) Does available record reasonably support PTSD, or other boardable behavioral health conditions, existed at the time of the applicant's military service? (2) Did these conditions fail medical retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness), warranting a separation through medical channels? (3) Any additional information deemed appropriate. b. Documentation reviewed included the applicant's ABCMR application and evidence submitted and a limited review of VA records through the Joint Legacy Viewer (JLV). The electronic military medical record was not reviewed as it was not in use during the applicant's time in service. c. The applicant served in the Army from 8 June 1966 to 7 June 1968 as an Infantryman. He was honorably discharged. He did one tour in Vietnam from 4 December 1966 to 30 November 1967 with the 5th Infantry Division. During his tour in Vietnam, he became a team leader and obtained a CIB, Purple Heart, and Bronze Star Medal along with other entitled awards. The applicant did not adjust well after leaving the Army. d. His available records showed an Army profile with no issues, which was the same as when he was inducted into the Army. At least one problem in the submitted records – alcohol – predated his military service. His "Application for Determination of Moral Eligibility for Induction" of 29 March 1966 showed 3 self-admitted instances of offenses, all involving alcohol, and two verified by the police. He admitted to illegal consumption offenses in 1960 and 1961 and driving while intoxicated (DWI) in 1966. The latter two offenses were verified by the Chandler, Arizona, police department. e. His VA doctor in a note of 17 August 2011 indicated his alcoholism is in remission. He was also assessed as having PTSD and recurrent major depression that was in partial remission, meaning he still had depressive symptoms, but did not meet full criteria for having an active major depressive episode. He dated his PTSD to 1966. He first had treatment for PTSD by his own admission in 1996 at the Tucson VA Medical Center. Although the applicant stated he is rated 100% service connected by the VA, the rating in his VA records indicated 80%, but that was in 2011 and did not break out percentages. The applicant also did not break out his percentages, but said he was 100% for "ears, PTSD, diabics (sic) and right hand." f. In regard to functional impairment, his Global Assessment of Functioning scores, a measure no longer in use, in the VA records were all consistent with a high level of active, debilitating psychiatric symptoms. In any event, it would have been impossible to medically have discharged him in 1967 based on available records for at least three reasons. None of his profiles warranted it. Second, PTSD was not at the time a recognized diagnosis in DSM III. Third, there is no evidence the applicant ever sought mental-health treatment during his service. Even if, as is highly probable, it is true that he does have a VA disability rating of 100% service-connected, his belief that he deserves more compensation is irrelevant to what he actually receives, as his benefits are fixed by rules independent of an applicant's beliefs and preferences. g. In regard to the referral questions: (1) The applicant's medical records do at the time of his discharge reasonably support him having had a boardable medical condition for that period. (2) He did meet standards in Army Regulation 40-501and Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) for retention at the time of his discharge. (3) Based on available behavioral health evidence, the applicant has experienced considerable distress in years since his exposure to combat in Vietnam, including his being wounded in action. Nevertheless, he appears to be getting the aid he is entitled to under the law and his request for more aid or medical retirement does not, based on available records, meet requirements for additional aid he would like to receive. h. In conclusion, the applicant did meet medical retention standards in accordance with chapter 3, Army Regulation 40-501, and following the provisions set forth in Army Regulation 635-40 that were applicable to the era of service. His medical conditions were considered at the time of his discharge and a review of available documentation did find evidence of service related PTSD; however, him having PTSD did not justify his request for a change to his discharge. 7. A copy of the advisory opinion was forwarded to the applicant on 18 January 2017, for information and to allow him the opportunity to submit comments or a rebuttal. The applicant did not respond. REFERENCES: 1. Army Regulation 15-185 (ABCMR) states ABCMR members will review all applications that are properly before them to determine the existence of an error or injustice; direct or recommend changes in military records to correct the error or injustice, if persuaded that material error or injustice exists and that sufficient evidence exists on the record. The ABCMR begins its consideration of each case with the presumption of administrative regularity. 2. Army Regulation 40-501 governs medical fitness standards for enlistment, induction, appointment, retention, separation, and retirement. Chapter 3 (Medical Fitness Standards for Retention and Separation, including Retirement) provides guidance on the various medical conditions and physical defects that may render a Soldier unfit for further military service, and that fall below the standards required for service. 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; may compromise or aggravate the Soldier's health or well-being if the Soldier were to remain in the military service; may compromise the health or well-being of other Soldiers; or may prejudice the best interests of the government if the individual Soldier were to remain in the military service. 3. Title 38, U.S. Code, sections 1110 and 1131 permit the VA to award compensation for disabilities which were incurred in or aggravated by active military service. However, an award of a higher VA rating does not establish error or injustice on the part of the Army. The Army rates only conditions determined to be physically unfitting at the time of discharge which disqualify the Soldier from further military service. The VA does not have the authority or responsibility for determining physical fitness for military service. The VA awards disability ratings to veterans for service-connected conditions, including those conditions detected after discharge, to compensate the individual for loss of civilian employability. These two government agencies operate under different policies. Unlike the Army, the VA can evaluate a veteran throughout his or her lifetime, adjusting the percentage of disability based upon that agency's examinations and findings. 4. 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." 5. 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. 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. The acting Under Secretary of Defense for Personnel and Readiness provided clarifying guidance on 25 August 2017, which expanded the 2014 Secretary of Defense memorandum, that directed the BCM/NRs and DRBs to give liberal consideration to veterans looking to upgrade their less-than-honorable discharges by expanding review of discharges involving diagnosed, undiagnosed, or misdiagnosed mental health conditions, including PTSD; traumatic brain injury; or who reported sexual assault or sexual harassment. DISCUSSION: 1. The applicant requests correction of his record to show he was separated for medical reasons in lieu of his honorable discharge upon his ETS date. 2. The applicant contends his PTSD started in 1966 as a result of his military service and his duty in the Republic of Vietnam. He served two years of active duty service and was honorably released from active duty upon reaching his ETS date. 3. The applicant's record does not contain evidence that shows he failed to meet retention criteria in accordance with Army Regulation 40-501 nor any evidence he was diagnosed with having a physical disability that prevented him from reasonably performing his military duties while serving on active duty. 4. The applicant provides medical documentation from the VA, for the period covering 2004 through 2011, which shows he was diagnosed with PTSD and depression and has received medical treatment and medication. 5. The ARBA Clinical Psychologist opined that all his medical conditions were appropriately evaluated at the time of his discharge. The applicant's VA records do indicate a diagnosis of PTSD, depression, and other ailments: however, simply noting the VA provided a disability rating of 100% service-connected does not justify his request or support a change of the reason for discharge in this case. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160004900 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160004900 7 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2