ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 22 July 2019 DOCKET NUMBER: AR20170009042 APPLICANT REQUESTS: reconsideration of: * Change the narrative reason for separation from in lieu of trial by court martial to show retired for disability * Change characterization from General under Honorable Conditions to Honorable APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * Veterans’ Administration Form 21-22a (Appointment of Individual as Claimant’s Representative) * Texas Civil Rights Project request for reconsideration * Statement from his wife, C.O. * Statement from applicant FACTS: 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 AR20140019861 on 28 April 2016. 2. The applicant representative states in response to a letter, dated 29 April 2016, from the Army Board for Correction of Military Records to the applicant, in which the Board denied Cpt. X's application for correction of military records. On behalf of Cpt. X., she now submit, within the one-year deadline, additional evidence and argument for the Board's consideration that was not previously presented when it denied his application. They respectfully request that the Board reconsider its decision, and grant the applicant a discharge upgrade. a. The applicant states, He served as a member of the U.S. Army for 13 years, from March 1997 to April 2010. He was honored to be trusted enough to rise in rank to the position of an air defense officer. He was proud to have served his country for 13 years. During his service, he had two deployments: one to Iraq for almost a year in 2003, and one to Afghanistan for about a year from late 2007 to late 2008. Both involved combat. But, while both deployments were challenging, it was really the deployment to Afghanistan, rather than to Iraq, that he experienced the most intense combat related stress and trauma. (1) During the deployment to Afghanistan, he was stationed at Camp Sweeney, a base in Zabul. His team was assigned to set combat missions, like search and destroy, or search and rescue. They targeted the Taliban, and provided humanitarian aid. His unit was isolated. They originally had 20 officers and special force operators, but they were quickly divided into four groups of five to pair up with Afghan Soldiers. They had no telephone, no Internet, no cook, and no medic. He served as the medic because he had prior training. For communication, they had only a satellite phone that he used with a calling card, to call his wife, maybe once a month. They were scheduled for a one-year deployment, but they knew that anything was possible. If, for example, the Army did not have a replacement ready, they knew they could be deployed for longer than a year. (2) During deployment, they were attacked and ambushed regularly. They were shot at and subjected to explosions on a daily basis. They ran over Improvised explosive devices (IED) while driving. One of these times was the time that the explosion caused permanent injury to his head, resulting in traumatic brain Injury (TBI). He can't count the number of times he went into battle. They knew they were going to be under fire. It was really not a question of if, but how many times. Oftentimes, they were attacked or ambushed four times each trip. Because he was on forward observation, the fire was particularly close. (3) He saw people injured and killed. He saw death over and over again. Of the 20 people who came to the base, 15 sustained injuries by IED explosions. More than once, he had to pick up and carry the remains of fellow Afghan Soldiers who had died. Formally, our mission was to set combat missions; by the end of the deployment, we were told that our mission was "to sustain life." They found out later that the location was actually deemed to dangerous to have troops based there, and was closed by the Army after they left. (4) When he returned from deployment, the rage and numbness got even worse. He knew he needed time to decompress, but unfortunately couldn't get it. He was irritable and spoke loudly to others. He was reckless, and he took stupid risks. He had suicidal ideations. When he first returned home, he drove through red lights. He is not sure if he did not notice or just didn't care. He remember his wife telling him that he was a completely different person. (5) The most reckless risk he took, however, was turning to other women. He knew it wasn't right, but it was the only way he knew of escaping reality, of escaping the compression and confusion that had become the day to day. Prior to his deployment to Afghanistan, he never had the urge to tum to other women. It was only after his deployment, and trying to cope with the symptoms he was experiencing, that he turned to other women; had it not been for these symptoms, he would never have taken the actions he did. He knew it wasn't him, and eventually decided to report it. Unfortunately, one of the women made the report first. (6) Since leaving the service, he has been diagnosed with post-traumatic stress disorder (PTSD), TBI, and severe depression. While he knew during his deployment and upon his return that he had all the symptoms of PTSD, and in fact believed he had PTSD. He never tried to seek treatment for them at the time. Medical records got reported up the chain. He saw the records of those in his command, and he knew his superiors would see his. He was very cognizant of his role as a leader, and did not want to jeopardize his ability to command. The women involved were in fact civilian, not military, and therefore had no connection to the Army. Ultimately, he felt that it just did not look right to seek mental health treatment