IN THE CASE OF: BOARD DATE: 30 November 2017 DOCKET NUMBER: AR20170000771 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. 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: 30 November 2017 DOCKET NUMBER: AR20170000771 BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :mwm :dt :mra DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 30 November 2017 DOCKET NUMBER: AR20170000771 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 Assistant Secretary of the Army (Manpower and Reserve Affairs) (ASA M&RA) submits an application on behalf of a group of Soldiers requesting that the Army Board for Correction of Military Records (ABCMR): a. Consider whether a potential violation of Title 10, U.S. Code, section 1177 (Members diagnosed with or reasonably asserting post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI): medical examination required before administrative separation) occurred during these Soldiers' separation processing. b. Determine whether a diagnosis of PTSD and/or TBI should result in an upgrade of these Soldiers' characterizations of service. 2. The group application states the ASA M&RA was unable to confirm that these Soldiers' PTSD and TBI diagnoses were considered by the separation authority during separation processing. 3. The ASA M&RA provides an attached list of Soldiers who may have been affected by a potential violation of Title 10, U.S. Code, section 1177. CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 8 March 2007. He held military occupational specialty 19D (Cavalry Scout). 2. A review of his record shows he served in Iraq from 5 May 2008 through 22 May 2009 and in Afghanistan from 30 July 2010 through 26 February 2011. 3. Orders A-02-103934, issued by Landstuhl Regional Medical Center on 24 February 2011, show the applicant was attached to the Warrior Transition Battalion, Fort Bragg, NC, for the purpose of continued medical care. His report date was 24 February 2011 with an end date of 16 March 2011. 4. A DA Form 4187 (Personnel Action) indicates the applicant's duty status was changed from present for duty to civilian confinement effect 23 March 2011. 5. A Sentencing Order from the Virginia Circuit Court, Roanoke County, dated 24 August 2012, shows the applicant was found guilty of malicious wounding, abduction, and reckless driving on 18 May 2012. He was sentenced to a total of 30 years and 12 months, of which all except 20 years and 12 months were suspended with a $1,000 fine. 6. On 19 September 2012, the applicant's immediate commander notified him of his intent to initiate separation actions against him under the provisions of Army Regulation 635-200 (Active Duty Enlisted Administrative Separations), section II, paragraph 14-5, for conviction by civil court. The applicant’s commander cited the bases for his recommendation was the applicant's conviction on 24 August 2012 for malicious wounding, abduction, and reckless driving. The commander indicated he was recommending the applicant receive an under other than honorable conditions discharge and advised him of his rights. On the same date, the applicant acknowledged receipt of the notification memorandum. 7. The applicant consulted with legal counsel on 11 December 2012 and was advised of the basis for the contemplated separation action, the effects of such a discharge, the rights available to him, and the effect of any action taken by him in waiving his rights. He waived his rights to have his case considered by an administrative separation board, to personally appear before a separation board, and to submit statements in his own behalf. 8. On 11 December 2012, the applicant’s immediate commander recommended his discharge under the provisions of Army Regulation 635-200, section II, paragraph 14-5, by reason of his conviction by civil court for malicious wounding, abduction, and reckless driving. It was further noted that a report of mental status evaluation or psychiatric report or a report of medical examination was not attached. 9. On 11 January 2013, the separation authority, after reviewing the applicant's entire file and matters regarding him, approved his unconditional waiver and directed that he be discharged under the provisions of Army Regulation 635-200, paragraph 14-5, due to civil conviction, with an under other than honorable conditions discharge. The separation authority also directed that he be reduced to the lowest enlisted grade and that he not be transferred to the Individual Ready Reserve. 10. The applicant was discharged on 21 February 2013. His DD Form 214 (Certificate or Release or Discharge from Active Duty) confirms he was discharged under the provisions of Army Regulation 635-200, chapter 14, section II, by reason of misconduct (civil conviction). This form also shows his service was characterized as under other than honorable conditions, his rank at the time of discharge was private, and he had lost time from 23 March 2011 through 21 February 2013. His awards and decorations include the Purple Heart and the Combat Action Badge. 11. The applicant applied to the Army Discharge Review Board (ADRB) for an upgrade of his discharge within that board’s 15-year statute of limitations. The ADRB denied his request for an upgrade of his discharge on 19 August 2015. 