as an officer. (7) He eventually sought treatment for the symptoms he was experiencing, and he is doing much better. More importantly, he’s been lucky enough to reconcile with his wife, and moved forward in their marriage. She has even been incredibly supportive of the decision to try to upgrade his discharge characterization. Today, they live together in a home outside of San Antonio with their three children. b. Statement from X. states, she met her husband, about 15 years ago, when they were both stationed at Fort Bliss in El Paso, Texas. She also served in the Army, from 2000 to 2012, in the Medical Specialty Corps. They got married in 2003, and raised three children together, one son and two daughters. They currently reside in a home on the outskirts of San Antonio, Texas. (1) She do not remember every detail from the time that he was deployed to Afghanistan in 2007 and 2008, as his deployment was almost 10 years ago now. But certain details do stick out from that year. For example, although she don't remember exactly how often they spoke by phone, but she do remember that his tone was very different from call to call, switching from angry and irritable to almost aloof, just depending on the day. On one particular call, she could hear in the background that his unit was under fire; however, he remained calm the entire time and at one point even made a joke that she was hearing things. Most Soldiers would have had a strong and immediate reaction to the barrage, yet he seemed as if he either didn't notice it or wasn't bothered by it. (2) Upon his redeployment, the irritability she had started to sense from him during his deployment became much worse. Anything and everything irritated him. He also started to exhibit reckless behavior. There has been more than one occasion that he has run through a red light. On one particular occasion she noticed the traffic light turning yellow, but he showed no signs of slowing down. He wasn't talking, he was just "in the zone". Before she knew it he had driven right through the red light. When she questioned him about seeing the red light he stated that he did not notice it. (3) She suggested on several occasions that he seek mental health treatment for his irritability and reckless behavior. He insisted he didn't need it, and he refused to go. He seemed genuinely concerned about seeking treatment, but felt that people would know about it and that they would react negatively to it. It was not until much later on that he eventually went in for treatment, and although he still has his moments of irritability, he has been doing much better. As his wife, she of course know the circumstances surrounding his discharge from the Army. It has understandably taken much time, effort, and healing to move past the incident, but we have done our best to move forward together. Ultimately, we have stayed married throughout, and she is fully supportive of his effort to upgrade his discharge characterization. 3. The applicant provides: * A statement that explains what may have cause his transgressions * A statement from his wife O.G. explaining from her point of view his actions once he return home * A detailed rebuttal by his attorney 4. A review of the applicant’s service record shows the following: a. He enlisted in the Regular Army on 7 March 1997. b. On 6 March 2001, he was discharged from active duty under the provisions of AR 635-200, chapter 4 (Completion of Required Active Service) with an honorable characterization of service. He completed 4 years of active service. c. On 9 May 2002, he was commissioned as a Second Lieutenant in the United States Army Reserve and ordered to active duty. d. He was deployed to Kuwait from 20 January 2003 to 19 March 2003, and to Iraq from 20 March 2003 to 1 June 2003. Then again from Afghanistan from 20 December 2007 to 20 December 2008. e. On 27 October 2009 the applicant acknowledge receipt of a copy of the notification of relief for cause and the supporting documents. f. General Court martial charges were preferred on 30 October 2009. His DD Form 458 (Charge Sheet) indicates he was charged with: * Charge 1, having sexual intercourse with a woman not his wife on 31 July 2009, 19 September 2009, 1 March 2009, 8 September 2009 * Charge 2, having sexual intercourse with a woman not his wife on 31 July 2009, 19 September 2009, 1 March 2009, 8 September 2009 g. According to board proceedings, on 14 December 2009, the applicant requested resignation for the good of the service in lieu of a general court-martial under the provisions of Army Regulation 600-8-24, (Officer Transfers and Discharges) paragraph 3-13. h. Consistent with the chain of command's recommendation, on 11 January 2010, the separation authority approved the applicant’s request for resignation for the good of the service with an under other than honorable conditions discharge. i. On 10 March 2010, the Deputy Assistant Secretary of the Army (Review Boards) approved the applicant's resignation for the good of the service in lieu of general court-martial and directed that his separation characterization of service be general, under honorable conditions. j. The applicant request for resignation for the good of the service was unavailable for review. k. On 15 March 2010, the applicant acknowledge receipt of action taken. l. On 15 April 2010, he was discharged from active duty under the provisions of AR 600-8-24, Chapter 3-13 (In Lieu of Trial by Court-Martial) with an under honorable conditions characterization of service. He completed 7 years, 11 months, and 7 days of active service. His total active service is 11 years, 11 Months and 7 days. 5. The Army Review Boards Agency (ARBA) clinical psychologist rendered a medical advisory opinion on 24 March 2016. The opinion states: a. On 20 Oct 14, The applicant requested that the Board change his reason for retirement to a medical disability. The Office of The Surgeon General was asked to determine eligibility for a military upgrade based on medical documentation of post-traumatic stress disorder (PTSD) and if this was evaluated as an issue." b. No information was provided by the Board to suggest that the applicant met criteria for PTSD at the time of his separation. The only behavioral health entry in his electronic medical record is dated 05 Oct 09 when he was escorted to the clinic by his executive officer after a text he had written was interpreted as being suicidal. This occurred shortly after his marital infidelity became known to his wife and his Command. There is no indication that he was evaluated for PTSD at this visit and it was noted that the visit was not deployment related. c. The records provided by the Board do not appear to encompass the totality of the applicant contact with the veterans administration (VA). Although they treated him for PTSD and major depressive disorder (MOD), the VA notes provided are sporadic and include reference to behavioral health (BH) appointments for which there is no documentation. They range in date from August 2013 to June 2015, but do not specify when or on what basis the applicant was diagnosed with PTSD. There is no mention of a specific stressor beyond the observations that he "avoids anything military" and "reports these problems go back to when he was in the military and was traumatized." Records indicate he dropped out of prolonged exposure Therapy in 2012 and returned a year later for one session of cognitive processing therapy which he discontinued because of work-related travel. Records indicate he was first prescribed psychiatric medication in August 2013. d. There are several issues that make it difficult to provide a definite answer in this case. These include the absence of behavioral health treatment or evaluation for PTSD while the applicant was on active duty. No records indicate that PTSD or any other BH condition impaired his ability to function in a military setting. Although the incomplete VA records indicate that he may have had service-connected PTSD, there is insufficient information to determine the nature of the trauma or what impact this might have had on his functioning at the time of his separation. 6. The applicant representative was provided with a copy of this advisory opinion to give him an opportunity to submit a rebuttal and comments. His attorney responded on 25 April 2017 and stated: a. In response to this finding, they submitted evidence that indicates that adultery with other women can be, and for the applicant was, attributable to PTSD. Specifically, research indicates that PTSD can have a twofold effect for an individual of (1) decreasing his or her ability to connect emotionally with a spouse, and (2) increasing his or her tendency for risky sexual behavior. b. On the one end, PTSD can decrease an individual's ability to connect emotionally with a spouse. As described in a guide published by the National Center for PTSD of the Department of Veterans Affairs, PTSD can affect, among other things, the way a veteran experiences interpersonal relationships: The veteran who is experiencing high levels of irritability and anger may now have more conflicts with others and handle them less well. Particularly in close relationships, the emotional numbing and feelings of disconnection from others that are common after traumatic events may create distress and drive a wedge between the survivor and his or her family or close friends. Another publication from the VA's National Center for PTSD goes on to elaborate that veterans who struggle with this kind of emotional numbing and feelings of disconnection can find it particularly difficult to show love and affection toward a spouse, as close relationships like marriage require both people involved to effectively express emotion. c. In addition to driving an individual away from intimacy with a spouse, PTSD can at the same time draw that individual toward relations with others outside the marriage. The publication "Military Medicine" has in particular chronicled this tendency. One study, for example, identifies the way in which veterans may experience two different feelings in response to the negative affect associated with PTSD: "Negative Urgency," which a veteran may mitigate with "impulsive" behaviors; and/ or "Sensation Seeking," which a veteran may ameliorate with "risk-taking" behaviors. The study identified "risky sexual behavior" as an impulsive or risk-taking behavior in which veterans with PTSD may engage, and noted that many of these feelings and behaviors tend only to increase among veterans with a mild Traumatic Brain Injury (TBI) diagnosis. d. A second study published by "Military Medicine" further established the relationship between PTSD and risk-taking behavior, identifying in particular "risky driving behavior, suicidal ideation, and sexual risk taking" as three of the top ways in which veterans engage in risk-taking behavior. The study specifically included in the definition of "risky sexual practices": "having unprotected sex, "being sexually promiscuous," and "cheating on your partner." Notably, the study also showed that Operation Enduring Freedom / Operation Iraq Freedom veterans, more than veterans from any other war era, scored significantly higher on measures for PTSD symptoms, as well as