12. In the processing of this case, on 22 February 2017, an advisory opinion was obtained from the Army Review Boards Agency (ARBA) Psychiatrist, who opined: a. The applicant entered the Army on 8 March 2007. While on active duty, he served a tour in Iraq (5 May 2008 through 22 May 2009) and in Afghanistan (30 July 2010 through 26 February 2011). On 21 February 2013, he was separated from the Army with an under other than honorable conditions discharge in accordance with Army Regulation 635-200, chapter 14-5, misconduct (civil conviction). He was found guilty by a civilian court of malicious wounding, abduction and reckless driving. He was sentenced to 30 years in prison, 10 years of which were suspended. He applied to the ADRB for an upgrade of his discharge, which he was denied on 19 August 2015. The applicant is now applying to the ABCMR for discharge relief as part of a Group Application for Correction of Military Records contending that his misconduct was a direct result of his untreated TBI and PTSD. b. Documentation reviewed includes the applicant's ABCMR application, his 2015 ADRB Record of Proceedings, his military separation file, civilian court documentation, his electronic military medical record (AHLTA) and the electronic Department of Veterans Affairs (VA) medical record (JLV). c. A review of the VA documentation indicates the applicant underwent a Compensation and Pension Examination on 17 October 2016 which diagnosed him with PTSD. The examination also indicated the applicant did not have a diagnosed TBI. d. A review of the military medical record indicates the following: (1) On 23 May 2009, the applicant was evaluated in a post-deployment screening. At this time, the applicant denied problems with anxiety, concentration, irritability, depression or sleep. He denied having a fear of being killed. He denied nightmares, flashbacks or decreased interest. He was cleared to return to duty without limitations. (2) On 11 September 2010, the applicant presented to the theater clinic in Afghanistan complaining of anxiety attacks. He reported he had seen psychiatrists in the States who had treated his anxiety symptoms with Prozac, Paxil, and Buspar with no effect. However, he reported that when the State-side psychiatrist placed him on Xanax (a benzodiazepine) and he had good results. As a result of this history, the applicant was diagnosed with panic disorder with agoraphobia and placed on clonazepam (a benzodiazepines also known as Klonipin). (3) On 13 September 2010, he presented to the theater clinic in a somnolent, intoxicated state. It was determined at that time he had taken most of his monthly supply of Klonipin which had been prescribed 2 days earlier. The treating physician determined, after getting a link to the military electronic medical record, the applicant had never seen any military psychiatrists in the States who prescribed him Xanax, Prozac, or Paxil. At this time, the applicant was diagnosed with benzodiazepine abuse. (4) On 20 January 2011, the applicant presented to the theater clinic and was evaluated by a neurologist for complaints of headache and irritability after being exposed to a blast explosion. At the time of the blast, he denied loss of consciousness but endorsed having an alteration of consciousness and peri-event amnesia. He also reported tinnitus and dizziness. He was diagnosed with a Grade II, possibly Grade Ill concussion; DVBIC (Defense and Veterans Brain Injury Center) severity rating for TBl-mild. (5) On 2 February 2011, the applicant underwent an umbilical hernia repair. On 7 February 2011, he presented to the follow up clinic and requested more pain medication. The treating provider documented, "Upon review of narcotic use here he had 90 Percocet and 45 Vicodin tabs (8 were returned to the pharmacy) since his surgery which was 6 days ago ... it appears he has a significant drug issue." (6) On 7 February 2011, he presented to the theater clinic with complaints of anxiety. During his assessment, he endorsed the following symptoms: intrusive memories, flashbacks, avoidance behaviors, irritability, a sense of a foreshortened future, and increased physiological activity. During this appointment, he again requested benzodiazepine. He was diagnosed with acute stress disorder at this time. He was not prescribed any benzodiazepine. (7) On 19 February 2011, the applicant was sent to Fort Bragg for a comprehensive TBI evaluation. This was performed on 28 February 2011. During the exam, it was documented that the applicant currently had no complaints of visual problems, photophobia, hearing loss, memory lapses or loss, speech difficulties, stuttering or tingling. His “PCL” (PTSD Checklist) score was zero; his Beck Depression Inventory and Beck Anxiety Inventory scores were also zero. During this TBI evaluation, the applicant was noted to have a completely normal neurological exam. No motor difficulties, coordination problems, or sensory problems were noted. The applicant's scored 30/30 on his Mini Mental Status Exam (MMSE) with intact concentration and intact immediate/recent/long term memory. The MMSE indicated the applicant had intact executive (i.e., frontal lobe) function with no difficulty following a three-part command, copying a complex design, or following a written command. The examining neurologist concluded his evaluation by documenting: "22 year old Soldier presenting to TBI clinic for initial evaluation with a chief complaint of irritability post multiple blast exposures ... Physical exam and cognitive assessment WNL. Soldier has been prescribed substantial