for "aggressive behavior, sexual risk taking, and risky driving practices. e. All in all, current research indicates that PTSD can and very often does have a twofold effect of both decreasing a veteran's ability to connect emotionally with a spouse, as well as increasing a veteran's tendency for risky sexual behavior. Additionally, OEF / OIF veterans with PTSD tend to have higher incidences of risk-taking, and particularly sexual risk-taking behaviors. The combination makes it not only possible, but in fact probable, that applicant adultery can be attributed to his underlying diagnoses of PTSD and TBI. As he says so clearly himself, "had it not been for these (PTSD] symptoms, He would never have taken the actions he did. f. The Board's second concern with application, states as follows. There is insufficient evidence to show the applicant had PTSD or another BH condition severe enough to make him unfitting for continued service at the time of his separation or which would have been the basis for his two-time non-selection for promotion to major. Further, his PTSD symptoms were not presented until after his discharge according to the VA medical records. g. In response to this concern, we submit evidence that indicates the applicant did in fact exhibit PTSD symptoms prior to his discharge, and that those symptoms were severe. Specifically, the testimony shows that he (1) experienced during service both common combat and operational stressors and sustained from them resulting trauma, (2) exhibited common symptoms of PTSD, and (3) did not report or seek treatment for those symptoms until after his discharge. h. VA and independent publications have identified some of the most common combat and operational stressors for service members. Combat stressors include, for example, being attacked or ambushed, particularly if under fire by shooting or explosions, and particularly if assigned to "forward" areas during combat. Combat stressors also include seeing and especially knowing others injured or killed, as well as seeing dead human bodies. Operational stressors include, among others, uncertain or lengthy deployments, and separation from family. Importantly, as exposure to and intensity of these stressors increases, so does the probability of developing PTSD. i. The applicant experienced several, if not all, of these stressors during service, and in particular during his deployment to Afghanistan from late 2007 to late 2008. As he describes in his declaration, he regularly experienced attack and ambush, was shot at, and encountered IED explosions. He was also assigned to forward observation, and thus encountered the enemy in close range. He witnessed others, including others he knew, injured and killed. He arrived with 20 officers and Special Forces Operators, and saw 15 of those sustain serious injury by IED; he in fact saw more people tom apart by explosives than not. When fellow Afghan Soldiers died from IED explosions, the applicant not only saw the dead human remains, but had to carry them out of the wreckage. He faced a long separation from his family, as well as isolation even from other Army units. He experienced this and all the while also an uncertain duration of deployment. j. In addition to stressors, VA and independent publications have also identified some of the most common symptoms for service members and veterans. As noted above, these include irritability and anger, on the one hand, as well as emotional numbing and feelings of disconnection, on the other. Also as noted previously, PTSD symptoms can include impulsivity and risk-taking, which very often manifest in the form of aggression, suicidal thoughts, risky driving behavior, and, as for many like him sexual risk-taking. k. He was exposed to combat and operational stressors during deployment, and, unsurprisingly, developed many, if not most, of these symptoms of PTSD. He experienced competing feelings of irritability and anger at some times, and numbing and disconnection at others; he was angry all the time, yet almost aloof to the-very real-possibility of death. When he returned from deployment, the intensity of those contradictory emotions only increased. He would become irritated at everything and anything, and he would talk to others with excessive volume for no reason. l. Upon his return, he showed clear and classic signs of impulsivity and risk-taking behavior, also both common to veterans with PTSD. He even exhibited the classic trio of risky driving behavior, suicidal ideation, and risky sexual behavior. With driving, he was reckless, and drove through red lights; his wife witnessed it more than once while riding with him. In turning to other women, he behaved in ways specifically identified by current research as "risky," which unfortunately meant being sexually promiscuous and cheating on his wife. Further, and maybe most importantly, he acknowledges that he took part in this risky behavior in an effort to mitigate the negative affect he experienced every day. As he describes, women were the only way he knew of escaping the reality of the unbearable day to day. m. While he exhibited symptoms of PTSD during service, he did not report or seek treatment for those symptoms until after his discharge. Doing so, however, is common for service members; for officers, it is almost expected. As noted by the National Center for PTSD of the Department of Veterans Affairs, veterans experiencing symptoms of PTSD very often do not seek treatment for them, citing reasons such as "concern over being seen as weak, concern about being treated differently, concern that others would lose confidence in them, and concerns about privacy. For these reasons and others, in fact, only a mere 30 percent of those with PTSD or depression turn to the VA health care system for treatment. In short, there remains to this day a very strong stigma associated with mental illness in military communities. n. The Board's third concern with his application reads as follows. The applicant voluntarily requested discharge for the good of the service in lieu of a general court-martial. The character of service for discharge under these circumstances would normally be under other than honorable conditions. However, the Assistant Secretary of the Army (Review Boards) directed that the applicant's character of service at his discharge be general under honorable conditions, recognizing his combat service and otherwise dedicated service. His overall service was not sufficiently honorable as to warrant an honorable discharge considering his multiple counts of adultery, his conduct unbecoming of an officer, and bringing discredit upon the armed forces and the officer corps. o. In response to this finding, he submit evidence that supports his otherwise dedicated and commendable service to the U.S. Army, which would warrant an honorable discharge. Specifically, we submit clarification regarding several character recommendations from his previous application. Namely, that the four unsigned character recommendations submitted in his original application are a printout of the recommendations posted to his Linked ln profile page, and thus appear unsigned and undated for this reason. The Board may find the recommendations updated from time to time on his profile page. As when he submitted his original application, his recommendations remain reflective of his peers' esteem for his honorable work ethic as he has carried it admirably from military to civilian life. p. In sum, this additional evidence and argument indicate that he can attribute adultery with other women to PTSD, exhibited symptoms of PTSD both quickly and severely during his service, and had an overall term of service honorable enough to outweigh his actions with other women. Having addressed the three main concerns the Board expressed in its letter denying his original application, he respectfully requests that the Board reconsider its decision, and grant him both an upgrade of discharge characterization and a change to the reason for his separation. 7. By regulation, Army Regulation (AR) 635-5 (Separation Documents) * item 24 (character of service) enter the regulatory or statutory authority cited in directives authorizing character of service * item 28 (narrative reason for separation) enter the reason for separation (shown in AR 635-5-1) based on the regulatory or statutory authority 8. On 18 April 2011, the Army Discharge Review Board (ADRB) reviewed the applicant's discharge processing but found it proper and equitable. The ADRB denied his request for an upgrade of his discharge. 9. Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement 10. Army Regulation 600-8-24 provides the definitions for characterization of officer service upon separation. 11. In reaching its determination, the Board can consider the applicants petition and his service record in accordance with the published equity, injustice, or clemency determination guidance. BOARD DISCUSSION: After reviewing the application and all supporting documents, the Board found the relief was not warranted. The applicant’s counsel contentions, his medical concerns, and the medical advisory opinion, and the rebuttal were carefully considered. The Board applied Department of Defense standards of liberal consideration to the complete evidentiary record and did not find any evidence of error, injustice, or inequity. Although his actions were premeditated, one member voted to grant some relief assuming PTSD can cause a member to commit adultery. Based upon the preponderance of the evidence, the majority of the Board determined he did not exhibit PTSD symptoms so severe that he would have been found unfit for military service. In addition, it was clear he mentioned not wanting to live after his misconduct surfaced. Due to applicant’s failure to accept responsibility and show remorse for the events leading to his separation, the Board agreed that the applicant's discharge characterization was warranted as a result of the misconduct, and does not recommend amending the previous Board’s decision. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : X : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING X : X DENY APPLICATION 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 of the ABCMR set forth in Docket Number AR20140019861 on 28 April 2016. 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. REFERENCES: 1. Title 10, USC, section 1552(b), provides that applications for correction of military records must be filed within three 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 three-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. 