amounts of pain and anti-anxiety medications over the past seven days. Plans are to have Soldier evaluated by behavioral health. Soldier will be cleared and released from TBI clinic without restriction, limitation or profile." (8) A note dated 14 March 2011 documented the applicant's chain of command had been informed the applicant had cancelled one appointment with his primary care manager and was a no show for a second appointment. It was also noted the applicant did not follow up with his behavioral health consult. (9) On 18 March 2011, the applicant was admitted to Lewis Gale Hospital with the diagnosis of major depressive disorder. A case management note dated 29 March 2011 documents the following: "Note in Health Net system said: 'Suicidal with a plan to overdose, depressed, feels worthless, fatigue, can't concentrate ... TBI with losses in his platoon 19 January 2011. Opiate addiction up to 80mg daily, recurrent heroin use, alcohol past 4 days ... Ox Major Depression, Opioid Depression.' ... pt [patient] was discharged yesterday to the Roanoke County Police Department. He [the applicant] is facing charges related to a GSW (gunshot wound) to another person ..." (Of note, the applicant's court documents indicate the date of the applicant's aforementioned offenses occurred on 17 March 2011). e. There is no indication in the applicant's medical records that he failed to meet retention standards in accordance with Army Regulation 40-501 (Standards of Medical Fitness). f. A review of the applicant’s VA records indicates he was diagnosed with PTSD in 2016. There is no diagnosis of PTSD in his military medical records although there is a diagnosis of acute stress disorder which was made on 7 February 2011. This is the only mention of a stress related disorder in his military medical chart. During his comprehensive TBI evaluation which occurred on 28 February 2011, he screened negative for PTSD (PCL score-0) which indicates his acute stress disorder had resolved. g. A review of the applicant’s military medical records indicate he was exposed to three blast exposures during his military deployments. While these did not cause him to lose consciousness, they did cause him to experience headaches, transient visual problems, dizziness, and peri-traumatic amnesia. The applicant was evaluated by three separate neurologists in Afghanistan, Germany and Ft. Bragg. The examining neurologist in Landstuhl, Germany, indicated the applicant had suffered a Grade II concussion and had a DVBIC severity rating for TBI of mild. The applicant was extensively evaluated for TBI at the Fort Bragg TBI clinic on 28 February 2011. At this time, he had a normal neurological exam and a normal mental status exam. He was cleared and released from the TBI clinic without restriction, limitation or profile. h. In conclusion, the applicant was diagnosed with PTSD by the VA in 2016. His military medical records indicate that the applicant was diagnosed with acute stress disorder on 7 February 2011 which subsequently resolved as indicated by his negative PCL screen on 28 February 2011. The applicant was also diagnosed with mild-TBI while on active duty. He was evaluated by the Ft Bragg TBI clinic where he was found fit to return to duty with no restrictions, limitations or profile. The applicant's VA records indicate he was not diagnosed with TBI by the VA. i. Under the liberal guidance criteria of the Secretary of Defense Memorandum, dated 3 September 2014: Supplemental Guidance to Military Boards for Correction of Military/Naval Records Considering Discharge Upgrade Requests by Veterans Claiming PTSD, the applicant's VA diagnosis of PTSD provides sufficient evidence to establish a diagnosis of in-service PTSD. The medical record also supports a diagnosis of in-service mild TBI. The applicant contends in his application that these two conditions are responsible for the misconduct which resulted in his discharge from the Army. It is important for the applicant to realize that, even when taking the aforementioned Secretary of Defense Memorandum into consideration, neither of these diagnoses mitigates the offenses of malicious wounding, abduction, or reckless driving. 13. The applicant was provided a copy of the advisory opinion on or about 23 February 2017 to allow him an opportunity to comment and/or submit a rebuttal. He responded on or about 2 March 2017 by addressing points in the advisory opinion with hand-written comments and submitted an affidavit by his commander during his deployment (Colonel G.) in Afghanistan and a two page medical document. a. The applicant’s hand-written comments, in effect, state: (1) It is correct he was diagnosed with PTSD on 17 October 2016 by the VA during a compensation exam; however, he was not diagnosed for TBI because he had not yet filed for TBI compensation. (2) During his post-deployment screening in 2009, he did deny any mental issues. As a young Soldier he did not want to be looked upon as weak. However, he did have significant problems, as described in Colonel G's affidavit discussing his stressors. (3) He was prescribed Xanax by a private physician prior to his Afghanistan deployment. (4) It is true that he took more Xanax than prescribed as his anxiety level was extremely high and the recommended dose did not help. (5) His MACE score was 22/30 on 20 January 2011, as a possible stress reaction to the event (blast explosion). (6) As a result of seven months of facing enemy contact, he did ask for more benzodiazepines to help ease his anxiety. (7) He was eventually prescribed anti-anxiety medication. On 28 February 2011, he felt he could manage his stress and anxiety symptoms with the help of medication and he wanted to leave the hospital. He believed he could handle his mental state, but instead it rapidly deteriorated. He tried to seek help at the VA in Salem, Virginia in March. (8) He stated he missed appointments because his rear detachment chain of command advised him to reschedule since he was on leave at the time. (9) His medical records clearly state his diagnosed PTSD led to his offenses and eventually his discharge. Any substance abuse was a result of the only way of coping with his PTSD. His civilian doctor states he does not have a benzodiazepine dependency. (10) He did have acute stress disorder. He has documented complaints of what he knows to be PTSD symptoms while in combat. He was prescribed benzodiazepines and his symptoms did subside from time to time, then not at all unless he took more and more. (11) He was "blown-up" on six different occasions, however, only three were documented and he believes he has permanent brain damage from these blast explosions. His offenses occurred less than 8 weeks from his last TBI examination. He realizes he was cleared for duty and his PTSD and TBI and the advisory opinion stated they could not have caused his violent offenses; however, his mental state (paranoia, anxiety, anger, mood swings, headaches, flashbacks) went completely downhill and he could not sleep without alcohol. (12) He has PTSD and TBI based on his military service. His civilian doctors and Colonel G's affidavit clearly indicate that his actions on 17 March 2011 (his civilian misconduct) were a direct result of his untreated PTSD and TBI. b. A three-page written affidavit, dated 18 August 2015 from a Colonel G, who was his Commander while he deployed to Afghanistan. This letter is written to "Whom It May Concern" and addressed to the Commonwealth of Virginia. It additionally requests a more lenient sentence to allow the applicant the opportunity to resume leading a productive life out of prison. It states, in pertinent part, the applicant: (1) Has clearly made some poor decisions and he believes these decisions can be directly related to his service record. (2) Has served in combat in Iraq and Afghanistan. He has been involved in mass casualty events and was personally injured in two explosive attacks. He was injured in an enemy rocket attack on Kandahar Airfield (Afghanistan) on 19 January 2011 and he suffered a TBI, shrapnel wounds, and ruptured eardrums. He was eventually evacuated in February to a U.S. medical facility where he was diagnosed with PTSD, and eventually evacuated back to Fort Bragg in March 2011. (3) Stressors of combat, his physical injuries, and survivor's guilt were directly attributed to his incarceration. He knows he should be punished for his offenses; however, based on his military service he should be granted leniency in his sentence. c. A two-page medical write-up (only pages 1 and 2 of 5 pages), from the applicant's attending physician at the Center for Behavior Heath (Lewis-Gale Regional Health System), dated 18 March 2011, shows he was admitted on this date for treatment in regards to substance abuse, suicidal ideations, feeling overwhelmed, and having thoughts of killing himself. This document states his family history of substance abuse; however, the two pages do not list any diagnoses. REFERENCES: 1. Title 10, U.S. Code, section 1177, states: a. Medical Examination Required: (1) Under regulations prescribed by the Secretary of Defense, the Secretary of a military department shall ensure that a member of the armed forces under the jurisdiction of the Secretary who has been deployed overseas in support of a contingency operation, or sexually assaulted, during the previous 24 months, and who is diagnosed by a physician, clinical psychologist, psychiatrist, licensed clinical social worker, or psychiatric advanced practice registered nurse as experiencing PTSD or TBI or who otherwise reasonably alleges, based on the service of the member while deployed, or based on such sexual assault, the influence of such a condition, receives a medical examination to evaluate a diagnosis of PTSD or TBI. (2) A member covered by paragraph (1) shall not be administratively separated under conditions other than honorable, including an administrative separation in lieu of court-martial, until the results of the medical examination have been reviewed by appropriate authorities responsible for evaluating, reviewing, and approving the separation case, as determined by the Secretary concerned. (3) In a case involving PTSD, the medical examination shall be performed by a clinical psychologist, psychiatrist, licensed clinical social worker, or psychiatric advanced practice registered nurse. In cases involving TBI, the medical examination may be performed by a physician, clinical psychologist, psychiatrist, or other health care professional, as appropriate. b. Purpose of Medical Examination. The medical examination required by subsection (a) shall assess whether the effects of PTSD or TBI constitute matters in extenuation that relate to the basis for administrative separation under conditions other than honorable or the overall characterization of service of the member