2. Violation of UCMJ Article 133 is defined as: (1) the accused did or omitted to do certain acts; and (2) under the circumstances, these acts or omissions constituted conduct unbecoming an officer and gentleman. Conduct volatile of this article includes action or behavior in an unofficial or private capacity which, in dishonoring or disgracing the officer personally, seriously compromises the person's standing as an officer. There are certain moral attributes common to the ideal officer and the perfect gentleman, a lack of which is indicated by acts of dishonesty, unfair dealing, indecency, indecorum, lawlessness, injustice, or cruelty. Not everyone is or can be expected to meet unrealistically high moral standards, but there is a limit of tolerance based on customs of the service and military necessity below which the personal standards of an officer, cadet, or midshipman cannot fall without seriously compromising the person's standing as an officer, cadet, or midshipman or the person's character as a gentleman. This article prohibits conduct by a commissioned officer, cadet, or midshipman which, taking all the circumstances into consideration, is thus compromising. This article includes acts made punishable by any other article, provided these acts amount to conduct unbecoming an officer and a gentleman. 3. Violation of UCMJ article 134 for adultery is defined as: (1) the accused wrongfully had sexual intercourse with a certain person; (2) at the time, the accused or the other person was married to someone else; and (3) under the circumstances, the conduct of the accused was to the prejudice of good order and discipline in the armed forces or was of a nature to bring discredit upon the armed forces. 4. Army Regulation 600-8-24 (Officer Transfers and Discharges), paragraph 3 -13 states that an officer may submit a resignation for the good of the service in lieu of a general court-martial (GCM) when court-martial charges have been preferred against the officer with a view toward trial by GCM. 5. Army Regulation 600-8-24 provides the definitions for characterization of officer service upon separation. a. Honorable characterization of service. An officer will normally receive an honorable characterization of service when the quality of the officer's service has met the standards of acceptable conduct and performance of duty. b. General under honorable conditions characterization of service. An officer will normally receive an under honorable conditions characterization of service when the officer's military record is satisfactory but not sufficiently meritorious to warrant an honorable discharge. A separation under honorable conditions will normally be appropriate when an officer is separated based on misconduct, including misconduct for which punishment could be imposed by court-martial or was imposed, which renders the officer unsuitable for further service, unless an under other than honorable conditions separation is appropriate. 6. By regulation, Army Regulation (AR) 635-5 (Separation Documents) * item 24 (character of service) enter the regulatory or statutory authority cited in directives authorizing character of service * item 28 (narrative reason for separation) enter the reason for separation (shown in AR 635-5-1) based on the regulatory or statutory authority 7. Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement. Once a determination of physical unfitness is made, the PEB rates all disabilities using the Veteran's Affairs Schedule for Rating Disabilities (VASRD). Ratings can range from 0 to 100 percent, rising in increments of 10 percent. 8. 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-Ill 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." 9. 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 fraumatic 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. 10. On 25 August 2017, the Office of the Undersecretary of Defense for Personnel and Readiness issued clarifying guidance for the Secretary of Defense Directive to DRBs and BCM/NRs when considering requests by Veterans for modification of their discharges due in whole, or in part, to: mental health conditions, including PTSD; traumatic brain injury; sexual assault; sexual harassment. Boards were directed to give liberal consideration to Veterans petitioning for discharge relief when the application for relief is based in whole or in part on those conditions or experiences. The guidance further describes evidence sources and criteria, and requires Boards to consider the conditions or experiences presented in evidence as potential mitigation for that misconduct which led to the discharge. 11. On 25 July 2018, the Under Secretary of Defense for Personnel and Readiness issued guidance to Military Discharge Review Boards and Boards for Correction of Military/Naval Records (BCM/NRs) regarding equity, injustice, or clemency determinations. Clemency generally refers to relief specifically granted from a criminal sentence. BCM/NRs may grant clemency regardless of the type of court-martial. However, the guidance applies to more than clemency from a sentencing in a court-martial; it also applies to other corrections, including changes in a discharge, which may be warranted based on equity or relief from injustice. This guidance does not mandate relief, but rather provides standards and principles to guide Boards in application of their equitable relief authority. In determining whether to grant relief based on equity, injustice, or clemency grounds, BCM/NRs shall consider the prospect for rehabilitation, external evidence, sworn testimony, policy changes, relative severity of misconduct, mental and behavioral health conditions, official governmental acknowledgement that a relevant error or injustice was committed, and uniformity of punishment. Changes to the narrative reason for discharge and/or an upgraded character of service granted solely on equity, injustice, or clemency grounds normally should not result in separation pay, retroactive promotions, and payment of past medical expenses or similar benefits that might have been received if the original discharge had been for the revised reason or had the upgraded service characterization. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20170009042 11 1