as other than honorable. c. Inapplicability to Proceedings Under Uniform Code of Military Justice (UCMJ). The medical examination and procedures required by this section do not apply to courts-martial or other proceedings conducted pursuant to the UCMJ. 2. Army Regulation 635-200 sets forth the basic authority for the separation of enlisted personnel. a. Paragraph 3-7a states 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 states 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. Paragraph 3-7c states a discharge under other than honorable conditions is based on an administrative separation from the service, and may be issued for misconduct, fraudulent entry, security reasons, or in lieu of trial by court martial. When a Soldier is to be discharged under other than honorable conditions, the separation authority will direct an immediate reduction to the lowest enlisted grade. d. Chapter 14 of this regulation establishes policy and prescribes procedures for separating members for misconduct. Specific categories include minor disciplinary infractions, a pattern of misconduct, commission of a serious offense, conviction by civil authorities, desertion, or absences without leave. Action will be taken to separate a member for misconduct when it is clearly established that rehabilitation is impracticable or is unlikely to succeed. A discharge under other than honorable conditions is normally considered appropriate. However, the separation authority may direct a general discharge if such is merited by the Soldier's overall record. 3. 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." 4. 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. 5. 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. 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. 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? 9. Although the 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 presumed they were properly discharged based upon the evidence that was available at the time. a. Conditions documented in the record 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 under other than honorable conditions characterization of service. b. Corrections Boards will exercise caution in weighing evidence of mitigation in cases in which serious misconduct precipitated a discharge with a characterization of service of under other than honorable conditions. 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. c. Correction Boards 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. 10. 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's record shows he was evaluated at a theater clinic while in Afghanistan, on or about 20 January 2011, after being exposed to a blast explosion. He was treated and diagnosed with a Grade II, possibly a Grade III concussion, with a severity rating of mild TBI. 2. On or about 7 February 2011, he was evaluated at the theater clinic again in Afghanistan with complaints of anxiety. He was diagnosed with acute stress disorder and was not given any requested medication. Subsequently, he was medically evacuated to Fort Bragg via Landstuhl, Germany on or about 19 February 2011 for a comprehensive TBI evaluation. On 28 February 2011, the examination noted his PCL (PTSD checklist) score was zero, and TBI evaluation indicated a completely normal neurological exam with no problems noted. He was cleared and released from the TBI clinic without restriction, limitation, or profile. Due to his complaints he was referred to behavioral health for consultation. However, on 14 March 2011 it was noted that his chain of command had been informed the applicant cancelled an appointment and was a no-show for another appointment with his primary care manager. 3. Additionally, he did not follow-up with his behavioral health consult. The applicant's rebuttal indicated he was advised not to go since he was on leave. 4. On 18 March 2011, he was admitted to a civilian hospital with the diagnosis of major depressive disorder. A case management note, dated 29 March 2011 indicated the following observations: depression, opiate addiction, heroin use, and alcohol use. It further stated he was released (on or about 28 March 2011) to the Roanoke County Police Department. 5. The ARBA Psychiatrist, after a review of his available medical records, opined: a. The applicant was diagnosed with PTSD by the VA on 17 October 2016, while being incarcerated. However, there is no diagnosis of PTSD in his military medical records although there is a diagnosis of acute stress disorder on 7 February 2011, which subsequently resolved as indicated by his negative PCL on 28 February 2011. b. The applicant was also diagnosed with mild-TBI while on active duty. He was evaluated by military medical professionals at the Fort Bragg TBI Clinic and found fit to return to duty with no restrictions, limitations or profile. Additionally, his VA records indicate he was not diagnosed with TBI by their examination. c. Although the PTSD and mild TBI diagnoses were supported as being in-service, even under the liberal guidance criteria of the Secretary of Defense memorandum, neither condition mitigates the offenses of malicious wounding, abduction, or reckless driving for which he is currently incarcerated. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20170000771 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20170000771 17 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2